A broadcast on family planning in Hefeng County]

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

Applying information to improve family planning in Gaoping County]

The scientific management method of improving family planning through information has produced a low birth rate and natural increase rate in Gaoping County, China, since 1976. In order to promote good family planning, Gaoping County incorporated the scientific management method with the establishment of an information network that included information banks, files, and newspaper columns. The officials of Gaoping County focused their efforts on women most susceptible to unplanned childbirth, e.g., women uneducated in birth control and prenatal care. The women were divided into groups according to their educational needs, e.g., women who were hesitant toward birth control, women who used birth control, women who never reproduced, and women who were newly married. By educating these women to the aspects of planned childbirth, prenatal testing, prenatal care, and contraceptives, Gaoping County effectively promoted good family planning in the areas of birth control and family health. The following statistics are the results of incorporating the scientific management system in family planning of Gaoping County. In 1983, the birth rate in Gaoping County was 11.3%, a 2.8% decline from 1982; the mortality rate decreased 0.2% to a rate of 7.6%; and the natural increase rate decreased 2.6% to a rate of 3.7%. The planned birth rate in 1983 was 90.1% and the rate of 1 child per couple was 91%. This was an increase from the 1982 rates of 21.3% and 25.2%, respectively. From January 1984 to June 1984 the planned birth rate reached 97.2%. These statistics are evidence of the positive results in using information in family planning.     

Correctly understand and use the measures of progress of the family planning program]

It is necessary to understand correctly the measures of progress in the accomplishments of family planning work. From a developmental and historical perspective the primary measures are constantly in flux. In the last decade, the criteria used to assess the progress have ranged from the natural rate of growth to the birth rate, to multiple-child rate, and to the planned family rate, all of which reflect different emphasis in the various stages of family planning work. They also show a tendency toward making planning work more scientific. None of the criteria is flawless, however. For instance, the planned family rate can be influenced by the total number of births. When that number increases, it can cause the planned family rate to decrease; or, when the number of births decreases, the planned family rate can increase. The measures used for assessing the accomplishments of family planning work only reflect individual aspects of the work; it can never reflect the totality of family planning work because the scope is so vast, encompassing virtually all levels and organizations of society.     

Survey and analysis of family planning work at Xindian Brigade]

Through personal interviews, it was found that the success of family planning at Xindan Brigade can be attributed in part to the Brigade party's contribution to family planning education, with the party members acting as family planning models. Moreover, economic objectives are used to secure the results desired. Devoted members are recruited to promote family planning, while economic rewards and restrictions reinforce planning goals. Family planning work in the village of Sung Chuang was reasserted in late 1983 with party leaders acting as family planning models. The results were significant and in 1984, 18 out of 24 brigades fulfilled projected goals by 100% with the average for the entire Sung Chung village being 98.5%. A single-child family rate was obtained in 12 brigades with the average rate in the village for single-child families being 95.9% overall. It is thought that the role of agricultural production must be correctly analyzed and family planning modified to adjust to the "new" type of farming village. Furthermore, a long-lasting contradiction must be forseen between the viewpoints of these 2 sectors of society (i.e., agricultural and political). The policy of the party will be to implement the program and to correctly handle any objections or problems that may arise. Finally, collective management methods must be adopted by the authorities in order to effectively control population growth, especially that seen in the farming village.     

Comparison and fairness in family planning]

There are two kinds of comparison in family planning (FP) practice. First, people compare the number of children they have with their desired family size. Second, people compare their number of children with other's. The extent of their satisfaction from the comparison often depends on their expectation. And people's expectation about their family size may have an impact on the level of fertility. One task in a FP program is to regulate people's objects for comparison and to reduce the number of children they expect to have. But, changes in people's desired number of children are largely dependent upon the socio economic charges which can not be achieved in short time. Therefore, it would be more advisable to direct people to compare their fertility behavior with those of couples who have only one child, rather than those who have 3 or 4. Satisfaction with family size also comes from a feeling of fairness. People not only look at what they get, but also at what others get. Fairness and justice in FP program implementation is important. If those who violate local birth control policies and regulations are not properly punished, other people would feel that the situation is unfair and they would regret that they did not do the same. The pressure brought by over-population to socio-economic development has been gradually felt by most people. But, it is still difficult to have them strictly observe the present fertility regulation policy. If restrictions of various kinds are enforced and education and publicity are used, people will feel that they are being treated fairly. This will facilitate the promotion of the FP program.     

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.     

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.     

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.     

