Combining vertical service with horizontal service to promote family planning]

How Bazhong County of Sechuan Province, China, carries out family planning through a combination of what are termed vertical and horizontal services is described. Vertical service refers to assistance such as premarital education, prenatal hygiene, child health care, and family planning, while horizontal service refers to household assistance for married women. Premarital education is designed to help young people acquire sufficent knowledge about family planning, hygiene, and eugenics, and stresses the disadvantages involved in marriages between close relatives. Prenatal hygiene provides safe and convenient medical accommodations for delivery of the child as well as maternal care. Child health services assure that the best facilities are to be made available for physical examinations, vaccinations, and medical treatment. The family planning program involves comprehensive measures such as distribution of contraceptives and safe sterilization. In addition, the county provides medical assistance for couples unable to have children. Horizontal service providing household assistance for married women promotes scientific farming (e.g., how to use fertilizer), helps people increase their income by teaching them skills, and provides social services to improve life style and education. These vertical and horizontal services have brought about substantial improvements in the standard of living, family harmony, and population control.     

Reinforcement of family planning service strategy in India

The efforts of the Center for Population Studies at the Administrative Staff College of India offer an excellent example of the way in which resources available in the public and private sectors can be brought together to strengthen national population programs. Since the late 1960s the Administrative Staff College of India has been involved in population programs, and these activities coalesced into the Center for Population Studies which was formally established in 1972. The 1st task of the Center for Population Studies was to provide management inputs into the State of Karnataka for the India Population Project. The attempt was made to build up expertise through research and to subsequently transfer this to operating programs through management training and management consultancy. The delivery of services was identified as the priority area for the Center. The Primary Health Center (PHC) is the biggest component of the delivery system, yet there was little understanding of the working of the PHCs and their problems. Studies were launched to correct this deficiency and this led to a series of training programs for PHC doctors. Along with studying PHCs, the Center was asked to look into the program at higher levels, and this led to a study of the Health Department of the State of Karnataka and its subsequent reorganization. Similar efforts are now underway in several other States of India. The 3rd area of the Center's efforts is hospital administration, and studies have been conducted concerning the management fo hospital systems and training programs offered.     

Perceived factors of family planning clinic performance and service quality

As part of a larger operations research project, this 1990 study analyzed the performance of the Philippine Department of Health's (DOH) family planning (FP) clinics. Specific study objectives were 1) to measure acceptor targets, servicing capacity utilization, outreach, and costs; 2) to determine what providers believed affected performance; 3) to record which quality indicator providers use; and 4) to determine the perceptions of acceptors about clinic personnel, the clinic as a FP outlet, FP service processing, and FP service quality. Data were gathered from clinic records and from sample surveys in 25 clinics in four specified locations. Eight clients were sampled from each of the 100 clinics. It was found that clinic staff accepted low attainment of FP acceptor targets and that clinic capacity utilization levels were at 25% of capacity. Providers were unaware of the number of potential FP acceptors in their areas and had no information about the costs of running their clinics. The FP clinic managers identified 34 major determinants of clinic performance, but more than half reported that they had very little control over these determinants. The providers described quality service from the point of view of the acceptors and described the quality of a clinic in terms of the minimal physical characteristics required. The acceptor survey revealed that acceptor satisfaction depends upon 1) clinic accessibility and lay-out, 2) intensive personal contact, and 3) clinic infrastructure. The study uncovered a need for the DOH to institute management training programs for clinic managers and to provide managers with the resources and personnel to shift priorities in favor of FP coverage and prevalence. Managers, who are resource allocators, must also receive information about the costs of FP services in their clinics. In addition, the DOH's determination that its FP program would be facility- rather than community-based should be modified to incorporate community outreach elements. The DOH can also make a big impact on perceptions of quality (of both providers and acceptors) by improving clinic conditions to meet basic standards. Once these basic needs are met, additional needs of acceptors can and must be addressed.     

