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.     

NFP promotion in the Philippines: all program components covered

At least 50 of the 105 agencies in the Philippines listed in the "Directory of Agencies with Population Activities" are actively participating in the promotion of natural family planning (NFP). Of these, 40 offer instruction on its use, 22 provide training to clinic personnel or field workers, 19 conduct information/education/communication (IEC) activities, and 6 undertake research. The Population Center Foundation's (PCF's) Information Support to Population Projects (ISP) has prepared a preliminary inventory of programs and projects on NFP, covering some of those that were done in recent years, are being implemented, or have been proposed. Some projects described in the inventory are reviewed. Recent research or research proposals are showhow related, all leading to how the method can be effectively promoted and how couples can be taught its proper use. Instruction on NFP appears in all training activities of Popcom's regional offices, particularly in their refresher courses. Program managers are being trained in managing and monitoring activities to promote the method. In 1980 outreach workers, doctors, nurses, and midwives were trained by Popcom to motivate couples to practice the method and to teach them how to use it correctly. That same year, Popcom's office in the Ilocos region introduced the rhythm dial calendar, a simplified version of the rhythm slide rule. The Ministry of Health National Family Planning Office incorporates natural family planning instruction in its training seminars for the Ministry's health personnel in the regions. As in training, all regional offices of Popcom promote NFP along with other methods that they make available to prospective acceptors. This is in keeping with the program's "cafeteria approach" to family planning. In 1982 Popcom began intensifying the provision of services in NFP, allocating around 4 million pesos to preparations for its effective promotion. In support of service delivery efforts are IEC activities such as the development, production, and distribution of brochures and other reading material on NFP, schoolroom instruction, and lectures. The intensification of IEC efforts in the private sector to promote the modern and scientific techniques of NFP is most clearly evident in a fairly recent seminar sponsored by the Communication Foundation for Asia. Program agencies with activities in natural family planning are listed.     

Technical information via print

The amount that the staff of family planning clinics learn through technical publications is discussed in this article on the Philippine Population Center Foundation's Study of the flow of scientific information. The main questions raised include to what extent doctors, nurses and midwives learn from publications sent to their clinics, or from colleagues who have read the journals. If the latter is true, do the staff members teach one another or merely refer each other to the technical information available? 99 copies of "Population Reports" were sent out to various clinics throughout the Philippines. A 3rd of the issues were on the pill, a 3rd were on the IUD, and a 3rd were on the condom. 6 weeks after the information was sent out, tests on all 3 contraception methods were given to all staff members who were part of the survey. Ideally clinic staffs would perform best on the tests of the method on which they had received information. Tables giving breakdowns on the individual areas tested show that while clinics which had been sent information on the IUD scored best on the IUD test, clinics which had been sent pill and condom information did not do better on their respective tests than the others. Nurses and midwives from clinics with good interpersonal relations scored higher on the tests on which they had been sent information. Results also showed that the more involved a professional was with a contraceptive, the more he/she read about it. While encouragement and referral occurred between colleagues, teaching did not. A 2nd study was then run on how levels of interpersonal communication could be determined. A multiple regression analysis showed that the best predictors of intraclinic communication were age difference among clinic staff, similarity in clinic staff's length of family planning service, family planning caseload, similarity of clinic staff's reading of professional literature, average length of service of staff members in the medical profession, and average age of clinic staff.     

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.     

Sterilization: the barriers are being crossed

The sterilization program begun in the Philippines by Presidential Decree in 1974 is described. The goals of the program are: 1) training of program practitioners, to equip a corps of physicians with needed skills; 2) recruitment of acceptors to test the acceptability and viability of the approach among eligible groups; and 3) "professionalization" of medical practice in sterilization. The training of program physicians has been taken over by Popcom as part of its 1-year sterilization training program. The institutionalization of the surgical sterilization in medical schools and family planning organizations has been undertaken by the Study and Training Center for Surgical Sterilization. Various types of sterilization clinics are described. The reaction of the population and methods of handling potential acceptors are described. Sterilization techniques and side effects are presented for male and female sterilization. 3 models for information-education-communication in sterilization are reported. The number of births averted by this sterilization program is estimated. Problems encountered are revealed.     

