A welcome family planning service center

The Family Planning Service Center of Luohu District was organized by the Family Planning Committee of the district to help couples of child bearing age and 1-child families to overcome their difficulties. The services provided by the center include: distributing contraceptives, and providing consultation on birth control, contraception, healthy births and better upbringing, and maternal and child care. A peculiar feature of the center is that one sees many young and middle-aged people of both sexes going in and out of the place at all hours of the day and night. Workers from the center even go to offices and factories to provide services and distribute contraceptives. In close cooperation with neighborhood family planning centers, the center has also set up offices to distribute contraceptives and give advice. It is estimated that in Luohu District, at present, 90% of the couples of childbearing age are current users of contraceptives. In the city, the proportion of 1-child families is quite large. As a rule in China, preschool children are looked after by their grandparents. Living separately from their parents, however, many couples in the city find it difficult to find someone to care for their children. The center also provides assistance in finding child care help. The center has also invited experts and medical personnel to give 10 lectures on child nutriology, child psychology, birth control, contraception and pregnancy health.     

Indonesian survey looks at adolescent reproductive health

The Baseline Survey of Young Adult Reproductive Welfare in Indonesia, conducted from September to December 1998, provides information about young Indonesians on topics concerning work, education, marriage, family life, sexuality, fertility, and HIV/AIDS and other sexually transmitted diseases. The survey interviewed 4106 men and 3978 women aged 15-24 years in three provinces of Java. Survey findings showed that 42% of the women and 8% of the men are currently or have been married. There was a strong inverse relationship between marriage and schooling, which suggests that greater educational attainment and a higher average age at marriage are likely to go together. Although most young couples prefer to delay and space births, only half of currently married young women are using any type of contraception. These results indicate that there is a need for better reproductive health care as well as improved reproductive health education. Moreover, the current economic crisis has lead to a decline in the use of the private sector for health care. Instead, young people are using the less-expensive government services, and young women are turning to pharmacies and midwives rather than to private doctors to obtain contraceptives. These findings have several policy implications including the need for reproductive health programs that provide services needed by young people.     

Service station established at villages and towns in Fufeng County pushed forward the family planning program there]

In 1985 the 15 villages and towns of Fufeng County, Shanxi Province, established service stations to promote family planning. The County invested over 90,000 yuan in an x-ray machine, operation table and necessary medical supplies. The service stations provided fluoroscopy, surgical and propaganda rooms. The purpose of each station, staffed by female physicians and family planning cadres, was to develop contraceptive birth control, teach eugenics, and counsel women. The establishment of service stations obviously proved significant and useful, as seen from the following data: for the years 1983-85, the county birth rate fell 2%; the multiple child rate dropped 7.7%; the birth control rate rose by 12.6%; the sterilization rate rose by 1.3%. By October 1986, these figures showed even more improvement. The success of the service stations was also due to: taking its services to the people, their homes, and their workplace; making family planning work a service, rather than a management; systematizing family planning work and making it available at all times.     

CFPA in development

The China Family Planning Association (CFPA) was established in Beijing on May 29th, 1980 as a nongovernment organization. Its purpose and tasks are defined as uniting all the people and activitists involved with family planning to assist the government family planning units in communicating the state principles, policies and tasks on family planning, motivating the people to practice family planning voluntarily, organizing academic activities in family planning in cooperation with the related units, and promoting international exchanges and cooperation. Since its establishment, the CFPA has organized a variety of activities (communication, training, consulting) for promoting communication and education so as to spread among the masses of people the scientific knowledge about contraception, and maternal and child care. The services provided by the associations of various regions in response to the needs of the local people were greatly welcomed and highly appreciated by the people.     

