The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

Shuangyang County popularizes contraceptive knowledge

Shuangyang County is located in the southeast of the Changchun City, Jilin Province, with a total population of 385,000 and a total area of 2,000 square kilometers. The rural population makes up 96% of the total with 8.2% minorities. As the county government vigorously promoted the family planning program in the period of the 6th Five-Year Plan, the rapid growth of the population was effectively controlled. Since 1982, the county government has put the emphasis of the family planning work on publicizing scientific knowledge, on provviding technical services and on training the working staff at the grass-roots level. In response to the different needs of the community for knowledge about premarriage, preconception, and postnatal cares as well as infant feeding, the county government started a program in 1985 for popularizing knowledge about puberty, hygiene, sexual physiological hygiene, pregnancy care, and birth control. As a result, a number of young people have delayed their former marriage date to the ideal marriage age. Many newlyweds voluntarily chose the most proper age for giving birth. To improve the effectiveness of contraception, the county government promoted widely the use of a new type of IUD. Finally, the county government believes that it is most important to improve the quality of the family planning workers at the grass-roots level. Accordingly, the government worked out a plan to train the community workers regularly.     

The marketing of the condom

The Commercial Contraceptive Marketing Program was developed by the Population Center Foundation in the Philippines to increase participatio n of private commercial firms in promotion and distribution of nonclinical contraceptives. The program was started to eliminate ignorance concerning contraceptive methods, to increase contraceptive acceptance, and to decrease dropouts from the program. It is hoped that all 200,000 sari-sari stores in the Philippines will eventually become involved in marketing contraceptives. This will free government personnel for the work of extending family planning services to the rural areas. The history of the development of a plan for commercial marketing of condoms in the Philippines is discussed.     

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.     

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.     

Malaysia implements the integrated approach

Malaysia has implemented an integrated approach in providing family planning services to eligible couples. In 1964 the government of Malaysia adopted a national family planning program, and implementation began in the urban areas and extended into the rural areas. Other agencies are involved in providing family planning services and information including the Federation of Family Planning Associations, the Ministry of Health, the National Family Planning Board, and the Federal Land Development Authority. The number of women practicing contraception has increased from 20,726 in 1967 to 533,646 by 1976. and other methods, 3.9%, respectively. There has been an increase in the percentage of acceptors between ages 15-29 from 56% in 1968 to 71.3% in 1975. The 2nd Malaysian national plan will use a multidisciplinary approach to the problem.     

Fresh impetus to family planning programmes planned in India. APPN interviews Mr. B. Shankaranand Union Minister for Health and Family Welfare,India

Mr. B. Shankaranand, Union Minister for Health and Family Welfare in India, speaking on new policy measures planned to give family planning a major boost, stated that programs related to population and family welfare should be interwoven with the minimum needs program so that the message of the small family norm becomes attractive to acceptors. The new incentive measures, outlined by Shankaranand, are based on the understanding that the existing infrastructure for service delivery must be fully utilized. The new package of incentives places equal emphasis on state level campaigns which will be suitably dovetailed with services and supplies. Monetary rewards in the form of community assets will be given to organized and identifiable groups actively engaged in the implementation of the Family Welfare Program. Cash awards will be given to the best performing states. A new incentive scheme will be introduced for industrial labor groups in the organized sector. Innovative publicity campaigns in selected areas will be conducted. Reorganization of the service delivery outreach system will include establishing health posts staffed by nurse midwives and health workers in urban slums and congested areas. A scheme is in preparation to issue green cards to acceptors of terminal methods after 2 children. The card holders will be entitled to priority attention and preferential treatment in schemes where such practices are feasible. Currently, there are 5000 Primary Health Centers and 50,000 subcenters offering integrated health services. Family planning statistics provide supportive evidence of programmatic response to the achievement of longterm goals of population stabilization. During the 1st 10 months of the current financial year 2,800,000 sterilizations were performed, a 43% higher achievement rate than the corresponding period last year. The number is likely to rise to 4,000,000 by the end of this financial year. Similarly, the number of IUD acceptors is 760,000, 35% higher than last year. Another encouraging sign has been the formulation of a National Health Policy.     

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.     

Population goal set for China's new five-year plan

China's 7th Five-Year Plan recommends that China's total mainland population be held within the limit of 1.113 billion, with an annual average natural growth rate of about 12.4/1000. As a large number of youths will reach marriage and childbearing age during the course of the 7th Five-Year Plan, the Plan affords a high priority to the family planning program and to the control of population growth. The plan proposes 5 policies and measures to realize its goal: continuous efforts need to be made to give family planning a high priority; late marriage, late childbearing, and the 1-child family should be advocated; ideological and political education should be strengthened; scientific and technological research devoted to family planning should be intensified; and family planning communication and service centers at the county level should be consolidated and strengthened, and the family planning program should be conducted systematically and be ongoing.     

