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.     

Integrated family planning/parasite control project: a different approach to community health problems

An obstacle to the acceptance of family planning is the fact that its advantages are not immediately apparent or tangible. A way to get around this obstacle is through the use of "entry points"--projects which yield tangible results in a relatively short time. Through these entry points, the fieldworker builds credibility and wins the confidence of the people in the community he or she is serving. Thus, when the time comes, the people will be receptive to the family planning message. This strategy of the use of entry points is common to integrated projects with a community development program becoming a sort of entry point for family planning fieldworkers. 1 such project, begun quite recently by the Family Planning Organization of the Philippines (FPOP) in 4 pilot sites, uses deworming as an entry point. It is officially known as the Integrated Family Planning/Parasite Control/Nutrition Project. It is 1 of several projects cosponsored and financed by the Japanese Organization for International Cooperation in Family Planning (JOICFP) and the Asian Parasite Control Organization (APCO) in almost a dozen other Asian and Latin American countries. The immediate objective of the project is to establish or increase the credibility of family planning fieldworkers among the people in a target area. Fieldwork connected with family planning is conducted alongside a related community health effort that can produce immediate and visible results. The ultimate goal is to encourage community participation to such an extent that there will no longer be a need for the fieldworker. Strategic planning involves thinking up the "backbone" and molding the "skeleton" of the project, i.e., its concept and basic policies. As the project goes into the design and development stage, additional people are drawn into it. Project experience in Thailand underscores the need to consult with local leaders. The earliest projects were initiated in 1976, but some are already showing successful results. The overall Philippine experience provided support to JOICFP Director Kunii's reiteration of his belief in the effectivity of parasite control as an entry point for population planners. Integration of the nutrition element in the project is regarded as essential.     

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.     

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.     

Combining vertical service with horizontal service to promote family planning]

How Bazhong County of Sechuan Province, China, carries out family planning through a combination of what are termed vertical and horizontal services is described. Vertical service refers to assistance such as premarital education, prenatal hygiene, child health care, and family planning, while horizontal service refers to household assistance for married women. Premarital education is designed to help young people acquire sufficent knowledge about family planning, hygiene, and eugenics, and stresses the disadvantages involved in marriages between close relatives. Prenatal hygiene provides safe and convenient medical accommodations for delivery of the child as well as maternal care. Child health services assure that the best facilities are to be made available for physical examinations, vaccinations, and medical treatment. The family planning program involves comprehensive measures such as distribution of contraceptives and safe sterilization. In addition, the county provides medical assistance for couples unable to have children. Horizontal service providing household assistance for married women promotes scientific farming (e.g., how to use fertilizer), helps people increase their income by teaching them skills, and provides social services to improve life style and education. These vertical and horizontal services have brought about substantial improvements in the standard of living, family harmony, and population control.     

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.     

Bangladesh: programs geared to meet population goals; communication as a major factor in UNFPA funded projects

The population policy of Bangladesh is aiming for a zero population growth rate at a suitable level of equilibrium. It is hoped that a net reproductive rate of 1.0 will be achieved by 1990, and that by 1985 fertility will be reduced to replacement level. Various measures to attain these goals have been suggested and they include such ones as the integration of family planning programs with other development efforts through a multisectoral approach and the introduction of incentives and disincentives for acceptance of the idea of the small family. Communications by radio and television play a critical role in the program to reduce fertility. UNFPA-funded projects emphasize education, motivation, and communication with the hope of creating a favorable attitude towards family planning and the concept of the small family. Numerous projects in progress are mentioned with regard to their current status. These projects include: rural development cooperatives and population education; pilot projects for family planning motivation and services in industry and on plantations; population education in agricultural extension; strengthening (IEM) information, education, and motivation and training; population awareness for out-of-school youth; a population education program for the Ministry of Education; and a national population information service.     