Ilocos region: BSPO paramedics: training in Abra pays off

The study entitled "the comprehensive Baragay Medical System in Arba: An Evaluation" analyzed the performance of trained paramedics and found that the effectiveness of barangay service point officers (BSPOs) as outreach workers depeded on: the knowledge and skills they acquired after traning, which helped them meet the medical needs of community residents; their acceptability to the community; and their positive attitude toward their job. The study indicated that adquate training for the job was crucial to the effective performance of outreach workers. The study compared the performance fo BSPO paramedics and BSPO nonparamedics in metting the health care and family planning needs of residents of the communities the served. BSPO paramedics fared much better as outreach workers in the tasks they were trained for -- rendering services in family planning and health care -- than BSPO nonparamedics wo were not given that kind of training. The study was conducted in the towns of Sallapadan, Pilar, and Danglas for BSPO paramedics and in Manabo, Villaviciosa, and La Paz for BSPO nonparamedics. Interviewed were a sample group of married adults in the areas, 15 BSPO paramedics, and 15 BSPO nonparamedics. The BSPO paramedics had undergone training in preventive medicine, environmental sanitation, and treatment of minor illnesses. The were taught advanced first aid techniques, over the cunter dispensing of medicines, and basic laboratory analysis. The nonparamedics were not trained in these functins. The residents preferred to approach BSPO paramedics for both family planning and medical servies, and more community members also derived the "highest degreee of satisfaction" from the paramedics' services. The BSPO paramedics also served more family planning clients and provided community residents more kinds of medical services. These included medical checkup, the distribution and sale of medicines, curing illnesses, and assisting in child delivery. In terms of job satisfaction, 13 out of every 15 BSPO paramedics interviewed indicated that they were "very satisfied" with their jobs, while only 6 of 15 nonparamedics gave the same rating. The survey findings suggest that the Arba Comprehensive Barangay Medical System can be a viable model for outreach workers in remote communities.     

Meeting health and family planning needs in Latin America and the Caribbean

The operations research and technical assistance (OR/TA) project in The Population Council has concentrated on fertility and infant mortality issues in Latin American and the Caribbean for more than a decade through INOPAL. INOPAL is an acronym for Investigacion Operacional en Planificacion Familiar y Atencion Materno-Infantil para America Latina y el Caribe (Operations Research in Family Planning and Maternal-Child Health in Latin America and the Caribbean). In March 1995, the project entered its third phase, INOPAL III, with the renewal of its contract from the United States Agency for International Development (USAID). To facilitate communication between INOPAL, collaborating agencies, and USAID, INOPAL Director James Foreit moved from Peru to a Council office in Washington, D.C. INOPAL has six objectives: 1) to test the integration of family planning and reproductive health services; 2) to increase access to family planning; 3) to develop strategies to reach special populations; 4) to improve the sustainability of family planning programs; 5) to improve service quality; and 6) to institutionalize operations research capability in the region. INOPAL II conducted 61 subprojects in 12 countries in collaboration with 24 USAID cooperating agencies and other international organizations. The project established new services for postpartum women, adolescents, and rural women; improved program quality and financial sustainability; increased vasectomy promotion and the range of available contraceptives; and developed new modes of service delivery. A key finding of INOPAL II operations research was the importance of increasing cost-effectiveness to ensure program sustainability. INOPAL III will work toward all six objectives, with an emphasis on integrating reproductive health and family planning services. Operations research and technical assistance (OR/TA) subprojects will focus on the prevention and treatment of sexually transmitted diseases, perinatal and postpartum care, and postabortion care.     

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.     

Sex role effects on female response to illness

This study of sex differentials in health behavior and health service choice among the Korean rural population is based on 1421 individuals aged 14 and over who received medical care at hospitals or clinics, pharmacies, a government health center, or through Chinese medical practices. Logistic regression is used to explore the relationship between the dichotomous variable, the log of the odds of the probability of using formal health care services, and the independent variables (sex, age, education, marital status, perceived health status, perceived medical care need, illness days in bed, limited activity days, total sick days, date of illness). A profile of rural Korea shows for all ages fewer adult females than males, but more females 65 years who have been previously married, which suggests higher male mortality rates in the middle ages. Health service usage is higher among the elderly. Higher level of education is associated with greater use of formal medical service. The results of binomial and multinomial analysis indicate that women receive less medical care from the formal system in spite of complaints and restricted activity, and least of all from health centers. It is suggested that personnel at health centers may reduce the desire for care because of incompatible social backgrounds (young single males who are inexperienced, city bred, and completing required service). A woman must carefully choose from the formal system and may more easily use the informal system of pharmacies and Chinese medicine practice. The responses to self rated health showed many differences; males report better health than females and older people consider themselves more unhealthy than young or adult groups. Those with lower educational attainment also consider themselves unhealthy, and indicate greater need for health services. Females and older age groups also stated their need for professional medical care for an illness within 15 days prior to the survey. The mean number of bed days followed a similar pattern as the perceived need and self rated health. However, women had a lower volume of bed days than men in contrast to typical Western trends. Females reported more restricted days of activity. The old age group had the same restricted days but more bed days than the adult group. Reported chronic diseases were greater for lower socioeconomic groups.     

