Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

ASEAN projects reviewed

The ASEAN Population Expert Group met in Manila and was followed by a meeting of the ASEAN heads of population programs, during the period November 5-10, 1979. Heads of population programs from Indonesia, Malaysia, Singapore, Thailand, and the Philippines attended. The meetings were held to review progress-to-date on phase 1 projects and to consider the development of an expanded population program. 5 projects funded by UNFPA are reviewed in tabular form with the project, the sponsoring country, date of implementation, data analysis, and date of completion. Suggestions were made for improving and extending these projects and it was also suggested that all projects being developed and proposed should include a section on use of research. 7 new projects were proposed as phase 2 projects. The 1st, sponsored by Malaysia, deals with women in development; project 2, lead by Thailand, will investigate population movement and its effect on development; project 3, led by the Philippines, will develop and strengthen national population information systems and networks in ASEAN countries; project 4, led by Indonesia, is directed towards institutional development and exchanges of personnel; project 5, led by the Philippines, will examine population and development dynamics and the man/resources balance; project 6, led by Thailand, will develop ASEAN social indicators; and project 7, led by Indonesia and Malaysia, will make a comprehensive analysis of existing medical/health care and family planning systems. It was recommended that an executive director of the proposed ASEAN population coordination unit should be appointed to expedite the recommendations of the meeting related to preparation and submission of phase 2 project proposals.     

Nepal: NFP/MCH Project's prime target

Sterilization as a means of permanent family planning will be the prime target of the Nepal Family Planning and Maternity and Child Health Project in the current fiscal year. Under the permanent sterilization scheme, the project plans to open 18 laparoscopic camps in addition to 34 vasectomy camps in different parts of the country. The 146 mobile teams of the project sent to different parts of the country performed vasectomies on over 9000 males in the previous fiscal year. According to project statistics, more than 38,000 males have undergone vasectomy so far in Nepal. The rate of population growth is estimated to continue to increase by 3% in the next 5 years. This estimate is much higher than the original estimate made during the formation of the current 5-year plan.     

Integrating parasite control and family planning

A pilot project started recently in 4 locations by the Family Planning Organization of the Philippines in cooperation with the Japanese Organization for International Cooperation in Family Planning and the Asian Parasite Control Organization uses de-worming as an entry point to establish credibility for family planning workers among the target population. The ultimate goal of the project is to encourage community participation to such an extent that family planning and related efforts are sustained by the community itself and the field worker is no longer needed. Integrated parasite control/family planning projects have already gone through the 4 principal developmental stages of strategic planning, project design and development, implementation and assessment, and program maintenance in some areas since their beginnings in 1976. Support for such programs has been obtained from 3 international bodies working in family planning, and 2 others have recently indicated interest. Activities to develop criteria for project expansion are now underway. The 4 projects in the Philippines, located in Binakayan, Cavite; San Pedro, Laguna; Caramoan, Camarines Sur; and Davao City, are each staffed by a project manager, doctors, nurses, and medical technologists. The projects, especially the Caramoan project, have been quite successful, and efforts are being made to include nutrition in the integrated program.     

Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

网络与阶层的双重区隔——内地优才在港融入网络的差异

1990年代以来经济的纵深转型导致香港发展所需人才严重不足,政府逐步推出人才引进计划,内地优才为了实现其"香港梦",源源不断赴港工作。本研究发现,内地优才在融入香港生活过程中出现了双重区隔的状况:首先,内地优才有选择性地融入不同的网络,情感化的"大陆圈子"与工具化的本地网络二者区隔开来,这是文化惯习使然,亦是内地优才维持个人优势的潜在条件;其次,内地优才处于职业阶层的中上层,在客观位置上与主观阶层品味上都区分于其他内地新移民及香港本地底层;这二者交叉互动,使内地优才成为"孤立"的群体,难以建立对香港的归属感和认同感。文末,笔者认为进一步加快两地社会经济的融合是解决双重区隔问题的根本前提。     

