Integrating family planning with development programmes

20 experts at an ESCAP meeting discussed linking family planning programs to such development programs as rural health projects or maternal and child health projects. Linkages must occur to integrate specialized programs and between programs on central and local levels. The human needs in various areas determine the linkages that can be formed. Linkages which already exist can serve as models for future linkages. Barriers of authority in the bureaucracy must be broken down. Personnel to administer these linkages must be trained, and money to fund the linkages must be obtained. Studies should be done which evaluate such integration projects, how each of the component programs is affected, and how the processes in forming the linkages differ.     

Desired family size in Thailand: Are the responses meaningful?

Data for both rural and urban women in Thailand indicate that the large majority of respondents are able to provide numerical responses to questions on desired family size. Although there is evidence that some women tend to rationalize the number of children they have when stating the number they would want if they were recently married, the vast majority of respondents prefer a number which is different from the number of living children they had at the time of the interview. Women who had already reached or exceeded their desired number were almost universal in stating they wanted no additional children, whereas only a minority of women who had yet to reach their desired family size said they wanted no more children. Finally, the proportion of women who practiced family planning is substantially greater among women who had already achieved or exceeded their desired family size than among women who had fewer than their desired number. The results thus suggest that, in Thailand at least, responses to family size preferences need to be interpreted with caution but nevertheless can be of use to the population analyst.     

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.     

Desired family size and its determinants among urban Nigerian women: A two-stage analysis

This paper proposes and carries out a two-stage analysis of the determinants of desired family size, using data gathered from a sample of women in the city of Ilorin, Nigeria. The analysis first focuses on differences between women who report numerical family size desires and those who report nonnumerical desires. Findings suggest that there are important differences between these two groups, but there is little variation in the actual number reported by those expressing numerical desires. Implications of these findings for survey design are discussed. In particular, the practice of forcing numerical responses by instructing interviewers to probe when women report nonnumerical desires is questioned.     

Sri Lanka: current status of family planning

In Sri Lanka the family planning program is closely related to socioeconomic and cultural variables. The expectation is that in the near future family planning will be included as a component of a network of social services. The official program is a response to the economic necessities and welfare demands of individuals and families. The method of family planning most frequently requested is female sterilization, and no attempts are being made to direct people to other methods. 12 United Nations Fund for Population Activities assisted projects have provided the framework and basis for the institutional coverage of family planning activities in Sri Lanka. However, the experience of these projects revealed a lack of facilities, shortage of personnel and management inadequacies, all related to the delivery of family planning services. The following steps are suggested as a means of overcoming the current problems and expanding the program: 1) establish a pattern of interacting relationship between the mass media, community health education and the available services; 2) provide an operational approach to program management, monitoring and periodic reviews of the program; 3) involve the private sector health facilities; and 4) incur additional capital cost to increase the capacity for delivery of better health facilities and personnel.     

颁布、施行人口与计划生育法对人口与计划生育工作的挑战

颁布、施行人口与计生法为加强人口与计生工作提供了法律保障 ,无疑是一件大好事。但是 ,特殊的国情决定了实施人口与计生法会遇到许多困难和问题 ,对人口与计生工作的思路、方法 ,对人口与计生工作的任务、要求 ,对人口与计生工作的作风、工作效率 ,等等 ,都是一种挑战。因此 ,我们必须采取有力措施 ,积极应对这种挑战 ,切实搞好依法管理 ,依法实行计划生育     

Subjective efficacy and ideal family size as predictors of favorability toward birth control

This study is an assessment of the relevance of subjective efficacy and ideal family size as predictors of favorability toward birth control. The samples considered are male factory workers in five developing nations. The effects of ideal family size and subjective efficacy are generally strong relative to those of education and the other social variables that are considered. The focus of the study is an analysis of whether subjective efficacy and ideal family size function more as independent determinants or more as intervening variables. Overall these psychological variables function more as independent determinants than as intervening variables, but in some samples these two functions are equally important.     

Family planning programmes and action in Western Europe

Abstract Neo-Malthusian organisations for spreading birth control propaganda were created in many West European countries in the 1870s and '80s. But the birth control movement proper, with its provision of clinics and other means of supplying advice on contraception, began much later-generally after World War I and largely on a welfare basis, divorced from Malthusianism. Legal and other difficulties impeded progress and conditioned the nature of the movement. Since World War II, however, the relevance of birth control has come increasingly to be recognized and the movement has expanded markedly. In some countries - especially in France, West Germany and Italy - there are still legal obstacles, though ways have been found of avoiding them. But even in other countries the direct impact of birth control clinics is far smaller than might have been expected and married couples still obtain their information on contraception from other sources. In recent years the various national movements have shown a greater interest in the evaluation of their activities. As a result, the near future may see substantial changes in their structure and in the approach to their potential clientèle.     

