Upholding the freedom of couples to use a method of their choice

A recent review of the Philippine Population Program's 5-year plan, ended in December 1982, showed that in 1980, natural family planning (NFP) users were only about 12.5% of couples practicing family planning. This figure doubled by 1982. Based on these responses the decision was made to intensify the NFP program as early as 1982. The 1st step was to put more money into the NFP program. The program includes the modern scientific techniques such as cervical mucus, basal body temperature, and sympto-thermal. The program also will fund the training of doctors and other clinic personnel and the production and distribution of appropriate training and information material. Other family planning methods, such as sterilization, oral contraception (OC) and the condom, also will be promoted. Promotion of NFP will depend on the choice of the family planning practitioners themselves. The program's community based services are being intensified. NFP, together with the other family planning methods such as sterilization and OC, will always be made available to couples in the community based services. All agencies in the population and family planning program will be promoting NFP. Knights of Columbus doctors have been invited to assist the program and share their own training modules for the training of trainers. An agreement has been entered into with the Gabriel M. Reyes Memorial Foundation based in Aklan. The goal is for trainers who need further knowledge and skills in NFP to learn from the foundation's wealth of organized orientation and training techniques in NFP. NFP is emphasized at this time because it is acceptable to a great number of couples.     

Multivariate relationships between modernity value orientations and family planning indicators

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

NFP promotion in the Philippines: all program components covered

At least 50 of the 105 agencies in the Philippines listed in the "Directory of Agencies with Population Activities" are actively participating in the promotion of natural family planning (NFP). Of these, 40 offer instruction on its use, 22 provide training to clinic personnel or field workers, 19 conduct information/education/communication (IEC) activities, and 6 undertake research. The Population Center Foundation's (PCF's) Information Support to Population Projects (ISP) has prepared a preliminary inventory of programs and projects on NFP, covering some of those that were done in recent years, are being implemented, or have been proposed. Some projects described in the inventory are reviewed. Recent research or research proposals are showhow related, all leading to how the method can be effectively promoted and how couples can be taught its proper use. Instruction on NFP appears in all training activities of Popcom's regional offices, particularly in their refresher courses. Program managers are being trained in managing and monitoring activities to promote the method. In 1980 outreach workers, doctors, nurses, and midwives were trained by Popcom to motivate couples to practice the method and to teach them how to use it correctly. That same year, Popcom's office in the Ilocos region introduced the rhythm dial calendar, a simplified version of the rhythm slide rule. The Ministry of Health National Family Planning Office incorporates natural family planning instruction in its training seminars for the Ministry's health personnel in the regions. As in training, all regional offices of Popcom promote NFP along with other methods that they make available to prospective acceptors. This is in keeping with the program's "cafeteria approach" to family planning. In 1982 Popcom began intensifying the provision of services in NFP, allocating around 4 million pesos to preparations for its effective promotion. In support of service delivery efforts are IEC activities such as the development, production, and distribution of brochures and other reading material on NFP, schoolroom instruction, and lectures. The intensification of IEC efforts in the private sector to promote the modern and scientific techniques of NFP is most clearly evident in a fairly recent seminar sponsored by the Communication Foundation for Asia. Program agencies with activities in natural family planning are listed.     

NFP update: researcher cites need to improve instruction

In the Philippines more and more couples are practicing natural family planning (NFP), but there is a need to improve instruction on this method to increase its effectiveness. Calendar rhythm has been the most popular technique of NFP, but failure rates have been high. This could be changed by improved calendar rythm instruction and the introduction of newer, more effective natural techniques like the basal body temperature, cervical mucus, and symptothermal methods. Dr. John E. Laing, in a paper entitled "research on Natural Family Planning in the Philippines," examines the trends in NFP and summarizes major findings of past research related to NFP and the status of current research. It also discusses the implications of such findings for the National Population Program and the needs for current research. Cting World Fertility Survey (WFS) data on 19 developing countries, Laing states that the Philippines is second only to Peru in current and past use of the rhythm method. He also indicates that since the start of the National Population Program in 1971, rhythm has been offered as an official program method. Yet, in the early years of the program rhythm was not promoted as actively as the other family planning methods. In the last few years, program, officials have become more interested in NFP. 1976 National Acceptor Survey (NAS) data showed that rhythm reduced fertility by 78% compared to the condom's 79%, oral contraceptive's 94%, and the IUD's 98%. A comparison of data from the 1972, 1974, and 1976 NAS indicated a decline in continuation rates and an increase in overall pregnancy rates for all methods except rhythm. The overall pregnancy rate of rhythm declined, but there was no significant change in continuation rate. Laing suggests that probably, while the national population program was increasingly recruiting less motivated couples to try other methods, the rhythm acceptors, who were largely self initiated, mantained earlier levels of motivaton. Evidence points to the widespread use of crude formulas that do not take into account individual variations in cycle length. Many users do not even fully understand the mechanism by which rhythm affects fertility. There is also little knowledge among acceptors of the new and more reliable techniques of NFP for identifying the safe and unsafe periods. Despite problems, a considerable number of acceptors still prefer rhythm to other methods. The commission on population has embarked on a solution to some of the problems by committing itself to the training of volunteers of community-based organizations, particlarly lay leaders. 3 large scale projects are planned for this purpose.     

