Integrating family planning with nutrition and parasite control

At the Inter-Governmental Coordinating Committee Workshop on an Integrated Approach towards Family Planning and Health Programs held at Kuala Lumpur from March 23 to 25, 1977, the feasibility of integrating family planning with nutrition and parasite control through the proper planning of motivational considerations, resource allocation and coordination was studied in detail. Discussion focused on the experience of participating countries in generating community participation in total health programs. Malaysia reported that in the expansion of the national program into the rural areas functional integration has been the approach. In Indonesia nutrition has been an important objective of maternal and child health services. A total integrated development approach has been the objective in the Philippines where family planning information-education-communication has been integrated with nutrition programs and a pilot project on integration of family planning and parasite control has been conducted. Thailand reported on the introduction of an integrated family planning and parasite control program, while Sri Lanka reported on an integrated approach that included family planning with maternity and child health services. A recommendation of the meeting was that experimental pilot projects be established which include nutrition and parasite control elements within the framework of family planning services.     

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.     

A cost benefit analysis of the barbados family planning programme

Abstract Of the Caribbean islands, Barbados has the lowest fertility level. The crude birth rate in 1970 was only 20·5 per 1,000, which is one of the lowest found in any country of similar economic development anywhere in the world. In 1960 the crude birth rate was much higher, at about 33·6 and for almost 40 years before that had fluctuated around a value of 33. Thus, a decline of about 40% has been achieved within the comparatively short period of a decade. The reasons for this rapid decline are of particular interest to all those concerned with population growth and economic development in the less developed areas. In Barbados, the importance of population control and the role of family planning was recognised early by the government and other civic agencies, and the Barbados Family Planning Association (BFPA), an autonomous national family planning agency, was established. Since its modest beginning in 1955 the BFPA has grown to be a major social institution, comprising 14 clinics situated in various localities throughout the island. In 1970, a full-time staff of 28 were providing services to an estimated 10,000 clients, about 20% of all women of reproductive age. Funds for the BFPA have come from local government with considerable assistance from international agencies.     

The National Conference of Propaganda Work on Family Planning held Beijing]

The National Conference on Propaganda Work in Family Planning, held in Beijing from November 1-6, 1982, was sponsored by the the Propaganda Department of the Chinese Communist Party Central Committee and the National Family Planning Committee. Among the 136 participants were representatives from various provincial, city, and autonomous region propaganda and family planning units, the General Political Department of the People's Liberation Army, general trade unions, All China Women's Federation, Communist Youth League, and propaganda reporters. The purpose of the conference was to discuss how to organize family planning propaganda in meeting China's goal of limiting the population to 1,200,000,000 by 2000, and how to arrange a Family Planning Propaganda Month for early 1983. The Chairman of the National Family Planning Committee made 3 points: family planning is a basic national policy, greater propaganda efforts must be made towards peasant family planning, and everyone must work hard to create a new situation in family planning work. The Vice Minister of the Propaganda Department remarked that family planning propaganda was foremost among the 12 national propaganda topics; these sentiments were supported totally by the representatives of the women and youth groups. The Vice Chairman of the Advisory Committee of the Central Committee said that family planning work was longterm, and that its success lay in the countryside. Finally, the Vice Chairman of the National Family Planning Committee encouraged all delegates to take the spirit of the conference back to their home. During the conference delegates also met to discuss important points in planning the Family Planning Propaganda Month.     

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.     

Hong Kong: The Family Planning Association continues its pioneering role

Vital population statistics for Hong Kong are mentioned. The 1st efforts at providing birth control services in Hong Kong began in 1936 with the Eugenics League. The League was reorganized and formed into the Family Planning Association of Hong Kong (FPAHK) in 1950. The government began providing family planning services in 1974. Although there is no governmental incentive/disincentive policy, certain laws and practices do have the effect of encouraging population growth limitation. These are described. The FPAHK directs its efforts toward motivational activities. The Association is encouraging the concept of male responsibility for family planning. Personal visits to fisherfolk families have been instituted to combat their tendencies toward large families. Various separate activities of the government program and the FPAHK are discussed.     

Pakistan: FPAP projects reflect integrated approach

The Family Planning Association of Pakistan has conducted a number of projects reflecting the government's integrated approach to family planning. The youth project aims at alerting young people to the need for family planning. A full-scale feasibility scan was conducted prior to implementation of the project to determine the best way to reach people. Volunteers were recruited among college students. The project's strategy for 1979 included organization of a youth leadership national workshop and oratorical contest on the topic, "Whatever your cause, it is a lost cause without population planning." Other FPAP projects include a group of "better living projects" which aim to educate young mothers in child care and family nutrition. Projects in the organized sector include a program at the Pakistan Mint, where a motivation center and clinic are set up. Training projects concentrate on fieldworkers and traditional birth attendants (dais). A 3-day course for dais includes reorientation on septic deliveries, child care, maternity care, and record keeping. In the cities, FPAP has a network of multipurpose centers in slum areas, where adult education and income generating activities are integrated with family planning.     

