Communique of the State Family Planning Commission on a nationwide fertility sampling survey of every person per thousand

In 1982, the Chinese State Family Planning Commission conducted a nationwide fertility survey of 1 person/1000 in 28 provinces, municipalities, and autonomous regions. 815 sample units were selected and 310,462 women aged 15-67 were interviewed, 99.9% of those identified. 252,094 (24.77%) were of childbearing age (15-49) with 24.76% 15-19 years old. Among women of fertile age, 31.46% were unmarried, 64.53% were married to their 1st husbands, 2.89% were remarried, .19% were divorced, and .94% were widowed. Average age of 1st marriage increased from 18.4 in the 1940s to 22.8 in 1981. Total fertility rate dropped from 5.44 in the 1940s to 2.63 in 1981. In 1981, the birth rate was 85/1000 women of fertile age. Fertility was much higher among minority nationalities. 118 million of China's 170 million married couples of reproductive age (69.46%) use birth control at present; 50.2% use the IUD, 25.4% tubal ligation, 10.0% vasectomy, 8.2% oral contraceptives, and 2.0% condoms. About 21 million married women should have begun using contraception but have not. 14 million or 42.3% of 33 million 1 child couples have pledged to have only 1 child. If the fertility level of 1981 is maintained and the average woman continues to have 2.63 children, 2.91 in rural areas, China's population will reach 1.2 billion by 1993 and will exceed 1.3 billion by 2000. The Central Committee has a target population of 1.2 billion by 2000.     

Birth control techniques in China

This article describes the major birth control techniques in use in China, based on data from a contraceptive prevalence study conducted in September, 1982. 118 million of the 170 million married women of child bearing age use birth control. IUD insertion accounts for 50.2% of birth control methods used, tubal ligation accounts for 25.4%, vas deferens ligation 10.0% oral contraceptives (OCs) 8.2%, and condoms 2.0%. A table of clinical data on 9 China made IUDs reveals that pregnancy rates range from 0 (V Cu-300 model) to 5.83% (mixed ring model). A method of IUD insertion immediately after delivery has been researched and adopted, using a silastic Delta IUD with barium added to reduce the high postpartum expulsion rate. fixing the IUD by sutures during Cesarean section has also been developed. Electronmicroscopic studies of the endometrium of women who have used a stainless steel IUD for more than 20 years showes no tendency towards malignancy, nor negative effects on the endocrine functions of the ovaries. 28 million Chinese women have accepted sterilization as of June, 1982. Local anesthesia and the use of acupuncture have reduced complications due to general anesthesia seen previously. Sterilization by means of chemically induced adhesion of Fallopian tube tissue has also been performed successfully; however, this method makes later anastomosis difficult, and is not suitable for young women with only 1 child. Fallopian tube occlusion by means of a silver clip has been performed in 1,128 cases, with a pregnancy rate of only .85%. 10.62 million men have accepted sterilization. While most of the procedures are val ligations, 300,000 men have been sterilized by direct injection of an adhesive agent throuh the skin of the scrotum. No increase in auto immune or vascular disease has been found. 3 low-dose OCs, used since 1969, have proven to be reliable and freer of side effects than higher-dose compounds. In addition, longterm OCs containing quinestrol have been used since 1969 with a success rate of 98.3% women-year. These pills are taken 1x monthly. R and D priority will be given be given to monthly injectable contraceptives; megestrol and norethindrone are the compounds most preferable. In trials so far, the effective rate has been 99.9% with mild side effects. Gossypol, a male contraceptive, has shown an antifertility effect in 99% of 8000 cases studied; however, hypokalemia and irreversibility of spermatogenesis were reported in some cases. Vacuum suction is the most common method for abortion, but Radix Trichosanthis and lilac daphne terpine, traditional abortifacients, anre acceptable for 1st trimester abortions. Prostaglandins are also used.     

Understanding U.S. fertility: findings from the National Survey of Family Growth,Cycle III

The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.     

