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In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (IVO-05)The number of family planning (FP) service delivery points (SDPs) in Cote d'Ivoire is increasing rapidly with the assistance of several USAID projects: SEATS for overall management assistance, INTRAH for clinical training, Johns Hopkins University/PCS for information, education, and communication (IEC), and the Africa operations research/technical assistance (OR/TA) project for the management information system (MIS). For example, during 1991, the Association Ivoirienne pour le Bien-Etre Familial (AIBEF) increased its SDPs from 3 to 19. By the end of 1992, 33 AIBEF-assisted public sector maternal and child health centers will become FP SDPs. This is the first step in a longterm program to increase the government's FP service delivery capacity and is a model for future activities. This study, which cost US $29,392, will monitor the management information system (MIS) to define its impact and role in the expansion. The MIS project will provide data on contraceptive use, reproductive intentions, and community flow but it will not describe several service delivery functions or information relative to the client, such as provider relations and IEC activities. The MIS data, therefore, must be complemented by data on 1) the quality of provider-client interactions, 2) the SDPs functional capacity for providing FP services (both physical and human resources), and 3) the user's experiences with FP services. This study will adapt a situational analysis methodology developed by The Population Council. Information will be collected from all operational SDPs (approximately 20). Of the 13 SDPs observed, 4 serviced 1200 to 1800 new and continuing users in 3 months. 3 other clinics serviced between 22 and 37. 24,221 clients accepted modern methods during that time, with 19% (mainly men) choosing condoms and 81% selecting prescription methods (85% oral contraceptives (OCs), 11% injectables, and 3% IUD). All clinics had a system for ordering contraceptives, yet all experienced stock-outs. Only 8% of clinics had an appropriate storage system. 55% of clinics held discussions about FP and reproductive health with service providers and clients. The study also revealed that 25% of all clients interviewed had had an abortion. In terms of personnel, there was a lack of FP educators disseminating IEC, and most clinics needed updated IEC materials. The record-keeping land logistics departments needed improvement as stock-outs were common. International management meetings and external supervisory visits were infrequent. For the most part, clients were satisfied with the FP services, although some mentioned a long wait and a lack of privacy. Numerous recommendations were made in order to provide FP services in clinics including: development of FP activities, improvement of quality of services, and development of counseling and interpersonal communication skills.
Geneva, WHO, 1975. (WHO Technical Report Series No. 564) 41 p.Studies indicate that seriously debilitating mental illness is likely to affect at least 1% of any population at any one time and at least 10% at some time in their life. Since about half the population in many developing countries is under age 15 there is a high quantity of child and adolescent disorders. The prevalence of organic brain damage will diminish with the introduction of public health services, but the same measures are liable to increase the number of surviving children with brain damage. The World Health Organization recommends the pooling of mental health experts to aid the developing countries lacking personnel and resources to cope with mental disorders. Pilot programs in mental care are also recommended to create awareness in communities that mental illness exists and can be treated.
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.
PLANNED PARENTHOOD CHALLENGES. 1997; (1-2):28-30.The percentage of people living in poverty in Nicaragua's cities has increased significantly in recent years and reflects an increase in the number of households headed by women. Among the nongovernmental organizations created to help meet the needs of Nicaragua's population is Profamilia, the International Planned Parenthood Federation affiliate founded in 1971. Profamilia offers high quality sexual and reproductive health services at regional clinics operating in 9 out of 16 political subdivisions and manages a nationwide network of over 1000 community-based contraceptive distribution posts. Knowledge of modern contraception is almost universal in Nicaragua, and a 1992-93 health survey revealed that almost half of women of reproductive age were using contraception. Profamilia uses the mass media and other means to advertise its services, which are preferred by many over the free government services. In the communities, trained volunteer promoters distribute contraceptives and provide counseling. Because adolescent pregnancy and fertility rates are high, Profamilia has developed services, including educational workshops, that target youth. These workshops offer information on responsible sex behavior and ways to reduce the risk of pregnancy or infection. In addition, Profamilia offers training courses for teachers and educational sessions for parents, pregnant adolescents, and adolescent parents.