Implementation of China's population policy

On July 1, 1982 China's 3rd national population census reported the population of the 29 provinces, municipalities, and autonomous regions on the mainland at 1,008,175,288, showing a net increase of 460,000,000 or 84% over the 548,000,000 recorded at the end of 1949. At this time China's population is about 1/4 of the world. Its population policy must conform to her national conditions and will be successful only to the extent that it does so. Discussion focuses on the main features of China's population policy. In 1953 the State Council instructed the Ministry of Health to support birth control by providing contraceptives. It also ratified provisions concerning contraception and induced abortions. In 1962 the State Council issued "Instructions on Conscientious Advocacy of Family Planning." China not only advocates and publicized family planning but also takes specific measures. Special administrative organizations were established in 1964 to oversee scientific research, production, and supply of contraceptives and to provide couples of childbearing age with free contraceptives. An all round attack on family planning work in 1966 led to unchecked childbirth resulting in rapid population growth. In 1971 Premier Zhou Enlai reiterated the importance of population control in 1971 and asked that it be incorporated into the 4th Five Year Plan for the development of the national economy. Family planning was incorporated into the Constitution in 1978. China's 20 years of experiences with family planning suggest that a country's population policy becomes effective only with repeated efforts. The 10-year period of turmoil undermined the enforcement of the population policy. Recently the State Family Planning Commission organized a nationwide fertility survey which indicated tremendous successes for China's population control drive. The total fertility rate dropped from 5.29 in the 1950s to 2.63 in the 1980s. The population census shows that the momentum of China's population growth cannot be checked without strict measures because the population is characterized by a huge base figure, a young age composition, and a fertility rate much higher than a population replacement level. China's population policy is formulated in line with her national conditions. Specific provisions for family planning reflect different ways to deal with different people.     

Current status of and prospects for China Population Information Centre

The China Population information Centre (CPIC), set up in May 1980, is a national institution for population information research under the State Family Planning Commission. Its main functions are to 1) collect, process, and distribute and foreign materials on population and family planning; 2) collect, tabulate, and analyze population and family planning data; 3) keep abreast of new population and family planning developments within and outside the country; 4) edit and publish information materials; and 5) provide information users with diversified services. The CPIC has 8 operational units: 1) the Library, 2) the Statistics Division, 3) the 1st Information Research Division, 4) the 2nd Information Research Division, 5) the Editorial Division, 6) the Translation Division, 7) the Computer Division, and 8) the Technical Support Division.     

World Population Day '93 observed

President Abdur Rahman Biswas inaugurated the World Population Day '93 at the Osmani Memorial Hall in Dhaka, Bangladesh, on July 11. He stressed the importance of reducing the national population growth rate from 2.03% in 1923 to 1.82% by the 1995. The event was organized jointly by the Ministry of Health and Family Welfare, the Directorate of Family Planning, and the United Nations Population fund (UNFPA). The president expressed his deep concern over the population growth rates in developing countries, which are much higher than resources. He noted with satisfaction that 40% of the eligible couples in the country practice family planning (FP) and expressed hope that this could be raised to 50% by 1995. If the program becomes successful, ideal families would consist of two children by 2005. He later presented prizes and certificates to field workers, ulemas, traditional birth attendants, FP depot holders, and the workers of nongovernmental organizations for their commendable services in Fp and maternal-child health services. The Health and Family Welfare minister in his speech warned that if the current population growth is not checked, the consequences would be disastrous, which could be averted by adopting new strategies. The deputy minister for Health and Family Welfare illustrated the threat of population escalation and recounted some of the recent government control measures. The secretary, Ministry of Health Family Welfare, said that at the present rate of growth the Bangladeshi population would double in 34 years. The director general, Directorate of Family Planning, said that the FP program has become accountable with a system of incentives and disincentives. Earlier, the UNFPA country director in his speech remarked that it was crucial for the entire world to solve the population problem. In the morning, in the main cities, hundreds of people involved in national FP activities paraded to demonstrate the social legitimacy of the Bangladeshi Fp program.     

