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.     

Corporate clinics take on a new role

The Philippines Department of Labor, in conjunction with the U.N. Fund for Population Activities, is sponsoring a pilot family planning program. The industrial program, supervised by the Labor Management Coordinating Council, aims at integrating family planning services into the health services or clinics of 1000 corporations with at least 200 employees within the 2-year period ending June 1977. Family planning seminars are conducted at 3 levels within the corporations and include training sessions for medical personnel. Companies have found that provision of family planning services is more economical in the long run than provision of family welfare services for employees and families.     

Adolescent sexuality in Asia: new focus for population policy

As the age at marriage continues to rise in East and Southeast Asia, the fertility behavior of unmarried teenagers is receiving more attention from population policymakers. In addition to fertility reduction through family planning, Asian societies today consider population planning strategies in relation to national needs and social goals, including such matters as the population's growth rate, age structure, educational quality and skills. The number of single youth in Asia is growing much more rapidly than the total youth population. By the year 2010, for example, India is projected to have nearly 70 million single teenagers, aged 15-19, 188% more than in 1980. In many developing countries today, such as the Philippines and Korea, the rising age at marriage has combined with rapid urbanization, improved status for women, and more educational opportunity to alter both the behavioral norms of young people and the traditional means of social control over youth. Studies of contemporary adolescent sexuality have been conducted in 4 Asian countries. In the Philippines an overt independent youth homosexual culture was found to exist in urban and to some extent rural areas. In Thailand research revealed little conservative resistance to family planning or to contraceptives for young unmarried people. Surveys in Taiwan indicate that behavior related to dating and choice of spouse has become more liberal, and a survey in Hong Kong revealed a higher level of premarital sex and use of prostitutes among Chinese men than expected. Population policy perspectives that need to be considered in these changing times include: 1) issues of access to family planning services by unmarried people below the legal age of maturity; 2) the development of social institutions, such as exist in Thailand and the Philippines, to guide adolescents' behavior; 3) more extensive study of adolescent sexuality; 4) establishment of the scope of family policy.     

PPAT works with private clinics and industrial enterprises

Doctors from private clinics have responded to an effort by the Planned Parenthood Federation of Thailand (PPAT) to enlist their voluntary services in support of family planning goals. The private doctors will provide contraceptive services at a nominal cost to the public or free to those who cannot pay. Representatives of PPAT, the Labor Department, the Health Department, and 31 industrial factories in Parthum Thani province met last year to work to find ways of including family planning services as part of workers' welfare in every factory. The participants recommended that family planning services should be officially included as part of workers' welfare. The National Population Clearinghouse/Documentation Center has established its home office at Bangkok. Documentary collection activity is focusing on 5 subject areas: family planning, population/demogrpahy, maternal/child health, nutrition, and primary health care. The Center has already begun to translate selected materials from English into Thai.     

Population growth and poverty in the developing world

The links between rapid population growth and the absolute poverty currently affecting 780 million people in the developing countries (excluding China and other centrally planned economies) were examined. Absolute poverty is defined as having less than the income necessary to ensure a daily diet of 2150 calories per person ($200 per person a year in 1970 United States dollars). Focus is on poverty and demography in the developing world (defining poverty; income, fertility and life expectancy; demographic change and poverty), effect of poverty on fertility, family planning programs and the poor, and the outlook for the future. Rapid population growth stretches both national and family budgets thin with the increasing numbers of children to be fed and educated and workers to be provided with jobs. Slower per capita income growth, lack of progress in reducing income inequality, and more poverty are the probable consequences. Many characteristics of poverty can cause high fertility -- high infant mortality, lack of education for women in particular, too little family income to invest in children, inequitable shares in national income, and the inaccessibility of family planning. Experience in China, Indonesia, Taiwan, Colombia, Korea, Sri Lanka, Cuba and Costa Rica demonstrate that birthrates can decline rapidly in low income groups and countries when basic health care, education, and low-cost or free family planning services are made widely available.     