Mothers’ Marital Status and Type of Delivery Medical Care in Guatemala

The use of modern medical care for child delivery in rural Guatemala is low relative to other Latin American countries. In the previous literature, factors such as a woman’s age, education, ethnicity, religious affiliation and income are found to be important determinants of the type of delivery medical care she receives. This study hypothesizes that a woman’s marital status influences her decision as well. Using a binomial logit framework, the study finds that unmarried women are more likely to see a modern medical provider in delivery than married women, even after controlling for demographic, socioeconomic, and husbands’ characteristics. Therefore, unmarried women seem to make more informed decisions in terms of their attitudes in childbearing and maternal health relative to their married counterparts. As a result, both economic as well as social developments seem necessary to induce changes in the high incidence of maternal mortality and morbidity in Guatemala.     

The effect of child care and part time opportunities on participation and fertility decisions in Italy

Economic models of household behavior typically yield the prediction that increases in schooling levels and wage rates of married women lead to increases in their labor supply and reductions in fertility. In Italy, low labor market participation rates of married women are observed together with low birth rates. Our explanation involves the Italian institutional structure, particularly as reflected in rigidities and imperfections in the labor market and characteristics of the publicly-funded child care system. These rigidities tend to simultaneously increase the costs of having children and to discourage the labor market participation of married women. We analyze a model of labor supply and fertility, using panel data. The empirical results show that the availability of child care and part time work increase both the probability of working and having a child. Received: 14 February 2000/Accepted: 20 February 2001     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Women are key players in the economies of East and Southeast Asia

In 1996, the East-West Center's Program on Population investigated the links between population change and economic growth in Japan, South Korea, Taiwan, Singapore, Thailand, and Indonesia. This document discusses the findings pertaining to women's changing marriage and childbearing patterns, education attainment, and labor force participation as well as changes in family life. In eastern and southeastern Asia, women are delaying marriage and having fewer children as a result of their overwhelming acceptance of modern contraception. Concurrently, women's secondary school enrollment has increased dramatically since 1960, and women have accounted for steadily increasing proportions of total labor force growth. Economic development has led to fewer women employed in agriculture and more in clerical positions. Women continue to be marginalized in low-paying manufacturing jobs and to lose these jobs more frequently than do men. Women's labor force participation continues to be dependent upon their child care responsibilities, but women are beginning to combine both activities with the help of live-in grandparents. Women have made an important contribution to economic growth in Asia. Policies should address job discrimination against married women, wage discrimination, the problems faced by young women who leave home for employment in the manufacturing and service sectors, and the lack of child care facilities.     