Family configuration and adolescent sexual attitudes and behavior

Several measures of family configuration, derived from the number, age, and sex of siblings and the number of parents, were related to adolescent sexual attitudes and behavior in a sample of 836 high school-aged teenagers from two Western states. Zero-order correlations showed that sexual intercourseexperience was less common among adolescents who lived with both parents and also among those who had younger siblings. Similarly, the zero-order correlations showed least permissiveattitudes among adolescents who had more siblings, especially younger siblings, and among those who lived with both parents. Controlling for adolescents' age, sex, race, religion, church attendance, and parents' educational attainment, however, essentially eliminated the relationships between family configuration variables and sexual attitudes and behavior. Only parents' marital structure, reflecting whether adolescents lived with both original parents or not, continued to be weakly related to adolescents' sexual attitudes and behvior.     

Can NFP be taught in two short,easy lessons? Simplified NFP for isolated and/or busy couples

Researchers used life table rates from study and comparison groups from rural and urban areas of Cagayan de Oro City, the Philippines to test a simplified method of teaching natural family planning (NFP) defined by calendar, mucus, and cervix indicators. This method included a 6 page booklet, 2 30-minute training sessions, and a question and answer period. Fear of side effects from other contraceptive methods was the leading reason for using NFP (79.4% urban, 85.8% rural). Religious motivation and fear of side effects followed for urban couples, but the percentage was low (14.6%). In rural areas, religious motivation place 3rd (4.1%) preceded by other reasons (6.9%). User error resulted in low accidental pregnancy rates (.8%). Method failure was responsible for higher failure rates than user error, but they were still relatively low (3.4% total). In rural areas, the reason for failure was unclear in 2.6% of couples, but it was only .9% among urban couples. Rural couples who used NFP to space births (spacers) had 2 times the failure rate of those rural couples who used NFP to limit births (limiters) [69% vs. 31%]. Urban spacers had a higher failure rate than urban limiters, but the difference was smaller than it was for rural couples (54.8% vs. 45.2%). Lactation did not have a clear effect on failure rates. For example, in urban areas, partially lactating women had a lower failure rate than nonlactating women (41.9% vs. 58.1%), but in rural areas, lactation had the opposite effect (63.6% for lactating women and 36.4% for nonlactating women). Risk taking resulted in more 6 month pregnancy rates among urban couples than rural couples (12.3% vs. 8.2%). At the end of 6 months, 67.5% of all couples still used the new simplified NFP method (70.3% rural vs. 64.7% urban). Therefore the new simplified NFP method was an effective method for spacing or limiting births.     

Interpersonal communication and the diffusion of family planning in West Malaysia

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

Factors Associated with Advance Care Planning Among Older Women in Southwest Florida

ABSTRACT

As the nation's population continues to age, many older women will face care needs that can be anticipated in advance. However, little is known about the advance care plans of older women and the characteristics of those who plan. This study utilized a stratified random sampling design to survey older women (n = 124) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of attitudes toward future care and planning behavior by domain. Results suggest that advanced age predicts greater planning behavior, while living alone is associated with less advance care planning behavior. Other factors associated with less planning by domains of care needs include income status, chronic health conditions, educational attainment, and religious status. Nonaccepting attitudes toward planning were associated with a decreased likelihood to have advance care planning documents.     

