Adolescent fertility: worldwide concerns

There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.     

Publicity and education on family planning information in Keshan County

In 1984 the Keshan (Northeast China) County Government and the Family Planning Committee initiated an education campaign to disseminate family planning information to farmers. The team of propagandists consisted primarily of full-time family planning workers. Village cadres, school teachers, and rural physicians, who are properly educated and positive about family planning work, enjoy high prestige among the workers. They were invited to be team members after training and are supported by the villagers because they come from among the local people. All the childbearing women aged 15-49 in each village were classified by the propagandist into 5 groups according to their marital and childbearing status, i.e., women at the age of puberty, women of new marriage, pregnant and lying-in women, women with children to be reared, and middle-age and old women. The women were organized into groups to attend lectures on different subjects such as population policy, relationship between population growth and socioeconomic development on the 1 hand and individuals and environment on the other. Also included were physiology, the health birth and rearing of children, and health care for women and the aged. The publicity effort included broadcasting, films, video aids, and slide shows. Increased classs were during the slack seasons, and lectures were given once a week. By 1986, about 80% of the population at childbearing age in Keshan County had attended the family planning lectures.     

Planning population development in Pakistan

Population development planning is an effort to reconcile numbers with individual, national, and global needs. The emphasis is on the integral linkage that exists between development planning and people's needs, which is best identified through demographic characteristics. Population development planning should focus on the 40% of those living below the poverty level and the 50% at the subsistence level. Limiting a country's population, or family planning, is not an end in itself; it should be complemented by long-term development. Planners and programmers in education, rural development, trade, social welfare; health, labor, agriculture, or local government should ensure a consonance between the people's aspirations and the nation's needs. Family planning must be joined with efforts to change standards of living. Individual behavior is affected by intermediary areas of association and authority, the extended family, the neighborhoods, and the local community. Government programs will fail if they do not consider the grass-roots, individual, and community needs.     

Seven measures for population control announced in Guangzhou

On 7 October 1988, the Municipal Government of Guangzhou, China, announced the following Decision: "First, great efforts should be made to strengthen education on the situation and tasks of the family planning programme. Second, family planning work is included in the target responsibility system of leaders at all levels during their terms of office and whether it is good or bad for the fulfillment of their family planning tasks will be considered as one of the criteria for the assessment of cadres in their work to link up with rewards and punishments. Third, the current family planning policies must be resolutely and unswervingly carried out. For those units where family planning policies have not been well carried out and where family planning work has long been stagnant, competent authorities should send capable cadres to help them improve their work within a definite period of time. Fourth, the principle of 'three priorities' (i.e., priority of publicity and education to economic restriction, priority of contraceptive measures to induced abortions, and priority of day-to-day work to shock work) must be adhered to while technical service and work of transforming the backward situation in some places should be done. Fifth, the family planning organizations at all levels must be perfected and ranks of family planning workers be strengthened with the stress on those at the township, town, and street neighbourhood levels. Moreover, the family planning offices should be set up or full-time family planning workers be staffed for enterprises and undertakings in the cities. Sixth, funds for the family planning work must be guaranteed. Seventh, the management of family planning for [the] floating population must be strengthened and a management group for [the] floating population, which consists of representatives from the Municipal Government and departments concerned, must be established."     

Establishing evaluation indicators on the population knowledge,attitudes, practices and skills (KAPS) of secondary school teachers and students in the Philippines

This study was conducted to establish evaluation indicators to be used as a basis in evaluating the integration of the population education program (POPED) of the Ministry of Education, Culture, and Sports within the Philippine 2ndary school curriculum. Questionnaires were used to determine existing knowledge, attitude, practice and skills (KAPS) of 3,136 high school students and 490 teachers, and data was analyzed for significant relationships between KAPS concerning POPED and demographic characteristics, exposure to population information sources, type of school attended, and exposure to POPED. KAPS and teaching method determine KAPS of the student. Data indicate that 81% of teachers had integrated POPED into the curriculum; only 19% of these had attended training on POPED. 93% utilized a lecture-discussion method in teaching POPED. Knowledge tests given to students and teachers were the same, covering demography, family size, age at marriage, responsible parenthood, use-effectiveness of methods, and population and development. Teachers performed better than students in questions on knowledge; on attitude statements teachers showed a slightly more favorable attitude towards POPED issues, most favorable to responsible parenthood, and least favorable to age at marriage. Mean preferred age at marriage (25) and mean desired number of children (3) was the same for teachers and students; teachers desired wider child spacing than students (3.3 years vs. 2.7 years). 84% of teachers used or wanted to use a family planning method, 76% of students felt they would use a method after marriage. Factors useful in predicting KAPS of teachers and students on POPED are: region of residence, age, sex, educational level, marital status, grade average, type of school, and exposure to various sources of POPED information.     