The achievements in family planning work in Rudong County as suggested by the data of the Fertility Survey]

A 15% random sampling from Rudong County was recently taken to survey fertility rates. 1153 primary units were chosen, which included 160,832 people. Among this group were 57,050 women aged 15-67 years. Topics surveyed included: marriage, birth, contraception, and population structure. Rudong County, among the earliest counties in China to begin the work of birth control, started in the 1960s with birth control education. The natural rate of population increase by the early 1970s had already fallen. From 1974 to 1982 the average rate of natural population growth was 3.8/1000. Reproduction has gone from a rising trend to a stabilized trend. The base of the population structure pyramid has shrunk; the number of youths aged from birth to 14 years has fallen from 35.05% in 1964 to 21.77% in 1982. The number of people who must be supported (the old and the young) has decreased, lessening society's responsibility for them. 29.45% of the total population are over 65 years or under 14. Society's coefficient factor of support has fallen from 66.31% in 1964 to 41.75%. There is a decrease in the number of people marrying at a young age; the trend is toward marriage at a later age. The average age at marriage had risen from 23.81 years in 1980 to 23.89 years in 1981. The fertility rate has decreased, as has the number of offspring per woman. 1 child family is on the rise and multiple children family is on the decline. In 1981 the 1 child rate reached 92.98%, the 2 children rate was 6.63% and the multiple children rate was 0.49%. Prior to 1979 the 1 child rate was under 10%. The fertility rate fell from 136/1000 in the 1960s to 41.5/1000 in 1981.     

Family planning and economic development in Shifang County]

According to Marx, population either hinders or expedites economic development. During the late 1950s and early 1960s, Shifang County's population grew unchecked. In the 1960s its annual rate of population growth was higher than the national average. Because the growth of material goods was insufficient in supporting the increase in population, the national economy suffered. In 1977, of those Shifang families in debt to the production brigade, over 80% were multiple children families. Some of these families owed over 1300 yuan after 10 years. Obviously such families cannot be counted on to expand the economy or to increase family incomes. Between 1971 and 1981 when Shifang County began family planning, the average annual rate of growth was lower than the national average. At the same time, material production gradually matched population reproduction, expediting economic development. If, with the current age structure (32.19% are aged 0-15 years; 4.95% are over 65 years; average age is 28.41 years), each family has only 1 child, then the rate of natural growth from 1981-2000 will be 3.6% annually. A yearly decrease in population would enable the County to build up pension funds, save on food, maintain the current standard for acreage allotment and expand accumulated capital.     

Assessing the impact of a family planning nurse training program in Egypt

In 1991 the Egyptian Ministry of Health introduced a new training program for family planning nurses. The training program stressed the development of nurses' counseling skills. As part of the Operations Research Program, sponsored by Family Health International in collaboration with the Egypt National Family Planning Board, managerial staff from family planning agencies designed and implemented a study to evaluate the impact of the new training program. The study objective was to assess the impact of nurse training on nurse performance in the clinic and on clients' family planning knowledge, attitudes and contraceptive use. The study was designed to provide usable information to family planning managers in the field within a time period of less than one year. The study results indicate that there is an association between improved family planning training for nurses and positive changes in family planning knowledge, attitudes and behavior among women attending MoH clinics in this study. The greatest relative change occurred in knowledge. Women in the experimental group, relative to the control group, displayed increased knowledge about contraceptives, particularly the pill and the IUD. Attitudinal change was less pronounced. Favorable attitudes toward oral contraceptives and condoms became more prevalent, and reports of husband-wife communication about family planning also increased. Finally, although contraceptive use was already high prior to the nurse training, IUD use increased significantly among women in one governorate.     

Interaction and family planning in the french urban family

During the last two years, a survey about interaction in the couple has been conducted among 550 urban families in France by the National Center for Scientific Research, with the assistance of the United States Public Health Service. The data given here are relative to the importance of the couple's interaction in the realization of family planning goals.These data are used to answer the question, are socioeconomic variables (husband's level of education, occupation, and income, for example) more closely correlated with the success of the couple's family planning than are the variables of positive interaction (agreement, communication, and equality in decision-making, for example)?While the Indianapolis study has not answered this question, the Puerto Rican study has shown that freedom of the wife and communication between spouses were more closely connected with the success of family planning than were the husband's level of education or income. But, one might think that this result was linked to the Puerto Rican sample, in which the levels of income and education were generally low.The French survey, undertaken with a random sample stratified according to the socioeconomic level of the husband, shows that this last hypothesis is not true. Just as in the Puerto Rican study, the factors of positive interaction in the couple are more closely associated with the success of family planning-particularly with the eradication of excessive fertility-than with socioeconomic variables. These results show the importance of the couple's education as a determining factor in a successful family planning program.     

The roles of individuals' socioeconomic characteristics and the government family planning program in China's fertility decline

This paper explores answers to the following two questions: first, did individuals' socioeconomic characteristics play any role in the rapid fertility decline that occurred in China during the 1970's? Secondly, if the rapid fertility decline during the 1970s is mostly a result of the government policy, as many have perceived, to what extent was the government policy effective? Using the 1982 Chinese 1/1000 fertility survey data for Hebei province of China, this paper examines variation in fertility among women of two age cohorts by linking their fertility outcome with their socioeconomic background and earlier reproductive experiences. In addition, this paper assesses the effect of government policy by comparing the determinants of fertility outcome between two cohorts of women and by studying the factors affecting their current contraceptive use. The findings reveal that the individual's socioeconomic background was important in explaining earlier fertility variation. Government policy, although powerful enough to override most of the effect of socioeconomic factors on fertility, was not able to eliminate differences in contraceptive behavior among Chinese women.     