FORUM. 1997 Jul; 13(1):19.This article describes a Model Clinic of the Uruguayan Family Planning Association (UFPA) that received support from UNFPA during 1994-96. The Model Clinic includes an operating room that permits voluntary surgical sterilization, which is new to Uruguay. The Clinic is located in the Pereira Rossell Hospital in Montevideo, which makes it accessible to many people. The Hospital includes the largest maternity ward in the country and provides 80% of the nation's public health services. The UFPA also operates a clinic in Santa Rita, an area which has the lowest income in metropolitan Montevideo. The UFPA expected in 1994, to provide services for 2000 new family planning (FP) acceptors and 5000 return visits to the Model Clinic and 600 new acceptors and 1800 return visits to the Santa Rita Clinic. It was anticipated that the clinics would recover 30% and 25% of their costs, respectively. Findings indicate that, in 1996, outcomes exceeded expected returns. At the Model Clinic, there were 4394 new acceptors. At the Santa Rita Clinic, there were 2787 return visits. Santa Rita, an impoverished area, recovered 46% of costs, which was double the estimates. The program aims to integrate FP services within existing government health services and to improve FP for low-income populations. A by-product of this program was the staff experience of learning how to share and collaborate with government programs. The UFPA exceeded its projections and is expected to continue service provision in these clinics regardless of possible UNFPA funding withdrawal.
Client satisfaction studies: a simple, inexpensive way to measure quality. Meeting the needs: client satisfaction studies.
FORUM. 1995 Jul; 11(1):22-4.The International Planned Parenthood Federation (IPPF) Strategic Plan Vision 2000 addressed the need for improved quality of care as the key to the future viability of IPPF and its affiliates. The Transition Project relies on IPPF standards and the family planning associations (FPAs) themselves for medical supervision and evaluation of medical quality. In order to do this, a one-page model questionnaire was organized into three categories: information, interpersonal relations, and access/site conditions. In just the first year of this initiative, more than 8200 clients were interviewed at 35 clinics of 8 FPAs. The average sample size was more than 230 clients per site. The most frequent area of dissatisfaction was long waiting times, followed by high prices and access/location of the clinic, respectively. In response to long waiting times, INPPARES's Arequipa clinic plans to separate medical and family planning services by opening a new space and hiring additional staff for medical procedures while the current space and staff concentrates on family planning. Other FPAs have implemented appointment systems during certain time period as a means to reduce waiting times, and FPATT in Trinidad and Tobago has a system where clients can call in advance to find out how many clients are waiting at any given time. Setting prices is a major challenge for FPAs, given their mission to provide quality family planning services to lower income communities and their mandate to achieve sustainability. FPATT and INPPARES/Peru have implemented sliding scales to allow waiver or reduction of fees to low-income clients. To address access issues in Trinidad, FPATT strengthened outreach activities to better serve those who live far from the urban clinic setting. Community Based Distribution outlets assist FPATT in distributing low-cost contraceptives, education, and counseling to their clients.
[Unpublished] 1993. Presented at the Expert Meeting on Information Systems and Measurement for Assessing Program Effects, Washington, D.C., September 9-10, 1993. Sponsored by National Academy of Sciences Committee on Population.  p.Profamilia has been affiliated with the International Planned Parenthood Federation since 1967, and it objectives are to promote family planning (FP) in Colombia with information and services. 70% of couples using modern methods obtained them from Profamilia. 69% of Colombian women of reproductive age are current users of FP. There are 47 Profamilia clinics, 8 of which offer FP only to men. Surgical contraception was offered to men starting since then. The 1990 Demographic and Health Survey indicated that female sterilization led the way in FP methods, followed by oral contraceptives and the IUD. About 80% of new acceptors choose sterilization and the IUD, and they have become progressively younger. In 1970 Profamilia started community-based distribution of OCs and condoms and inaugurated social marketing in 1974. OCs and condoms donated by foreign agencies are sold in pharmacies at low prices. The Evaluation and Research Department comprises the Service Statistics, Evaluation, and Research Sections. Monthly reports are produced on FP services provided, based on total number of new acceptors per clinic and per method, total number of follow-ups, sociodemographic characteristics of new acceptors, number of male and female sterilizations, number of couple years of protection per program and per clinic, educational activities, finances, and supplies used. Service statistics are used for client care, program operation, administrative monitoring, measurement of program activity, supervision, evaluation, and research. Volume indicators measure services rendered and the number of clients served; coverage indicators measure the extent of services provided to various groups; quality indicators include measures of comprehensiveness, timeliness, continuity, and satisfaction; effectiveness indicators measure the achievement of objectives; and efficiency indicators relate to inputs such as cost and facilities.