How peasants view couples with only one child]

A study on attitudes toward the one-child policy in Dayi county, Sichual, China, is presented. It is reported that, following the adoption of this policy in 1979, the rate of natural increase in this population of some 440,000 fell from a 1970 level of 33.3 per 1,000 to 1.62 in 1980. The study shows that although individual preferences were for more children, peasants realized that more people meant less land per head. The benefits of a small family were also perceived, and the importance of government support for the elderly in affecting attitudes toward having children is stressed.     

Development and Validation of the ADAS Scale and Prediction of Attitudes Toward Affective-Sexual Diversity Among Spanish Secondary Students

Violence against non-heterosexual adolescents in educational contexts remains a worrying reality, but no adequate attitudes toward affective-sexual diversity (AtASD) measure exists for Spanish adolescent students. We developed a 27-item scale including cognitive, affective, and behavioral aspects, which was completed by 696 secondary school students from the Madrid area. Factor analyses suggested a unidimensional model, Cronbach’s alpha indicated excellent scale scores reliability, and item calibration under the item response theory framework showed that the scale is especially informative for homophobic attitudes. A hierarchical multiple regression analysis showed that variables traditionally related to AtASD (gender, age, religion, nationality, perceived parental/peer attitudes, direct contact with LGB people) also were so in our sample. Moreover, interest in sexuality topics and perceived center’s efforts to provide AtASD education were related to better AtASD. Our scale was reliable and valid, and it may also prove useful in efforts to detect those students with homophobic attitudes and to guide interventions.     

Self-concept and contraception: Pre-conception decision-making

This paper deals with the extent to which two dimensions of self-concept, perceived competence and attitudes toward the female role, are a factor in pre-conception decision-making on contraceptive usage among women who have unwanted conceptions. The study was done throughout Michigan in 1974–75. The sample was 1746 women with unwanted conceptions, selected by means of a two-stage stratified sampling design. A standardized questionnaire included items on demographics, birth control use, and pregnancy resolution, as well as a feminism scale and a scale to measure perceived competence. Several multiple regression analyses were carried out. A hypothesis that contraceptive usage would be positively associated with perceived competence and negatively associated with traditional attitudes toward the female role was strongly supported. In an analysis of various subgroups, differing in age, race, and marital status, self-concept variables were significant predictors only among unmarried adults, regardless of race. Other important predictors of contraceptive usage among the subgroups were father's educational level, number of children raised by respondent, having a regular physician, and frequency of church attendance. For this sample, self-concept variables generally were better predictors of the pre-conception decision-making than of the post-conception decision.This research was supported by Grant #HD07739, NICHD. The authors are affiliated with Wayne State University.     

Family planning: knowledge, attitude and practice of childbearing women in rural areas]

Knowledge, attitude, and practice (KAP) of family planning techniques, is seen as potentially a very effective means for promoting the fundamental principles, objectives, and practices of family planning. In September 1983, a 2-part survey was conducted in the northeast rural area of Hubei province, China, to learn how much local women knew about birth control techniques, devices, available information, and services, as well as personal attitudes and apprehensions toward family planning. The data, based on the ages and educational backgrounds of the surveyed women, are analyzed. The 2nd part of the survey measured the difference in attitudes between women and men regarding the desired number and sex of offspring. While 99% of the surveyed women supported family planning, many expressed a strong desire to learn more about family planning, particularly as related to government policies.     

Sexual Prejudice Among Puerto Rican Young Adults

Abstract

Sexual prejudice is linked to hate crimes, mental health, risk behaviors, and stigma. Few studies have examined sexual prejudice among Latinos. We surveyed 382 college students in Puerto Rico. A structural model tested whether contact and positive experiences with homosexuals, perceived similarities with peers' attitudes toward homosexuality, and religiosity were predictive of sexual prejudice among Puerto Rican young adults. Sex differences in the structural model were explored. With the exception of peers' attitudes toward homosexuality, all study variables predict sexual prejudice. No sex differences were found. Implications for decreasing sexual prejudice among Puerto Rican youth in a college setting are discussed.     