India's population: second and growing

Attention in this discussion of the population of India is directed to the following: international comparisons, population pressures, trends in population growth (interstate variations), sex ratio and literacy, urban-rural distribution, migration (interstate migration, international migration), fertility and mortality levels, fertility trends (birth rate decline, interstate fertility differentials, rural-urban fertility decline, fertility differentials by education and religion, marriage and fertility), mortality trends (mortality differentials, health care services), population pressures on socioeconomic development (per capita income and poverty, unemployment and employment, increasing foodgrain production, school enrollment shortfalls), the family planning program, implementing population policy statements, what actions would be effective, and goals and prospects for the future. India's population, a total of 684 million persons as of March 1, 1981, is 2nd only to the population of China. The 1981 population was up by 136 million persons, or 24.75%, over the 548 million enumerated in the 1971 census. For 1978, India's birth and death rates were estimated at 33.3 and 14.2/1000 population, down from about 41.1 and 18.9 during the mid-1960s. India's current 5-year plan has set a goal of a birth rate of 30/1000 population by 1985 and "replacement-level" fertility--about 2.3 births per woman--by 1996. The acceleration in India's population growth has come mainly in the past 3 decades and is due primarily to a decline in mortality that has markedly outstripped the fertility decline. The Janata Party which assumed government leadership in March 1977 did not dismantle the family planning program, but emphasis was shifted to promote family planning "without any compulsion, coercion or pressures of any sort." The policy statement stressed that efforts were to be directed towards those currently underserved, mainly in rural areas. Hard targets were rejected. Over the 1978-1981 period the family planning program slowly recovered. By March 1981, 33.4 million sterilizations had been performed since 1956 when statistics were 1st compiled. Another 3 million couples were estimated to be using IUDs and conventional contraceptives.     

Focus on family planning measures

A blueprint for responsible parenthood titled "The Tokyo Initiative" was drawn up at a conference sponsored jointly by the Japan Science Society and the Population Crisis Committee in April 1977. Representatives of several U.N. agencies and nongovernmental organizations participated. The blueprint urges additional resources to make family planning services available in rural areas and unserved areas of cities. Expanded social and economic roles for women were also recommended since it was felt that unless women were allowed to participate in family and community decision-making, "programs for responsible parenthood will be doomed to failure." Adolescents should be educated about reproductive behavior, stressing the adverse effects of early pregnancy. Integrated family planning services which serve the cause of infant and child health and total responsibility for program design be placed as close as possible to people affected. The conference then issued a call for action to implement these family planning objectives.     

Population policy in India

The financial allocations made for the family planning program in India since the early 1950s suggest that a very high priority is attached to population control policy. At the current rate of exchange, the public sector investment will have been over 5.3 billion U.S. dollars by the end of the Seventh Five Year Plan, 1985–1990. It is claimed that over 85 million births have been averted over the last three decades. The number of couples currently protected by the various contraceptive methods, as of March, 1987, is estimated to be 55 million, or 41.4% of the 132.6 million eligible couples with wives 15–44 years-old.The long-term goal of the national population policy is to attain replacement level fertility (approximately 2.3 children) per couple by the turn of the century, implying a crude birth rate of 21 and a death rate of 9 per 1,000 persons. In view of very slow progress in the reduction of the crude birth rate, particularly in the Hindi-speaking populous states of Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, and Haryana, the target for the country as a whole is most likely to be reached by 2010–2015 A.D.The observed stalled decline in the crude birth rate between 1975 and 1984 at the national level is analyzed in terms of changing age-sex composition, marital status, set-back to the family planning efforts, and other factors.The long-term projections indicate a national population of 996 million by the year 2,000 A.D., and 1,336 million in the year 2030 A.D. Further, for the very long run, a stationary population of 1.7 billion is hypothesized for India in the middle of the 22nd century.The data analyzed in this paper was collected in 1986 at the Delhi School of Economics through the courtesy of the Shastri Indo-Canadian Institute, Calgary/New Delhi. Appreciation is expressed to both institutions and to Drs. P.P. Talwar, M.K. Premi, K.B. Pathak, and Dr. Ashish Bose. Please direct correspondence to Dr. Chaudhry, Department of Political and Economic Science, Royal Military College of Canada, Kingston, Ontario, Canada K7K 5L0.     

Family planning as preventive health measure

The link between health and family planning efforts in the Philippines goes back to the beginnings of the National Population Program. In this interview, Dr. Dumindin of the Ministry of Health (MOh) discusses the impact of family planning on health. The family planning program of the MOH, since its inception in 1970, has undergone expansion and taken new initiatives and directions to meet the changing needs of the target clientele. Family planning information, education, and motivation is provided and maintained during routine prenatal, natal, and postnatal clinic and field activities. As of January 1986, the MOH had a total of 2100 clinics--rural health units, medical centers, hospitals, mobile clinics, and special clinics--all over the country. It is estimated that the Ministry's family planning activities have averted around a million births. It is hoped to extend the coverage of the programs to areas that have not been reached before, through further community involvement, by enlisting the participation of more workers in the community, training them on integrated health and family planning services, setting up more service facilities and clinic extensions, and by improving contraceptive use-effectiveness. Hopefully, the Philippine people will become less program-dependent and more self-motivated, and they will recognize the need for birth spacing, birth limiting, and total health care--not as suggested from the outside, but coming from within themselves.     

