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A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.
New York, New York, Population Council, 1990. x, 185 p.Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail firstname.lastname@example.org.
New York, New York, FPIA, 1985. 206 p.Summarizing the work of the Family Planning International Assistance (FPIA) for the past 14 months, with emphasis on 1985, this document contains both regional and country reports for Africa, Asia and the Pacific, and Latin America. FPIA's strategy in Africa during 1985 was to focus on small, high-risk projects which call for extensive technical assistance. Project Assistance accounted for 48.8% of the total value of FPIA assistance to the region; Commodity Assistance accounted for 47.5% of the total value of FPIA assistance to the region. Special Grants accounted for slightly over 2.1% of the total assistance to Africa. In the Asia and Pacific Region, components of the FPIA strategy include: consolidate support and provide technical assistance to those agencies whose family planning services can be institutionalized and serve to complement and influence the goals, objectives, and program procedures of their governments' national family planning programs; problem solve with grantee agencies approaches to innovative delivery of temporary method services; provide training opportunities and technical assistance to project management and staff as well as to influential nonproject persons; and establish how FPIA commodities can complement supplies available to nongovernmental organizations through their government warehouses and bilateral supported community retail sales program. Project Assistance accounted for 47.1% of the total value of FPIA assistance in the region; Commodity Assistance accounted for 50.8% and Special Grants slightly over 1% of total assistance to the region. In Latin America, FPIA's program goals respond to agency goals of promoting family planning services in areas of unmet need, upgrading existing family planning service models, and encouraging service continuation following the phase-out of FPIA support. Project Assistance accounted for 46.8%, Commodity Assistance 52.2%, and Special Grants less than 1% of total FPIA assistance to the region. The combined value of all types of assistance provided worldwide during 1985 totaled over $18 million: $7.2 million in direct support to 128 funded projects in 39 countries; and $10.1 million in commodities shipped to 218 institutions in 66 countries. Oral contraceptive and condom shipments alone were sufficient to supply 2.4 million contraceptors for 1 year.
New York, New York, Population Council, Center for Poplicy Studies, 1985 Aug. 42 p. (Center for Policy Studies Working Papers No. 113)This analysis of family planning program funding suggests that current funding levels may be inadequate to meet projected contraceptive and demographic goals. Expenditures on organized family planning in less developed countries (excluding China) totaled about US$1 billion in 1982--about $2/year/married woman of reproductive age. Cross-sectional analysis indicates that foreign support as a proportion of total expenditures decreases with program duration. Donor support to family planning in less developed countries has generally declined from levels in the late 1970s. This is attributable both to positive factors such as program success and increased domestic government support as well as requirements for better management of funds and the worldwide economic recession. Foreign assistance seems to have a catalytic effect on contraceptive use only when the absorptive capacity of family planning programs--their ability to make productive use of resources--is favorable. The lower the stage of economic development, the less visible is the impact of contraceptive use or fertility per investment dollar. On the other hand, resources that do not immediately yield returns in contraceptive use may be laying the foundation for later gains, making increased funding of family planning programs an economically justifiable investment. The World Bank has estimated that an additional US$1 billion in public spending would be required to fulfill the unmet need for contraception. To increase the contraceptive prevalence rate in developing countries to 58% (to achieve a total fertility rate of 3.3 children) in the year 2000 would require a public expenditure on population programs of US$5.6 billion, or an increase in real terms of 5%/year. Improved donor-host relations and coordination are important requirements for enhancing absorptive capacity and program performance. A growing willingness on the part of donors to allow countries to specify and run population projects has been noted.