Socialist system creates favourable social environment for fertility decline in China

The Chinese experience suggests that the socialist system can create more favorable conditions for a decline in fertility than the capitalist system. This is related to 5 factors: 1) changes in the traditional functions of the nuclear family; 2) popularization of education and the transmission of culture; 3) improvements in the status of women; 4) rapid decreases in mortality, especially infant mortality; and 5) social security for the aged. In addition, the structure of social organizations and the widespread dissemination of information about birth control methods have facilitated family planning practice. The impact of theswe structural factors has been intensfied by the Chinese social environment, which has changed individual attitudes toward family size. Overall, the social environment has created attitudinal change while implementaton of the national family planning policy has made the fertility decline in China possible.     

Preference for caesarean and attitudes toward birth in a Chilean sample of young adults

BackgroundLittle empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide.AimTo identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures.MethodsAn online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference.FindingsAmong eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9–14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1–2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0–3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0–6.8) were associated with caesarean preference.DiscussionPreference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth.ConclusionsPatient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.     

Attitudes towards demographic trends and population policy: Italy and the Netherlands in a comparative perspective

A comparative analysis was carried out using survey data on attitudes regarding population trends and policy in Italy and in the Netherlands. The results show that current trends and the determinants of those trends are perceived similarly in both countries. With regard to policy, the Italians exhibit much more positive attitudes toward suggested new family policy measures than the Dutch. In the Netherlands, family policy generally is given a much lower priority than other areas of social policy. It appears that having children reflects different values in the two countries. Those who attach greater value to having children are also more in favour of new family policy measures than others. However, the results suggest that introduction of these measures would not raise the reproduction rate to anywhere near a stationary level.     

Contraceptive attitude-behavior consistency in adolescence

Thornburg (1973) suggests that adolescents experience a high level of value-behavior inconsistency compared to individuals in other stages of the lifespan due to engaging in peer-oriented behavioral realms that are contrary to values shared with the parental family. Extending Thornburg's value-behavior inconsistency model to encompass contraceptive attitudes and behavior, it is predicted that contraceptive attitude-behavior inconsistency is prevalent among sexually-active adolescents, and that inconsistency would be greatest when parental and peer contraceptive attitudes are perceived to be incongruent. Analysis of a sample of 167 sexually-active adolescent females ages 13-to-18 indicates that general contraceptive attitudes are consistent with contraceptive use, whereas attitudes toward specific contraceptive methods are unrelated to contraceptive behavior. The data lend support to the predictions of Thornburg's model in that contraceptive attitude-behavior inconsistency is greatest under peer favorable/parent unfavorable and peer unfavorable/parent favorable contraceptive attitude conditions.This research was supported by a grant from the United States Department of Agriculture, Agricultural Experiment Station, University of Arizona. The data for the study were gathered in 1978 and 1979.     

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.     

Attitudes toward family size and family planning in nairobi

In Nairobi, 352 married African adults, 152 men and 200 women, were interviewed on their attitudes toward family size and family planning. The respondents had, on the average, slightly less than three children at the time of interview and hoped to add slightly more than three children to this total. There was little difference in desired family size by sex.About one-half of both men and women had some knowledge of family planning methods, and there was a general interest (75 percent of the men and 90 percent of the women) in learning more. In addition, two out of every three men, and nine out of every ten women, approved of family planning, and even greater majorities of both sexes were willing to have the government of Kenya provide such services.In spite of their approval, however, only 13 percent of the men, and 2 percent of the women, had ever practiced family planning. These findings are broadly comparable to those found in other emerging nations and suggest that knowledge, interest, and approval generally precede use.     

Family planning communication between spouses in Sri Lanka

Drawing on data from a national follow-up survey of 2310 currently married women aged 15-49 conducted in Sri Lanka in 1985, this study examines patterns of family planning communication between spouses, social and economic factors related to those patterns, and the consistency between spouses in their responses to questions about family planning attitudes and practice. The results of the analysis indicate a high degree of family planning communication between spouses in Sri Lanka. The communication, however, varied according to couples' number of living children and to wives' age, education, place of residence, religion, and work status. Multivariate logistic regression generally confirms that older women, those with little or no education, those living on tea estates, and Muslims were less likely to communicate with their husbands on family planning matters than were women in other age, education, residence, and religion categories. These findings suggest the existence of social and cultural obstacles to communication between spouses about family planning matters in Sri Lanka. Among the 577 pairs of spouses whose answers were compared for consistency, a large proportion of wives reported hearing about male contraceptive methods directly from their husbands, and a large proportion of husbands reported hearing about female methods from their wives. These findings are a reminder that both spouses are potentially important sources of information about contraception.