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New York, FPIA, 1975. 13 pFPIA promotes family planning in the developing world by providing money, materials, and know-how to the local agencies which need them most and use them best. The organization works through agencies people know and trust, using methods that will work in areas where the need is greatest. This approach gives the program exceptional reach and leverage. In its 1st 3 years of operation, the FPIA Program built a unique international delivery system through which tools people need for family planning can reach them promptly. Work is done through 400 carefully chosed constituent agencies in 64 countries. Most of these agencies are church-related, and a growing number are Catholic. The work of FPIA is based on the premise that a worldwide delivery system through which family planning can be provided already exists. Essential to the program is continuing discovery of new ways of working through its constituent agencies. Brief reports are provided of the help provided by FPIA to Colombia, Nepal, Ghana, the Philippines, Haiti, Indonesia, Peru, Manila, and Kenya. FPIA is careful to focus its resources on areas of greatest need. It distributes its services according to a comprehensive profile of comparative need.
New York, New York, UN. April 14, 1975. 39 pAny shortage in the supply of oral contraceptives (OCs) or condoms in the next 5-10 years will be a result of the planning and procurement system rather than shortages of raw materials or production capacity. Production of OCs could be doubled with existing facilities and trebled (if manufacturers were assured of demand) within 2 years; production of condoms is at capacity but could be increased quickly if industry were assured of demand. Because of the rapid growth of the public sector contraceptive market, which will probably overtake commercial sales within 5 years, an organized system that uses longer term planning for future needs and single-point negotiations with suppliers is needed to hold down costs and ensure continuity of supply. As part of this planning, manufacturers, family planning program directors, and international agencies support the institution of a data system to report contraceptive distribution on a regular basis by country, method, and sector, with the capacity to forecast demand by method and country over a 5-year period.
October. 1975; 7.A project for the community-based distribution of oral contraceptives (OCs) and condoms in Korea is outlined. The project is to run from October 1975 to September 1978, in 3 areas (to test the 3 models of government-, mothers'-club-, and commercial-centered delivery systems). The target population for the 1st year is 14,900; after expansion in the 2nd year, it will be 24,000. The project is to mobilize members of family planning mothers' clubs and other rural organizations as distributors, to correct negative popular attitudes toward contraceptives, and to devleop a self-supporting and expanding organized supply system. The condoms and OCs will be sold, but about 10% of them may be given free of charge to those who cannot pay. The project is conducted under the auspices of the Planned Parenthood Federation of Korea.
People. 1975; 2(1):10-12.Increasing use of contraceptive pills by women around the world, stockpiling by international organizations, and changes in the basic supply of the Mexican yam have combined to create a shortage of bulk steroids. In addition, corticosteroid use is increasing worldwide and these drugs also compete for the limited raw material supply. It was felt in 1968 that contraceptive use in the U.S. had peaked with 8 million women or 20% of potential users on pills, but now 11 1/2 million U. S. women, about 30% of the fertile female population, use oral contraceptives and non-U.S. sales are double those of the U.S. Community-based distribution systems funded by International Planned Parenthood Federation and other agencies will further increase demand. At the same time, the Mexican yam is being overharvested, efforts to cultivate it have not been successful, and other sources of yams (India, South Africa, Latin America) have remained unexploited. China is a great source of diosgenin, the basic raw material, but its own birth control program is using most of the supply. Alternative raw materials exist but they are contaminated with the steroid tigogenin or are in short supply. Technology exists for using these other materials but the drug companies must be convinced that the large capital investment necessary is worthwhile and that the contraceptive and corticosteroid markets will continue to increase. Total synthesis of steroids is also possible but expensive. The steroid shortage is not yet a crisis but if supplies of the pill lag behind, use of other contraceptives must be encouraged.
Injectable progestogens - officials debate but use increases. Les progestatifs injectables : les autorites en debattent, mas l'usage s'en repand.