“十五”时期上海市劳动就业容量与结构预测

应用国际通行的相关回归分析方法 ,对“十五”时期上海市劳动就业容量与结构进行预测。上海市的经济总量虽保持高速增长 ,但由于产业结构的调整 ,劳动力就业容量的增长却急剧下降。由“九五”末期的 6 2 %开始下降到“十五”末期的 0 8～ 1 1% ,就业矛盾加剧。劳动力产业结构则可向更优化的方向发展。第三产业从业人口将占总就业人口的 4 9 6～52 0 0 % ,比“九五”末期提高近 8～ 10个百分点     

高校创新型外语人才的时代特质与培养机制

培养创新型外语人才是知识社会的时代诉求。是高校外语教育建设创新型国家的历史使命。我国创新型外语人才培养的分层次特色培育模式及其未来走势．把培养高水平创新型外语人才定位为高校外语教育的永恒追求。高水平创新型外语人才的培育。是一项系统工程。建立由高校外语教师“我”系统的白循环机制和“我-你”世界双轨互动运行的外循环机制组成的双轮驱动机制．是高校外语教育培养高水平创新型外语人才的现实抉择。     

山东省养老保障的现状评估与需求分析

伴随着人口老龄化程度的提高,老年抚养比的增加,一个非常现实的问题就是养老保障需求的增加。本文以山东省为例,根据山东省老龄委重大专项课题的实地调查数据和人口预测数据,对山东省养老保障的现状进行评估发现：目前阶段,居家养老仍是老年人最主要的养老方式,但是在人口老龄化程度逐步加深的客观影响下,机构养老需求将会面临巨大的市场需求。因此,本文进一步预测了山东省未来五年内的养老机构需求,以期为山东省合理配置社会保障资源、有效实施社会养老保障需求提供客观事实基础。     

Mayors accept the population challenge

The Commission of Population (Popcom), together with the Philippine Ministry of Local Government ond the National Economic and Development Authority devised a multiagency project entitled "Population, Local Development and Local Administration." Expected to improve the capabilities of mayors in fulfilling their new roles, the project called for holding consultative conferences with town mayors as participants. From March to november 1985, the sponsoring agencies conducted 12 consultative conferences for 281 municipal mayors and 13 representatives throughout the country. Mayors learned that they are empowered to implement the local population program and that the population workers, being local coordinators of the population program, should be reporting to them. The mayors' feedback given at the conferences made some officials realize that there are local government units that may not be able to fully absorb the full-time outreach workers. To help implement population programs, the mayors suggested fiscal reforms. Overall, the conferences gave the mayors a sense of importance.     

青海省香巴农业扶贫开发项目及其人口迁移

香巴农业扶贫开发项目是青海省在20世纪末实施的集人口迁移和扶贫为一体的异地扶贫开发工程。文章介绍了其实施的背景、项目区基本状况以及项目中的人口迁移情况,并初步探讨了项目实施的意义。     

Sarikaya: toward community self-reliance in health and family planning

The Sarikaya Project of the Philippine Ministry of Health's National Family Planning Office was conceived as an innovative approach to providing information, education, and communication on health, nutrition, and family planning using the services of neighborhood leaders who can gain the cooperation and participation of community members in health and family planning programs. The Sarikaya worker (SW) serves as the link between the community and the Ministry of Health. Selection of SWs is a collaborative effort of the Barangay Health Service midwife, the community, and the barangay council. SWs are trained by the BHS midwife in a 5-day seminar which includes an orientation to the role and function of the Sarikaya Project, health and family planning IEC, and 1st aid. SWs undertake activities in family planning, maternal and child health, nutrition, environmental sanitation, communicable disease control, and emergency treatment. As volunteers, the SWs receive no compensation except for a nominal training allowance. The SW relies on the BHS midwife for technical and logistical support, on the health committee of the barangay council for coordination and administrative support, and on informal community leaders for guidance and advice. Pilot testing of the sarikaya project was undertaken in 1979, when 241 workers were trained. Results of early evaluations were encouraging, and plans were made to expand the project in 1980.     