Pakistan rapidly institutionalizes the concept and implementation of family planning operations research.
ALTERNATIVES. 1994 Apr; (1):4-5.The Population Council carried out six major operations research activities during September 1991-June 1993 which proved that operations research can also be used effectively to improve existing family planning services. Since June 30, 1993, work has continued with the Population Council, the United Nations Population Fund [UNFPA], and donor agency funding. UNFPA provided support to continue a field study of Mobile Service Units as well as a Male Attitude and Involvement in Family Planning study. Three teams studied 100 Family Welfare Centers to assess the availability, functioning, and quality of family planning services. Findings included: a low caseload, inadequate facilities, lack of educational materials, insufficient outreach, unnecessary medical and social barriers to providing contraception, and insufficient information to clients about side effects. The Ministry of Population Welfare held an in-house seminar to review findings and discuss remedial actions. The 1991 Pakistan Demographic Health Survey findings suggested that insertions reported did not correspond to reported IUD prevalence rates among married women of reproductive age. A national IUD acceptor survey followed up the 33,196 IUD acceptor cases on the Client Registers at the clinics; Family Welfare Center workers identified only 7824, or 23.6%, as actual IUD acceptors. Among these 2553 were selected for study. Findings of the discrepancy were instrumental in the Ministry's decision to revise the IUD target system and develop other methods to evaluate performance. Eight program officials visited Bangladeshi villages in April 1992 to study how to train literate married women with children to deliver family planning services to villagers. The goal is to raise the contraceptive prevalence rate to 24% by 1998 by extending services to 70% of the rural population. Government officials used findings of the Eighth Five-Year Plan to design a pilot village-based Family Planning Worker project, which has been expanded to 2000 villages. Another 10,000 are planned by 1996 to cover all villages with a population of 2000 or more.
Management information systems in health and family welfare programmes: observations from experimental projects.
In: Monitoring and evaluating family planning programmes in the 1990s, [compiled by] United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. Bangkok, Thailand, ESCAP, 1990. 169-87. (Asian Population Studies Series No. 104; ST/ESCAP/945; UNFPA Project No. RAS/86/P09)The primary health center (PHC) data systems serves the delivery of health care in rural India with a medical officer in charge. PHC provides health and family welfare services to at least 30,000 people. Subcenters are staffed by 2 paramedics and cover 5000 people or more. Recordkeeping consists of village records, family folders, prenatal, natal, and postnatal services, eligible couple registers, monthly reports, vital events, conventional contraceptive registers, IUD registers, sterilization registers, and oral pill registers. Monthly meetings are held and monthly reports are compiled on blood smears, malaria-positive cases, DDT spraying, tuberculosis, gastroenteritis, diarrhea cases, and mortality of major diseases. Shortcomings of the existing system include data that are incomplete, frequently of poor quality, and unsatisfactory maintenance of eligible couple registers. An effective management information system (MIS) is indispensable for planning and implementation of programs. In the Dindori block of the Nashik district of Maharashtra state the Economic and Social Commission for Asia and Pacific (ESCAP) provided technical assistance to improve MIS for 200,000 people. An experimental MIS model was tested in 1987. A family health card was developed for data on household members, immunization coverage of children, malaria, TB, and leprosy incidence. In 1986 an experimental computerized MIS was also developed at Bavala, Ahmedabad district covering 260,000 people in 3 blocks with records of 38,000 mothers and 18,000 children under 3. WHO supported an experimental MIS project in 1988 in the state of Gujarat whose objective of reducing records kept was attained.
For the public good. A history of the Birth Control Clinic and the Planned Parenthood Society of Hamilton, Ontario, Canada.