Men and family planning: toward a policy of male involvement

The stated aim of this discussion is to examine the extent of male use of family planning and the nature of men's role in family planning in developing countries. Case studies are presented which are successful examples of strategies for involving men in family planning. Policies that aim to increase male involvement must be sensitive to cultural values, apply to a decentralized government approach toward information and supplies, include adequate political will, and consider the costs and benefits of changing values. A male family planning policy would not always be compatible with all fertility values in developing countries or traditional values of the older population. A policy should stress the value of male individuals contributing as much as possible for their own and others' welfare. Community participation is considered important in order to create a feeling of mutual support. A sizeable investment will be required for mass distribution of contraceptive information. Schools are viewed as an ideal place for educating youth about the problems of high fertility and about use of family planning methods, such as the condom. Religious organizations should be used to educate people about responsible parenthood and to minimize barriers to use of modern contraception. Comic books on how to use condoms are suggested as a good source. Local authorities who are trusted are useful in influencing acceptance among local populations. Local personnel may be trained as information disseminators. Adequate contraceptive information needs to be supplied to a wide audience. Lack of supply and inadequate information are given as two key reasons for insufficient use of male contraception. Condoms should be priced to be affordable to the average person and free to those with no income. Program strategies that proved successful are cited for Thailand's Mechai Viravaidya program and Bali's grass-roots program. The vasectomy program in Bangladesh is also noted for its success. Low levels of condom use are attributed to factors such as price, education, availability, accessibility, culture, religion, and economic conditions. Male sterilization levels can be enhanced with wider availability of clinics and provision of correct information for challenging beliefs that vasectomy is a form of castration.     

Clinical management of gender dysphoria in children and adolescents: the Dutch approach

The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth's functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty. Gender dysphoric adolescents can be considered eligible for puberty suppression and subsequent cross-sex hormones when they reach the age of 16 years. Currently, withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.     

Does family planning work in a Chinese way

The demographic and economic characteristics of China make it necessary to do family planning work in China in a Chinese way. Special characteristics of China and corresponding strategies are detailed 1) China is rather underproductive and underdeveloped, with a huge population, whose growth must be curtailed while industrial and agricultural production is enhanced. 2) In the next 10 years, a large number of young people will center childbearing age, prompting a government policy favoring late marriage and one child per couple. 3) China is large and heterogeneous, and regional authorities should have some population policymaking functions to take sociocultural differences into account. 4) Male child preference ideology in rural areas has been gently combated with a resulting increase in family planning rate from 65.1% to 74.2% from 1979 to 1983. Family planning authorities have made considerable progress, as demonstrated by figures such as a drop of women's total fertility rate from 5.68 in the 60s to 2.07 in the 70s. The task at hand remains large: the population at the end of 1983 was 1,024,950,000. However, family planning is an element of state policy, the marriage law, and the constitution, and mored an more, societal ideology. Government policy equates family planning with child wellness and societal welfare and attempts supportiveness of couples showing positive birth limiting attitudes. An ample system of family planning programs and resource persons furnishes education, a variety of high quality methods are available, and contraceptive research is some of the best in the world.     

Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

Pop-ed programs for the out-of-school youth

39% of the Philippines youth are not in school and these youths receive no training for responsible parenthood and community life. A number of agencies try to reach these members of society, including the Bureau of Youth Welfare (BYW), the Family Planning Organization of the Philippines (FPOP), the Foundation for Youth Development in the Philippines (FYDP), the Rizal Youth Development Foundation (RYDF), the Philippine Rural Reconstruction Movement (PRRM), and the Philippine Youth Welfare Coordinating Committee. BYW conducts informal group sessions including discussions among 13-24 year old members who have started self-employment projects. FPOP's youth program, SIGLA, aims at developing out-of-school youths social y and having them disseminate information to other out of school youths. This information includes family development, family planning, and population-related information, and is disseminated through activities and workshops. FYDP aims at functional literacy but also disseminates family planning information to out-of-school youths. RYDF conducts week-long seminars in topics such as birth processes, family relations, and care of babies. PRRM integrates population and family planning into its nonformal education program for out-of-school youth and adults in Nueva Ecija Province. Problems encountered in these programs are 1) suspicion of parents, and 2) feelings of inadequacy on the part of teachers. While emphasis has been on unemployed youth, efforts should be made to reach those youth who are employed.     