Family planning programmes and action in Western Europe

Neo-Malthusian organisations for spreading birth control propaganda were created in many West European countries in the 1870s and '80s. But the birth control movement proper, with its provision of clinics and other means of supplying advice on contraception, began much later-generally after World War I and largely on a welfare basis, divorced from Malthusianism. Legal and other difficulties impeded progress and conditioned the nature of the movement. Since World War II, however, the relevance of birth control has come increasingly to be recognized and the movement has expanded markedly. In some countries — especially in France, West Germany and Italy — there are still legal obstacles, though ways have been found of avoiding them. But even in other countries the direct impact of birth control clinics is far smaller than might have been expected and married couples still obtain their information on contraception from other sources. In recent years the various national movements have shown a greater interest in the evaluation of their activities. As a result, the near future may see substantial changes in their structure and in the approach to their potential clientèle.     

Interaction and family planning in the french urban family

During the last two years, a survey about interaction in the couple has been conducted among 550 urban families in France by the National Center for Scientific Research, with the assistance of the United States Public Health Service. The data given here are relative to the importance of the couple's interaction in the realization of family planning goals.These data are used to answer the question, are socioeconomic variables (husband's level of education, occupation, and income, for example) more closely correlated with the success of the couple's family planning than are the variables of positive interaction (agreement, communication, and equality in decision-making, for example)?While the Indianapolis study has not answered this question, the Puerto Rican study has shown that freedom of the wife and communication between spouses were more closely connected with the success of family planning than were the husband's level of education or income. But, one might think that this result was linked to the Puerto Rican sample, in which the levels of income and education were generally low.The French survey, undertaken with a random sample stratified according to the socioeconomic level of the husband, shows that this last hypothesis is not true. Just as in the Puerto Rican study, the factors of positive interaction in the couple are more closely associated with the success of family planning-particularly with the eradication of excessive fertility-than with socioeconomic variables. These results show the importance of the couple's education as a determining factor in a successful family planning program.     

We must pay attention to the difference between the original intention and the current status of family planning]

Due to imperfections in the current family planning (FP) policy, and the differences un program implementation in urban and rural areas, the fertility of the urban population with higher IQ scores is under control but this is not the case for the rural population. Among rural couples, one child is rare and two or three are commonplace, while in cities over 70% of couples are having one child. In the metropolitan cities, this figure is about 90%. In the rural areas, provision of education is a serious problem because of insufficient resources, a lack of qualified teachers and inadequate facilities. At the present, at least 3 million school age children in rural areas can not go to primary school. Besides there is a big contrast in FP practice between Han nationality and minorities. Population growth is basically under control among the more advanced Han nationally but not among the less advances minority nationalities. This growth rate among the minority population was about 50.27/1000 in the past five years, which is alarming. Furthermore, the couples given opportunity to have a second child are often those whose first child had birth defects or is mentally retarded, whereas couples with a normal child can have only one child. This has become a vicious circle, since subsequent children are more likely to have the same birth defects. It was discovered from a 1983-85 survey that the prevalence of birth defects was 12.8/1000. The current situation is that the fertility of urban, educated, and healthy people is restricted while the less educated, those living in less developed areas, and those with health defects are having more children. The outcome of this situation is the decline of national population quality, which greatly deviates from the original intention of the FP.     

Intelligence and family size

This paper describes the results obtained in administering a modified Terman intelligence test to 327 Greek children aged from 7 to 12 years. A negative correlation between intelligence and family size was obtained. The results are compared with those obtained in similar inquiries in Britain and the U.S.A.     

Communicating population and family planning

This thorough look at the change in the American family 1900-1700 finds that 40% of marriages among women now in their late 20s may end in divorce, that the divorce rate is stabilizing, that between 1-4% of unrelated men and women are living together in informal unions (the figure made difficult to obtain by the difficulty in framing the question), that 15 million adults live alone, and that only 67% of children live with their own once-married parents. About 33% of births are premaritally conceived. The median age for mothers at birth of last child has moved downward from 33 years in the early 1900s to about 30 years. Childbearing has declined from 3.9 children per mother in the early 1900s to 2.5. The period of childbearing has been compressed to about 7 years, between ages 23-30. 10% of remarried women's children are born between marriages. 50% of pregnancies end in abortion. It was found that persons who had completed an educational level, whether it be high school or college, generally had more stable marriages; those who had not completed a level were more likely to get divorced. Despite changes in lifestyle, however, some typical family situations are experienced by most Americans. 2 of 3 marriages will last until death of 1 of the partners and most young women questioned in census surveys expect 2 children.     