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.     

To the barrios] The new course charted by the national population program

In order to reduce the Philippine birthrate to 2% by 1980, the number of rural women practicing contraception must be trebeled. To facilitate such an effort, a large-scale reorganization and reorientation in all areas of family planning activity--delivery, training, research, information, education, and communication--is proposed, shifting the delivery of family planning services from clinics to the 36,000 barrio bases. A goal of 16,000 extension workers in family planning is set for 1976; these workers will be the ones to make the initial contacts with potential acceptors. Then full-time family planning workers will try to make potential acceptors into bonefide ones, giving advice or prescribing the method and providing follow-up. Family planning workers will be supervised by nurses and midwives in health stations, who in turn will be supervised by the physician in the rural health unit. Acceptability among community residents is the most vital characteristic of a family planning worker, with the country's 27,000 hilots (birth attendents) seen as leading candidates. Attracting and training manpower in the field is a major challenge, as is lack of personnel in the area of research. Several possible avenues for the development of research interest and manpower for the population program are explored.     

Sterilization in the Philippines: the score after half a decade

Since the initial use of sterilization in the Philippines in 1973 as a family planning method, it has become more and more widespread. A bar graph, giving yearly percentages of acceptors for 5 family planning methods, for the years 1974 -- 1977, shows sterilization increasing steadily in popularity, from 3% in 1974, to 12.7% in 1977. Objections to sterilization generally stem from sociocultural and religious considerations as well as misconceptions and fear. People have feared that sterilization is a form of mutilation and castration. Due perhaps to the male fears of castration, female sterilization acceptors account for 90.6% of sterilizations in the Philippines. In 1974, the Philippine government's Commission on Population set guidelines for the training of physicians and the setting up of sterilization centers. The guidelines also stipulated that the procedure would be undertaken on a voluntary basis, would not include abortion, and that clients would be informed of all medical implications, particularly the irreversibility of sterilization. Programs for sterilization in the Philippines have different requirements for acceptors; most stipulate parity of 2 to 4. Difficulties have also arisen from the uneven distribution of sterilization providers throughout the country as well as a lack of physicians trained in both male and female sterilization methods. The need to create effective linkages among the various agencies engaged in sterilization work is noted.     

Full-time workers reach out to the villages

The Philippine Commission on Population (Popcom) has fielded 2721 fulltime outreach workers (FTOWs). The FTOWs are the outcome of a shift from a clinic-based, motivation-oriented family planning effort to the Rural Outreach Program which is part of the new Total Integrated Development Approach (TIDA). Organizationally, the workers are under local government supervision and their purpose is to make the family planning program more responsive to community needs. This article profiles the average FTOW, describes recruitment and training procedures and discusses problems of the program -- funding, transportation, inadequate training, lack of educational materials, shortage of contraceptive supplies -- and possible solutions.     

Central Mindanao: selling family planning informally

A research study was conducted in Central Mindanao, Philippines, to evaluate the effectiveness of " selling" informally the idea of family planning to potential acceptors. The study, entitled "the Extent of Involvement of Satisfied Acceptors Clubs/Satisfied Users Clubs" was conducted for the regional office of the Commission on Population (Popcom) by the Notre Dame University Socioeconomic Research Center in Cotabato City. Organized by fulltime outreach workers (FTOWs), the clubs are concerned primarily with the promotion of family planning. The first such club in the region was organized in 1979. Currently, the clubs are linked with other development agencies. The study's respondents were 200 continuing users of a family planning method and were members of the clubs in Illigan City and Cotabato City. Respondents were mostly women (191 or 95.5%), in their early 30s (31%), had 4 children on the average, had reached high school, and belonged to low income families. On the average, respondents had been practicing family planning for around 4 years and 7 months. They were aware of or knowledgeable about the condom, oral contraception (OC), IUDs, rhythm, tubal ligation, vasectomy, and withdrawal. Some of them were aware of injection, abstinence, foam, and the diaphragm. The majority of respondents indicated they had tried other family planning methods before changing to the method they were using. The primary reason for method change was the desire to use a more effective method. The respondents became club members either by being recruited or by applying for membership on their own. Motivating clients to practice contraception was the club's primary activity. 133 club members (66.5%) "claimed to have successfully motivated persons/couples to practice family planning." Among the problems encountered by the clubs, the indifference of people toward the family planning program appeared to bethe most serious from the respondents' perspective. Inactivity of some members was cited as the 2nd most serious problem. The study concluded that despite problems the clubs had been "fairly successful" in helping Popcom promote family planning.     