Female sterilizing operations in New South Wales: A demographic perspective

This paper examines trends in female sterilizing operations from a demographic perspective. These operations have declined in New South Wales since 1981, with a substantial drop in tubal ligation and hysterectomy, particularly among younger women. The decline in sterilization of women of childbearing age has been due to postponement of births. Younger women have avoided terminal methods of birth control and continued to use methods, such as oral contraceptives and back-up abortion, which allow for a pregnancy at a later age. Sterilizing operations still remain the most commonly reported means of birth control by women over age 35.     

The trends of contraceptives of people in Shanghai since early 1980s

Shanghai has had the lowest fertility rate in China for many years. Shanghai had a negative rate of natural growth during 1990-95. During 1980-93, fertility dropped continuously. In 1982, contraceptive use among married women included 29.47% using IUDs, 29.33% using oral pills, 23.44% using female sterilization, and 10.48% using condoms. Contraceptive prevalence declined slightly from 98.6% in 1982 to 92.29% in 1993. By 1993, method use changed. Oral pill and female sterilization use declined to 8.04% and 7.22%, respectively, among married women of reproductive age. IUD use increased dramatically to 72.2% in 1993. Condom use declined to 8.83% of total users. Despite reduced contraceptive prevalence, the birth rate declined from 18.51/1000 population in 1982 to 6.50/1000 population in 1993. The proportion of women accepting the one-child certificate increased from 53.32% of all married women of reproductive age in 1984 to 70.13% in 1993. The shift use of contraceptive methods means reliance on long-term reversible methods.     

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.     

Contraceptive use in China

A national sampling survey carried out in China in 1988 showed that 90.71% of the population were using some form of contraception: male sterilization (10.99%); female sterilization (38.24%); and IUDs (41.48%). Compared with 1982, the figures gathered in 1988 showed an increase in male sterilization and female sterilization and a decrease in condoms, oral or injected contraceptives, IUDs and spermicides. A great difference was found between the contraceptive methods used by women in rural areas as compared to women in urban areas. In urban areas IUDs accounted for 58%, female sterilization for 15%, male sterilization for 1% and condoms for 13%. In the country, female sterilization accounted for 42%, IUDs for 39%, male sterilization 15%, condoms 1% and oral contraceptives for 4%. There was also a strong difference between women of certain ages; the use of IUDs was highest among women between the ages of 15-29 years, while female sterilization was more prevalent for women over the age of 30. There was also a considerable difference between the birth control taken by women with children and those without; the majority of women (31%) without children used condoms; the majority of children (78%) with 1 child used IUDs; the majority of women (65%) with 2 children were sterilized. The sample study shows that 91% of the women using contraception used long-acting contraception.     

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.     

Tonga: family planning survey

A survey was carried out in 1975 in Tonga to determine how many families are practicing family planning. Public health nurses visited every household except the Niuas and remote islands. 4253 women out of the total of 9307 married women aged 15-44 years were using a contraceptive (45.7%). The percentage of users ranged from 4.5% in Ha'afeva District to 63.6% in the district of Kolonga. 60% of the users practice effective methods such as the pill, Depo-Provera, IUD, or sterilization; 23% use the condom, and 17% rely on withdrawal, calendar ovulation, or rhythm.     

Can LARC Fulfill Its Potential to Reduce U.S. Women’s Unintended Pregnancy Risk? Examining Women’s Contraception and Childbearing in the Year Before Initiating LARC

