Family growth and family planning: Responses to a family-planning action program in a rural district of Thailand

A resurvey of a rural district in Thailand, of about 70,000 population, was conducted after a family-planning program had been in operation for eight months in order to ascertain indications of effectiveness of the program. Both the "before" and "after" surveys employed a 25 percent simple random, though non-overlapping, sample of married women 20-44 years of age whose husbands were living. The only difference in design and execution was the inclusion in the resurvey of questions about the action program. Barring one or two exceptions, the characteristics of the two population samples were so similar that differences in knowledge, attitudes, and practices could be regarded as effects of the program.The action program not only made itself widely known in the district, it also evoked a highly favorable appraisal, to such an extent that nine of every ten women thought the program should be extended over the entire kingdom. Motivation to engage in family planning increased perceptibly. A substantial proportion (23 percent) of the women who formerly disapproved of the practice changed their attitudes to approval, mainly because they had become convinced of the harmlessness and the utility of fertility control. Less than 3 percent of the former approvers had become negative.The proportion of women who claimed some kind of knowledge about contraceptive methods more than doubled during the eight months of the program's operation. More impressive, however, was the change in actual use of methods, which rose from 1 to 21 percent of the eligible women (women who were not pregnant, subfecund, or sterilized). Another 16 percent, in the resurvey, planned to begin use of contraceptives in the near future, in most instances after a current pregnancy. The frequency of acceptance of family planning practice exceeded the expected frequency among women who were approaching or had attained the "ideal" number of children (4.0 children). High-parity women 40 or more years of age seldom accepted clinical assistance.     

Family planning in choiseul province,Solomon Islands

The results presented are from a rural prevalence survey on family planning in Choiseul Province, Solomon Islands. Married women aged 15–49 years with at least one living child and married men whose wife met the same criteria, provided data on knowledge, attitudes and practices of contraceptive use. Fifty one per cent of the female sample were using some form of contraception, 26 per cent reversible and 25 per cent non-reversible methods. Sixty-five per cent of men claimed that they or their spouse were using a method of family planning. Tubal ligation was the most common currently used method (25 per cent in the female survey). Desired family size was four for both males and females. Knowledge and approval of family planning was high, with 83 per cent of females and 81 per cent of males knowing of at least one method. Problems in accessing information and services for family planning include cultural and logistical constraints. Religious affiliation was the major variable affecting knowledge, use and approval of contraceptive methods. Nearly a quarter of the sample lived further than two hours travel time from the nearest health clinic supplying contraceptive methods. These clinics often have only an intermittent availability of supplies. A strong interest in family planning was demonstrated by both respondents and service providers.     

Desired family size in Thailand: Are the responses meaningful?

Data for both rural and urban women in Thailand indicate that the large majority of respondents are able to provide numerical responses to questions on desired family size. Although there is evidence that some women tend to rationalize the number of children they have when stating the number they would want if they were recently married, the vast majority of respondents prefer a number which is different from the number of living children they had at the time of the interview. Women who had already reached or exceeded their desired number were almost universal in stating they wanted no additional children, whereas only a minority of women who had yet to reach their desired family size said they wanted no more children. Finally, the proportion of women who practiced family planning is substantially greater among women who had already achieved or exceeded their desired family size than among women who had fewer than their desired number. The results thus suggest that, in Thailand at least, responses to family size preferences need to be interpreted with caution but nevertheless can be of use to the population analyst.     

The marriage of mentally handicapped people and family planning services for them in Shanghai

This brief article discusses findings from a study by the Shanghai Population Information Center on marriage, fertility, and family planning among mentally handicapped adults in Shanghai, China, and population dynamics. The sample included 184 mentally handicapped persons aged 20-49 years (79 men and 116 women). 47 people had mild, 92 had moderate, and 45 had severe mental deficiencies. The mean age was 33 years. About 29% were married or ever married. 49 were married or ever married women. 6 spouses were mentally deficient. About 70% of the married or ever married had children. 43 had ever used contraception. The most commonly used method was the IUD. Several people had the approval of family members and were sterilized. Only 3 women were prevented from use of contraceptive services by family. 38% of the unmarried women's parents or relatives wanted their mentally deficient family members to be married before old age. 48% discouraged marriage because of the mental deficiency.     