The population program shifts to 'high-scenario' targets

The Philippine Population Program would like to achieve a replacement level of 1 daughter per childbearing woman by the year 2000 to reduce the population growth rate to 2% by 1992. Laing projected that high performance by the National Population Program would mean continued increase of sterilization prevalence at an average 1978-1983 rate. Strategies have been adopted to strengthen information-education-communication efforts, to attain higher contraceptive prevalence rates and use-effectiveness, to develop manpower, to achieve self-reliance, and to effect better program coordination, monitoring, research use. Effective service delivery will be a key to achieving the high-scenario targets. Effective use of natural family planning (NFP), will help in achieving the high-scenario goals. Apart from the heavy demand on NFP follow-up, need for prompt delivery of supplies, and lack of doctors and nurses, other factors may impede the high-scenario targets. Saniel believes that program workers should be allowed to insert IUDs and to dispense pills. Under the cost-recovery and cost-sharing schemes of the high-scenario targets, only sterilization will be done for free. It might affect the campaign for increased acceptors, but the start for self-reliance must happen now.     

Bicol hospital reaches out to rural folk

The Ago General Hospital in Legaspi City of the Philippines was opened in 1965, antedating the national family planning movement by 5 years. The 180 bed hospital integrates family planning into the overall hospital service; sterilization is the main method used. Of the 3600 patients per year, 15% are family planning acceptors. The hospital employs 3 family planning strategies: inhospital, out patient and supportive. Inhospital strategies center on sterilization counseling and motivation. The counseling sessions include patient education. Primary targets include high risk pregnancies and young couples with a lot of children. Outpatient strategies include a referral system involving hospitals and agencies with family planning programs, lectures for community organizations and personal visits to other clinics and rural health units. The hospital's mobile clinic, staffed mainly by students, provides information, deworming, and pediatric services to the community. Supportive program strategies consist of mass communication, and an acceptor's club for previous acceptors of sterilization. These clubs meet regularly to share and discuss experiences.     

Pakistan: re-organization at the top

New measures for population program planning have been introduced in Pakistan. 3 wings were added in the Population Planning Council: administration, coordination, and planning; operation; and technical. New elements in the program include: 1) setting up of new directorates; 2) opening of more family welfare clinics, model clinics, and sterilization centers; and 3) expansion of training facilities for medical and paramedical personnel. 2 national training institutions have been established: the Population Training Centre at Lahore, and the National Institute of Advanced Training at Hyderabad. 16 centers have training courses for doctors performing sterilization. There has been a restructuring of the information, education, and communication aspects of the program. The commercial distribution of contraceptives has become an important element. There are efforts to relate the program to other development programs.     

