New perspectives on population: lessons from Cairo

The lessons from the 1994 World Population Conference in Cairo, Egypt, are summarized in this publication. The topics of discussion include the evolution of population policies, the changing policy environment, demographic trends, and solutions in the form of gender equity, provision of reproductive health services, and sustainable social and economic development. The program of action supported by 180 governments and targeted for 2015 articulated the goals of universal access to a full range of safe and reliable family planning methods and reproductive health services, a specified level of reduction in infant and child mortality, a specified level of reduction in maternal mortality, an increase in life expectancy to 70-75 years or more, and universal access to and completion of primary education. Other features include goals for improving women's status and equity in gender relations, expansion of educational and job opportunities for women and girls, and involvement of men in childrearing responsibilities and family planning. Steps should be taken to eliminate poverty and reduce or eliminate unsustainable patterns of production and consumption. Population policy must be integrated within social and economic development policies. About $22 billion will be needed for provision of family planning and reproductive health services by the year 2015. Costs will increase over the 10-year period due to the increased population to be served. Per person user costs for family planning alone are higher in countries without infrastructure and technical skills. Actual costs vary with the cost of contraceptive supplies, patterns of use, and efficiency of delivery systems. Although the plan offers 16 chapters worth of advice and recommends 243 specific actions, countries will have to be selective due to cost limitations. The 20/20 Initiative is proposed for sharing social service costs between international donors (20%) and host countries (20%). A separate UN projection of need is for 33% of support from international donors for family planning and related programs. The constraints to the implementation of the action plan are identified as the rate of demographic change, the extent of public support for population limitation and provision of family planning services, and potential conflicts of interests and funding between cooperating agencies. The World Bank has developed guidelines for policy development according to a country's identification as an emergent, transitional, or advanced country.     

India: New family planning program direction outlined

The focus of the current Family Welfare Program in India is education and active community involvement rather than coercion and compulsion. The government is totally committed to the program and has indicated that it will spare no efforts to motivate people to voluntarily accept family planning. However, there is a need for family planning efforts to include all aspects of family welfare, particularly those designed to promote the health of mothers and children. All family planning methods will be made available, and the family will be free to choose the method they prefer. As part of the program, employees of the Union government, State governments, autonomous and local bodies are expected to set an example and adopt the small family norm. The policy statement made by Mr. Raj Narain, Minister of Health and Family Welfare, revealed the government's decision not to legislate, either at the national or the State level, for compulsory sterilization. Sterilization services will be available free of charge to those who voluntarily choose this method. A plan for training indigenous midwives will be implemented as part of the program in order that maternity services may be available to all expectant mothers. Additionally, in recognition of the direct correlation between illiteracy and fertility and between infant/maternal mortality and age at marriage, the government will introduce legislation to raise the minimum age at marriage to 18 years for girls and to 21 years for boys. The plan is for trade unions, Chambers of Commerce, cooperative societies, women's organizations, teachers' federation, district councils, and other voluntary institutions to be associated intimately with the educational campaign launching the Family Welfare Program.     

PPAT works with private clinics and industrial enterprises

Doctors from private clinics have responded to an effort by the Planned Parenthood Federation of Thailand (PPAT) to enlist their voluntary services in support of family planning goals. The private doctors will provide contraceptive services at a nominal cost to the public or free to those who cannot pay. Representatives of PPAT, the Labor Department, the Health Department, and 31 industrial factories in Parthum Thani province met last year to work to find ways of including family planning services as part of workers' welfare in every factory. The participants recommended that family planning services should be officially included as part of workers' welfare. The National Population Clearinghouse/Documentation Center has established its home office at Bangkok. Documentary collection activity is focusing on 5 subject areas: family planning, population/demogrpahy, maternal/child health, nutrition, and primary health care. The Center has already begun to translate selected materials from English into Thai.     