Long-acting reversible contraceptives (LARCs) have received increased attention in recent decades for their potential to reduce the high level of unintended pregnancy. We know little about women’s contraceptive use and (unintended) childbearing prior to LARC initiation, even though it provides vital context to considering the extent to which increased LARC use could be expected to reduce the U.S. unintended pregnancy rate. Data from 849 women who initiated LARC in the 2–3 years prior to the 2006–2015 cycles of the National Survey of Family Growth were analyzed to describe U.S. women’s contraceptive use and (unintended) childbearing in the year before initiating LARC. Results show that more than half of women (55.4%) who initiated LARC did so within a year of giving birth, with 47.3% of these births resulting from an unintended pregnancy. Among women without a recent birth, 5.0% had last relied on sterilization, 54.7% had last used a moderately-effective method, 34.7% had last used a less-effective method, and 5.6% had not used contraception in the year prior to initiating LARC. These findings advance understanding of the extent to which increased LARC use could be expected to reduce the unintended pregnancy rate. Women initiating LARC after a recent birth are selective of those at high risk of unintended pregnancy. In contrast, the majority of LARC initiators without a recent birth last relied on a moderately-effective method or sterilization—a pattern that could reduce LARC’s impact on the unintended pregnancy rate.

     

Problems of abortion in Britain - Aberdeen, a case study

Summary This paper reports on nearly all pregnancies occurring in the City of Aberdeen in the years 1961-74 (births, and therapeutic and spontaneous abortions) and on male and female sterilization and the use of contraception. The collection of these data for a defined community was made possible through the coordinated and comprehensive maternity and contraceptive services. Several important innovations made during the years included the introduction of oral contraception and the inter-uterine device, laparoscopic sterilization and vasectomy. The Abortion Act 1969 came into force and at different times the Local Authority Family Planning Clinic made many changes including the removal of charges and of the need for referral. The pattern of outcome differs for legitimate and illegitimate pregnancies, which are considered separately. Over half of all first pregnancies now occur before marriage and their outcome in women in different occupational groups is discussed. Oral contraception is favoured for postponing or spacing pregnancies, but when it comes to limitation of family size, couples have increasingly requested sterilization. Nevertheless there has been a ten-fold increase in the proportion of pregnancies being terminated. Aberdeen's birth rate is now below replacement level but the real objective 'every pregnancy a wanted pregnancy' is far from being achieved in either married or unmarried women.     

Priority research projects on family planning technique during the "Seventh Five-Year Plan" period

Research activities focused on family planning techniques and perinatal care will be given priority during China's 7th 5-Year Plan period. In terms of birth control technology, an emphasis will be placed on improving the reversibility of tubal sterilization and vasectomy, reducing complications (e.g., expulsion) associated with IUD use, refining methods of early pregnancy termination, and development of more long-acting contraceptive methods. Also explored will be the safety and effectiveness of herbs traditionally used for fertility control in China. To facilitate the development of more perfect types of contraceptives, basic research on spermatogenesis, sperm transportation, and fertilization will be conducted continuously. Studies on quality control indicators, pharmacodynamic indicators, and toxicological markers will be emphasized. In the area of eugenics, an emphasis will be placed on the prevention of congenital abnormalities and the monitoring of birth defects. Screening methods for the early diagnosis of genetic diseases will also be explored. Finally, attention will be given to the detection of teratogenic factors in the environment and other preventive measures.     

Understanding calendar rhythm

Rhythm has been among the family planning methods endorsed since the start of the National Population Program in the Philippines, but it has not been given as much emphasis as the other methods such as oral contraception (OC), the IUD, and sterilization. For several years, no systematic effort was made to promote the effective use of rhythm. The 1978 Community Outreach Survey (COS) tried to determine the extent to which contraceptive methods were being used in the Outreach Project areas. The project covered 2,000 barangay service points (BSPs) with 1.76 million married couples of reproductive age (MCRA), representing 32% of the estimated total MCRA in the Philippines. The COS findings revealed that, of the total sexually active married women aged 15-49, 48% were using contraceptive methods. Of these, only 11.4% were using modern methods, 20% were using other program methods (rhythm, condom, and combination of rhythm and condom); and 16.7% were using nonprogram methods (withdrawal, abstinence, and others). When used in combination with other methods, rhythm had a monthly continuation rate of 96%; when used alone, 94%. The COS data showed that the rhythm method is practiced by a large number of Filipino couples. With the renewed interest in rhythm, it became imperative for the program to help rhythm acceptors use the method more effectively and thus reduce user failure. There continues to be need for data on the "product image" of rhythm. These include the emotions that come into play in the acceptance or rejection of rhythm, the perceived side effects as well as advantages of the method, the ways women communicate their "safe" and "unsafe" days to their husbands, the manner in which couples prevent sexual contact during "unsafe" days, and the attitude of couples toward abstinence. Among important study findings were the following: couples choose rhythm because it does not disturb the sexual act, has no side effects, and poses no religious objections; 1 of the problems of rhythm users is that they get varied explanations and instructions from service delivery personnel on the correct way to practice rhythm; and many rural women do not have a clear understanding of the menstrual cycle. Requirements of successful rhythm practice include cooperation, regular cycle, and the couple's age.     

