Thailand: family planning program exceeds targets

According to Dr. Somboon Vacharothai, Director General of the Ministry of Public Health, the number of people in Thailand who practiced family planning exceeded last year's target. 664,895 individuals used family planning services; this was 62.2% above the planned target for 1976. It was further predicted that 700,000 persons would be recruited by the family planning program in 1977. The preferred method of birth control was the oral contraceptive; it is the method of 800,000 acceptors. Service outlets have been extended rapidly with 5836 medical centers providing family planning services throughout Thailand. Government allocations for family planning have increased from 0.9 million dollars in 1975 to 2.47 million dollars in 1977.     

India: New family planning program direction outlined

The focus of the current Family Welfare Program in India is education and active community involvement rather than coercion and compulsion. The government is totally committed to the program and has indicated that it will spare no efforts to motivate people to voluntarily accept family planning. However, there is a need for family planning efforts to include all aspects of family welfare, particularly those designed to promote the health of mothers and children. All family planning methods will be made available, and the family will be free to choose the method they prefer. As part of the program, employees of the Union government, State governments, autonomous and local bodies are expected to set an example and adopt the small family norm. The policy statement made by Mr. Raj Narain, Minister of Health and Family Welfare, revealed the government's decision not to legislate, either at the national or the State level, for compulsory sterilization. Sterilization services will be available free of charge to those who voluntarily choose this method. A plan for training indigenous midwives will be implemented as part of the program in order that maternity services may be available to all expectant mothers. Additionally, in recognition of the direct correlation between illiteracy and fertility and between infant/maternal mortality and age at marriage, the government will introduce legislation to raise the minimum age at marriage to 18 years for girls and to 21 years for boys. The plan is for trade unions, Chambers of Commerce, cooperative societies, women's organizations, teachers' federation, district councils, and other voluntary institutions to be associated intimately with the educational campaign launching the Family Welfare Program.     

Measuring components of family planning program effort

The measures of family planning program effort developed by Lapham and Mauldin have played a key role in family planning program analysis, but surprisingly little is known about them. This article investigates the measurement of family planning program effort based on data reflecting conditions circa 1982 in 100 developing countries. Using confirmatory factor analytic techniques, it tests some hypotheses implicit in the work of Mauldin and Lapham. Since the data do not fully support these hypotheses, an alternative conceptualization is proposed that consists of eight rather than four components. The discussion focuses on the expanded set of components and includes an assessment of the empirical indicators associated with them.     

Regional variation in acceptance of Indonesia's family planning program

Indonesia's family planning program is regarded as a major success.Survey data from 1997 reveal that rates of contraceptive use vary dramatically amongIndonesia's 27 provinces, from a high of 67 percent of ever married women currently using contraceptives in the province of North Sulawesi, to a low of 19 percent current users in East Timor and28 percent in Aceh. This study uses both a quantitative analysis of the 1997 Indonesia Demographic and Health Survey, and a qualitative study carried out in July of 2000 to understand regionalvariation. The study identified a small number of factors that show a clear relation with levels of contraceptive use. Media exposure and education are the strongest and most consistent predictors of levels of contraceptive use, and appear to be the surest strategies for promoting family change. But the study also showed that the process of social change is subjectto culturally and historically specific local factors whose presence and importance is difficult to predict. Our study of regional variation in contraceptive use illustrates the range and complexityof obstacles faced by Indonesia's leaders in attempting to forge a single nation fromsuch a diverse and far-flung population. Although the creation of Indonesia in the space of just half a century is a monumental achievement, the project is clearly not yet complete.     

Measures of influence of family planning program on fertility]

The question of how to measure the influence of family planning in fertility has been addressed by numerous international scholars. Highlighted briefly here are some of the methods endorsed by United Nations publications and recognized by scholars of various countries: 1) Standardization; 2) John Bongaarts model; 3) Trend analysis; 4) Wishik model; 5) Converse model of Dorothy Nartman; 6) Potter model; 7) Nathan Keyfitz model; 8) "Plural model"; 9) Model analysis.     