Selling family planning to the farmer

Dr. Juan M. Flavier of the International Institute of Rural Reconstr uction (IIRR) found medical terms used by family planning teams had little meaning for rural audiences. In addition, the family planners lectured too much and did not truly reach their farm audiences. The Institute developed a series of materials based on agricultural parallels with captions in verse, capitalizing on the rural Filipino's love of balagtasan (debate in verse) and duplo (couplets). The IUD is likened to a stone which prevents a seed from germinating. The ill-effect of frequent childbirth is likened to a citrus tree laden with too many fruit. The program talks about birth control or limitation in number, spacing, and infertility. Dr. Flavier believes it is important to include infertility if only to show that family planning is an aid to all couples. Many times the farm illustration will spark discussion, which allows the group to bring up questions about birth control which otherwise they would not. A 3-year grant to study the IIRR approach found that this adaptive technique, though slower in the beginning, led to greater continuation rates and more confidence in family planning. It could be used in urban poor areas as well because many slum and working-class families have rural backgrounds. Also, the household illustrations (comparing a cervical cap to the lid of a pot which keeps unwanted items out) would be understandable to most women.     

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.     

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

Measurement of the quality of family planning services

The quality of health services is a subject of increasing interest to health care providers and organizations responsible for financing and promoting health services. The importance of the client's perspective (and by inference, the perspective of potential clients, as well) is now well established, but efforts to define and measure quality have thus far been limited to the perspective of experts even when the experts claim to speak for the clients. In this paper we utilize family planning programs to explore issues of the quality of health services. We propose that a better understanding of the view of quality actually held by family planning program clients will clarify the influence of quality on the use of services, a clarity that has not been possible by looking at quality only as defined by providers, managers or experts. We review the literature on quality of services and identify the gaps in research that must be filled if a better understanding of what quality is and how it relates to service outcomes is to be obtained. A first step must be the research required to develop a set of measures of quality that reflects the multi-dimensional nature of quality, includes the clients' view of services in the definition of quality, and incorporates methodologies required to ascertain the true view of clients. Finally, we suggest that dimensions of quality identified as important for clients as a group will be more predictive of use of services than dimensions identified as important to providers.     

Village family planning: the Indonesian model

The goal of the Indonesian National Family Planning Program is to reduce the 1970 birthrate by 50% by the year 2000. Since the late 1960s the government has taken an active role in family planning. The National Family Planning Coordinating Board initially concentrated on offering family planning services through health clinics on Java and Bali, but, as of 1974, family planning has been expanded to 10 provinces in the outer islands. Early in 1975 the family planning program was extended to the village through the establishment of village contraceptive distribution centers and sub-village family planning groups. The experience generated from the initiation, development and evaluation of the village family planning scheme is useful in many aspects which may be adapted in other countries of the region. The guiding concepts of Java and Bali village family planning have been non-standardization, maintaining a link to the clinic in the movement to the village, and focusing 1st on contraceptive resupply. The following conclusions can be drawn on the basis of the Indonesian experience with village family planning: 1) family planning at the clinic level alone is insufficient in the long run; 2) the village must become involved in the process of providing services; 3) the enthusiasm and imaginative response to the movement in the village has exceeded expectations; and 4) rural people are, in fact, future oriented.     

Serving the people stressed in family planning

There are 9 districts and 7 townships under the jurisdiction of Yuxi City in the Yunnan Province with a population of more than 280,000. The agricultrual population accounts for 85.3% and minority nationalities represent 11.6%. In the past few years, family planning has been carried out in an earnest way in Yuxi City. The natural population growth rate dropped from 17.5 per 1000 in the 1970s to 9 per 1000 in 1984 and the proportion of the 3rd or higher parity births dropped from 34% in 1979 to 2.14% in 1984. The workers of the Family Planning Committee of the Yuxi City program provide good service for family planning in 7 aspects; 1) publicity service; 2) economic aid for single-children households; 3) technical service for birth control; 4) welfare service; 5) health service; 6) service for infertile couples; and 7) nurseries, kindergartens and homes for the aged.