Integrating family planning with nutrition and parasite control

At the Inter-Governmental Coordinating Committee Workshop on an Integrated Approach towards Family Planning and Health Programs held at Kuala Lumpur from March 23 to 25, 1977, the feasibility of integrating family planning with nutrition and parasite control through the proper planning of motivational considerations, resource allocation and coordination was studied in detail. Discussion focused on the experience of participating countries in generating community participation in total health programs. Malaysia reported that in the expansion of the national program into the rural areas functional integration has been the approach. In Indonesia nutrition has been an important objective of maternal and child health services. A total integrated development approach has been the objective in the Philippines where family planning information-education-communication has been integrated with nutrition programs and a pilot project on integration of family planning and parasite control has been conducted. Thailand reported on the introduction of an integrated family planning and parasite control program, while Sri Lanka reported on an integrated approach that included family planning with maternity and child health services. A recommendation of the meeting was that experimental pilot projects be established which include nutrition and parasite control elements within the framework of family planning services.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

Total maternal and child care: an approach to the population problem

This article describes the Bohol Province Maternal Child Health/Family Planning Project, a 5-year project financed by the United Nations Fund for Population Activities and the Philippines Department of Health. The objectives of the project are to improve general health services, introduce family planning services in the context of the MCH program, improve training of personnel and evaluated the results of the program. 88 barrio health centers have been established, offering a range of maternal, child health and family planning services. 34 boticas (drugstores) have been set up in local variety stores, dispensing drugs at low cost. A strong research unit collects data for program evaluation and has so far published 23 reports, which are listed at the end of this article. Community acceptance of the program has, in general, been good; midwives have been welcomed. The program has encountered problems of religious conservatism and insufficient contraceptive supplies and has learned the need for good relations with the barrio leaders and residents. The 5-year limit needs to be extended. Progress in health services has been excellent. The effect on family planning, while encouraging, cannot yet be evaluated.     

Socialist spiritual civilization enhances consciousness in family planning

Since 1985, there have been no cases of coercion in the practice of family planning and yet also no unplanned births among the over 1200 members of the Chinese Communist Party in Hunan Province's Fuxing Township. Ideological work is aimed at demonstrating that fertility control is in the interest of both individuals and the state. All township cadres are asked by the government to take the lead in practicing family planning, publicizing population policies, and assisting in solving the difficulties of the masses. They are further expected to take the lead in the provision of 5 services: 1) publicity about population theory and family planning policy; 2) birth control training and provision; 3) management and distribution of contraceptives; 4) maternal-child health services, including free health check-ups for the 870 children in the township and follow-up visits to the 2100 women who have undergone tubal ligation; and 5) development of social welfare and assistance to 1-child households.     

Beyond population,beyond family planning: the Commission on Population's total integrated development approach

The Philippine Commission on Population (Popcom) after 5 years of operation has succeeded in reducing the national population growth rate from 3.01% in 1970 to 2.66% by the middle of 1975. More than 50% of the country's eligible couples are practicing family planning or have received services at some time. New acceptors recruited during the fiscal year 1974-1975 totaled 716,650 as compared with 191,426 in 1970. As of December 31, 1975, continuing users amounted to 22% of the population. Despite the accomplishments, however, the following operational problems exist: 1) 57 out of every 100 married women of reproductive age have not been reached by the program; 2) in all regions, only 2 out of 3, or even fewer, women are aware of the existence of a family planning clinic to serve them; 3) there is a definite shift from the more effective to the less effective methods of contraception; and 4) there is a large disparity between knowledge and practice of family planning among both urban and rural women. Additionally, the clinic-based system limits the program's outreach to urban areas, and the doctor-centered approach limits the provision of services. In response to these problems, Popcom developed the Total Integrated Development Approach in 1975. This approach is currently being implemented in 7 pilot provinces and under the auspices of this approach, various strategies have been developed to improve service delivery and to expand coverage of the rural areas. 1 such strategy is the establishment of barrio resupply points which are complemented by mobile clinics which service remote and inaccessible areas. Eventually, depending on the success of the program, the approach will be implemented in all provinces within the next 3 or 4 years. Each Total Integrated Development Approach will include the 4 components of services delivery, IEC (mass and interpersonal communication and special projects), training, and research and evaluation.     