Premarital information efforts under way

Premarital couples are among priority targets of family planning information in the Philippines national population program as they can serve a pivotal role in slowing population growth. Applicants for marriage licenses are required to attend a family planning session as a prerequisite. Following recommendations of a training effort and seminar on Premarital Family Planning Counseling, on July 20, 1976, premarital information was institutionalized in the country by Presidential DEcree 965 which made family planning counseling obligatory to the marriage license applicants. Shortly after that, a multiagency effort gathered information on the status of the Premarital information program in the Philippines, which showed that there is no full-time specialist for the work. Medical officers; social workers; community welfare supervisors; and program and training officers do this work of information in addition to their usual duties. Distribution of the applicants varied greatly in age groups, educational levels, and professional category. The size of the group, length of session and topics of discussion varied greatly. Necessary efforts should be made to solve the major problems by selecting better sites for group sessions and training more personnel for the purpose. There is a great need fordeveloping more effective and research oriented information, education and communication materials, according to the needs and cultural traits of the target audience.     

A preliminary survey of specialized households with single children in Tianjin rural areas

A preliminary survey of specialized households with single children in Tianjian rural areas was carried out in order to understand the impact of the economic system reform on family planning programs. Out of 180,000 specialized households, 37,000 are those of young peasants under 35, accounting for 24% of the total specialized households. The survey showed that family planning publicity could be improved in 4 ways. A change in the peasants' concept of childbearing in favor of family planning should be actively promoted. Publicity efforts should be strengthened. Both the content and methods of family planning education and publicity should be improved. Publicity should be integrated with service. Centers of publicity and guidance should become centers of publicity and service. Family planning workers should become close friends of young couples of reproductive age. Education must be integrated with service. A recent trend of having fewer children has set in. This change manifests itself in 3 ways: the state policy of making the people rich greatly encourages young couples to devote themselves to pioneering causes; after becoming rich, the peasants become aware that they should have healthier and better educated children; when the peasants become rich they worry less about their old age and other problems. The recent trend toward early marriage in rural areas should be curbed.     

HEW devising teen pregnancy plan

In response to the national problem of teenage pregnancy, the Department of Health, Education, and Welfare has been developing a package of programs costing some $245 million to help teenagers avoid pregnancy and to help those who do become pregnant. In an August 4 decision memorandum to Health, Education, and Welfare Secretary Joseph Califano, an interagency task force underlined the 3 problems the initiatives must deal with: 1) adolescents are at high risk of pregnancy; 2) about 300,000 U.S. teenagers receive abortions annually; and 3) pregnancy and parenthood during adolescence pose serious health, economic, and social risks for both the young woman and her child. The decision memorandum recommended that state policies permitting adolescents to receive contraceptives without their parents consent be encouraged. Additionally, the memorandum outlined 9 spending options for the Secretary's consideration. However, in late November the decision memo gained notoriety when the press reported on its support for abortions for teenagers, and the controversial abortion issue obscured 3 other important issues involving Health, Education, and Welfare's teen pregnancy initiative: 1) the mix of funding and where it will come from, 2) the assignment of responsibility for implementation of the package, and 3) the amount of support for family planning services and sex education for teenagers.     

Depo-Provera: clarifying the issues

In this interview, deputy executive director Ester B. Sy-Quimsiam of the Commission on Population talks on Depo-Provera, the latest method officially accepted by the Philippine Population Program. Medically, Depo has been proven to be safe, effective, long-acting, and reversible. A single dose of this drug can prevent a woman from pregnancy for 3 months. In clinics where the nurse or the midwife is trained in comprehensive family planning technology the drug will be introduced. Clinics in areas where prevalence of the more effective method is low must be targeted. Managers, supervisors, trainers of service providers, and fieldworkers will be trained to implement the information and education campaign and generate demand among married couples of reproductive age who are most eligible for Depo. Family planning services will continue to be subsidized by the program, but the cost of contraceptive supplies will be shared by the user. But there will still be subsidized supplies for those who cannot afford them. Service providers must be well informed; they must not only at the contraceptive, they must also consider a prospective client as a total person.     