Multivariate relationships between modernity value orientations and family planning indicators

Using canonical correlation techniques in the analysis of data collected from interviews with 1,737 married women of three Indian states, this paper evaluated three modernity value orientations—subjective efficacy, openness to change, and propensity to plan—as predictors of a set of four family planning indicators. The analysis revealed that, in Haryana, both subjective efficacy and openness to change were related to family planning knowledge and attitudes as well as to favorability toward small family size. Propensity to plan was related to adoption. In rural Tamil Nadu, subjective efficacy and openness to change were related essentially to family planning attitudes, whereas in urban Tamil Nadu they were strongly related to adoption. In the latter area, the best linear association between the modernity variables (predictor set) and the family planning variables (criterion set) resulted when the criterion set was so weighted that it involved a large amount of adoption and a moderate amount of contraceptive knowledge and attitudes. Thus, in urban Tamil Nadu, the four family planning variables seemed to cohere, reflecting cognitive, attitudinal, and behavioral consistency. Except in Meghalaya, it appears that married women with higher subjective efficacy, openness to change, and planning tendency may be more likely than others to translate their family planning knowledge and favorability toward small family size into action, under suitable conditions. Some of the implications of the findings are discussed.The author is affiliated with the Council for Social Development, 53 Lodi Estate, New Delhi, 110003, India.     

To grasp the family planning program early, carefully and surely according to the law of reproduction]

China's February 1982 Directive on Improving Family Planning Work stipulated that family planning should be incorporated into national economic and social planning by understanding it early, carefully, and surely according to the law of reproduction. Understanding family planning early means to implement the policy of birth control as a primary goal, to plan early for births, and to carry out birth control measures, i.e., formulating a plan is the basis of understanding early. For example, the following must be considered when mapping out a plan for 1983: the number of fertile women who wanted children but who remained childless for 3 years of marriage; those who conceived late in 1982 and will deliver in 1983; the number of newlyweds over 23 years of age who have not planned a pregnancy; those with 1 child over 4 years who due to unusual circumstances will have a 2nd child; the number of people planning marriages before March 1983. The next step is to make arrangements, which include submitting individual requests, getting permission from communes and approval from the general public, and delivering contraceptives to the homes of newlyweds and mothers. 9 months after arrangements are completed, adjustments must be made, e.g., those who were unsuccessful in their plan to conceive this year will try the next year. To understand carefully is to understand the concept, circumstances, and data of family planning and thus be able to administer it scientifically. This means primarily controlling fertile women who are newlyweds, mothers of 1 child, and mothers of multiple children. To understand surely is to conform to the organization, concept, policy, planning, and measures of family planning. This means training basic level birth control cadres in population theory and methods of family planning. In addition, it means persuading the masses to be enthusiastic, diligent, fearless, understanding, and to show initiative toward family planning.     

Gender differences in knowledge and attitudes toward modern and traditional methods of child spacing in Malawi

This paper examines male-female differences in knowledge and attitudes towards traditional and modern methods of child spacing in Malawi, based on the survey on traditional methods of child spacing in Malawi which was conducted in 1988. The results show that most people in Malawi are knowledgeable about both traditional and modern methods of child spacing. In general more men than women report knowledge and practice of traditional methods. For modern methods, however, females are more knowledgeable than males of all the specific methods, with the exception of condoms. The greater knowledge by women of female-based modern contraceptives appears to be a manifestation of the exclusion of males from the family planning program. The high rates of knowledge do not translate into equivalent high rates of utilization for both modern and traditional methods of contraception. The study further demonstrates that, while women are involved in making decisions to use contraception, the proportion of men initiating such decisions is greater than that of women. This finding calls for family planning planners to think seriously about revising their target population to include men.     