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.     

Thinking about several problems of the research of our family planning strategy]

On the basis of 1982 census data, it is estimated that from 1987-1997 13 million women will enter the age of marriage and child-bearing each year. The tasks of keeping the population size around 1.2 billion by the year 2000 is arduous. Great efforts have to be made to continue encouraging one child/couple, and to pursue the current plans and policies and maintain strict control over fertility. Keeping population growth in pace with economic growth, environment, ecological balance, availability of per capita resources, education programs, employment capability, health services, maternal and child care, social welfare and social security should be a component of the long term development strategy of the country. Family planning is a comprehensive program which involves long cycles and complicated factors, viewpoints of expediency in guiding policy and program formulation for short term benefits are inappropriate. The emphasis of family planning program strategy should be placed on the rural areas where the majority of population reside. Specifically, the major aspects of strategic thrusts should be the linkage between policy implementation and reception, between family planning publicity and changes of ideation on fertility; the integrated urban and rural program management relating to migration and differentiation of policy towards minority population and areas in different economic development stages. In order to achieve the above strategies, several measures are proposed. (1) strengthening family planning program and organization structure; (2) providing information on population and contraception; (3) establishing family planning program network for infiltration effects; (4) using government financing, taxation, loan, social welfare and penalty to regulate fertility motivations; (5) improving the system of target allocation and data reporting to facilitate program implementation; (6) strengthening population projection and policy research; (7) and strengthening training of family planning personnel to improve program efficiency.     

Indonesia: family planning target stepped up for 1980; twofold success of integrated project

The recruitment of 3 million additional family planning acceptors for the fiscal year 1979/80 was the target of Indonesia's family planning program. Available data shows that Indonesia was the 1st country in the world to have consumed 200 million cycles of contraceptive since the program's inception 9 years ago. The achievement of a lower birth rate of between 20 and 22 per 1000 (present rate is approximately 38/1000) is possible within the next 10 years should the program maintain its present pace. Education of women; health of pregnant mothers, and nutrition of children are factors which strongly affect family planning. Current conditions are such that 30% of children aged 0 to 6 years and a large proportion of mothers are malnourished. A coordinated family planning-rural development project launched by the Indonesian Planned Parenthood Association and Indonesian Women's Association was launched 2 years ago and has proved successful. The project's core activity is the organization of income-generating projects such as poultry-raising, vegetable cultivation, handicrafts and small industries. Family planning and other health measures (eg, environmental sanitation) were also promoted. The project utilized selected cadres of married women who were then trained in community development. These women became trainers in their own villages. The project proved to be successful in terms of income-generating activities for the women and in terms of gaining 623 new family planning acceptors within a period of 5 months.     

After the demographic transition: policy responses to low fertility in four Asian countries

In the low fertility countries of South Korea, Taiwan, Singapore, and Thailand, policy-makers are concerned about the consequences of low growth. In South Korea, a family planning (FP) program was instituted in the early 1960s, and fertility declined to 1.6 by 1987. Rural fertility is still higher at 1.96, and abortion rates are high. 32.2% of fertility reduction is accomplished through abortion. South Korean population will not stabilize until 2021, at 50.6 million people. The elderly are expected to increase and strain housing, energy, and land resources. Government support for FP is being reduced, while private sector services are being enhanced. Government sterilization programs have been reduced significantly, and revisions in the Medical Insurance Law will cover part of contraceptive cost. Integrated services are being established. Many argue for an emphasis on birth spacing, child and family development, sex education, and care of the elderly. In Taiwan, replacement level fertility was reached in 1983. Policy in 1992 recommended increasing fertility from 1.6 to 2.1. The aim was to stabilize population without pronatalist interventions. Regardless of policy decisions, population growth will continue over the next 40 years, and the extent of aging will increase. In Singapore since the 1960s, the national government focused on encouraging small families through fertility incentives, mass media campaigns, and easy access to FP services. Fertility declined to 1.4 in 1988. Since 1983, government has established a variety of pronatalist incentives. In 1989, fertility increased to 1.8. The pronatalist shift is viewed as not likely to succeed in dealing with the concern for an adequate work force to support the elderly and economic development. In Thailand, fertility declined the fastest to 2.4 in 1993. The key factors were rapid economic and social development, a supportive cultural setting, strong demand for fertility control, and a successful FP program. The goal is to reduce fertility to 1.2 by 1996. Replacement level may be reached in 2000 or 2005. Future trends are not clear.     