A survey of China's birth control among women of child-bearing age

To further implement China's family planning policy of "prevention first, birth control first," a study of the current family planning situation was conducted. A survey of the birth control methods employed by women of childbearing age and by men was based on a nationwide randomized sampling of 1/1000. In the different age groups, ranging from 15-49 years old, IUD users accounted for over 50%, tubal sterilization 25%, and vasectomy 10%. The main IUD users were women in the 20-24 age group. Tubal sterilization was more prevalent among the women in the 35-39 age group. The use of oral contraceptives (OCs) was more common among younger women but accounted for less than 10% of the total. The survey was based on the replies to questionnaires from 172,788 married women of childbearing age; 120,022 of them practiced contraceptive methods for a birth control rate of 69.46%. The breakdown was as follows: IUD, 34.84%; tubal sterilization, 17.63%; vasectomy, 6.94%; OCs, 5.86%; condom users, 1.39%; and other methods (including chemical suppositories, rhythm, or safe period method and withdrawal before ejaculation), 2.78%. There was a higher percentage of OC users in urban areas, and a marked preference for IUDs in the rural communities. The rural birth control rate was 68.58%; the urban rate was 74.17%. The use of the IUD has priority in all the areas; its percentage approaches the national average level. The use of vasectomy as a birth control method varies considerably according to area as does the use of OCs, condom, and tubal sterilization. Rural minority groups prefer the IUD and OCs; tubal sterilization, the condom, and vasectomy are preferred by the Han nationality. The birth control rate differed according to the different occoupation groups: 77.85%, workers; 76.01%, farmers; 85.15%, cadres; 59.52%, housewives; and 66.67%, others. The birth control rate was higher among those who received a college education than the illiterates, but statistics did not show a significant difference in the rate of those with a high school education and the illiterates. Mothers of 0-1 children generally preferred OCs; tubal sterilization was preferred by mothers with 2-3 children. The nonusers of contraception accounted for 30.54% among married women of childbearing age. A breakdown gives the following figures: menopause and infertility, 6.17%; divorced and widowed, 1.64%; planned parenthood, 10.51%; nonusers who should have practiced contraception, 12.22%. On a national level, the estimated number of nonusers of contraception among those who should be practicing contraception comes to about 20,000,000 women.     

The Filipino male as a target audience in family planning

Since the official launching of the Philippine Population Program in 1970, family planning campaigns have substantially addressed themselves to women. The suggestion to devote equal, if not more, attention to men as family planning targets had been raised by Dr. Mercado as early as 1971. It was not until 1978, that the deliberate inclusion of males as a target audience in family planning became a matter of policy. The Population Center Foundation (PCF), from 1979 to 1982, carried out research projects to determine the most suitable approaches and strategies to reach Filipino men. The objectives of the PCF's Male Specific Program are: 1) to test alternative schemes in promoting male family planning methods through pilot-testing of family planning clinics for men, 2) to develop teaching materials geared toward specific segments of the male population, 3) to undertake skills training in male-specific motivational approaches for program professionals, and 4) to assess the extent of the husband's role in family planning. An important finding of 1 study was that most outreach workers were female stood in the way of the motivation process, thus hampering the campaign. While the consultative motivational skills training improved knowledge, attitudes, and skills of outreach workers with regard to vasectomy and the motivation process, there were certain predispositions that were hindering the fieldworkers' effectiveness in motivating target clients. Overall, in-depth, 1-to-1 motivation in dealing with men is needed to strengthen internalization of family planning values.     

Choosing a contraceptive method: why does it matter?

The use of contraceptives varies widely among Asian countries. Based on the most recent survey data available, the rate varies from nearly 8/10 married women aged 15-44 in Taiwan to fewer than 1/10 in Pakistan and Nepal. Women in East Asian countries are most likely to practice contraception, followed by those in Southeast Asia, with lower contraceptive prevalence rates found in South Asia. The rates of some East Asian nations now match those of the US and other developed nations, while in most South Asian nations contraception is spreading slowly. Contraceptive methods in use vary widely by country. The leading method in the greatest number of countries is sterilization, but in most countries several methods are nearly equal in popularity. Only in India is sterilization used by a majority of those people who practice contraception. Japan is the only country in which a majority of contraceptors use condoms, and only in China do 1/2 use IUDs. The choice of a particular contraceptive method is strongly influenced by 1) methods available through family planning programs, or promoted through the use of target systems; 2) religous and cultural factors; 3) concerns about side effects and safety; 4) ease of access to particular methods; 5) the medical profession; and 6) legality--in Japan the pill is illegal. In most countries the type of contraceptive that people prefer has changed since the introduction and promotion of modern methods of contraception. In general, there has been a shift to more effective methods. An increase in female sterilization at the expense of other methods such as the IUD or pill is the most common pattern. In countries where female sterilization is unpopular, use of such modern methods as the pill, IUD, or condom has increased at the expense of traditional methods.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