Satisfied users clubs: family planning acceptors as model agents of the program

The National Population Program in the Philippines has encouraged family planning acceptors to shift from their passive role as recipients of family planning services into an active role as program participants. In the mid 1970s the Commission on Population (Popcom) began setting up satisfied users clubs in various regions of the country with the aid of the Ministry of Social Services and Development (MSSD). Other government institutions like the Ministry of Labor and Employment (MOLE) formed similar family planning groups. So did private agencies participating in the Program. There were indications at that time that community based family planning clubs could help the Program in informing couples about family planning and in motivating them to practice contraception. In 1977 a study conducted by the University of the Philippines Institute of Maternal Clinic found that family planning acceptors in Dumaguete City received social and psychological support from local barrio women's clubs. A 1978 Community Outreach Survey indicated that full time outreach workers (FTOWs) found statisfied users clubs helpful in increasing the number of new acceptors in their areas and in bringing down the number of family planning dropouts. Once a decision to create a club is made, club organizers meet with the barangay captain and his council to get their approval and seek their cooperation in inviting people to join the proposed club. Once the approval is given known family planning users in the community or mothers of reproductive age are invited to attend a community assembly. Of 59 clubs surveyed, only 10 had a formal constitution and bylaws. All clubs elected their officers and conducted monthly meetings which lasted from 2-4 hours. The main selling proposition of the clubs is the involvement of members in nonfamily planning activities like income generating schemes, skills training, nutrition seminars, and immunization of children. 81% of the officers of all 59 clubs were family planning acceptors. The majority of officers had undergone voluntary sterilization. Only 8 of the 59 clubs considered themselves single purpose clubs committed to the promotion of family planning. The other 51 were multipurpose organizations, with both family planning and nonfamily planning activities. In the area of family planning, the club's objectives were to increase family planning acceptors, disseminate family planning information, and maintain current users.     

A components method for measuring the impact of a family planning program on birth rates

One of the major goals of family planning programs worldwide has been to reduce the level of fertility in hopes of slowing the rate of natural increase and promoting social and economic development. Such programs have now been in existence for sufficient lengths of time to have had an impact on fertility levels. In general countries with organized family planning programs, marked declines in fertility levels have been observed. The extent to which such declines may be credited to organized programs has not been rigorously measured because an appropriate research methodology has been lacking. This paper describes one method of directly linking declines in fertility levels to the contraceptive protection experienced by a population. The contribution of organized family planning programs is estimated by decomposing the amount of total contraceptive protection into within-program and outside-program sources.     

Study findings on evaluation of integrated family planning programme performance

In 1976 the United Nations's Economic and Social Commission for Asia and the Pacific launched a comparative study on integrated family planning programs in a number of countries in the region. In November 1979 the study directors from the participating countries meet in Bangkok to discuss the current status of the studies in their countries. The Korean and Malaysian studies were completed, the Bangladesh study was in the data collecting phase, and the Pakistani research design phase was completed. The meeting participants focused their attention on the findings and policy implications of the 2 completed studies and also discussed a number of theorectical and methodological issues which grew out of their research experience. The Malaysian study indicated that group structure, financial resources, and the frequency and quality of worker-client contact were the most significant variables determining program effectiveness. In the Korean Study, leadership, financial resources, and the frequency and quality of contact between agencies were the key variables in determining program effectiveness. In the Malaysian study there was a positive correlation between maternal and child health service performance measures and family planning service performance measures. This finding supported the contention that these 2 types of service provision are not in conflict with each other but instead serve to reinforce each other. Policy implications of the Korean study were 1) family planning should be an integral part of all community activities; 2) family planning workers should be adequately supported by financial and supply allocations; and 3) adequate record keeping and information exchange procedures should be incorporated in the programs.     

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

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

Perceived factors of family planning clinic performance and service quality

As part of a larger operations research project, this 1990 study analyzed the performance of the Philippine Department of Health's (DOH) family planning (FP) clinics. Specific study objectives were 1) to measure acceptor targets, servicing capacity utilization, outreach, and costs; 2) to determine what providers believed affected performance; 3) to record which quality indicator providers use; and 4) to determine the perceptions of acceptors about clinic personnel, the clinic as a FP outlet, FP service processing, and FP service quality. Data were gathered from clinic records and from sample surveys in 25 clinics in four specified locations. Eight clients were sampled from each of the 100 clinics. It was found that clinic staff accepted low attainment of FP acceptor targets and that clinic capacity utilization levels were at 25% of capacity. Providers were unaware of the number of potential FP acceptors in their areas and had no information about the costs of running their clinics. The FP clinic managers identified 34 major determinants of clinic performance, but more than half reported that they had very little control over these determinants. The providers described quality service from the point of view of the acceptors and described the quality of a clinic in terms of the minimal physical characteristics required. The acceptor survey revealed that acceptor satisfaction depends upon 1) clinic accessibility and lay-out, 2) intensive personal contact, and 3) clinic infrastructure. The study uncovered a need for the DOH to institute management training programs for clinic managers and to provide managers with the resources and personnel to shift priorities in favor of FP coverage and prevalence. Managers, who are resource allocators, must also receive information about the costs of FP services in their clinics. In addition, the DOH's determination that its FP program would be facility- rather than community-based should be modified to incorporate community outreach elements. The DOH can also make a big impact on perceptions of quality (of both providers and acceptors) by improving clinic conditions to meet basic standards. Once these basic needs are met, additional needs of acceptors can and must be addressed.     