The Impact of the Use of Energy Sources on the Quality of Life of Poor Communities

Over the last few decades, the energy literature has been dominated by a theory of transition. The theory of transition is based on the notion that households gradually ascend an ‘energy ladder’, which begins with traditional biomass fuels (firewood and charcoal), moves through modern commercial fuels (kerosene and liquid petroleum gas (LPG)) and culminates with the advent of electricity. The ascent of the ‘energy body’, though not fully understood, is thought to be associated with rising income and increasing levels of urbanisation. Empirical evidence on energy and poverty issues has been to suggest that reality is rather more complex than the simple transitional theory would appear to suggest. To choose an appropriate set of indicators to measure the impact of electrification, this paper takes three basic different perspectives on human welfare, namely, basic needs, monetary, and non-monetary into consideration. According to the basic needs approach, welfare relates to people’s ability to satisfy their basic material needs. In the monetary approach it is a generally accepted view that the purchasing power of the household provides the best overall indicator of welfare. According to the non-monetary approach there has been a trend towards complementing economic measures of deprivation with non-monetary measures to obtain a multidimensional view of human well being, particularly by tracking health and education indicators. In the rest of the paper the two primary research projects conducted in two provinces in South Africa, namely KwaZulu-Natal and Limpopo, will be discussed. The one research project is still in process. However, the methodology will be discussed. In this project a comparison will be made of households’ experiences in villages with and without electricity to see if and to what extent electrification contributed to the welfare of the communities. In the second project households were interviewed about their experiences in the use of paraffin as source of energy.     

A study in family planning communication—Direct mailing

It is sometimes stated that direct mailing to individuals in developing countries like India may be wasteful due to the low literacy rate among village people. Direct mailing is a relatively new development in India and comparatively a newer channel of communication. An exploratory study was carried out by the Central Family Planning Institute to test this hypothesis. The observations made showed that direct mailing is practical, controllable, inexpensive, and useful.The information provided by direct mailing seems to cross the barriers of illiteracy. Based on this experience, the Central Family Planning Institute has initiated a large-scale communication action research project in Meerut district in North India where the impact of direct mailing on specific groups is being studied further. It is hoped that such studies would help in developing prototype information material and would provide a methodology to supplement the available channels of communication in a nation-wide family planning program.     

Impacts of behavioral intentions,social support,and accessibility on contraception: A cross-cultural study

Multivariate analysis of survey data from women at risk of pregnancy in three cultures (Venezuela, Kenya, and Philippines) are used to examine the relative impacts of socio-demographic and personal psychological determinants on contraceptive intentions and actions. The analyses show that the impacts of behavioral intentions on contraceptive actions vary significantly by cultures and socio-demographic strata. The consistency between contraceptive intentions and actionalso varied significantly by several social psychological factors which are discussed. The analyses revealed that within a given cultural and sociodemographic setting, contraceptive action is a function of the additive effects of these factors: specific behavioral intentions, social support, accessibility of services, and the action situation. The paper discusses implications for research and policy.Please send request for reprints to Snehendu Kar, School of Public Health, University of California, Los Angeles, CA 90024.This is a revised version of a paper presented at the 89th Annual Convention of the American Psychological Association, held in Los Angeles, CA, August 24–28, 1981.This research was made possible through grants from the Office of Population and Humanitarian Affairs, Agency for International Development, Washington, D.C., and from the United Nations Educational, Scientific and Cultural Organization (UNESCO), Paris. The authors extend special thanks to Dr. Ramon Gonzales-Cerrutti, codirector of the Field Trial project in Venezuala; to Dr. Gloria Feliciano, Dean, Institute of Mass Communication, University of the Philippines, codirector in the Philippines; and to Cynthia Dean and Joseph Mbindyo, who assumed major responsibilities for the field operations in Kenya. The Institute of Development Studies, University of Nairobi, provided administrative support for the project in Kenya. In Venezuela, the Association Venezolana de Planificacion Familiar supported the initial phases of the project, while the Ministerio de Sanidad Asistencia Social supported the later phases. These institutions deserve special recognition for their administrative support, without which these baseline surveys could not have been implemented.     

