Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

Adolescent sexuality in Asia: new focus for population policy

As the age at marriage continues to rise in East and Southeast Asia, the fertility behavior of unmarried teenagers is receiving more attention from population policymakers. In addition to fertility reduction through family planning, Asian societies today consider population planning strategies in relation to national needs and social goals, including such matters as the population's growth rate, age structure, educational quality and skills. The number of single youth in Asia is growing much more rapidly than the total youth population. By the year 2010, for example, India is projected to have nearly 70 million single teenagers, aged 15-19, 188% more than in 1980. In many developing countries today, such as the Philippines and Korea, the rising age at marriage has combined with rapid urbanization, improved status for women, and more educational opportunity to alter both the behavioral norms of young people and the traditional means of social control over youth. Studies of contemporary adolescent sexuality have been conducted in 4 Asian countries. In the Philippines an overt independent youth homosexual culture was found to exist in urban and to some extent rural areas. In Thailand research revealed little conservative resistance to family planning or to contraceptives for young unmarried people. Surveys in Taiwan indicate that behavior related to dating and choice of spouse has become more liberal, and a survey in Hong Kong revealed a higher level of premarital sex and use of prostitutes among Chinese men than expected. Population policy perspectives that need to be considered in these changing times include: 1) issues of access to family planning services by unmarried people below the legal age of maturity; 2) the development of social institutions, such as exist in Thailand and the Philippines, to guide adolescents' behavior; 3) more extensive study of adolescent sexuality; 4) establishment of the scope of family policy.     

Reproductive health care in India: a new paradigm

India has adopted a new approach to family planning that locates these services within the reproductive health care context. This means that family planning and reproductive health services will be offered as an integrated package. To implement this approach, the government will follow a framework for reproductive health designed by Saroj Pachauri, director of the Population Council's office in New Delhi, to guide the government's new Reproductive and Child Health Project. This initiative marks a significant paradigm shift in India; away from a population-control approach, implemented through a top-down, bureaucratic, target-driven program, towards a gender-sensitive high-quality services responsive to the health needs of clients, especially the women. Considering the geographical variations in reproductive health, the framework contains two service packages: an essential and comprehensive version, each consisting of broad categories of service and matrix of interventions. To support the transition underway, the Council has launched an advocacy project to educate health care providers and policymakers about reproductive health issues and help them translate the framework into effective programs. In order to successfully implement this initiative, partnerships with the nongovernmental sector, especially at the community level are essential.     

Traditional health workers finally earn recognition

In the Philippines the growing need for medical manpower and services can no longer ignore the traditional birth attendant, the hilot, who always played a big role in obstetrical practices, particularly in areas where paramedical workers are not available. In 1974 a survey identified more than 31,000 hilots, who assisted about 40% of all births in the islands. It must be remembered that in the Philippines 70% of the population lives in rural areas, that 65% of physicians live in urban areas, and that almost all hospitals are in metropolitan Manila. Until the early 50s the government's attitude was to discourage hilot practices, but limited resources and the small magnitude of existing health programs prompted the government to grant hilots official permission to continue their work. In 1955 the Philippines Dep. of Health and the WHO initiated a training program for 9000 selected hilots, to enable them to handle maternal and health situations in rural areas in the absence of physicians or nurses. From 1955 to 1972 only about 9200 hilots attended training programs, but from 1975 to 1977 about 10,500 hilots were trained to respond to local community health demands. Maternal and perinatal morbidity and mortality has sharply decreased from 1954 to 1972; with nearly half of the births attended by hilots it is valid to assume that the program of teaching and supervising them has contributed to such a decline.     

Peer counseling: the young helping the young

Reports on the use of peer counseling in sex and fertility control for adolescents in the Philippines. Among the programs described are the early and innovative program at De La Salle University, which includes a telephone hotline; a similar phone service used by the Kapatiran sa Kaunlara Foundation in Manila; and the Catholic Education Association of the Philippines. Universitites in Manila and other cities have also developed programs. The types of problems peer counselors are likely to encounter and ways in which they are frequently handled are noted, the importance of sound training is stated, and the key role of experience in the development of good counselors is emphasized. Counselors are generally offered some kind of incentive (college credits or an honorarium) but the personal rewards are noted as being possibly more significant.     

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' perceptions of available support networks and patterns of disclosure in order to raise awareness of their struggle against HIV and homophobia and to assist in empowering the low-income HIV-positive WSW community.     

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.     

4th International Population Conference: drawing the community into population programs

Summarizes the deliberations and recommendations of the (1978) 4th International Population Conference: "Expanding Rural and Urban Community Participation in Population Programs," sponsored by the World Population Society and the Population Center Foundation, and held in the Philippines. The 2 main concerns were finding ways of involving people in rural villages and urban communities in population programs, and fostering the sharing of ideas and experiences for the benefit of program administrators. Topics covered by the conference and reviewed here were organization and action for community participation; relating population and family planning to other services and the relevant personnel; role of women and women's organizations; involvement of youth; distribution of family planning information, techniques, and supplies; and new ideas and approaches. The resolutions of the delegates and other recommendations are also reviewed.     