Adding choice to the contraceptive mix: lessons from Indonesia

Researchers asked 1945 women of reproductive age living in East Java, Indonesia what contraceptive method they preferred during the women's 1st visit to a government family planning clinic. Soon after field workers introduced them to a method, the researchers asked the women what method the field workers suggested and what method the women planned to use. They again spoke to them 1 year later to determine contraception continuation. The field workers granted 86.3% of the women their method choice. Only 9% of these women had stopped using their chosen method while 72% of the women who were not allowed to use their chosen method stopped using the method assigned to them. Thus choice was a key factor in sustained use of contraceptives. Further if family planning workers stick to a mutual participation of both themselves and their clients, they respect clients' method choices and, by informing clients about the chosen method, they strengthen clients' decision making. In the early 1990s, another researcher had developed a system to determine contraceptive needs at various stages of the reproductive period (before 1st marriage, after 1st marriage but prior to 1st birth, after 1st birth but prior to last birth, and after last birth). She applied observed contraceptive preferences for women using contraception within each life cycle stage to the age specific contraception need, derived from data from the 1987 Contraceptive Prevalence Survey for Indonesia, to determine the ideal contraceptive mix. Her calculations demonstrated that oral contraceptive use was high, IUD use was low, particularly among older women, and too few sterilizations had occurred, particularly among older women. Thus Indonesia needed to broaden the contraceptive mix to encourage methods that better meet women's reproductive life cycle needs.     

Low fertility and limited diffusion of modern contraception in Italy during the second half of the twentieth century

During the last two decades of the twentieth century, Italy, Greece, Spain, Portugal, and Japan were characterized by very low fertility levels and limited diffusion of the pill, IUD and sterilization for contraceptive purposes. This paradox is discussed for Italy by revisiting the history of contraception and reproduction during the second half of the twentieth century, and by using new data for the end of that century and the early twenty-first century. The main results are: (1) it has been possible to maintain low rates of planned and unplanned fertility without resorting to more effective contraceptive methods thanks to a careful use ofcoitus interruptus; (2) the pace of diffusion of the pill and IUD was so slow because of the opposition to contraception of the Catholic Church, a gender system emphasizing traditional male and female roles, and a medical culture that made physicians reluctant to prescribe the pill for their patients; and (3) the contraceptive patterns of Italian women born after 1960 are more similar to those of their Western counterparts, although new peculiarities appear, for example, substantial reliance on the condom by people living as couples as well as sexually active singles.     

