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[New York, New York], Guttmacher Institute, 2018 Apr. 2 p.The United States -- through its Agency for International Development (USAID) -- has long been a global leader in enabling women’s access to contraceptive services in the world’s poorest countries. Empowering women with control over their own fertility yields benefits for them, their children and their families. It means fewer unintended -- and often high-risk -- pregnancies and fewer abortions, which in poor countries are often performed under unsafe conditions. Better birth spacing also makes for healthier mothers, babies and families, and pays far-reaching dividends at the family, society and country levels.
Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception.
Lancet. 1998 Aug 8; 352(9126):428-33.A previous study suggested that provision of two 0.75 mg doses of levonorgestrel for emergency contraception caused less nausea and vomiting and was more effective than the Yuzpe regimen of combined oral contraceptives (two doses of 100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel). These two regimens were evaluated further in a double-blind, randomized World Health Organization study of 1998 women recruited from 21 centers worldwide who requested emergency contraception within 72 hours of unprotected intercourse. Among the 1955 women for whom the outcome was known, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group and 3.2% (31/979) in the Yuzpe group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% confidence interval, 0.18-0.70). The proportion of pregnancies prevented was 85% in the former group and 57% in the latter group. Nausea and vomiting occurred significantly less frequently in the levonorgestrel group (23.1% and 5.6%, respectively) than in the Yuzpe regimen group (50.5% and 18.8%, respectively). The efficacy of both treatments declined significantly (p = 0.01) with increasing time since unprotected intercourse. These findings confirm that the levonorgestrel regimen may be more effective and is better tolerated than the current standard in emergency contraception.
In: Addendum. Manual IX: The methodology of measuring the impact of family planning programmes on fertility, by the Population Division of the Department of International Economic and Social Affairs of the United Nations. New York, New York, United Nations, 1986. 9-14. (Population Studies No. 66; ST/ESA/SER.A/66/Add.1)This chapter describes and applies a new methodology for estimating the fertility impact of contraception obtained through a family planning program. This approach is called the prevalence method because the principal data required for its application are estimates of the prevalence of contraceptive use at a given point in time. It is the objective of the prevalence method to estimate the number of births averted as well as the reduction in the crude birth rate that results form the use of program contraception. A single application of the procedure produces these estimates for 1 year, but repeated applications for different years can yield a time-series of births averted or other impact measures. The procedure for calculating births averted by program users consists of 6 parts to obtain, consecutively, estimates of: natural fertility, potential fertility, fertility impact of program use, births averted, birth rate impact, and method-specific results. Each of these steps is described in some detail. This new approach provides a simple and straightforward alternative to existing methods for estimating the gross fertility impact of program contraception. In contrast to several of the other procedures, the prevalence method does not require detailed input data on numbers of past acceptors and continuation rates. Instead, estimates of the prevalence of program and non-program contraception by age and method are required as principal input data. While such data were rarely available in the past, prevalence estimates are now routinely obtained from national surveys in many developing countries, thus making the application of the prevalence method possible.
Journal of Population and Health Studies. 1981 Dec; 1(1):135-78.This paper concentrates on the management development aspects of the Korean family planning program which began in 1962. Population growth rate in Korea went from 2.9% in 1962 to 2% in 1971, and total fertility rate declined 57% from 1960 to 1979. Program cost during 1962-80 totaled $147.7 million, of which 81.2% came from the national government. It has been calculated that between 1962-80 about 3.5 million births were averted. In December 1980 the program employed a total of 3811 full time employees in 4 different organizations; currently the coverage is about 1 family planning worker for every 4200 urban couples, and for every 1200 rural couples. Major methods of birth control used the IUD, the condom, the pill, female sterilization, male sterilization, and menstrual regulation. A total of 1.107 million acceptors received services between 1962-80. Responsibility for the national program rests with the Ministry of Health and with the Economic Planning Board. If it is reasonable to say that the program has been successful, there are still problems to be solved which include: 1) an inadequate approach to contraceptive services in rural areas, 2) a high discontinuation rate of contraceptive usage, 3) high turnover of fieldworkers, 4) poor coordination with other health programs, 5) poor quality of research, and 6) weak management training. Improvements in program management functions include program planning, better distribution of economic resources, better training and use of personnel, and better use of private clinics and mobile vans. Also necessary are interministerial and interagency coordination, improvements in the record reporting system, and better program evaluation. The current management system is making efforts to integrate family planning services with maternal and child health and expand the role of international agencies in training courses and research investment.