The need for family planning

The purpose of this paper is to examine the evidence on the need for family planning. The available evidence on current levels of unmet need for contraceptives, fertility preferences, and the non-contraceptive benefits of family planning is reviewed. I argue that expansion of family planning programs is still needed. These programs provide couples with tools to reach their desired family size; can significantly impact maternal and child mortality by decreasing fertility and optimizing child spacing; and by decreasing fertility, slow population growth. It is therefore imperative to continue to expand the provision of family planning services.     

Upholding the freedom of couples to use a method of their choice

A recent review of the Philippine Population Program's 5-year plan, ended in December 1982, showed that in 1980, natural family planning (NFP) users were only about 12.5% of couples practicing family planning. This figure doubled by 1982. Based on these responses the decision was made to intensify the NFP program as early as 1982. The 1st step was to put more money into the NFP program. The program includes the modern scientific techniques such as cervical mucus, basal body temperature, and sympto-thermal. The program also will fund the training of doctors and other clinic personnel and the production and distribution of appropriate training and information material. Other family planning methods, such as sterilization, oral contraception (OC) and the condom, also will be promoted. Promotion of NFP will depend on the choice of the family planning practitioners themselves. The program's community based services are being intensified. NFP, together with the other family planning methods such as sterilization and OC, will always be made available to couples in the community based services. All agencies in the population and family planning program will be promoting NFP. Knights of Columbus doctors have been invited to assist the program and share their own training modules for the training of trainers. An agreement has been entered into with the Gabriel M. Reyes Memorial Foundation based in Aklan. The goal is for trainers who need further knowledge and skills in NFP to learn from the foundation's wealth of organized orientation and training techniques in NFP. NFP is emphasized at this time because it is acceptable to a great number of couples.     

Sri Lanka: current status of family planning

In Sri Lanka the family planning program is closely related to socioeconomic and cultural variables. The expectation is that in the near future family planning will be included as a component of a network of social services. The official program is a response to the economic necessities and welfare demands of individuals and families. The method of family planning most frequently requested is female sterilization, and no attempts are being made to direct people to other methods. 12 United Nations Fund for Population Activities assisted projects have provided the framework and basis for the institutional coverage of family planning activities in Sri Lanka. However, the experience of these projects revealed a lack of facilities, shortage of personnel and management inadequacies, all related to the delivery of family planning services. The following steps are suggested as a means of overcoming the current problems and expanding the program: 1) establish a pattern of interacting relationship between the mass media, community health education and the available services; 2) provide an operational approach to program management, monitoring and periodic reviews of the program; 3) involve the private sector health facilities; and 4) incur additional capital cost to increase the capacity for delivery of better health facilities and personnel.     

Programmed learning: a training alternative for population workers

Self-instruction (SI), also termed programmed learning, is a fairly new family planning training tool adopted in 1975 by the National Population Program in the Philippines. According to Antonia Coronel, project officer of the Population Center Foundation (PCF), SI uses carefully designed materials in order to meet specific objectives. The information is presented in logically sequenced small frames or sets and is followed by a series of practice exercises requiring immediate feedback from the learner. The learner's reward takes the form of correct answers at the frames' end. There are many forerunners to SI, including the Greek philosopher Socrates, the Roman orator Quintilian, and the American social scientist Sidney Pressey who thought of a programmed instructional review and multiple-choice testing materials as devices which required the learner's active participation and provided immediate knowledge of his/her accuracy. SI has 6 characteristics: emphasis on the needs of the learner shown by allowing self pacing, meaning, the learner proceeds at his/her own learning rate, and stressing feedback from the trainer who holds individual meetings with the learners; a clear statement of objectives; a breakdown of learning tasks into smaller and easy to absorb units; a self administered posttest which enables the learner and others to see whether or not the objectives have been realized; inclusion of frequent practice exercises relevant to the objectives and the posttest; and provision of immediate feedback, which reinforces and lets the learner improve his/her comprehension and retention. Operationally, the method takes 4 steps: the objectives of instruction are specified in terms of learner behavior; the learner is rated as to his/her level of knowledge with respect to the objectives; instructional activities built into SI modules are designed to bring about the intended objectives; and the learner's attainment of the objectives is evaluated. The modules referred to are the 12 SI modules on various aspects of family planning developed by the PCF. In the Philippines the need for programmed learning became apparent with the signing of Presidential Decree No. 79. Among the provisions of this decree are the following: nurses and midwives can dispense oral contraceptives (OCs) and insert IUDs; large business firms and factories must provide family planning services to their employees; and family planning services like sterilizations costs can be charged to Medicare. The SI method met the criteria of giving uniform training, cutting down training costs, and ability to upgrade knowledge, attitudes, and skills. Thus far there are 21 completed program learning materials and these are identified and described.     