How female education affects reproductive behavior in urban Pakistan

Although Pakistan remains in a pretransitional stage (contraceptive prevalence of only 11.9% among married women in 1992), urban women with post-primary levels of education are spearheading the gradual move toward fertility transition. Data collected in the city of Karachi in 1987 were used to determine whether the inverse association between fertility and female education is attributable to child supply variables, demand factors, or fertility regulation costs. Karachi, with its high concentration of women with secondary educations employed in professional occupations, has a contraceptive prevalence rate of 31%. Among women married for less than 20 years, a 10-year increment in education predicts that a woman will average two-fifths of a child less than other women in the previous 5 years. Regression analysis identified 4 significant intervening variables in the education-fertility relationship: marriage duration, net family income, formal sector employment, and age at first marriage. Education appears to affect fertility because it promotes a later age at marriage and thus reduces life-time exposure to the risk of childbearing, induces women to marry men with higher incomes (a phenomenon that either reduces the cost of fertility regulation or the demand for children), leads women to become employed in the formal sector (leading to a reduction in the demand for children), and has other unspecified effects on women's values or opportunities that are captured by their birth cohort. When these intervening variables are held constant, women's attitude toward family planning loses its impact on fertility, as do women's domestic autonomy and their expectations of self-support in old age. These findings lend support to increased investments in female education in urban Pakistan as a means of limiting the childbearing of married women. Although it is not clear if investment in female education would have the same effect in rural Pakistan, such action is important from a human and economic development perspective.     

Preliminary achievements of China's national economy development and family planning]

A preliminary view of the population control policies of the People's Republic of China is the subject of this report. The report maintains that population control policies are closely linked to economic growth and indicates that criticism by the West of these policies is unfounded. According to an investigation of 1000 married women of child-bearing age carried out in 1981, 19.1% of them have 1 child, 21.4% of them have 2, 49.5% have 3 and only 9.9% of them have no children. This would seem to refute the West's idea of the "1 child only" policy as strict and clear-cut. The report maintains that economic growth and family planning are functions of one another. Although China has made marked progress in population control, its population problem is still far from being resolved as population growth is still relatively high compared to productivity. The marriageable population is extremely high and increase in population create a burden on education, employment, transportation, welfare, housing and medicine each year. The trend in rural areas (which make up 80% of China's population) to have larger families to produce more labor must be reversed in order to make population control objectives feasible. Thus, the need for China to continue its efforts to promote rural economy and family planning must continue. The needs for improvement in promotion and family planning education as well as for improved medical conditions are also evident.     

The International Parliamentary Assembly on Population and Development held in Mexico City

The International Parliamentary Assmebly on Population and Development took place on August 15-16, 1984, with the participation of more than 300 parliamentarians from 60 countries. The aim was to promote an exchange of views on population programs and policies among parliamentarians, and to support the recommendations adopted by the UN International Conference on Population. The assembly held discussion in 3 subcommittees on the subjects of 1) policies of population and development; 2) the legal and social status of women; and 3) the improvement of family planning service. On population policy, parliamentarians generally agreed that policy formulation is the prerogative of each sovereign country, stressing that such policies and programs should be integrated with social and economic development. The developing countries stronly demanded that a new international economic order be established and international aid increased to help them in solving the popultion problem. Concerning the status of women, the assembly unanimously agreed that both men and women should not only be legally equal, but should also have de facto equality for employment, education and social life. Attention should be given particularly to the rights and status of rural women. Examples of how the status of Chinese women has improved were offered by Chinese representative and were appreciated by the assembly. On improving family planning services, participants urged provision of information about birth control to people of marriageable age and of access to contraceptives to eligible couples; moreover, they advocated the strengthening of medical care for women and children and the lowering of infant and maternal mortality rates. Dr. Qian Xinzhong described the priorities and goals of family planning programs in China. Finally, the assembly unanimously adopted the "Action Plan," whose contents embody independence, respect for national sovereignty, and the spirit of cooperation and conformity to the interest of the international community, particularly the developing nations.     

India's National Family Health Survey provides new information on maternal and child health and AIDS awareness

Teams surveyed a sample of 88,562 households, drawn from 99% of the population of India in 24 states plus the National Capital Territory of Delhi, between April 1992 and September 1993 to collect a basic set of information on all 500,492 household members, with more details on the 89,777 women in the households who had ever been married and were aged 13-49 years. This National Family Health Survey (NFHS) collected information from the women on a range of health topics including child immunization, women's knowledge of AIDS, services and facilities use during pregnancy and childbirth, infant feeding and treatment for diarrhea, and infant, child, and maternal mortality. Levels of infant and child mortality declined in India, but 8% of all children still die before their first birthday and 11% die before reaching age 5. As for maternal mortality, there are an estimated 420 maternal deaths per 100,000 live births annually. That rate implies that at least 100,000 Indian women die each year due to causes related to pregnancy and childbirth. Survey results indicate the need to strengthen vaccination programs and teach women about proper infant feeding practices. They also highlight the need to increase antenatal care and other medical services. In all of these areas, the NFHS results indicate wide variation among India's regions and states. Furthermore, a general lack of AIDS awareness suggests that the government's AIDS awareness campaign, relying primarily upon electronic media, has not yet reached the majority of India's population.     