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.     

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.     

A survey of the family planning work done in Dongguan County

The total fertility rate of women of childbearing age of Dongguan County in China has been decreasing gradually from 5.9 during the period following the liberation in 1949 to 2.05 in 1982. In order to encourage young couples to implement the policy of family planning consciously, the people's government of Dongguan county decided in July 1980 that all cadres and employees in county towns who received 1-child certificates would be exempted from house rent of 45 square meters from the time they get their certificates and would be allocated a living space of a 2-children family until their children reached age 16. It also stipulated that every couple could enjoy 1 month's holiday every year for 3 years and during the holiday, their salary, bonus and rate of attendance would not be affected. Because women bear less children today, they are relieved from heavy household chores and become the main working force in collective production. As a result, the development of town-run enterprises was stimulated and the total industrial output value of these enterprises increased. The average monthly salary of each female worker is about 100 yuan. In 1984, the average income per capita of the country rose to 649.2 yuan. The implementation of family planning work has eased the tension in the education field. Previously, because of the large number of school-age children in rural areas, teachers had to teach 2 classes. In the past 4 years, great emphasis was laid on intellectual investment. During this period, 2351 schools were built and several fundraising projects were implemented. Since 1981, more than 200 new running water projects were built, and new public services have been developed, including old age homes.     

Family sizes of children and family sizes of women

This paper demonstrates the relation that obtains between the average family size of women and the average family size of offspring of those women. It estimates the value of these two measures for cohorts of American women aged 45–49 in various years from 1890 to 1970. It shows that children born during the post-war baby boom actually derived from smaller families than those born during the low-fertility 1930’s; that under current patterns a woman would have to bear an average of almost two children fewer than were borne by her mother merely to keep population fertility rates constant from generation to generation; and that average family size for nonwhite children exceeds that for white by 50 percent, although the racial difference in family sizes of women is only 19 percent.     

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.     

Secrecy and silence: why women hide contraceptive use

A recent Population Council survey of 1860 married women and 1056 of their husbands in urban Zambia found that many women who use contraception do so without their husbands' knowledge and that those women who hid their practice of contraception from their husbands did so because they found it very difficult to bring up the subject of family planning with them. These findings indicate that low levels of contraceptive use are not the result of a simple communication matter. Sex and sexuality are often the exclusive domain of African husbands. As such, if a wife initiates a discussion of family planning, she may threaten her husband's sense of control and create discord within the family. The culture of silence about sex and sexuality is very strong in Africa. 57% of women stated that were they to propose contraceptive use with their husbands and the husband opposed such practice, they would nonetheless use them without his knowledge. 7% of the women stated that if their husbands disapproved of contraceptive use, they would nonetheless openly use a method against his wishes. The majority of women correctly perceived their husbands' views on family planning use and fertility preferences. In focus groups, both men and women said that they did not believe that women have the right to independently act upon their reproductive preferences. A husband's inadequate financial support of his children could, however, justify clandestine contraceptive use. These findings point to the need to include easily hidden methods in the mix of contraceptives family planning programs offer. Moreover, service providers should not automatically encourage husbands' involvement. A client's right to privacy should always be respected.     

Interpersonal communication and the diffusion of family planning in West Malaysia

Using data from a 1966–1967 probability sample of West Malaysian married women 15–44 years of age, this paper analyzes the characteristics of women who were active in diffusing information about family planning. The woman’s age and her parity, her educational attainment, her race, her present residence (urban-rural), and whether or not she wanted more children were significantly related to opinion leadership in bivariate tables. However, these relationships appeared to be substantial mainly because these social and demographic characteristics were highly related to whether the woman participated in discussions about family planning with other women. Among women who did participate in such discussions, the social and demographic variables were not substantially related to opinion leadership. In fact, the critical variables for opinion leadership appeared to be participation in the discussions, greater knowledge of family planning, and a higher level of family planning use. An attempt is also made to assess the effect of interpersonal communication on the adoption of family planning among women in the sample.     