西部地区“少生快富”工程总体状况分析

“少生快富”工程是国家针对西部地区推出的一项计划生育利益导向政策。其目的是鼓励少生和促其脱贫致富相结合。本文首先介绍了该项工程到目前为止的实施情况。然后分析了该工程在全国的总体运行状况。紧接着．笔者分析比较了各省区在运行该工程方面的异同。最后,在了解情况基础上,对该项政策做了深层次的思考：该工程更为重要的意义：和养老保险的对接;与城镇化战略的呼应。     

Responding to the Psychological Context of Extreme Poverty: Using Cash Transfers to Stimulate Productive Investment Decisions in Bangladesh

The extreme poor in Bangladesh suffer from a particularly severe form of multidimensional poverty. Despite opportunities for investment made available by approaches such as microfinance, which could ensure future subsistence and graduation from poverty, the extreme poor continue to under-invest in long-term income-generating activities. This continued prioritisation of immediate needs perpetuates poverty, and often leads to its intergenerational transfer. While the evolving debate on multidimensional poverty has helped to unpack the structural causes behind this investment behaviour, very little literature has sought to understand the decision process itself. In this paper, we argue that investment decisions by the extreme poor are shaped by the psychological context of life in extreme poverty. We propose a psychological model of how extreme poverty—which is multidimensional as well as commonly chronic—affects the decision-making context of the individual, causing the future to be heavily discounted and inhibiting investment. The psychological impact of extreme poverty could be seen as an overarching and under-emphasised dimension of poverty itself due to its role in undermining the capability to invest, and impeding the long-term security of a household. We argue for a holistic approach to extreme poverty and wellbeing, involving a greater understanding that people’s own perceptions of agency and needs impact upon decision making for the present and the future, in this case specifically towards livelihood choices likely to stimulate productive gains. Using a case study of one demand-driven conditional cash transfer project in Bangladesh, we propose that the psychological context of extreme poverty must be addressed in order to stimulate investment. An analysis of the project’s success suggests that it was able to effectively promote investment by altering the context within which investment decisions were made. The paper concludes that effective poverty reduction programming must more directly address the psychological context of poverty and decision-making, and recommends that innovative choice architecture could provide one method of doing so.     

FP client-worker interaction as an ingredient of quality of care

In order to contribute to the improvement of the clinic-level management of the family planning (FP) programs of the Philippine FP Program, an assessment was made of client-staff interactions. Data were collected during May-June 1990 from 107 FP personnel and 1440 clients using a purposive sampling procedure which identified project sites on the basis of their FP performance; evenly divided the sample between government-sponsored programs and nongovernmental organizations; and randomly drew a sample of clients which included past users, never users, and current users. Data were gathered from a survey and from observations of at least 27 client-staff interactions in each of the four project sites. The observations were followed by in-depth interviews. While the interactions were positively viewed by the clients, some of the service providers (perhaps coping with an overly large case load) tended to shorten the duration of the interaction. The recommendations which arose from this study include: 1) FP personnel in this study, who indicated a preference for recruiting new acceptors rather than motivating past users, should be given a travel allowance and time to use the effective technique of home visits to try to reduce the number of drop-outs; 2) specific topics and counseling techniques should be included in the training courses for FP personnel; 3) the clinic setting must be improved to conform to quality standards and provide privacy for clients; and 4) clinic visits should be personally satisfying for the client as well as efficient.