Adolescent fertility programs: taking the first few steps

Adolescent fertility programs in Asia and the Pacific have a long way to go to check the problems associated with adolescent fertility, but a start has been made. Delegates from 8 countries met in 1982 to share their problems and experiences in their own countries. The conference participants drew up plans to deal with a high rate of adolescent fertility, sexually active adolescents, out-of-wedlock births, unwanted pregnancies, sexually transmitted diseases, prostitution, rape, abortion, and drug addiction. The delegates felt that for adolescent fertility programs to be effective the program workers must first be equipped with the needed skills through proper training. Inadequate knowledge of the subject matter, inability to communicate with adolescents, personal bias, and lack of counseling skills were among the worker-related problems that conference participants identified. A few months after the conference, participant countries conducted a training program on the effective delivery of adolescent fertility-related information and counseling services. The training program, held in Manila from January 23 to February 2, 1984, was conducted by the Population Center Foundation and sponsored by the Family Planning International Assistance. Training program objectives included: in crease the participants' knowledge of sexuality-related matters; help them to communicate better with adolescents on matters related to sexuality and fertility; make them aware of other ways of responding to fertility-related information needs of adolescents; and improve their skills in counseling adolescents. Lectures, structured learning activities, discussions, role playing, and other methods were used to maximize learning. The training program was divided into 6 modules: group dynamics; human sexuality; information dissemination; counseling techniques; management; and action planning. The plans of Fiji, India, Indonesia, Nepal, Sri Lanka, Thailand, and the Philippines are reviewed. Organizers of the training program are confident that the action plans of the individual countries will take shape soon and clear the path toward more effective adolescent fertility programs.     

Family planning for new mothers in the Philippines

From November 1997 to February 1998, a survey was conducted to evaluate postpartum family planning (FP) services in the Philippines. Data were gathered from records at 86 clinics in 28 provinces and from interviews with 338 FP providers and 3452 clients who began to use FP within 6 months of delivery. Only 7% of women began using FP within 6 months of delivery, and most postpartum attention was devoted to child care issues. Among the women surveyed, most resumed sexual intercourse at 2.4 months postpartum and experienced a return of menses at 4.4 months postpartum despite breast feeding for 6.2 months. The most commonly recommended method to space births was the IUD followed by the injectable contraceptive. Very few providers recommended use of barrier methods. The results indicate that many breast-feeding women are receiving hormonal contraceptives too soon and that IUD insertion may not be occurring at the ideal time postpartum. While a significant percentage of providers recommended use of the lactational amenorrhea method (LAM) and 16% of the women relied on it, the providers lacked sufficient understanding of LAM. In addition, many women switched or discontinued methods. The study led to the recommendations that postpartum FP services be promoted as an essential part of maternal-child health care and that FP providers receive improved training about contraception and LAM.     

Who uses reproductive health services in the Philippines (and who doesn't)?

Data from the 1993 National Demographic Survey and the Safe Motherhood Survey have filled gaps in knowledge about the accessibility and use of reproductive health services in the Philippines. Analysis of the data by the East-West Center's Program on Population has revealed that the number of women using family planning (FP) and maternal health services has risen to 40% in 1993 from 17% in 1973. Modest gains were also seen in the past five years despite disruption to program efforts. Prenatal care showed the greatest maternal care coverage rate increase, but 70% of births occurred at home, with only 51% attended by a trained person, and only 32% of postpartum women received care. Adolescents and women who are over age 40, uneducated, Muslim, and/or live in a rural setting have the most unmet need. In addition, less than half of the women reporting symptoms of a sexually transmitted disease sought treatment from a trained practitioner. Most women use public sector services, including 71% of those using modern contraceptives. While trained midwives provided 58% of prenatal care, traditional birth attendants delivered 52% of all births, and a high incidence of maternal mortality persists (209/100,000). Recommendations arising from this analysis include 1) improving prenatal and delivery care, 2) strengthening postpartum FP services, 3) expanding the program to reach more women, 4) extending the range of reproductive health services offered, 5) integrating traditional practitioners into the reproductive health system, and 6) balancing cost and service variations between the public and private sectors.     

Programs for adolescent girls documented in India

This paper documents the innovative strategies from seven governmental and nongovernmental organization programs addressing a range of adolescent issues. The collaborative effort of the Population Council and the local counterparts highlight the diversity of adolescent experience and emphasizes the need to look beyond reproductive health in order to ensure girls? safe transition to adulthood. The review suggests that programs need to focus on developing skills that can be applied to all aspects of the lives of adolescent girls, including self-esteem and confidence enhancement and improving their access to information. Moreover, the assessment also showed that the health needs of adolescent girls, especially the married ones, are often unmet. Considering the importance of an integrated approach, some of the programs evaluated were able to provide a strategy by collaborating with existing local services. It is documented that the strong links with the community were invaluable for the success of these integrated programs. Addressing the needs of other family members, particularly the boys are also emphasized. Experience of the program has shown that targeting boys prior to adolescence is a prudent strategy. Similarly, the training program for staff members is crucial in shaping a girl-friendly environment. Finally, the paper emphasizes the importance of crafting new programs that respond to the needs of specific communities and populations.     

