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World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
Socio-economic development and fertility decline in Costa Rica. Background paper prepared for the project on socio-economic development and fertility decline.
New York, New York, United Nations, 1985. 118 p. (ST/ESA/SER.R/55)This summary of information on the development process in Costa Rica and its relation to fertility from 1950-70 is a revision of a study prepared for the Workshop on Socioeconomic Development and Fertility Decline held in Costa Rica in April 1982 as part of a UN comparative study of 5 developing countries. The report contains chapters on background information on fertility and the family, historical facts, and political organization of Costa Rica; the development strategy and its consequences vis a vis the composition of the gross domestic product, balance of trade, investment trends, the structure of the labor force, educational levels, and income; the allocation of public resources in public employment, public investment, credit, public expenditures, and the impact of resource allocation policies; changes in land tenure patterns; cultural factors affecting fertility, including education, women and their family roles, behavior in the home, women and politics, work and social security, and race and religion; changes in demographic variables, including nuptiality patterns, marital fertility, and natural fertility and birth control; characteristics and determining factors of the decline in fertility, including levels and trends, decline by age group, decline in terms of birth order, differences among population groups, how fertility declined, and history and role of family planning programs; and a discussion of the modernization process in Costa Rica and the relationship between demographic and socioeconomic variables. Beginning with the 1948 civil war, Costa Rica underwent drastic changes which were still reflected in national life as late as 1970. The industrial sector and the government bureaucracy have become decisive forces in development and the government has become the major employer. The state plays a key role in economic life, and state participation is a determining factor in extending medical and educational resources in the social field. The economically active population declined from 64% in 1960 to 55% in 1975 due to urbanization and migration from rural to urban areas, but there was an increase in economic participation of women, especially in urban areas. Increased educational level of the population in general and women in particular created changes in traditional attitudes and behavior. Although there is no specific explanation of why Costa Rica's fertility decline occurred, some observations about its determining factors and mechanisms can be made: the considerable economic development of the 1950s and 1960s brought about a rapid rise in per capita income and changes in the structure of production as well as substantial social development, increased opportunities for self-improvement for some social groups, and a rise in expectations. The size of the family became an aspect of conflict between rising expectations and increasing expenses. The National Family Planning Program helped accelerate the fertility decline.
Report of the Task Force II on research inventory and analysis of family planning communication research in Bangladesh.
[Dacca, Bangladesh, Ministry of Information and Broadcasting] Oct. 1976. 85 p.Topics relevant to family planning such as interpersonal relationships, communication patterns, local personnel, mass media, and educational aids, have been studied for this report. The central theme is the dissemination of family planning knowledge. The methodology of education and communication are major factors and are emphasized in the studies. While the object was to raise the effectiveness of approaches, the direct concern of some studies was to examine a few basic aspects of communication dynamics and different human relationship structures. Interspouse communication assumes an important place in the family planning program and a couple's concurrence is an essential precondition of family planning practice. Communication between husband and wife varies with the given social system. A study of couple concurrence and empathy on family planning motivation was undertaken; there was virtually no empathy between the spouses. A probable conclusion is that there was no interspouse communication on contraception and that some village women tend to practice birth control without their husband's knowledge. Communication and personal influence in the village community provide a leverage for the diffusion of innovative ideas and practices, including family planning. Influence pattern and flow of communication were empirically studied in a village which was situated 10 miles away from the nearest district town. The village was found to have linkage with outside systems (towns, other villages, extra village communication network) through an influence mechanism operative in the form of receiving or delivering some information. Local agents--midwives, "dais," and female village organizers are in a position to use interpersonal relations in information motivation work if such agents are systematically involved in the family planning program and are given proper orientation and support by program authorities. These people usually have to be trained. 7 findings are worth noting in regard to the use of radio for family planning: folksongs are effective and popular; evening hours draw more listeners; the broadcast can stimulate interspouse communication; the younger groups can be stimulated by group discussions; a high correlation exists between radio listening and newspaper reading; most people listen to the radio if it is accessible to them; approximately 60% of the population is reached by radio. A positive relationship was found to exist between exposure to printed family planning publicity materials and respondents' opinions toward contraception and family planning. The use of the educational aid is construed as an essential element to educating and motivating people's actions.
Washington, D.C., U.S. Government Printing Office, September 1978. (International Research Document No. 6) 12pCompiling population data for Afghanistan is made difficult by the nomadic population. Estimates of their numbers range from 1-2 million people, 9-14% of the total. A 1972-73 survey of the settled population accumulated data from approximately 21,000 households and 120,000 individuals. Pregnancy and marital histories were acquired from 10,000 women. The age-specific fertility rate was 8 per woman; crude birth rate, 43/1000. Estimated life expectancy for males was 34-42 years, for females, 36-41 years. The crude death rate is 28-32/1000. Of the 10,020,099 total settled population, 5,373,249 were male, 4,646,850 were female. The Afghan Family Guidance Association opened the first family planning clinic in 1968. By 1972 there were 18 clinics in operation. When surveyed, 3% of women over 15 knew about family planning, only 1/3 of these had used a family planning method. 66% males and 90% females over 15 were ever-married. About 11% of those over 6 years were literate, 18.7% males, 2.8% females.