Measuring acceptances in a family planning program: the decomposition of rates by eligibility criteria

Acceptance rates in family planning programs can be broken into components useful in analyzing programs and in evaluating success. In almost any program some couples can be defined as "ineligible" on the basis of alternative criteria. (Sterilized couples are an obvious example.) Then, the total acceptance rate can be initially separated into two components-the proportion eligible and the acceptance rate among the eligible. If some of those initially defined as ineligible become acceptors, there is a third component-the ratio of all acceptances to acceptances among the eligible only. These various components can be used to analyze the basis for varying acceptance rates between different strata of a population.     

Agricultural production responsibility system and the work of family planning in the rural area]

With the establishment of the agricultural production responsibility system, the entire agricultural management and economic system has undergone great changes, and family planning in rural areas has met with many difficulties. Because of this responsibility system, households with more manpower seem to become wealthy more rapidly than others. An existing belief among the rural population is that more children will provide a larger labor force and thus more income. Birth control and family planning are therefore becoming more difficult. In order to change existing beliefs, a comprehensive ideological education for peasants is needed so that they may understand the question of birth control from the viewpoints of national interests. Economic rewards and administrative restrictions may be used as necessary birth control measures. Agricultural production and family planning can be managed well if there is close contact and cooperation between the cadres and the masses. Extra care and benefits should be given to women of childbearing age who undergo birth control operations and agree to a single child in each household. Welfare programs for the masses, such as kindergartens and nursing homes must be established in order to reduce their worries. In addition, efforts are needed to study the new situation and solve new problems. The goal of controlling the rural population growth should be achiefed through practical work and experience.     

Using operations research to guide family planning program development and policy formulation in sub-Saharan Africa

The process by which a population policy and family planning program evolve in a given country is influenced by many factors that combine to make each country's experience unique. One of the most influential factors among these is the role played by external technical assistance, normally provided through donor-supported mechanisms. One donor-supported mechanism that seeks to guide the operational policy and program development process is technical assistance through operations research. Many questions are raised during the design of family planning programs that are often best answered with reference to empirical evidence collected through applied, or operations research (OR). This paper provides a review of the three main OR approaches currently being used in sub-Saharan Africa: diagnostic or needs assessment studies; experimental pilot studies; and intensive technical assistance for problem-solving and institutional development. The extent to which these OR approaches can play a role in family planning program development to improve and expand service delivery activities is discussed, and examples where these approaches have been used are given.     

A research on the assurance of family planning and providing for the aged]

An important cause of resistance to China's family planning (FP) program in rural areas is the need to have children to support parents in their old age. Provision of insurance for old age support will facilitate the implementation of the FP program among the rural population. A trial project was initiated in five cities and counties in Fujian province i 1986. The program included schemes for both eligible couples and for single children. The township or the village pays a lump sum or monthly premium to the insurance company for each couple, which enables them to collect 30-35 Yuan/month after they reach 55 years of age. To further expand the insurance program, a survey was conducted in 1987 to determine whether rural farmers would be willing and able to pay the insurance premium themselves. 77% of the respondents reported that they could afford to pay 60% of the premium. Among them, 59% were willing to pay. It was suggested that besides individual purchase of the insurance plan, the rural communities could contribute to the payment of the premium from the fines for unplanned births, from the local tax, and from the country government budget. Preferential treatment should be given to the couples of two daughters who receives sterilization; the communities should pay for a larger share of their premium. The current insurance scheme needs to be reformed so that the plan can offer more than the individual's bank savings. To do so, the insurance company needs to be able to invest their premium income and obtain higher returns. The employees of the insurance company need to improve their work efficiency to win the trust of the people in the program.     

The differential effects and considerations of family planning programs in basic units]

It has been discovered that the grassroots units that did not well in family planning (FP) programs in China were short of funding, while those units that performed poorly had more funds at their disposal. One of the reasons is that communities which did a good job in FP have less violations of the birth policy, and therefore, fewer fines could be collected by the FP unit. But in those grassroots units were the FP policy was not well implemented, there were more cases of births exceeding the birth quota, and more fines could be collected. Such an outcome was penalizing the diligent and rewarding those who did not work hard. This phenomenon was caused by a severe short fall of funding for the FP program. The program budget allocated by the local government was only 1/5 of what was needed, the remaining part was to be provided by fines. The negative consequences of such a practice was damaging to the morale of FP workers. The following suggestions were make for solving the problem. First, the government budget allocation to the FP program should be increased, and part of the budget allocation should be determined by the performance of the FP program. Second, the spending of income from FP fines should be closely monitored to prevent misuse of the fund. Third, fine collection should not be used as means of income generation for the program, and not other agencies should reallocate the funds from fines. Fourth, the government and FP agencies at all administrative levels should pay attention to the management of funds from fines. FP organizations at higher levels should be able to reallocate the funds from fines collected by units with a poor performance to the units with good program performance as an incentive and to supplement their income.