The Population Program's Medium-Term Plan: a blueprint for welfare

The Population Program in the Philippines initially was preoccupied with the problem of fertility reduction. From 1981-85, the program will be carrying out a 5-year population plan which aims at the reduction of fertility as well as the broader goal of enhancing the well-being of the family and of society. Called the Medium Term Plan, this population plan began to evolve in January 1978 when President Marcos called for a comprehensive review of the population program in the context of the country's overall development plans. The Special Committee to Review the Philippine Population Program, worked from February to June 1978 and focused attention on the policy, program, and research components of the population program. They assessed the achievements of the program, analyzed its limitations, and recommended future policy and program thrusts. In performing its task, the committee observed the following guidelines: 1) the program must be evaluated by taking into account the overall development goals that are directly related to the population problem, 2) the program must be evaluated in its totality, 3) the concept of family planning must be redefined as family planning and welfare, 4) research must be recognized as a vital instrument for program formulation, and 5) the population program must be evaluated with an awareness of the role of financial and institutional support in its implementation. The committee's findings stressed the need to link family planning efforts with the rest of socioeconomic issues outlined in the government's 5-year development plan for 1978-82. The broad objective of the National Population Program is to reduce the population growth rate to levels that promote national welfare and individual well-being. Under the Medium Term Plan the population growth rate should be reduced from an estimated 2.3% to an estimated 2.0% in 1985. To achieve this objective, the program aims to raise the number and quality of protected couples, promote delayed marriage, promote internalization of the small family size norm, and study other development factors. 14 strategies and their objectives are outlined along with action steps.     

To grasp the family planning program early, carefully and surely according to the law of reproduction]

China's February 1982 Directive on Improving Family Planning Work stipulated that family planning should be incorporated into national economic and social planning by understanding it early, carefully, and surely according to the law of reproduction. Understanding family planning early means to implement the policy of birth control as a primary goal, to plan early for births, and to carry out birth control measures, i.e., formulating a plan is the basis of understanding early. For example, the following must be considered when mapping out a plan for 1983: the number of fertile women who wanted children but who remained childless for 3 years of marriage; those who conceived late in 1982 and will deliver in 1983; the number of newlyweds over 23 years of age who have not planned a pregnancy; those with 1 child over 4 years who due to unusual circumstances will have a 2nd child; the number of people planning marriages before March 1983. The next step is to make arrangements, which include submitting individual requests, getting permission from communes and approval from the general public, and delivering contraceptives to the homes of newlyweds and mothers. 9 months after arrangements are completed, adjustments must be made, e.g., those who were unsuccessful in their plan to conceive this year will try the next year. To understand carefully is to understand the concept, circumstances, and data of family planning and thus be able to administer it scientifically. This means primarily controlling fertile women who are newlyweds, mothers of 1 child, and mothers of multiple children. To understand surely is to conform to the organization, concept, policy, planning, and measures of family planning. This means training basic level birth control cadres in population theory and methods of family planning. In addition, it means persuading the masses to be enthusiastic, diligent, fearless, understanding, and to show initiative toward family planning.     

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.     

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.     

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.     

Cagayan de Oro taps own resources to cope with population problem

In 1972, the Model City Population Planning Project (MCPPP) was begun in the Philippine city of Cagayan de Oro. The MCPPP was an attempt to encourage family planning on the community level. Funding was provided by the Ford Foundation for the program in 1974, for 2 years. There were 5 main objectives of the program: to provide family planning information to parents, to test small scale projects which could be applied elsewhere in the country, to actively involve local government, to reduce the birthrate, and to facilitate, coordinate and strengthen population and family planning services of the different agencies of Cagayan de Oro. While the MCPPP's efforts to reduce the birth rate were mostly concerned with coordinating and facilitating prexisting family planning services, evaluators of the project credit it at least partially, for the cities' declining birthrate. In 1971, the birthrate was 36.5 per 1,000 and in 1975, it had dropped to 29 per 1,000. In mid 1976 the program was incorporated into the nationwide Outreach Program. Although some evaluators felt that private citizens were not sufficiently involved with it, the program has been judged successful in demonstrating a city's capacity to work toward solving it's own problems. Particularly successful were efforts at educating the population and dissemination of family planning information.     

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.     

Sri Lanka: sterilization bonus announced in Sri Lanka; new CBD experiments in Sri Lanka; orchids and family planning

The government of Sri Lanka will give a minimum bonus of SRs 100 ($US6.00) to anyone voluntarily being sterilized. Women will be given 7 days leave and men 3. Many public and private corporations pay sterilization bonuses; the new bonus was set to compete with generous maternity benefits. The average daily wage is about SRs 120. Currently the demand for sterilization is greater than the health services' ability to meet it. Depo-provera is becoming increasingly popular in Sri Lanka, especially among the Muslim communities. The Family Planning Association of Sri Lanka is to test new forms of social marketing of contraceptives to provide wider coverage through community-based distribution. One system will use the route of a commercial firm, Reckitt and Coleman Ltd., and another system will use a network of provincial organizers, commission agents, and local retailers. To create an awareness in young people of their responsibility toward society the Family Planning Association organized an orchid cultivation and family planning propaganda project. 40 young boys are being taught orchid culture and the benefits of family planning. Orchids can be grown in the back yard without any capital investment. There is a steady market for the orchids, and the training program lasts 6 months for each cohort of boys.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

新时期中国妇女生育水平与社会地位的发展与变化

国家计生委“计划生育家庭发展与变化”课题组在全国五省“五省一市”对6300多户、2.3万余人进行的选点问卷调查结果充分表明,实行计划生育,有效地降低妇女的生育水平,有利于推进我国妇女婚育行为的积极变化,有利于改善妇女和儿童的健康和教育状况,提高妇女的社会地位。     

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.