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    043126

    Madagascar: population and family health assessment, May 13-31, 1985.

    Ferguson-Bisson D; LeComte J; Kennedy B

    [Unpublished] 1985. 78 p.

    A Population/Family Health Assessment was conducted in the Democratic Republic of Madagascar (GDRN) to review population and family planning activities and to make general recommendations for improvement, including the type of US Agency for International Development (USAID) population assistance that should be provided. Despite the fact that Madagascar's population of approximately 9 million is growing at a rate of 2.8% annually, meaning the population will double in less than 25 years, there is no official population policy. Yet, it is significant that the reduction of maternal and infant mortality and morbidity has been identified as an explicit goal in the health sector, and the country's actions long have reflected an attitude of acceptance and support of family planning. The private family planning association is recognized as a nongovernmental organization, which provides clinical and contraceptive services throughout Madagascar. The public health system offers no family planning services. Although the French law of 1920 forbidding the sale and use of contraceptives has not been rescinded, it is not enforced. The private family planning association now provides contraceptive services in 40 Ministry of Health facilities at the request of public health physicians, and the government has approved the participation of 35 medical and paramedical personnel in training courses as well as the installation of laparoscopic equipment in 8 medical facilities. Several other organizations provide child spacing services. Despite the efforts being made, the availability of contraceptive services remains limited, and contraceptive prevalence was estimated at 1% of women aged 15-49 in 1982. Several obstacles impede accessibility to contraceptive services and expansion of family planning programs, including a culture which favors large families, the strong influence of the Catholic Church, and a limited number of medical centers providing family planning services. Further, communication between the Office of Population and the Ministry of Health has not been the most favorable for the development of effective programs either area, but the recent naming of a physician to the position of Director of Population may facilitate closer collaboration. The recommendations made outline a general strategy for the initiation of population activities in the shortterm.
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