Fertility concept changes with economic development

In 1985, a policy of allowing rural single daughter families to have a 2nd birth was practiced in the Datuan Village of the Xingfu Town in the Zhifu district, about 10 kilometers to the north of the Yantai City, Shangdong Province. Since the practice, 80 single-daughter families (26% of the total) have signed contracts of their own accord with the villagers' council, indicating they would have only 1 daughter in their lifetime. Clearly, family planning has been deeply rooted among the people in this area, and the childbearing concept of farmers is shifting along with economic development. Efforts have been made to accelerate the development of the rural economy and to increase the income of farmers. In Datuan Village, due to the vigorous development of the village-operated enterprises, the gross income of industry and agriculture in the village has increased from 1.958 million yuan RMB in 1980 to 4.769 million in 1986, with an average income ranging from 250-617 yuan. With the improvement in the living standard, people are willing to pursue a modern lifestyle, and the traditional childbearing concept is fading. It is necessary to provide good family planning publicity and services while the collective economy develops. The Datuan villagers now have a better understanding of family planning and have become more voluntary in the practice of family planning. There has not been a single unplanned birth since 1980.     

Community and contraceptive choice in rural Thailand: A case study of Nang Rong

This paper blends quantitative with qualitative data in an investigation of community and contraceptive choice in Nang Rong, Thailand. Specifically, it develops an explanation of 1) method dominance within villages, coupled with 2) marked differences between villages in the popularity of particular methods. The quantitative analysis demonstrates the importance of village location and placement of family planning services for patterns of contraceptive choice. The qualitative data provide a complementary perspective, emphasizing the importance of social as well as physical space and giving particular attention to the structure of conversational networks.     

The dynamics of contraceptive adoption in Bohol,Philippines: 1976-1978

A researcher analyzed 1976 and 1978 data on 414 rural women who had never used a family planning method to prevent pregnancy and lived in the predominantly Catholic island province of Bohol in the Philippines to look at the influence certain aspects of the family planning program, begun in 1976, as predictors of changes in contraceptive behavior. 34.5% accepted contraception between 1976-1978. The researchers learned that couple traits (e.g., age, income, education, and religiosity) had only an indirect effect on change in contraceptive behavior. A desire to stop, limit, or space births (motivation) was a strong predictor of family planning method acceptance (p.001). Further couples who clinic providers contacted the most often or who had received more family planning services (services) were much more likely to use contraceptives (p.001). Indeed a significant relationship existed between motivation and services (p.001). Moreover couples who were truly motivated to use family planning methods did not let distance to family planning services prevent them from seeking these services (p.001). On the other hand, couples who confronted personal obstacles to family planning including social, psychological, and other subjective costs (cost index) tended not to accept family planning methods (p.001). A negative association existed between services and location of households vis a vis the intervention program (p.001) which indicated that the program did have an effect in the area of the province where it was located. In conclusion, the strongest predictors of change in contraceptive behavior included motivation, services, and cost index. Services and cost index indicated the great importance of interpersonal and/or client staff contact, especially since they were more important in influencing behavior change than distance and family planning site.     

中国人口出生控制成效的比较分析

中国 ①的计划生育工作起始于 2 0世纪 5 0年代。从 1 95 5年到 1 971年 ,中国推行的是一般性的家庭计划生育政策 ,从 1 971年至今 ,中国推行的是家庭计划生育与国家计划生育相结合的政策。如果不实行任何形式的计划生育政策 ,2 0 0 0年末中国人口将会达到 1 8 5 8亿 ,如果象印度那样只倡导自愿实行家庭计划生育 ,将会达到 1 5 3 2亿。过去 45年中 ,中国一共少生了 5 88亿人 ,其中由于实行国家计划生育政策少生了 2 6 2亿人 ,而一般性的家庭计划生育政策少生了 3 2 6亿人。计划生育为中国的社会经济发展做出了巨大的贡献     

Health on wheels: public service of a private hospital

This article describes the history and activities of the mobile clinic field by the Lorma Medical Center in Carlatan, San Fernando, in the province of La Union. The clinic is free and offers integrated medical services to 4-5 baranguays (villages) per day, averaging 861 cases including an average of 86 family planning cases. The clinic is part of Lorma's Outreach Program which includes a daily radio program answering questions on "Better Health for You and Your Family," a seminar program for local, voluntary health assistants and an "Adopt a Family" program in which nursing students visit and care for an indigent family throughout their training. In September 1977, a mobile vasectomy clinic will begin daily rounds. The mobile clinic program has little access to remote areas because the van cannot navigate the narrow, bumpy roads. However, funding is the program's only real limitation and its possibilities for improved health and family planning services are very great.