Family planning and resilience: associations found in a Population,Health, and Environment (PHE) project in Western Tanzania

Using 2016 household survey data from Tanzania, we define and measure resilience within the context of Population, Health, and Environment programming and quantify the link between resilience and family planning. We created a multicomponent model using confirmatory factor analysis in a structural equation modeling context. Factor loadings for eight defined latent factors of resilience were statistically significant (p?<?0.001). We created a factor called “FP-MCH” reflecting awareness, attitudes, and access to family planning (FP) and health care services and use of maternal and child health care (MCH) facilities. Analysis, with controls, shows that a 1 standard deviation (SD) increase in FP/MCH was associated with a 0.68 SD increase in resilience (p?<?0.01), suggesting that the association between FP/MCH and resilience is robust across a range of factors. Analyses showed that the association between FP/MCH is broadly related to the construct of resilience and not through any single component. This study supports the importance of including FP/MCH as part of integrated projects to enhance resilience.     

Pakistan: innovative population planning

In Pakistan the population planning program has been "federalized." As part of the new plan, the Population Planning Division will be responsible for policy formation, preparation of plans, and program implementation. With this new organization, the program will promote close coordination with provincial governments. An effective information program has been planned to promote pro-family planning attitudes. In order to develop these attitudes among the young, population education is being integrated into the curricula of the schools and colleges. At the policy making level, development projects of the Ministries of Education, Local Government, Rural Development, Health, Labor and Manpower Production, and Agriculture will in future be prepared so as to contain a component of the population planning program. The operational structure of the program was strengthened during 1976-1977 in order to reduce the crude birthrate from an estimated level of 45 per 1000 in mid-1976 to 43.6 per 1000 in mid-1977.     

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.     

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.     

CFPA in development

The China Family Planning Association (CFPA) was established in Beijing on May 29th, 1980 as a nongovernment organization. Its purpose and tasks are defined as uniting all the people and activitists involved with family planning to assist the government family planning units in communicating the state principles, policies and tasks on family planning, motivating the people to practice family planning voluntarily, organizing academic activities in family planning in cooperation with the related units, and promoting international exchanges and cooperation. Since its establishment, the CFPA has organized a variety of activities (communication, training, consulting) for promoting communication and education so as to spread among the masses of people the scientific knowledge about contraception, and maternal and child care. The services provided by the associations of various regions in response to the needs of the local people were greatly welcomed and highly appreciated by the people.     

Subjective Wellbeing and its Meaning for Young People in a Rural Australian Center

In Australia, wellbeing has been used as an assessment of how young people are doing by health researchers, youth researchers and psychologists. The concept ‚wellbeing’ is increasingly applied to young people in their late teens and early twenties with little discussion of young people’s perspectives. Using quantitative measures of subjective wellbeing as well as qualitative interviews to allow young people to discuss the concept of wellbeing, this study explored the levels and meanings of wellbeing among 91 young people (aged 16–24) from a rural center in south-east Australia. Key components of wellbeing for young people were found to include relationships, psychological dimensions and personal issues while family and ‚pressure’ impacted wellbeing. For most young people, wellbeing was multidimensional, holistic and centred around their own lives. Findings suggest that the Deiner et al. satisfaction with life scale was an appropriate measure of young people’s wellbeing but that health, sociology of youth and psychological approaches all contribute to young people’s perspectives of wellbeing and need to be incorporated into a more holistic measure of SWB for young people.     

Pop-ed programs for the out-of-school youth

39% of the Philippines youth are not in school and these youths receive no training for responsible parenthood and community life. A number of agencies try to reach these members of society, including the Bureau of Youth Welfare (BYW), the Family Planning Organization of the Philippines (FPOP), the Foundation for Youth Development in the Philippines (FYDP), the Rizal Youth Development Foundation (RYDF), the Philippine Rural Reconstruction Movement (PRRM), and the Philippine Youth Welfare Coordinating Committee. BYW conducts informal group sessions including discussions among 13-24 year old members who have started self-employment projects. FPOP's youth program, SIGLA, aims at developing out-of-school youths social y and having them disseminate information to other out of school youths. This information includes family development, family planning, and population-related information, and is disseminated through activities and workshops. FYDP aims at functional literacy but also disseminates family planning information to out-of-school youths. RYDF conducts week-long seminars in topics such as birth processes, family relations, and care of babies. PRRM integrates population and family planning into its nonformal education program for out-of-school youth and adults in Nueva Ecija Province. Problems encountered in these programs are 1) suspicion of parents, and 2) feelings of inadequacy on the part of teachers. While emphasis has been on unemployed youth, efforts should be made to reach those youth who are employed.     