Cagayan de Oro taps own resources to cope with population problem

In 1972, the Model City Population Planning Project (MCPPP) was begun in the Philippine city of Cagayan de Oro. The MCPPP was an attempt to encourage family planning on the community level. Funding was provided by the Ford Foundation for the program in 1974, for 2 years. There were 5 main objectives of the program: to provide family planning information to parents, to test small scale projects which could be applied elsewhere in the country, to actively involve local government, to reduce the birthrate, and to facilitate, coordinate and strengthen population and family planning services of the different agencies of Cagayan de Oro. While the MCPPP's efforts to reduce the birth rate were mostly concerned with coordinating and facilitating prexisting family planning services, evaluators of the project credit it at least partially, for the cities' declining birthrate. In 1971, the birthrate was 36.5 per 1,000 and in 1975, it had dropped to 29 per 1,000. In mid 1976 the program was incorporated into the nationwide Outreach Program. Although some evaluators felt that private citizens were not sufficiently involved with it, the program has been judged successful in demonstrating a city's capacity to work toward solving it's own problems. Particularly successful were efforts at educating the population and dissemination of family planning information.     

The dynamics of contraceptive adoption in Bohol,Philippines: 1976-1978

A researcher analyzed 1976 and 1978 data on 414 rural women who had never used a family planning method to prevent pregnancy and lived in the predominantly Catholic island province of Bohol in the Philippines to look at the influence certain aspects of the family planning program, begun in 1976, as predictors of changes in contraceptive behavior. 34.5% accepted contraception between 1976-1978. The researchers learned that couple traits (e.g., age, income, education, and religiosity) had only an indirect effect on change in contraceptive behavior. A desire to stop, limit, or space births (motivation) was a strong predictor of family planning method acceptance (p.001). Further couples who clinic providers contacted the most often or who had received more family planning services (services) were much more likely to use contraceptives (p.001). Indeed a significant relationship existed between motivation and services (p.001). Moreover couples who were truly motivated to use family planning methods did not let distance to family planning services prevent them from seeking these services (p.001). On the other hand, couples who confronted personal obstacles to family planning including social, psychological, and other subjective costs (cost index) tended not to accept family planning methods (p.001). A negative association existed between services and location of households vis a vis the intervention program (p.001) which indicated that the program did have an effect in the area of the province where it was located. In conclusion, the strongest predictors of change in contraceptive behavior included motivation, services, and cost index. Services and cost index indicated the great importance of interpersonal and/or client staff contact, especially since they were more important in influencing behavior change than distance and family planning site.     

Satisfied users clubs: family planning acceptors as model agents of the program

The National Population Program in the Philippines has encouraged family planning acceptors to shift from their passive role as recipients of family planning services into an active role as program participants. In the mid 1970s the Commission on Population (Popcom) began setting up satisfied users clubs in various regions of the country with the aid of the Ministry of Social Services and Development (MSSD). Other government institutions like the Ministry of Labor and Employment (MOLE) formed similar family planning groups. So did private agencies participating in the Program. There were indications at that time that community based family planning clubs could help the Program in informing couples about family planning and in motivating them to practice contraception. In 1977 a study conducted by the University of the Philippines Institute of Maternal Clinic found that family planning acceptors in Dumaguete City received social and psychological support from local barrio women's clubs. A 1978 Community Outreach Survey indicated that full time outreach workers (FTOWs) found statisfied users clubs helpful in increasing the number of new acceptors in their areas and in bringing down the number of family planning dropouts. Once a decision to create a club is made, club organizers meet with the barangay captain and his council to get their approval and seek their cooperation in inviting people to join the proposed club. Once the approval is given known family planning users in the community or mothers of reproductive age are invited to attend a community assembly. Of 59 clubs surveyed, only 10 had a formal constitution and bylaws. All clubs elected their officers and conducted monthly meetings which lasted from 2-4 hours. The main selling proposition of the clubs is the involvement of members in nonfamily planning activities like income generating schemes, skills training, nutrition seminars, and immunization of children. 81% of the officers of all 59 clubs were family planning acceptors. The majority of officers had undergone voluntary sterilization. Only 8 of the 59 clubs considered themselves single purpose clubs committed to the promotion of family planning. The other 51 were multipurpose organizations, with both family planning and nonfamily planning activities. In the area of family planning, the club's objectives were to increase family planning acceptors, disseminate family planning information, and maintain current users.     