A fresh look at family planning communication

As a step toward development of a national information, education, and communication (IEC) plan, a reassessment of such efforts practiced by the agencies involved was undertaken. A paper published in 1978 by the Research Utilization Unit of the Population Information Division, Population Center Foundation, reviewed materials used and accounts of experience in conceptualizing and communicating family planning messages by 12 private and public sector agencies. The most common concepts employed by the agencies were small family size, responsible parenthood, family welfare, community and national development, birth spacing, delayed marriage, contraceptive use-effectiveness, "manliness," delayed 1st pregnancy, value and rights of children, human behavior and social environment, and population dynamics. Most of the messages were conceptualized and developed through formal and informal consultation with field staff. The need to consider the specific needs of target audiences was considered crucial, and thus decentralization of IEC production was recommended. Such decentralization has been a goal of the Philippine program since 1976, but the effort has been hampered by lack of local training and resources, and of studies to support successful implementation. Mass and mixed media approaches were found to be used by most of the agencies, although a reliance on interpersonal approaches was found to be most prevalent in rural areas. Among recommendations for policy makers were development of a systematized data base for IEC materials, regional capabilities in research and development, and studies of funding and existing resources.     

A second look at natural family planning

There is renewed interest in natural family planning (NFP) as the Philippine Population Program enters the 1980s. Much of this interest is due to the realization that, properly practiced, NFP can be a highly effective means of birth spacing. In 1978 the Special Committee to Review the Philippine Population Program recommended that more efforts be made to promote NFP. The different methods of NFP are reviewed. Sex without intercourse, coitus interruptus, and prolonged nursing are not officially recognized as NFP methods by the Program. The rhythm method was first described independently by Drs. Hermann Knaus of Austria and Kyusaku Ogino of Japan in the 1930s. Ogino's method of calculating a woman's fertile period is based on the lengths of the last 12 menstrual cycles which she recorded on a calendar. The advantages of rhythm are that it is inexpensive, it requires only the cost of charts which may be homemade, there are no physical side effects, control is in the woman's hands, and it is acceptable to people who consider it their duty to follow religious teachings. Disadvantages include: keeping constant, accurate records of cycles for long periods of time; the need for perseverance and correct interpretation of the chart; the possible need for medical advice and help; and the fear that something might upset a woman's cycle and change the time of ovulation. The continuation rates of rhythm acceptors in the Philippines are unimpressive. A study of 142 women revealed a high pregnancy/failure rate--25% for a 12-month period compared to 0 with oral contraception (OC) and the IUD's 2%. The basal body temperature method helps determine the unsafe period with some accuracy. Its premise is that there are slight but detectable changes in a woman's body temperature during her cycle. These changes herald ovulation. A special thermometer must record temperature changes of 0.1 degree Farenheit. This instrument and the charts are the only expenses involved. The reviewers of the Philippine Population Program noted that since the end of the unsafe period can be indicated only by the temperature, the total period of abstinence becomes long, although the basal body temperature method gives more or less 10 successive days for intercourse. The cervical mucus method, also known as the Billings method, takes into account the cervical secretions during the menstrual cycle. Appearance of this mucus is an indication of fertility. All that is required of a practitioner is to learn to distinguish the different sensations of wetness and dryness. The disadvantage is that the method becomes ineffective in areas where there is cervicitis or infection of the cervix. The symptom thermal method is the basal body temperature method combined with other NFP techniques and is widely used. With this method an accurate record of the 6 immediately preceding menstrual cycles is established. The start of the fertile period is set by substracting 20 days plus 1. The woman watches for symptoms like pelvic heaviness, breast softness, and mucus discharge.     

A brief introduction to China's family planning programme

China's family planning program is described in reference to its goals, approaches, and achievements. Between 1949-83, China's population increased from 541 million to 1,024,950,000. The population has a young age structure, and the median age is 22.9 years. 80% of the population is rural, and 90% of the population lives in the southeastern region of the country. In view of this demographic situation, the government recognizes the need to control population growth. China's goals for the year 2000 are to increase industrial and agricultural input by 400% and to keep population size below 1.2 billion in order to ensure that per capita income increases. In accordance with these goals, the government, in 1979, began advocating a 1-child policy. To ensure the survival of single children, the government also launched a program to upgrade maternal and child health (MCH). In some rural areas and among certain minority groups, the 1-child restriction is not applied. Family size goals will vary with time. These variations will reflect the need to maintain a balance between economic growth and population growth. A variety of incentives are used to promote the 1-child family. For example, single children receive medical and educational benefits, and in some rural areas, the parents of single children can obtain additional land contracts. Economic disincentives are also used. The government seeks to obtain compliance with the policy primarily through educating the public about the consequences of uncontrolled population growth. All channels of the mass media are used to deliver the messages, and the publicity campaign is especially intensive in rural areas. A comprehensive plan to provided family planning and population education for middle school students is currently being implemented. Each local area develops its own fertility control plan. This plan is then incorporated into the nation's overall plan and the overall plan is implemented from above. Family planning workers bring free contraceptives directly to the people, and family planning motivators are found in almost all villages, neighborhood committees, factories, and military units. As a result of these efforts, China made great strides in controlling population growth and improving MCH during the last decade. The birth rate declined from 27.93 to 18.62, and the total fertility rate declined from 4.01 to 2.48. 124 million couples were practicing contraception by the end of 1983. 41% used IUDs, 37.4% relied on tubal ligation, 12.9% relied on vasectomy, 5.1% on oral contraceptives, and 1% on other methods. The quality of maternal and child care also improved. 92.7% of all deliveries are now performed by trained midwifes. Infant and maternal mortality rates declined considerablely in recent years. Currently the respective rates are 35.68/1000 live births and 0.5/1000 live births. In 1983 alone, the gross national agricultural and industrial output increased by 46.1%. Since 1979 per capita income increased annually by 18.3% among rural residents and by 10.7% among urban workers. China controls and operates its own population program, but in recent years, it increased its cooperation with UN Fund for Population Activities, other UN agencies, and nongovernment agencies. China recently completed its 3rd national census, and demographic research institutes have been established in 10 universities.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.     