Population Reports. Series K: Injectables and Implants. 1975 Mar; (1): p.A report on the status of the injectable contraceptive agents, Depo-Provera (depot medroxyprogesterone acetate) and Norigest is presented. Depo-Provera is distributed in 64 countries, though it is not available in the U.S., the United Kingdom, and Japan. The drug is usually administered in single 150 mg injections every 3 months, and doses of 300-400 mg every 6 months have been studied. The contraceptive effect of Depo-Provera is primarily through its ability to inhibit ovulation. Norigest exerts its effect by altering the cervical mucus. The suppression of ovulation is most likely caused by action on the hypothalamus-pituitary axis, resulting in inhibition of the luteinizing hormone surge. Depo-Provera causes an atrophic endometrium, while Norigest has varying endometrial effects. The reported pregnancy rates for Depo-Provera are usually less than 1%, while those for Norigest are slightly higher. Most method failures occur either shortly after the 1st injection or at the end of an injection interval. Menstrual disorders have been the primary reason for discontinuation. The injectables can cuase shorter or longer cycles, increased or decreased menstrual flow, and spotting. Depo-Provera users experience increased amenorrhea with continued use, while normal cycles increasingly reappear in Norigest users. Cyclic estrogen therapy has been effective in treating excessive or irregular bleeding and amenorrhea. Long-acting estrogen injections have been administered in combination with Depo-Provera or Norigest, though the studies are limited in number. Weight gain of up to 9 pounds has been reported for users of Depo-Provera. Some researchers have found that Depo-Provera raises blood glucose levels, while others have reported it does not. No adverse effects have been reported for injectables on blood clotting, adrenal or liver function, blood pressure, lactation, and metabolic or endocrine functions. The continuation rate for Depo-Provera is reportedly higher than that for oral contraceptives. Generally, 60% of the acceptors will use the method for at least 1 year. Effective counseling on the menstrual alterations resulting from injectables can increase continuation of the method. The return of fertility in Depo-Provera users usually requires 13 months from the time of the last injection, while the afertile period in Norigest users is about 6 months from the time of the last injection. Instances of fetal masculinization as a result of Depo-Provera use have not occurred. The possibility that Depo-Provera can cause cervical carcinoma in situ has not been substantiated by the evidence; doubt about this possible association has prevented its approval as a contraceptive method in the U.S. Although Depo-Provera and Norigest have caused breast nodules in laboratory animals, there is no evidence to suggest that this effect would occur in human. Despite the advantages of injectables, family planning officials have been reluctant to permit its unrestricted use, primarily because it cannot be withdrawn guickly enough if problems arise and because the actual effect on fertility is not yet known. Nonetheless, the use of Depo-Provera has increased in recent years. The IPPF and the U.N. Fund for Population Activities currently supply the drug.
People. 1975; 2(2):34.Encouraged by 2 experiments in community-based distribution of contraceptives in Thailand and Sri Lanka, the IPPF has asked the U.N. Fund for Population Activities to help finance expansion of these 2 programs and to aid in establishing similar programs in South Korea and Brazil. The Thai experiment was undertaken to test new methods of expanding access to and information about contraceptive methods, particularly in rural areas, by using local villagers, shopkeepers, and other leaders as channels of communication and distribution. 22,000 new acceptors were recruited the 1st year. In Sri Lanka a massive campaign markets condoms through shopkeeprs and by mail. In Korea a network of Mothers' Clubs has been distributing condoms successfully. The Planned Parenthood Federation of Korea is planning to establish 100 more clubs in 10 cities. In Brazil a distribution scheme is already in operation in the state of Rio Grande do Norte involving 205 voluntary distributors in 150 semirural municipalities. IPPF plans to expand into the state of Goias where it hopes to reach 133,000 acceptors over 3 years. Other countries considering such schemes include Indonesia, the Philippines, Lebanon, Egypt, Tunisia, Pakistan, Lesotho, Mauritius, Botswana, Barbados, Honduras, and the Dominican Republic.
People. 1975; 2(4):5-11.A survey of selected countries to illustrate the variety of approaches used in supplying contraceptives through the community is presented; and the agencies involved are listed. The various types of community-based distribution schemes in 33 countries of Latin America, Africa and Asia are identified and briefly described. The personnel and methods utilized in individual countries include rural community leaders, fieldworkers, satisfied contraceptive users, paramedical and lay distributors, women's organizations, commercial marketing, education programs, market day strategies, and government saturation programs. The community-based program for distributing oral contraceptives with technical assistance from BEMFAM, an IPPF affiliate, in northeastern Brazil is described in detail, with emphasis onsocial marketing techniques and the mobilization of resources. In addition to IPPF, other agencies working in community-based distribution include Family Planning International Assistance, International Development Research Centre, Population Services International, The Population Council, UNFPA, USAID, and Westinghouse Health Systems Population Centre.