Tilamsik: bringing the hospital operating room to the barrio

Tilamsik, organized by the Mary Johnston Hospital's Fertility Care Center, answers numerous requests for vasectomy and laparoscopic sterilization in the remote areas of the Philippines. Literally, Tilamsik means "spark" or "splatter." As the name suggests, the project reaches out to patients who want to be sterilized but cannont come to the center in Tondo. Once the center receives a request, the Tilamsik Outreach Team (composed of 2 doctors, 1 nurse, 1 interviewer, and 1 orderly) immediately scedules the visit. It takes about 2-3 days to pack the sensitive equipment and supplies needed for the trip. The team works closely with the requesting or coordinating agency to make sure that patients are initially screened and properly motivated. Upon reaching its destination, the team can turn any setting into instant operation rooms where the surgical procedure can be performed safely and efficiently. Turover of patients is fast, thanks to the wonders of laparoscpy, a type of endoscopic procedure for tubal ligation. After the operation, the patient rests in a recovery room and waits for the preoperative sedation to wear off, In babout 2 hours she can go home. In the towns and barrios where Tilamsik operates, patients are brought to an improvised recovery room where they lie down on the floor with their own beddings. Traveling in the remote areas is 1 of the major difficulties of Tilamsik. Financial constrants have forced the center to limit the team's trips to places within driving distance form the Tondo center. Tilamsik's services are now made available only up to as far as Lucena and adjacent towns and barrios. With the growing popularity of laparoscopy as a female sterilization technique, the more recent requests for Tilamsik's services are for groups of acceptors numbering from 100-150. To avid duplication of family planning activities, the Tilasik project director has identified areas in the country with laaroscopic sterilization expertise. Project Tilamsik was inaugurated on June 1, 1973 at the Mary Johnstn Hospital. Like other mobile groups, Tilasik was affected as early as 2 years ago by the increasing cost of transportation. Popcom subsidizes the team's trips to provinces around Metro Mala to help the team cope with its transportation problems. Tilasik uses the new generation laparoscope called Laprocator. The unit is more handy and can be used in places where there is no electricity. The number of complications for every 1000 cases reported in a survey of 6871 cases was 116 for persistent pain following surgery, 54 for tubal transection, 32 for hemorrhage, and 22 for infection.     

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.     

Fresh impetus to family planning programmes planned in India. APPN interviews Mr. B. Shankaranand Union Minister for Health and Family Welfare,India

Mr. B. Shankaranand, Union Minister for Health and Family Welfare in India, speaking on new policy measures planned to give family planning a major boost, stated that programs related to population and family welfare should be interwoven with the minimum needs program so that the message of the small family norm becomes attractive to acceptors. The new incentive measures, outlined by Shankaranand, are based on the understanding that the existing infrastructure for service delivery must be fully utilized. The new package of incentives places equal emphasis on state level campaigns which will be suitably dovetailed with services and supplies. Monetary rewards in the form of community assets will be given to organized and identifiable groups actively engaged in the implementation of the Family Welfare Program. Cash awards will be given to the best performing states. A new incentive scheme will be introduced for industrial labor groups in the organized sector. Innovative publicity campaigns in selected areas will be conducted. Reorganization of the service delivery outreach system will include establishing health posts staffed by nurse midwives and health workers in urban slums and congested areas. A scheme is in preparation to issue green cards to acceptors of terminal methods after 2 children. The card holders will be entitled to priority attention and preferential treatment in schemes where such practices are feasible. Currently, there are 5000 Primary Health Centers and 50,000 subcenters offering integrated health services. Family planning statistics provide supportive evidence of programmatic response to the achievement of longterm goals of population stabilization. During the 1st 10 months of the current financial year 2,800,000 sterilizations were performed, a 43% higher achievement rate than the corresponding period last year. The number is likely to rise to 4,000,000 by the end of this financial year. Similarly, the number of IUD acceptors is 760,000, 35% higher than last year. Another encouraging sign has been the formulation of a National Health Policy.