Washington, D.C., USAID, 1979 Dec. 246 p. (A.I.D. Program Evaluation Report No. 1.)USAID sponsored a workshop in April 1979 to identify from research and experience the circumstances under which direct family planning services or developmental activities are most effective in reducing population growth in specific developing countries. Background papers prepared for the workshop on family planning efforts in Java, Colombia, and Thailand showed that family planning alone, without socioeconomic developmental additions, had lowered fertility levels significantly. However, these programs did not consider other factors which might have been responsible as well. Most of the crosscultural studies which have been done show that family planning and development activities taken together will have the greatest impact of fertility declines. Political commitment to these programs is necessary. Such commitment facilitates localized family planning activity, the most effective delivery system system. Administrative capability and socioeconomic/cultural acceptability of family planning are factors of major importance also. The workshop examined experience and made projections as to whether various countries, based on certain demographic and socioeconomic trends, will be able to achieve annual crude birth rates of 20/1000 by the year 2000. Countries were classified as certain, probably, possible, and unlikely. Flexibility of approach is urged.
Development Digest. 1972 Jan; 10(1):7-17.Family planning programs in various developing countries are reviewed in the following areas: history, current activities, the role of foreign assistance, success, and future effectiveness. Foreign assistance--1st, private; then foundation and governmental--has played a major role in the formation of most developing nation family planning programs. Programs differ according to their national population policies and the degree of government involvement. Funding for selected programs is duscussed and tabulated. International aid has been instrumental in the last 2 decades in creating a generally favorable public opinion toward family planning. It is felt that foreign assistance will provide less operational aid in the future and be used more for research and evaluative activities. The programs will be considered to be progressing as less foreign aid is needed and more domestic aid provided. The problems with evaluating family planning programs by crude birth rate or births averted measurements are mentioned. Evaluation is made more difficult by the fact that programs receive credit for other socioeconomic changes which occur in the community. A multiple regression fertility model can be used to assess quantitative success in family planning programs. Contraceptive usage levels and continuation rates as part of the measure of success of any family planning program are discussed. These programs must struggle against loss of momentum.
AID investment of $1 billion in family planning/population is resulting in sharp birthrate declines.
Family Planning Perspectives. January-February 1979; 11(1):45-46.The U.S. Agency for International Development spent approximately $1 billion on family planning/population assistance and related research in the years 1965-1977. 1/3 of this total was channelled to a variety of international agencies for use in family planning program activities, training, and education efforts in many countries. AID funds were also spent in the following areas in this order of support: 1) bilateral assistance; 2) contraceptive supplies; 3) demographic and fertility research; 4) administration of programs; and 5) support for institutions. This funding is tabulated. Donations from other sources for family planning efforts during this period are tabulated. The effects are finally showing; birth rates have fallen sharply in recent years in such countries as Korea, Colombia, Indonesia, and Thailand.
AID investment of $1 billion in family planning/population is resulting in sharp birthrate declines.
International Family Planning Perspectives and Digest. 1978 Winter; 4(4):127-128.This article is derived from testimony by Reimert T. Ravenholt, Director of the U.S. Agency for International Development (AID) Office of Population before the Select Committee on Population in the U.S. House of Representatives. The testimony dealt with the disbursement of the $1 billion in AID funds for the promotion of family planning in underdeveloped countries. A table gives the total, broken down into the various categories of aid: $345 million for international agencies, $261 million in bilateral assistance, $162 million for contraceptives, $102 million for demographic and fertility research, $55 million for improvement of contraceptive technology, $34 million for administration, $49 million for support of institutions training 3d World people for research in population related fields. The article also reports on the success in slowing population growth in many of the countries to which AID funds have been sent, particularly in Colombia, Thailand, Korea and Indonesia. Dr. Ravenholt stated that he feels the AID's investment has been instrumental in lowering birthrates, and that continued tenacity and effort will result in more successes.
Social Biology. 25(2):145-163, Summer 1978.This paper reviews and compares the methodologies of some 70 investigations of the effect of family planning programs on fertility levels. Differences among the studies include variations in questions asked, research methods used, program type investigated, and made of program action assumed. Programs can affect fertility by providing means of fertility control, education, legitimation, incentives/disincentives or any combination of these but the actual effect of these modes is unclear. Comparison is usually made between the effects on fertility of a program as a whole and a hypothetical estimate of what fertility rates would have been without the program. This hypothetical estimate is in fact not subject to empirical measurement, and a variety of methods have been developed largely to attack this methodological problem. The article compares the characteristics of several methods and provides a matrix comparing their strength, limitations and applications. The methods discussed include: 1) decomposition of change which identifies several factors affecting changes in crude birth rate; 2) correspondence between program activity and fertility trends over time to across areas or groups, which often takes close statistical association as evidence of causality; 3) matching studies, which try to remove the influence of nonprogram factors by controlling the characteristics of the subject; 4) experimental and control areas, comparing presumably similar groups with and without family planning programs; 5) multiple regression across areal units which provides some information on areal trends but requires extensive data for many statistical areas; 6) calculation of national effects of births averted among acceptors; and 7) simulation, which compares data to mathematical projection models, such as the TABRAP/CONVERSE and POPSIM models. No one method is best but certain methods are best to answer certain questions. All of the methods have difficulty establishing actual causality between the program studied and fertility trends and ruling out alternative explanations. Recent studies encouraged by the U.N. Population Division are seeking cross-method and cross-program evaluation.
Genus. 1976; 32(1-2):45-70.Add to my documents.