CBFPS (Community-based Family Planning Services) in Thailand: a community-based approach to family planning.
Essex, Connecticut, International Council for Educational Development, 1978. (A project to help practitioners help the rural poor, case study no. 6) 91 pThis report and case study of the Community-Based Family Planning Service (CBFPS) in Thailand describes and evaluates the program in order to provide useful operational lessons for concerned national and international agencies. CBFPS has demonstrated the special role a private organization can play not only in providing family planning services, but in helping to pioneer a more integrated approach to rural development. The significant achievement of CBFPS is that it has overcome the familiar barriers of geographical access to family planning information and contraceptive supplies by making these available in the village community itself. The report gives detailed information on the history and development of the CBFPS, its current operation and organization, financial resources, and overall impact. Several important lessons were learned from the project: 1) the successful development of a project depends on a strong and dynamic leader; 2) cooperation between the public and private sectors is essential; 3) the success of a project depends primarily on the effectiveness of community-based activities; 4) planning and monitoring activities represent significant ingredients of project effectiveness; 5) a successful project needs a sense of commitment among its staff; 6) it is imperative that a project maintain good public relations; 7) the use of family planning strategy in introducing self-supporting development programs can be very effective; 8) manning of volunteer workers is crucial to project success; and 9) aside from acceptor recruitment in the short run, the primary purpose of education in more profound matterns such as childbearing, womens'roles in the family, and family life should also be kept in mind. The key to success lies in continuity of communication and education.
(Description of the World Health Organization Special Programme of Research, Development, and Research Training in Human Reproduction.) (Statement, May 2, 1978))
In: United States. Congress. House of Representatives. Select Committee on Population. Population and development: research in population development: needs and capacities. Vol. 3. Hearings, May 2-4, 1978. Washington, D.C., U.S. Government Printing Office, 1978. p. 213-286The World Health Organization's Special Programme of research, Development, and Research Training in Human Reproduction is supported by 150 member governments spending over 15 million dollars on 5 specific areas of research: 1) effectiveness of existing birth control methods; 2) development of new methods; 3) psychosocial factors and health service delivery; 4) health rationale for family planning; and 5) infertility. A primary goal of the program is to strengthen fertility research within the developing country. Some results of WHO research on specific contraceptive practices found the following. Depo-Provera was frequently discontinued because the amenorrhea percentage over 90 days increased from 13% to 35% during the 4th injection interval. Male contraceptives are acceptable to 50% of men in Fiji, India, Korea, Mexico and the United States with a daily pill more desirable than a monthly injection. A majority of women believe that menstruation is the removal of impure blood, and that intercourse should not occur at that time.
New York, International Planned Parenthood Federation, Western Hemisphere Region, September 1975. 149 pThe primary focus in this 4th edition in the series of annual "overviews" of the contraceptive services in the Western Hemisphere Region of the International Planned Parenthood Federation is on clinical facilities, medical and paramedical services, and on the delivery of contraceptive methods by family planning programs. Family planning services link information on methods for spacing or limiting children to their availability, and they provide education on the advantages of contracepting. They seek to motivate acceptors to continue their chosen method. Counseling and information and education activities, although an integral component of family planning programs, are not included among the topics considered in the "Overview." In the Western Hemisphere Region, the most notable innovation has involved the community-based distribution of contraceptives (CBD), and for the 1st time, non-clinical distribution of contraceptives by associations in the region is a part of the "Overview." The Annual Reports submitted by IPPF affiliates and published and unpublished data from other programs are the primary sources of statistics for this report. Information for 1973 encompassed 29 associations related to IPPF and 4 other programs, and for 1974, 28 associations and 5 other programs could be covered. As for clinical input of family planning programs, the affiliates reported to the Regional Office of IPPF the number and types of clinics, weekly session hours, hours of medical and paramedical personnel. Data on the output of clinical activities of family planning programs for the calendar year were limited to 1st visits or new acceptors by methods, 1st revisits of the year or continuing (old) acceptors by method, number of revisits by old and new acceptors by method, demographic characteristics of new acceptors by method, and voluntary male and female sterilization performed or referred. Data on contraceptive services and clinical activities are summarized and presented in the form of tables.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, September 1975. 49 pThis is a compilation of family planning services provided by associations operating in the Western Hemisphere Region. Separate tables are compiled for 1973 and 1974. A list of each family planning program included in the study is appended to the report. The report does not guarantee the completeness or accuracy of the data; problems with reliability of data point up the necessity for a system of standardized record-keeping. Tables cover program input in the form of clinical facilities, medical and paramedical services, and the delivery of contraceptive methods by family planning programs and community-based distribution systems. Charts on program output include information on acceptor characteristics, numbers of new and continuing acceptors, numbers of voluntary sterilizations, and percentages of other methods in use.