Overall improvement of the standard for the family planning service level of the floating population

To strengthen the management of family planning services to the floating population is an important task to solve the population issue under the new situation in China. In 2006, the Central Committee of the Communist Party of China （CPC） and the State Council made a ＂Decision on Overall Strengthening of the Population and Family Planning Work to Address the Population Issue In an Allround Way＂, which took the floating population service management as one of the five major tasks for addressing the population issue under the new situation.     

A study in family planning communication—Direct mailing

It is sometimes stated that direct mailing to individuals in developing countries like India may be wasteful due to the low literacy rate among village people. Direct mailing is a relatively new development in India and comparatively a newer channel of communication. An exploratory study was carried out by the Central Family Planning Institute to test this hypothesis. The observations made showed that direct mailing is practical, controllable, inexpensive, and useful.The information provided by direct mailing seems to cross the barriers of illiteracy. Based on this experience, the Central Family Planning Institute has initiated a large-scale communication action research project in Meerut district in North India where the impact of direct mailing on specific groups is being studied further. It is hoped that such studies would help in developing prototype information material and would provide a methodology to supplement the available channels of communication in a nation-wide family planning program.     

A broadcast on family planning in Hefeng County]

New ideas for the promotion of family planning among distant regions is the objective of this report which states that rural communities lack effective means of communication mainly due to poor transportation facilities, a serious illiteracy problem, and the fact that in certain regions, households are virtually inaccesible because of mountainous terrain. Such is the situation in He Feng County, Hubei Province, in southern central China. It has a population of 180,000 people composed of 3 ethnic groups. The communication barriers mentioned above act to hinder the promotion of effective family planning. In a study carried out in He Feng County, it was found that bad transportation facilities were a contributing factor to the region's backward education. Moreover, the illiteracy and semiilliteracy rates in He Feng County comprise 20% of the population. The problem is compounded by the fact that its 40,000 households are scattered throughout the mountains. In an effort to combat the prevailing situations, the author suggests that an effective means of family planning promotion would be the installation of loudspeakers in almost every household in the county (a total of 25,000 loudspeakers). This would provide suitable family planning education to males and females of different age groups and would foster knowledge of its significance and importance, thereby changing existing rural attitudes about family planning. Furthermore, the government could provide support groups in these regions in order to promote family planning objectives.     

A sensitive approach to family planning motivation in Malaysia

The goals of the Malaysian Family Planning Program are not only to reduce population growth from 3% to 2% by 1985 and to bring the crude birth rate to 28.2 from 30.3, but to generally improve the health of the family, and to enhance the government's efforts to raise the per capita income. The work program is divided into the Creative Unit, the Media Unit, the Production Unit, and the Field Diffusion Unit. The objectives are to build up strong support from political, community, and opinion leaders, and to run educational campaigns aimed at motivating potential acceptors. The program also runs centers training medical and paramedical personnel. The program is combined with development programs for women, especially useful among the rural population.     