Gender differences in knowledge and attitudes toward modern and traditional methods of child spacing in Malawi

This paper examines male-female differences in knowledge and attitudes towards traditional and modern methods of child spacing in Malawi, based on the survey on traditional methods of child spacing in Malawi which was conducted in 1988. The results show that most people in Malawi are knowledgeable about both traditional and modern methods of child spacing. In general more men than women report knowledge and practice of traditional methods. For modern methods, however, females are more knowledgeable than males of all the specific methods, with the exception of condoms. The greater knowledge by women of female-based modern contraceptives appears to be a manifestation of the exclusion of males from the family planning program. The high rates of knowledge do not translate into equivalent high rates of utilization for both modern and traditional methods of contraception. The study further demonstrates that, while women are involved in making decisions to use contraception, the proportion of men initiating such decisions is greater than that of women. This finding calls for family planning planners to think seriously about revising their target population to include men.     

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.     

Does low fertility call for new policies in some Asian countries?

Over the past 2 decades, Japan, China, Singapore, Hong Kong, and South Korea have completed a demographic transition from high birth and death rates and runaway population growth to reduced fertility and mortality and population growth approaching replacement levels. Among the outcomes of fertility decline, 3 have particularly far reaching effects: 1) Changes in family types and structures. Marriage and family formation are postponed, childbearing is compressed into a narrow reproductive span that begins later and ends earlier, and higher-order births become rare. Large families are replaced by small ones, and joint and extended families tend to be replaced by nuclear families. 2) Shifts in the proportions of young and old. Declining fertility means that the population as a whole becomes older. Decreases in the proportion of children provides an opportunity to increase the coverage of education. Increases in the proportion of the elderly means higher medical costs and social and economic problems about care of the aged. 3) Changes in the work force. There is concern that low fertility and shortages of workers will cause investment labor-intensive industries to shift to countries with labor surpluses. Another outcome may be an increase in female participation in the work force. The potential consequences of rapid fertility decline have sparked debate among population experts and policy makers throughout Asia. Current family planning programs will emphasize: 1) offering a choice of methods to fit individual preferences; 2) strengthening programs for sexually active unmarried people; 3) encouraging child spacing and reproductive choice rather than simply limiting the number of births; 4) making information available on the side effects of various family planning methods; 5) providing special information and services to introduce new methods; and 6) promoting the maternal and child health benefits of breast feeding and birth spacing.     

A look at Asia's changing youth population

This report summarizes findings from a recent East-West Center study on demographic and social changes among young people aged 15-24 years in 17 countries in East, Southeast, and South Asia. Nearly every country in Asia has experienced fertility decline. Decline began in Japan and Singapore during the 1950s, followed by declines in Hong Kong, South Korea, Sri Lanka, the Philippines, Brunei, Taiwan, Malaysia, Thailand, and China during the 1960s. Declines occurred during the 1970s in Indonesia, India, and Myanmar. A "youth bulge" occurred about 20 years later due to declines in infant and child mortality. This bulge varies by country with the timing and magnitude of population growth and subsequent fertility decline. The proportion of youth population rises from 16% to 18% about 20 years after the beginning of fertility decline and declines to a much lower stable level after several decades. The bulge is large in countries with rapid fertility decline, such as China. Governments can minimize the effects of bulge on population growth by raising the legal age at marriage, lengthening the interval between first marriage and first birth, and increasing birth intervals. School enrollments among adolescents are rising. In South Korea, the population aged 15-24 years increased from 3.8 to 8.8 million during 1950-90, a rise of 132% compared to a rise of 653% among school enrollments. It is expected that the number of out-of-school youths will decline from 5.1 to 3.6 million during 1990-2025. Youth employment varies by gender. Policies/programs in family planning and reproductive health will need to address the changing needs of youth population.     

国际合作计划生育结合项目效果的定性分析

运用专题组讨论对国际合作计划生育结合项目第六周期的效果进行了定性分析,可见甘肃、山西两省的项目乡镇在寄生虫防治、妇幼保健和计划生育等方面都取得显著成绩。