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

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

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.     

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.     

Natural family planning: A comparison of continuers and discontinuers

Little research has been done on social-psychological variables related to the use of natural family planning. The objective of this study was to analyze variables that differentiated between continuers and discontinuers of natural family planning (NFP). Questionnaires were obtained from couples who had received instruction in the sympto-thermal method of natural family planning at a large urban hospital. Subjects who were attempting to become pregnant or who were using other methods of contraception in conjunction with NFP were deleted from the analysis, leaving N of 74. With Pearson correlation, variables significantly related (p<.05) to NFP continuance were: religiosity, planning more children, perceived severity of pregnancy, support from spouse and relatives, dissatisfaction with other contraceptive methods, attitudes toward NFP, perceived effectiveness of NFP, attitudes toward abstinence, and importance of intercourse.     

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

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

The multilevel dependence of contraceptive use on socioeconomic development and family planning program strength

Using World Fertility Survey data for 15 developing countries, we estimate an equation in which the dependent variable—whether the respondent has ever used an efficient contraceptive method—depends on the respondent’s education and location of childhood residence. All of the coefficients of this equation, including the intercept, vary over countries. Analysis based on new methodology shows that the intercept and education effects vary as a function of national family planning program efforts and that none of the parameters of the equation depend on gross national product per capita. The results demonstrate the efficacy of multilevel analysis, provide a partial test of the theory underlying the analysis, and refocus discussion of the contributions of development and policy variables to fertility reduction.     

A second look at natural family planning

There is renewed interest in natural family planning (NFP) as the Philippine Population Program enters the 1980s. Much of this interest is due to the realization that, properly practiced, NFP can be a highly effective means of birth spacing. In 1978 the Special Committee to Review the Philippine Population Program recommended that more efforts be made to promote NFP. The different methods of NFP are reviewed. Sex without intercourse, coitus interruptus, and prolonged nursing are not officially recognized as NFP methods by the Program. The rhythm method was first described independently by Drs. Hermann Knaus of Austria and Kyusaku Ogino of Japan in the 1930s. Ogino's method of calculating a woman's fertile period is based on the lengths of the last 12 menstrual cycles which she recorded on a calendar. The advantages of rhythm are that it is inexpensive, it requires only the cost of charts which may be homemade, there are no physical side effects, control is in the woman's hands, and it is acceptable to people who consider it their duty to follow religious teachings. Disadvantages include: keeping constant, accurate records of cycles for long periods of time; the need for perseverance and correct interpretation of the chart; the possible need for medical advice and help; and the fear that something might upset a woman's cycle and change the time of ovulation. The continuation rates of rhythm acceptors in the Philippines are unimpressive. A study of 142 women revealed a high pregnancy/failure rate--25% for a 12-month period compared to 0 with oral contraception (OC) and the IUD's 2%. The basal body temperature method helps determine the unsafe period with some accuracy. Its premise is that there are slight but detectable changes in a woman's body temperature during her cycle. These changes herald ovulation. A special thermometer must record temperature changes of 0.1 degree Farenheit. This instrument and the charts are the only expenses involved. The reviewers of the Philippine Population Program noted that since the end of the unsafe period can be indicated only by the temperature, the total period of abstinence becomes long, although the basal body temperature method gives more or less 10 successive days for intercourse. The cervical mucus method, also known as the Billings method, takes into account the cervical secretions during the menstrual cycle. Appearance of this mucus is an indication of fertility. All that is required of a practitioner is to learn to distinguish the different sensations of wetness and dryness. The disadvantage is that the method becomes ineffective in areas where there is cervicitis or infection of the cervix. The symptom thermal method is the basal body temperature method combined with other NFP techniques and is widely used. With this method an accurate record of the 6 immediately preceding menstrual cycles is established. The start of the fertile period is set by substracting 20 days plus 1. The woman watches for symptoms like pelvic heaviness, breast softness, and mucus discharge.