颁布、施行人口与计划生育法对人口与计划生育工作的挑战

颁布、施行人口与计生法为加强人口与计生工作提供了法律保障 ,无疑是一件大好事。但是 ,特殊的国情决定了实施人口与计生法会遇到许多困难和问题 ,对人口与计生工作的思路、方法 ,对人口与计生工作的任务、要求 ,对人口与计生工作的作风、工作效率 ,等等 ,都是一种挑战。因此 ,我们必须采取有力措施 ,积极应对这种挑战 ,切实搞好依法管理 ,依法实行计划生育     

Strengthening family planning management]

Prior to 1984, enforcement of family planning policies in an undisclosed PLA military settlement in China's Jinan Military Region was totally inadequate. After notification from the central government, this military settlement immediately began enforcing family planning policies, resulting in sudden and full compliance with the central government's family planning policies. The system of scientific management of promoting and enforcing family planning, established by local administrators, is described. Management by objectives, clearly defined individual tasks and responsibilities, an full cooperation and support on the part of the authorities are some of the factors responsible for the effectiveness and success of the family planning efforts in this military settlement. A number of potential problem areas are identified scientific management techniques in dealing with uncooperative parties are emphasized.     

Tonga: family planning survey

A survey was carried out in 1975 in Tonga to determine how many families are practicing family planning. Public health nurses visited every household except the Niuas and remote islands. 4253 women out of the total of 9307 married women aged 15-44 years were using a contraceptive (45.7%). The percentage of users ranged from 4.5% in Ha'afeva District to 63.6% in the district of Kolonga. 60% of the users practice effective methods such as the pill, Depo-Provera, IUD, or sterilization; 23% use the condom, and 17% rely on withdrawal, calendar ovulation, or rhythm.     

On China's family planning policy

The birthrate in China in 1985, according to Li Honggui, Deputy Director of the General Office, the State Family Planning Commission, was 17.8/1000 with a death rate of 6.57/1000 and a natural growth rate of 11.23/1000. The number of births in 1985 was 18,520,000; 59.1% of these births were 1st births, 24% 2nd births, and 16.9% 3rd or more births. Women of childbearing age who pledged to have only 1 child accounted for 15.6% but only for 10% in rural areas. The peak fertility age of Chinese women was 24. Due to the age structure, a birth boom will begin in 1986 and will last for a decade. It is projected that the natural population growth rate will rise to 12.4/1000 in the 1986-96 period. The Chinese government has advocated a "1 child for 1 couple" policy since 1979. Couples who have difficulties can have a 2nd child with approval. Minority nationalities are permitted to have 3 children. The strategy of China's family planning program is to combine the guidance of the government with the motivation of the population. Consequently, communication and education have been emphasized. The situation is reported to be improving. At this time, women are advised to terminate unplanned pregnancies as early as possible. Individuals who refuse to consider the advice will be taxed.     

Focus on family planning measures

A blueprint for responsible parenthood titled "The Tokyo Initiative" was drawn up at a conference sponsored jointly by the Japan Science Society and the Population Crisis Committee in April 1977. Representatives of several U.N. agencies and nongovernmental organizations participated. The blueprint urges additional resources to make family planning services available in rural areas and unserved areas of cities. Expanded social and economic roles for women were also recommended since it was felt that unless women were allowed to participate in family and community decision-making, "programs for responsible parenthood will be doomed to failure." Adolescents should be educated about reproductive behavior, stressing the adverse effects of early pregnancy. Integrated family planning services which serve the cause of infant and child health and total responsibility for program design be placed as close as possible to people affected. The conference then issued a call for action to implement these family planning objectives.     

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.     

Communicating population and family planning

This thorough look at the change in the American family 1900-1700 finds that 40% of marriages among women now in their late 20s may end in divorce, that the divorce rate is stabilizing, that between 1-4% of unrelated men and women are living together in informal unions (the figure made difficult to obtain by the difficulty in framing the question), that 15 million adults live alone, and that only 67% of children live with their own once-married parents. About 33% of births are premaritally conceived. The median age for mothers at birth of last child has moved downward from 33 years in the early 1900s to about 30 years. Childbearing has declined from 3.9 children per mother in the early 1900s to 2.5. The period of childbearing has been compressed to about 7 years, between ages 23-30. 10% of remarried women's children are born between marriages. 50% of pregnancies end in abortion. It was found that persons who had completed an educational level, whether it be high school or college, generally had more stable marriages; those who had not completed a level were more likely to get divorced. Despite changes in lifestyle, however, some typical family situations are experienced by most Americans. 2 of 3 marriages will last until death of 1 of the partners and most young women questioned in census surveys expect 2 children.