ASEAN projects reviewed

The ASEAN Population Expert Group met in Manila and was followed by a meeting of the ASEAN heads of population programs, during the period November 5-10, 1979. Heads of population programs from Indonesia, Malaysia, Singapore, Thailand, and the Philippines attended. The meetings were held to review progress-to-date on phase 1 projects and to consider the development of an expanded population program. 5 projects funded by UNFPA are reviewed in tabular form with the project, the sponsoring country, date of implementation, data analysis, and date of completion. Suggestions were made for improving and extending these projects and it was also suggested that all projects being developed and proposed should include a section on use of research. 7 new projects were proposed as phase 2 projects. The 1st, sponsored by Malaysia, deals with women in development; project 2, lead by Thailand, will investigate population movement and its effect on development; project 3, led by the Philippines, will develop and strengthen national population information systems and networks in ASEAN countries; project 4, led by Indonesia, is directed towards institutional development and exchanges of personnel; project 5, led by the Philippines, will examine population and development dynamics and the man/resources balance; project 6, led by Thailand, will develop ASEAN social indicators; and project 7, led by Indonesia and Malaysia, will make a comprehensive analysis of existing medical/health care and family planning systems. It was recommended that an executive director of the proposed ASEAN population coordination unit should be appointed to expedite the recommendations of the meeting related to preparation and submission of phase 2 project proposals.     

Women in development: the road toward liberation

Although women in the Philippines traditionally enjoyed considerable independence and equality, 3 centuries of Spanish colonialism greatly effaced their rights. The importance of the role women can play in development was highlighted at a recent consultation-workshop jointly sponsored by the FAO and the Population Center Foundation. Although 82% of Philippine women are literate, female education is accorded much less importance than that of males, and girls are often forced to discontinue their schooling early to help in housework. Rural Filipino women marry younger than their urban counterparts, and their fertility is correspondingly higher. Only 13% of rural women practice birth control. Participation of Filipino women in community affairs is mostly in social activities, although a few privileged women have gained elective office. The legal status of Filipino women is inferior to that of men in the areas of mixed marriage, choice of residence, parental authority, property rights, right to work, court suits, legal separation, and widow's rights. Labor force participation among women is only 1/2 that of men. As of 1975 only 0.6% of women workers occupied administrative or managerial positions. The National Commission of the Role of Filipino Women was created in 1975 as a coordinating body to promote the advancement of women in all levels of society to enable them to contribute more effectively to the development process. Specific programs carried out by government and private sector groups include extension education for women, basic skills training for income generating projects, community development, and population and family planning projects.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.     

Family planning as preventive health measure

The link between health and family planning efforts in the Philippines goes back to the beginnings of the National Population Program. In this interview, Dr. Dumindin of the Ministry of Health (MOh) discusses the impact of family planning on health. The family planning program of the MOH, since its inception in 1970, has undergone expansion and taken new initiatives and directions to meet the changing needs of the target clientele. Family planning information, education, and motivation is provided and maintained during routine prenatal, natal, and postnatal clinic and field activities. As of January 1986, the MOH had a total of 2100 clinics--rural health units, medical centers, hospitals, mobile clinics, and special clinics--all over the country. It is estimated that the Ministry's family planning activities have averted around a million births. It is hoped to extend the coverage of the programs to areas that have not been reached before, through further community involvement, by enlisting the participation of more workers in the community, training them on integrated health and family planning services, setting up more service facilities and clinic extensions, and by improving contraceptive use-effectiveness. Hopefully, the Philippine people will become less program-dependent and more self-motivated, and they will recognize the need for birth spacing, birth limiting, and total health care--not as suggested from the outside, but coming from within themselves.     

“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

BackgroundExperiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.AimThis study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.MethodsThis was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.FindingsWomen had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.ConclusionTo improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.     

Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic

The COVID-19 pandemic is impacting health systems worldwide. Maternity care providers must continue their core business in caring and supporting women, newborns and their families whilst also adapting to a rapidly changing health system environment. This article provides an overview of important considerations for supporting the emotional, mental and physical health needs of maternity care providers in the context of the unprecedented crisis that COVID-19 presents. Cooperation, planning ahead and adequate availability of PPE is critical. Thinking about the needs of maternity providers to prevent stress and burnout is essential. Emotional and psychological support needs to be available throughout the response. Prioritising food, rest and exercise are important. Healthcare workers are every country’s most valuable resource and maternity providers need to be supported to provide the best quality care they can to women and newborns in exceptionally trying circumstances.     

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors.