An economic evaluation of recent changes in Singapore's family planning program

Recently the Singapore government has stopped promoting family planning as a general policy applicable to all sections of society. A more selective policy has emerged, in which some groups are still urged to adopt family planning, while others are encouraged to have larger families. Using project evaluation techniques, part of the rationale behind this change is explored in this paper. The question of whether a general family planning program is no longer viable in view of recent developments in the Singapore economy is considered. The results support the movement away from a general policy on the assumption that the economy will continue to grow at the average rate observed since the early 1970s. However, a general policy would still be viable if the negative real growth of 1985/6 were to continue.     

Towards an integrated model of family therapy

One of the most important tasks for the contemporary family therapist is to be able to use efficiently and effectively the knowledge base already established in the field. This entails having a familiarity with the literature and also having a systematic model which organizes the material. This paper presents a model integrating six major family theories.This article is based in part on a panel presentation at the 37th Annual AAMFT Conference: Integrative Family Psychotherapy: Possibilities, Problems and Potential Models, Washington, D.C., October, 1979.     

Toward an assessment of the social role of rural midwives and its implication for the family planning program: an Iranian case study

An axiom of family planning programming is the importance of culturally-appropriate communicators and motivators. Traditional midwives seem ideal for this task but few studies have been done to verify this assumption by analyzing the midwife's social role as perceived by the community. 325 married women and 81 unmarried girls from a "model village" near Shiraz were interviewed by female undergraduates. 82.5% of the women are of childbearing age; 66% married before 14 years; 33% use contraception, mostly the pill, but most want large families because they expect high child mortality rates. Most of the older women are able to assist in childbirth but none, except the village's one recognized midwife, who is considered to have divine backing, will do so except in an emergency. The midwife's activities cause her to be held in low esteem by the community because 1) she has contact with a woman's sexual parts and this fact is public; 2) she has contact with vaginal excretia which are, in Islam, polluting; and 3) she is paid for her services, which labels her as a woman "without shame". The midwife is, however, widely used since women and their husbands fear the trip to the hospital and treatment by a male doctor much more than a midwife-supervised birth. The midwife in the study village had been there only 2 years and feels that she is not fully trusted. She is not consulted on birth control at all, because women expect the pill to be dispensed by doctors and consider other methods as a matter strictly between husband and wife. The midwife's role seems to complement that of the government health authorities rather than compete. The midwife's low status and circumscribed sphere of activity, the weak respect in which her advice is held and the pattern of having only 1 recognized midwife in a village at a time make the midwife a poor agent for family planning services. Her effectiveness as an agent of social change could be improved by training her in hygienic practices of childbirth and by redefining her role-relationship with the community. Studies should be done to identify the areas where traditional birth attendants are the best family planning communicators and those where that role is best left to others.     

The role of the clinician in natural family planning

Despite skepticism on the part of the health care delivery system, increasing numbers of women and couples are relying on natural family planning methods to avoid or achieve pregnancy. Most clients require 2-4 cycles to become familiar with the delineation of the fertile phase. Both the ovulation and the sympto-thermal methods are considered to have a method effectiveness of at least 98%. Teaching-related unplanned pregnancies fall below 5%. Use of the Billings ovulation method requires the couple to abstain from intercourse from the beginning of mucus until the 4th day after peak. The sympto-thermal method is preferred by those desiring a multiple-index approach. 75-80% of users of this method can detect cervical softening and dilatation, and 50% are aware of the change of position of the cervix. Knowledge of mucus buildup patterns can be expecially important for adolescents, lactating women, and premenopausal women in helping them to determine whether cycles are ovulatory. Instruction in interpretation of the mucus cycle is further advised in cases of infertility. Unwillingness of the partners to practice it constitutes the only contraindication to natural family planning. However, couples are advised to wait for the postovulatory infertile phase of the cycle to have intercourse in cases where prgnancy would pose a serious threat to the life of the mother or fetus. Although some groups recommend the use of a barrier method rather than abstinence during fertile periods, this practice makes mucus recognition more difficult and impedes confidence in the method. Attainment of couple autonomy in natural family planning involves 2 phases: 1) correct recognition of the signs of fertility and 2) comfort with periodic asbsinence. Successful autonomy is reflected in the high continuation rates found in programs that offer adequate counseling support.     

Determinants of marital fertility in Pakistan: the impact of education,work and family planning

The relative impact of the indirect and direct determinants of fertility of Pakistani women was assessed using the 1990/91 Pakistan Demographic and Health Survey (PDHS). A total of 7926 households was selected and 5713 women of reproductive age (15-49 years old) who had at least one birth were interviewed. Several social, economic, and demographic variables were employed to assess the number of children ever born. Ordinary least squares regression was used to estimate four multivariate models of children ever born. The direct and indirect determinants and the control variable of current age were simultaneously entered for each of four models that differed by age: 15-49, 15-24, 25-34, and 35-49 years. There was a 0.5 child difference between children ever born (4.64) and living children (4.11) for the 15-49 age group. This indicates infant and child mortality: 26% of the women experienced at least one child death before the age of 2 years. The oldest group had the lowest percentage ever attending school: 19% vs. 25% and 26% (15-24 and 25-34 age groups, respectively). Education was nonsignificant for the youngest and middle-aged cohorts, but it was negative and significant for the older cohorts. For employment, only the 25-34 age group was negative and significant. Age at marriage and breast feeding were strong and negative for all models. Current use of family planning was positive and significant for the oldest age group and the total. The younger cohorts did not have a negative and significant relationship between education and fertility; and the 15-24 age group living in a major city had significantly higher fertility than their town and village counterparts. The variables that showed differential impact were education, employment, residence, and contraceptive use. Education did not significantly lower fertility for the younger groups, but it did for the older group. Employment significantly lowered fertility for the 25-34 age group. Contraceptive prevalence steadily increased from 7% in the 15-19 age group to nearly 21% in the 35-39 age group.     

Putting the pieces together for queer youth: a model of integrated assessment of need and program planning

Needs assessments require staff with the necessary expertise to design the study, collect the data, analyze the data, and present results. They require money, time, and persistence, because the people one wishes to assess often are difficult to access. This article argues for the centrality of a well-done needs assessment when developing services for LGBTQ youth. Needs assessment methodology and adjunctive uses of the needs assessment data also are discussed. The authors present a needs assessment of LGBTQ youth living in out-of-home care in San Diego, California, as an example of the purpose, practicality, and power of a comprehensive needs assessment. The needs assessment identified several issues, as well as additional data supporting the project's necessity. The data also identified the most significant obstacles youth face in accessing housing and supportive services. Through the data collection process, non-LGBT housing providers better understood their need for additional training, and housing and city leadership communities obtained and spread knowledge of the project.     

The impact of the family on home-based work

This article reports on a study of 899 families with at least one member engaged in home-based work. Six work characteristics are examined in relation to family structure and gender of the home-based worker: business ownership, occupation of the home-based work, amount of income generated, location of the work space, number of hours worked, and availability of help with the work. Women in single-parent and full-nest families are found to do the most restructuring of work time and space and women home-based workers generate less income from the work than do men. Male home-based workers experience less conflict between family and work scheduling, are more likely to have an exclusive work space, and tend to have help with the home-based work.This article reports results from the Cooperative Regional Research Project, NE-167, entitled, At-Home Income Generation: Impact on Management, Productivity and Stability in Rural and Urban Families, partially supported by Cooperative States Research Service, U.S. Department of Agriculture and the Experiment Stations at the University of Hawaii, Iowa State University, Lincoln University (Missouri), Michigan State University, Cornell University (New York), The Ohio State University, The Pennsylvania State University, Utah State University and University of Vermont.Her research interests include divorce, work and family, and the economic well-being of women and children. She received her Ph.D. from Oregon State University.He has extensive experience in research, consulting, and training for small business owners and operators, including single parents, disabled veterans, Hispanics, rural and home-based. He received his Ph.D. from New York University.     

Women's status and family planning in Haiti

"The paper argues that women's status in Haiti is a factor favorable to the spread of modern contraception and a potential rapid demographic transition from high to low fertility. After briefly reviewing recent theories on the determining of fertility declines, the paper considers women's status in Haiti. It discusses family patterns, conjugal unions, and economic activities. Finally, it reviews current patterns of contraceptive use and considers how these are related to various aspects of women's status."     

Understanding innovation in health program planning and development

IntroductionA need for innovative public health programs is evident as the field adapts to address changes in health priorities and target populations. The Innovative Teen Pregnancy Prevention Program (iTP₃) was created to support and enable innovation in teenage pregnancy prevention, developing programs to reach the most at risk youth.MethodsA formative evaluation was conducted to understand what innovation means in the context of program development, and examine the process of innovation. Qualitative data was collected through baseline interviews with program development teams, referred to as Innovators, prior to the start of the project period and follow-up interviews conducted at the end of a 12-month funding period. Additional open-ended written responses were collected in the middle of the funding cycle. A thematic analysis with an open-coding scheme was used to identify emergent themes.ResultsInnovators considered programs innovative because of the target population of focus, program delivery mechanism, and/or program development approach. They specifically identified that a “culture” of innovation must be present if new programs are to be developed. Over time, Innovators began to shift their definition of innovation toward unique design processes and ecological approaches.DiscussionThrough creating a culture of innovation and utilizing systems thinking, this project provides important insights in how to develop innovations in public health.     

Social area analysis in program evaluation and planning

This article defines social area analysis and identifies its conceptual roots and principal applications. By reviewing the uses of demographic data among several disciplines, the utility of social area analysis is assessed. The authors cite and briefly review the seminal and most recent contributions to the field. Several types of ecological fallacies and other problematic facets of social area analysis are considered, as well as specific issues in the derivation of statistical inferences from cross-level and same-level areal and case data.     

The impact of general accounting office program evaluations on government

General Accounting Office (GAO) audit reports have an impact on government operations by encouraging growth in the size and scope of the state and by encouraging the Congress and executive agencies to attend to the auditor's dominant values of economy, efficiency, and effectiveness in government. Through its financial, management, and program audits, the GAO program evaluators seek to rationalize agency management and programs so that more resources are required. The GAO's program evaluation efforts also serve Congress by providing for oversight of public policy, a bludgeon to coax agencies into pursuing activities preferred by congressmen, and a tool for electoral activities. In the end, the evaluation auditors are doomed to frustration in achieving their ideals for effective democratic government. This is so because “practical business policy” is irrelevant to government operations and inconsistent with the core values of a democratic state.     

The results framework--an innovative tool for program planning and evaluation.

This article constitutes a case study of the development and implementation of the "results framework," an innovative planning and evaluation tool that is rapidly becoming a standard requirement for United States Agency for International Development (USAID) projects. The framework is used in a USAID-funded regional initiative for HIV/AIDS prevention in Central America. This new program evaluation and monitoring tool provides many advantages over traditional evaluation approaches that use outside consultants to provide midterm and end-of-project evaluations. The results-framework process, which spans the life of the project, provides an opportunity for program staff, donors, partners, and evaluators to work as a team to collect and use rich, longitudinal data for project planning, implementation, and evaluation purposes.     

The impact of family assets and debt on college graduation

This study examines the influence of family financial assets and debt, both measured during the time of youth's college enrollment, on the chances of college graduation. Data come from the National Longitudinal Survey of Youth. Results from analyses controlling for a number of student, parental, and institutional characteristics indicate that family assets are positively related to the chances of college graduation among White and Black students; family debt is negatively associated with the odds of college graduation among Black students, but neither family assets nor family debt is related to the chances of college graduation among Hispanic students. Overall, results indicate that family assets and debt explain a small portion of racial/ethnic gaps in college graduation. Policy implications are considered.