宫内节育器使用效果的调查分析

对2659例已婚育龄妇女放置宫内节育器(IUD)后1年进行了调查,了解IUD的使用效果。结果显示,农村妇女IUD放置后1年使用率为84.2%,低于城市妇女(P<0.001);带器妊娠和IUD脱落是IUD停止使用的主要原因。应加强技术服务,提高IUD的续用率。     

Contraceptive sterilization in the U. S.: 1965 and 1970

There was an impressive increase between 1965 and 1970 in the prevalence of contraceptive sterilization, an increase that accelerated in the later years of the period and was shared in by virtually all subgroups considered. Among couples in 1970 for whom sterilization had been an option (recognizing that it is a terminal method), about one of every five had chosen this method of contraception. About half of all sterilizations were vasectomies, though vasectomies have outnumbered tubal ligations in recent years. Differentials in prevalence and in increases during 1965–1970 are reported for a number of life-cycle and social variables. In addition, a profile of the contraceptive sterile is presented for recent sterilizations. Significant proportions are relatively young and of low parity at the time of sterilization. In the context of the continued diffusion of the pill and IUD and increases in legal abortion, the net demographic effect of increasing sterilization is regarded as low, though sterilization is an important component of an effective fertility control regime.     

A useful method of calculating age-specific fertility rates]

The practical use of mathematical formulas on the Chinese birth rate as broken down into age groups is analyzed. Through the use of mathematical formulas which are changed to accommodate various parameters, the report comes to 3 conclusions. 1st, the death rate among childbearing women from year T-1 to year T fits the normal distribution. 2nd, the birth rate by age for year T-1 for the above childbearing women seems to be equal to the birth rate by age in year T for all childbearing women. 3rd, every woman who died during childbirth gave birth to 1 live child in the year T-1. The main finding of the report, however, is that formula (1), when used to calculate the birth population for 1981, is quite satisfactory. This finding is supported by the fact that based on the data for 1982 from the general population survey, the birth population in 1981 as calculated by formula (1) is 20,713,434 persons. This figure is higher by 23,730 persons than the figure of 20,689,704 persons which was obtained from the general survey. The relative calculation error is 1.15%. Considering that this error absorbs the impact of 1.83% lost birth registration reports and an error in the number of women by age for 1981, the formula is sufficient.     

The initiation of contraception

Using data from the 1970 National Fertility Study, the trend in the initiation of contraception prior to the first pregnancy is examined. This trend is of interest because of its relationship to the tempo of familybuilding. Using data from a recent marriage cohort, it is shown that use before the first pregnancy is related to age at marriage, age at termination of first pregnancy and the probability of having a premarital conception. For women first married during the decade of the 1960’s, there was a substantial increase in the proportion using contraception before the first pregnancy. This trend is found among both white Catholics and white non-Catholics, but not among blacks. An examination of the specific method used by women using contraception before the first pregnancy reveals a shift from reliance on the traditional methods of diaphragm, condom and douche by the earlier birth cohorts to the use of the pill by the more recent cohorts. An appendix examines the reliability of various measures of the interval of first use of contraception.     

Marital relations and fertility control decisions among lebanese couples

This study examines how marital relations affect fertility control decisions among couples who want no further pregnancies. Marital relations studied include the degree of communication between husbands and wives, the extent that couples report marital tension, conflict, and separation, and the amount of intimacy and mutuality achieved in their sexual relations. Findings are based upon the responses of 530 Middle Eastern women who used the facilities of the University Hospital Family Planning Program of the American University of Beirut, Lebanon; 257 women were interviewed in their homes throughout Lebanon, and the remaining 273 were interviewed at the clinic. Three decisions were studied: (1) IUD/pill use; (2) tubal sterilization use; and (3) consideration of and refusal to use tubal sterilization. Women were interviewed using a standardized questionnaire prepared in colloquial Arabic. The decision to choose a reversible versus a permanent method was primarily sociodemographically determined. Among women who considered a permanent method, however, differences in their decisions were mainly attributable to their marital relations rather than to their demographic characteristics. Wife's attitude toward marriage and educational attainment were important and interactive components in the explanation of the association between marital relations and tubal sterilization use.I appreciate the assistance and critical comments offered by Drs. Joseph Veroff and George Simmons of the University of Michigan, and Dr. Joseph Chamie of Population Division, UN, New York. This article is a modified section of my doctoral dissertation which was recently completed at the University of Michigan. The anonymous reviewers' comments on the organization of this paper are greatly appreciated.