Sex,counseling, and the young industrial worker

The Population Center Foundation (PCF) has begun promoting greater awareness of the implications of adolescent fertility among Filipino teenagers. PCF has developed an information and counseling program on adolescent fertility attuned to the youth's particular conditions and tastes. Almost all teenagers preferred to talk with their peers rather than with adults or professionals, especially on intimate topics. The export processing zone (EPZ) is 1 of the most popular government strategies for pursuing an export-led industrialization. The Bataan EPZ, the site for 1 implementation of PCF's program for young workers, is the country's prime industrial estate. The presence of dormitories in the Bataan zone has given greater opportunities for interaction among workers; closer relationships are built, and the degree of trust and intimacy required for honest discussions of sexual problems is established. The Bataan program aims to assist the EPZs, the regional and local offices of the Commission on Population, and the Ministry of Labor and Employment in meeting the family planning needs of the zones' teenage workers. An information-education-communication campaign has been launched to get support for the sexuality counseling services offered by various institutions in this program. Those who take part in the adolescent sexuality counseling training program are asked to share their experience during feedback sessions.     

The jeepney driver: ally in family planning

Report of a project involving jeepney drivers as distributors of family planning information in the Philippines, implemented by the United Neighbors Philippines (UNP). This organization had previously experimented with using barbers and beauticians as distributors but lack of organization on their part led to difficulties. An experiment which used Protestant pastors had to be abandoned for lack of funds. The current program involves the 200-member jeepney driver's association in Cubao, Quezon City. A box of family planning informational materials is placed in each vehicle, within research of passengers. Materials include referral sheets entitling holders to free supplies (chiefly pills) at family planning clinics along jeepney routes. Encouraging numbers of passengers turned in the sheets, and some 50-80% of drivers themselves began to practice family planning. The project has since been expanded under the auspices of an 800-member driver's association in the Sta. Mesa area. Drivers in this project will undergo a 3-day paid training period, which will include information on location and facilities of family planning services along their routes.     

Thailand: family planning program exceeds targets

According to Dr. Somboon Vacharothai, Director General of the Ministry of Public Health, the number of people in Thailand who practiced family planning exceeded last year's target. 664,895 individuals used family planning services; this was 62.2% above the planned target for 1976. It was further predicted that 700,000 persons would be recruited by the family planning program in 1977. The preferred method of birth control was the oral contraceptive; it is the method of 800,000 acceptors. Service outlets have been extended rapidly with 5836 medical centers providing family planning services throughout Thailand. Government allocations for family planning have increased from 0.9 million dollars in 1975 to 2.47 million dollars in 1977.     

The nature of family planning management in China]

Family planning (FP) program management in China uses the power of the state to manage population reproduction. the characteristics of program management are as follows. 1) The FP program is for the benefit of the state, community and individual, 2) the FP program is a process of birth planning under social planning rather than an individual family's planning, 3) FP include both restriction on the number of people and the improvement of the quality of the population. 4) FP is a public affair. Government organizations at all levels of coordination and mobilize the FP program so that people of all walks of life can participate. 5) People participate in the FP program management by expressing their views in the people's congress, through communication with administration leadership, and through self-education. The special features of FP program management in China are also reflected in its concerns with a variety of target populations, its need for cooperation from people and its need for involvement of all institutions and enterprises. As the human reproductive cycle is long, making a long- term strategic policy for FP is no less important than long-term economic planning. The management of the program should emphasize direction and persuasion, the provision of services and help to people, and the efforts to involve government or public organizations in promoting planning programs.