Do incentives matter? – Evaluation of a family planning program in India

Indian Family Planning programs in the past haveintroduced a number of approaches such as providingmonetary benefits, and motivational programs toimprove contraceptive use among rural illiteratewomen. Under the Ammanpettai family welfare program,the Melatur PHC administered three program typesinvolving a combination of monetary and motivationalapproaches to improve contraceptive use in threetreatment areas. The program was introduced duringJanuary 1989 and was simultaneously discontinued aftera period of two years. The present evaluation wasconducted in 1994. Data from a random sample of 933non-sterilized women at the time of social surveyusing a questionnaire approach is used in this study. The implementation of incentive programs in asocio-economically homogenous population has resultedin an increase in the likelihood of current ofcontraceptive use. The results of this study suggestthat motivational programs are more likely to improvelong term use of temporary family planning methodsthan cash incentive programs. One implication of ourfinding is that motivational programs should provide peer based family planning education and training incommunity work to contact persons who make door todoor visits to promote family planning programs.     

Deworming/family planning project launched on estate

A deworming/family planning project funded by JOICFP was successfully initiated in Kerling Estate, Kuala Kubu Bahru, Malaysia. Rapport between estate management, workers, and the National Family Planning Board helped establish the project. A recent Gotong-Royong or community self-help project had encouraged enthusiasm among workers to clean up the estate. Mothers were exhorted to plan their families and devote attention to the health and welfare of the children. The need for parents to understand the causes of infestation and educate their children to wear slippers or shoes and develop good toilet habits was emphasized by Dr. Nor Laily Aziz. Continuing National Family Planning Board and Government support was pledged.     

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.     

Pakistan: family planning expands in non-governmental organizations

The Family Planning Association of Pakistan has begun a program of integration of family planning activities with other voluntary welfare agencies. 1 of the more successful projects has been in cooperation with the Family Welfare Cooperative Society of Lahore. Volunteers have provided facilities to very low-income women to help supplement income. At 1st it was knitting, embroidery, and cloth manufacture, but over several years it developed into a complex of several buildings with a comprehensive vocational training center, a showroom, schools for the children of mothers in training, a secretarial school, and a hostel for homeless women there. There is a medical unit, a full-time doctor, and family planning services.     

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.     

论计划生育“三结合”模式的科学性

计划生育“三结合”由吉林省率先提出近十年,并已被国家充分肯定。十年来的实践已证实了计划生育“三结合”的正确与可行,尚缺少理论上的深入研究,经在国家计生委立项的“计划生育三结合之路研究”的软课题中找到了计划生育三结合提出的理论依据,进一步论证了计划生育三结合的科学性。     

To raise the family planning work to a new level--a comprehensive introduction to the National Family Planning Working Conference]

The National Family Planning Working Conference convened on August 10-16, 1982 in Beijing, China. Among the 250 conferees were family planning representatives from various provinces, cities, autonomous regions, the People's Liberation Armt, representatives of partial progressive areas, counties, communes, the Central Committee, State Council, All China Women's Federation, All China Federation of Trade Unions, journalists and population theorists. Topics of discussion included the current situation of family planning work, how to implement the Central Committee's directive on improving family planning work, and the relationship between population law and population development by the year 2000. On August 18 Premier Zhao Ziyang told various representatives at a meeting that population control was a longterm national policy and emphasized its importance in long-range economic and social planning. The Vice-premier of the Chinese People's Political Consultative Conference, Wang Shoudao, implored the representatives to understand the directive's contents and said family planning would serve later generations. The Chairman of the National Family Planning Commission, Quian Xinzhong, reviewed the current population situation, noting the encouraging fact that the birth rate for the first 6 months of 1982 was higher than the first 6 months in 1981 by only 1/1000. In order to raise birth control work to a new level, he suggested the following steps: strengthen family planning propaganda; strenuously follow the policy of 1 child per family; obtain permission to have a 2nd child; oppose unplanned births; establish various birth control responsibility systems; and improve contraceptive research and techniques.     

Bangladesh

In Bangladesh the Population Control and Family Planning Division of the Ministry of Health and Population Control has decided to delegate increased financial and administrative powers to the officers of the family planning program at the district level and below. Currently, about 20,000 family planning workers and officials are at work in rural areas. The government believes that the success of the entire family planning program depends on the performance of workers in rural areas, because that is where about 90% of the population lives. Awareness of the need to improve statistical data in Bangladesh has been increasing, particularly in regard to the development of rural areas. An accurate statistical profile of rural Bangladesh is crucial to the formation, implementation and evaluation of rural development programs. A Seminar on Statistics for Rural Development will be held from June 18-20, 1980. The primary objectives of the Seminar are to make an exhaustive analysis of the current availability of statistics required for rural development programs and to consider methodological and operational improvements toward building up an adequate data base.     

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.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.