RESEARCH NOTE Some evidence against the assumption that approval of family planning is associated with frequency of spouses' discussion of the subject

Much previous work on the relationship between respondent's reported frequency of discussion with spouse about family planning and correctness of reporting spouse's approval of family planning has led to the conclusion that discussion promotes approval. In this paper, data from the 1998 Kenya Demographic and Health Surveys are used to show that a focus on the relationship between frequency of discussion and correctness of reporting partner's disapproval of family planning leads to sceptical conclusions about the effects of discussion in improving knowledge of partner's attitude or in promoting approval.     

The prediction of completed fertility

There has been considerable interest in the relation between familysize desires and completed fertility. Longitudinal data from the Princeton Fertility Study provide a unique opportunity to compare the number of children desired after the birth of a second child to the size of completed families. The average number of children desired by women after the birth of their second child predicts very well the average size of their completed families. The average family size desired at the first interview and average estimated completed family size some eight years later are identical for the total sample, and vary hardly at all within religious or education subgroups. One-third of the variance in the completed fertility of couples is "explained" by wife's family-size desires and the proportion of explained variance increases to two-fifths when we include the husband's first interview desires and the interval between marriage and second birth. Yet in spite of the relatively high correlation between desires and achievement, only 41 percent of these women achieved exactly the number of children they desired at the first interview, while 14 percent had two children more or fewer than originally desired. Nevertheless, data on contraceptive efficiency indicate that desires after the birth of the second child constitute meaningful goals in terms of which the respondents regulate their subsequent behavior-efficacy of contraceptive practice shows substantial improvement after the desired number has been achieved.     

Publicity and education on family planning information in Keshan County

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

Attitudes toward family size in some East European countries

Summary The paper is a review of published materials on attitudes toward family size derived from nationwide family planning studies conducted in Czechoslovakia, Hungary, Poland and the USSR around 1970. Priority is given to the findings on expected family size, though other attitudinal variables such as the ideal number of children and/or the number planned at marriage are also discussed. The paper shows that the majority of women in all the countries surveyed tend to have a limited number of children. Although the trend is especially striking among better-educated and gainfully employed women, it is also spreading fast, particularly among the younger generations, through the whole urban and rural population. The average expected family size is generally close to, and for a sizeable group of women below, replacement level. The trend toward a small family size is only partially a reflection of real desires. Various factors, most of them apparently of an economic nature, prompt many women to have fewer children than they would wish. If the average expected fertility were equal to that considered as ideal or to that planned at marriage there would be no danger that births would fall below replacement level. In contrast to the situation in the countries as a whole, women in the Asian Republics of the USSR not only expect but also tend to regard as ideal a family with larger numbers of children.     

A Family planning survey in four Delhi villages

A family planning attitude survey was conducted in four villages near metropolitan Delhi. Information was obtained through questionnaires from 455 currently married females of reproductive age: Of the women interviewed, 50 per cent were aware of family planning, 19 per cent had knowledge of a method and only 3 per cent used birth control methods. The method most commonly practised was prolonged lactation. Of the women interviewed, 253 were willing to learn about family planning; they said there was little opposition from their family members. These women thought that a family should have four children, and spacing between them should be roughly four years.     

A preliminary analysis of the high birth rate in India]

The author first provides some basic demographic data for India and points out that the current annual rate of population growth of 2.45 percent is slightly higher than the annual increase in food production. Problems in the areas of employment, education, housing, and transportation, as well as the general problem of poverty, are seen as a consequence of this imbalance. The lack of success of the national family planning program is attributed primarily to the failure to achieve a satisfactory rate of economic growth. Contributory factors include early marriage, the low status of women, the desire for large families, and administrative problems associated with the family planning program.