Singapore, 1972 (xi). 60 pThis report presents a detailed analysis of the demographic situation in Singapore, tracing trends in birthrates, fertility rates, and population growth. Family planning services available during 1970 are thoroughly explored, including their funding, birth control methods, and organization and administration. Detailed analyses are given of acceptors of birth control methods by method accepted as well as by acceptor characteristics such as age, parity, education, and race. The Family Planning and Population Board recruited 162,485 acceptors between 1966 and 1970. During that period there was a dramatic decline in the crude birthrate, which was 28.6/1000 in 1966 and 22.1/1000 in 1970. Fertility continued to decline in all age groups and in all ethnic groups during 1970.
Country Profiles. 1972 Oct; 19.The estimated population of Iran in 1972 was 31,000,000, with an estimated rate of natural increase of 3.2% per year. In 1966 61% of the population lived in rural areas, male literacy was 41% and female literacy 18%. Coitus interruptus is the most common form of contraception used in Iran, followed by condoms. Because of the rapid rate of population growth, the government has taken a strong stand in support of family planning. The Ministry of Health coordinates family planning activities through the Family Planning Division. Contraceptive supplies are delivered free of charge through clinics. The national family planning program also is involved in postpartum programs, training of auxiliary personnel, communication and motivation for family planning population education, evaluation and research. The overall goal of the program is to reduce the growth rate of 2.4% by 1978, and to 1% by 1990.
In: Diczfalusy, E. and Borel, U., eds. Control of human fertility. Proceedings of the Fifteenth Nobel Symposium, Sodergarn, Lidingo, Sweden, May 27-29, 1970. New York, Wiley, 1971. 39-51.A drug delivery system providing for a controlled release of progestogen and affecting ovulation and steroidogenesis minimally would deal effectively with some of the problems associated with contraception. 2 systems being developed which fit these criteria are the primary topics of discourse in this article. In 1 system an implant consists of a polymer membrane of polydimethylsiloxane (PDS) and contains the progestogen in crystalline form. Major problems with the PDS implants include a lack of intraindividual constance of release and interindividual variation in the slope of the decay in release. In the second system the implant consists of a lipid-steroid membrane containing a steroid. In this implant the concentration of the steroid in the membrane and the nature of the lipid phase may be important in determining the pattern of release. In vivo metabolic studies with lipid-steroid pellets are limited, but the patterns of output may be similar to those seen with PDS implants. Because of rate problems, a shorter regime slow-release implant seems more feasible than a longer lasting system. Surgical difficulties associated with the implantation and removal of the PDS implant make the choice of a lipid-steroid micropellet preparation more feasible for a short-term regimen. The discussion, following the main body of the article, focuses primarily on problems associated with implants.
[Unpublished] 1983. Presented at the International Conference on Population, 1984, Expert Group on Fertility and Family, New Delhi, January 5-11, 1983. 22 p. (IESA/P/ICP. 1984/EG.I/8)The World Health Organization (WHO) has been studying several national surveys with regard to certain health related aspects of fertility. The primary purpose of these studies was to stimulate the use of data by the national health authorities for an improved care system for maternal and child health, including family planning. Some preliminary results are reported in this discussion, in particular those relating to contraception, the reproductive health of adolescents, infertility and subfecundity, and breastfeeding. The national surveys concerned are those of Bangladesh, Indonesia, the Republic of Korea, the Philippines, and Sri Lanka. The methods of analysis were simple and traditional, except for 2 points: some of the data had to be obtained by additional tabulation of the raw data tapes and/or the recode tapes since the standard tabulations of the First Country Reports did not include the needed information; and Correspondence Analysis was used in an effort to stimulate and facilitate the use of the findings for improvements of national health programs. Methods of contraception vary widely, from 1 country to another and by age, parity, and socioeconomic grouping. The younger women tend to choose more effective modern methods, such as oral contraception (OC); the older women, i.e., those over age 35, tend to seek sterilization, if available. It is evident that the historical development of family planning methods has greatly influenced the current "mix" of methods and so has the current supply situation and the capacity of the health care system (particularly in regard to IUD insertions and sterilizations. Use of contraception among adolescents to postpone the 1st birth was practically unknown. The risk of complications at pregnancy and childbirth, including maternal and infant death, is known to be particularly high for young mothers, and the results clearly showed that the infant mortality rate is highest for the youngest mothers. All the women who suffer from infertility do not recognize their condition, but the limited data still point to the need to consider the health needs of women who suffer from unwanted fecundity impairments. This may require medical intervention to cure infections or the offer of relevant sexual counseling. Some infecundity may require the improvement of nutritional and personal hygienic levels before meaningful achievements are made. The prevalence of breastfeeding has declined in some population groups, and the consequences can be expected to be deleterious and to involve serious increases in specific morbidity and mortality.