A new study of China's population control during the past ten years

This paper summarizes the control of population in China in the past 10 years and the changes that are occurring. Recently, an increase in the number of family members has directly influenced socioeconomic status by increasing family income and improving living conditions. Rural families have no incentives to control the number of children born. The cyclic effect of the 1962-73 baby boom is also causing a recent surge in population. China has studied these problems and has taken the following measures: new family planning systems have been established; population has been controlled macroscopically and flexibility is allowed at an individual level; governmental family planning organizations have been set up and financed; family planning education has been increased; family planning services have been enforced; incentives and restrictions have been implemented. China must work as a whole to enact and enforce these policies. Families must show restraint in childbearing. The only way for this to be accomplished is by decreasing the socioeconomic incentives to have children. Finally, reforms should be in tune with changing situations.     

Shuangyang County popularizes contraceptive knowledge

Shuangyang County is located in the southeast of the Changchun City, Jilin Province, with a total population of 385,000 and a total area of 2,000 square kilometers. The rural population makes up 96% of the total with 8.2% minorities. As the county government vigorously promoted the family planning program in the period of the 6th Five-Year Plan, the rapid growth of the population was effectively controlled. Since 1982, the county government has put the emphasis of the family planning work on publicizing scientific knowledge, on provviding technical services and on training the working staff at the grass-roots level. In response to the different needs of the community for knowledge about premarriage, preconception, and postnatal cares as well as infant feeding, the county government started a program in 1985 for popularizing knowledge about puberty, hygiene, sexual physiological hygiene, pregnancy care, and birth control. As a result, a number of young people have delayed their former marriage date to the ideal marriage age. Many newlyweds voluntarily chose the most proper age for giving birth. To improve the effectiveness of contraception, the county government promoted widely the use of a new type of IUD. Finally, the county government believes that it is most important to improve the quality of the family planning workers at the grass-roots level. Accordingly, the government worked out a plan to train the community workers regularly.     

The statistician's role in development planning

Formulation of population polcies requires good statistical information, a lack of which is still a formidable impediment to "situation-oriented" planning. But more than good statistics, governments need good statisticians who are able to work closely with the planners to find out what type of data is needed, to observe 1st-hand what errors have been made in forecasting, and to be part of the planning team. The field of statistics is now sufficiently advanced to provide good data on the effects of alternative courses of action and give good guidance for effective daily decisions. The distinction between suppliers and users of statistics has been unfortunate. Before adequate data can be collected the supplier must know the uses contemplated. As far as specific population policies are concerned, an overall increase in the Gross National Product is not the answer. Statistical offices should investigate relationships between educational level, age at marriage, and other possible factors influencing fertility. Also, developing countries must be concerned about quality of life and the depletion of natural resources. To do this governments need good statistics.     

Establishing legal system completely and controlling the excessive population growth]

China during the early years of Socialism concentrated on economic development. Population problems were given a low priority. But now, at this point in China's history, it is necessary to maintain the stability and uniformity of the birth policy through legislation, alter attitudes toward childbearing through legal education, and protect through laws the enthusiastic nature of family planning work of cadres. Without legislation, family planning work cannot endure. It is the proper time to promulgate "Family Planning Law", the body of laws written by the State Council after 5 years of research in family planning work. Critics of this view feel that conditions in rural areas are not ripe for such a law, or that because China is large and populous, laws are not the proper method for controlling population, or that legal restrictions would bring unforeseen consequences in the future. But China's population problem is immediate and dire, and conditions are indeed ripe for passing this law.     

Preparing adolescents for adulthood

Pregnancy-related school dropouts have become a matter of public concern throughout sub-Saharan Africa. In most cases, schoolgirls who become pregnant either have to resort to unsafe illegal abortions, or they face official school expulsion. Because girls who drop out of school due to pregnancy usually do not return to school to complete their education after the birth of their child, their opportunities for socioeconomic advancement are limited. Many African governments have included family life education programs in the school curriculum in an attempt to educate adolescents about the consequences and responsibilities associated with sexual activity. The high rates of schoolgirl pregnancies suggest that these programs have their shortcomings, and indicate that educational policies should attempt not only to reduce the incidence of schoolgirl pregnancies, but also to assist pregnant schoolgirls to complete their education. In this paper, we use data from a sample of 154 Kenyan primary and secondary schools to study differentials in the extent to which various types of schools are affected by pregnancy-related school dropouts, and to examine the opinions of the head teachers regarding teaching about contraceptive methods and readmittance of pregnancy-related dropouts.     

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.