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.     

Costs and benefits of children: implications for population policy

Family size preferences are strongly affected by parents' perceptions of the value, economic contributions, and costs of children. Better understanding of these factors can help policy-makers to improve the effectiveness of population IEC campaigns, design strategies to persuade couples to have smaller families, assess the relationship between economic development and family size preferences, and devise national population policies and family planning programs that reflect individual choices. Parents in high-fertility countries are more likely to perceive children as productive investments than those in low-fertility countries. Parents in the former countries maintain children are an economic advantage or provide practical assistance in the household; they are less likely to emphasize the psychological advantages of children. As economic development occurs, and parents no longer value children for their economic contributions, psychological and social reasons become more important. Changing fertility preferences is more complex than providing couples with family planning services. Similarly, efforts to persuade families that large families are a burden are successful only when families are already interested in reducing their family size. Efforts to persuade couples to have smaller families are likely to be more successful if there are alternative sources of old-age support available, for example, from increased household savings, public or private pensions, or greater contributions from 1st and 2nd children. Investments in education and training, especially for women and children, would also support these goals.     

Children in large families

A summary was provided of issues presented by Dr. Cynthia Lloyd in her chapter on investing in children from the 1994 volume "Population and Development: Old Debates, New Conclusions." Children in large families may miss the opportunities offered in a modernizing society. The possibilities for adverse consequences because of a large size of families include a smaller share of resources (time, income, and/or nutrition) among family members, limited access to public resources (health care and education), unequal distribution of resources among family members, and gender defined roles. Dr. Lloyd's review of the literature exposed the lack of emphasis on the impact of opportunity, equity, and intergenerational transfers on child welfare. Children's smaller share of resources had less impact on child welfare. Later-born and unwanted children were particularly vulnerable in large families. Unwanted children were usually later born or girls. The lack of investments in girl's education not only affected the limited earning power and opportunity to escape from gender restricting roles but also contributed to the perpetuation of the cycle of high fertility and gender discrimination. Family decisions about fertility and investments in children's education and nutrition can not be separated from the social context of culture, class, social custom, and level of socioeconomic development. Disadvantage is not assured in large families, but statistically more probable. Fewer children are more likely to be wanted and to receive better care. Societies should provide high quality family planning services, safe abortion services, and enforcement of primary school education requirements. Measures need to be adopted for promotion of schooling for girls that is sensitive to cultural norms. Laws must protect children's rights to economic support from both biological parents. Gender discrimination against women must be eliminated.     

Junior partners: Women's contribution to family income in Canada

This research examines the degree of financial contribution of married women to their overall family income. This phenomenon is analyzed from the point of view of sex-role/human capital orientations. The sex-role position argues that regardless of women's social, economic and education background their financial input to household economy will always be less than fifty percent because women's financial opportunities are impeded by sex-role configurations and expectations. The human capital thesis explains women's apparent inability to contribute more than half of the family income as a function of their lower human capital; that is, education, professionalization and training in the labour market. Individual data pertaining to thirty-year old married women, taken from the 1981 Canadian census, are examined. Generally, we find support for the positions: Women with relatively high human capital assmulation contribute significantly to overall household income, but invariably that contribution is less than 50 percent of total family income. On average, all women contribute 22 percent of their families annual income, while working women provide approximately 33 percent of the total. This analysis demonstrates what appears to be a pervasive phenomenon in industrial nations: married women are generally junior economic partners within the family. The extent of junior partnerships, however, is somewhat conditioned by women's human capital resources.