Hamilton, Canada, W.L. Griffin, 1974. 35,  p.The history of the Planned Parenthood Society of Hamilton, Ontario, Canada has been prepared to recognize the fact that the Society is the oldest of its kind in Canada. It is approaching its 50th Anniversary, and it still plays a prominent role in Hamilton as well as being one of the founding members of the Family Planning Federation of Canada. The Federation is a member of the International Planned Parenthood Federation. The Society was founded by Mary Elizabeth Hawkins with the help of Albert R. Kaufman. Mr. Kaufman alleviated the plight of wives of the unemployed who were having unwanted children. The constitution of the Society had 2 parts: (1) "to establish and maintain a birth control clinic in Hamilton where free instruction will be given to married women in cases where there are definite physical or mental disabilities in order that the public good may be served." (2) "To educate the public as to the true aims of the birth control movement and its beneficial effect upon the race." In 1932 Mrs. Hawkins and Miss Burgar went to the Wentworth County Court House in Hamilton to talk to the Crown Attorney Ballard about the legality of operating their clinic. At the time the Criminal Code had prohibitions against "every one having for sale or disposal any means of instructions or any medicine, drug or article intended or represented as a means of preventing contraception." The result of the meeting was a letter from George Ballard that openly supported their activities and wished them success. The early days were the hardest because of a lack of money, most of which came from the founding members. There was also a great deal of opposition from the local community. However, it was the work of Society that helped make contraception legal in Canada today.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
[Unpublished] 1989. Presented at the First International Symposium on No-Scalpel Vasectomy, Bangkok, Thailand, December 3-6, 1989. 10 p.The paper describes the introduction and use of the no-scalpel vasectomy in the United States. Vasectomy is popular in the U.S., with 336,000 of them performed in 1987 almost exclusively buy urologists, family practitioners, and surgeons. Receiving no government funding for the new procedure's introduction in the U.S., the Association for Voluntary Surgical Contraception (AVSC) turned to family planning clinics, Planned Parenthoods, and medical schools to reach experienced vasectomists interested in co-sponsoring orientation seminars for other doctors. Programs were held in 1988, in California, Massachusetts and New York, in which attendees were provided self-training packages, and asked to report their experiences with the new technique. Field reports were received from 25 physicians on 2,237 vasectomies, and included both positive and negative comments. Even though the technique is uncomplicated, physicians generally found the technique difficult to master with only teaching materials. Accordingly, the U.S. training model was modified to include a rubbermodel f the scrotal skin and underlying was with the training packet, visits to practitioners' offices by clinical instructors, a compressed training period of 1 day, and hands on training. A minimum of 6-9 cases is generally required to properly learn the technique. 3-4 training seminars will be conducted over the next year in different regions of the U.S. in addition to other efforts aimed at meeting demand for training from interested doctors. Care is taken in choosing instructors and participants, with interest especially strong in training of trainers. Of central concern to the AVSC is their ability to keep pace with growing demand for training, while ensuring 6-12 month follow-up and high-quality instruction and practice of the technique.
Population libraries and information centers in Latin America and the Caribbean: problems and prospects.
In: Focus: international, [edited by] Jane Vanderlin and William Barrows. New York, New York, Association for Population/Family Planning Libraries and Information Centers-International, 1986. 15-33.In the 1960s and 1970s, the following various types of libraries and information centers in population and family planning developed in these ways: 1) official statistical agencies increased and diversified their holdings; 2) international organizations developed or increased their information dissemination; 3) some universities developed research and training programs; 4) various independent research centers were established; and 5) private family planning agencies conducted research on population matters. In the past few years, these developments have occurred: 1) national statistical offices are now conducting censuses regularly in almost all countries; 2) international agencies now have a lower profile and funding has been cut; 3) university programs have consolidated and progressed; 4) independent research centers have had funds reduced, and professional associations have been established; and 5) private family planning agencies have proliferated and official support and national organizations have also materialized. Great progress has been made in terms of 1) growth of information, 2) growth of demand, 3) improved access, and 4) a propitious political climate. The obstacles that remain to greater dissemination of population information concern 1) lack of centralization, 2) scarcity of funds, 3) shortage of personnel, 4) communications problems, and 5) users' habits and language. In the future, there will be a 1) mushrooming growth of information on population, 2) geographical spread of population activities, 3) great need for rapid organization and dissemination of information, and 4) potential for use of modern computer technology. Some suggestions to improve population information in Latin America and the Caribbean include 1) identification of institutions that produce or use population information, 2) classification of major libraries by their holdings, 3) recruitment of new members of the Association of Population Libraries and Information Centers, 4) compilation of a basic list of recommended holdings for different subareas in population studies, 5) compilation of regional holdings lists, 6) consideration of study tours for Latin American and Caribbean librarians to visit libraries in developed countries, and 7) participation of nonlibrarians in population information activities.
Report on the evaluation of the UNFPA funded project on labour and family welfare education in organized sector in Zambia (September-October 1986).
Arlington, Virgina, Development Associates, 1986. iii, 71 p.This report evaluates the UNFPA-funded Labor and Family Welfare project in the Organized Sector of Zambia, Africa. The project targeted 3 key elements of the Organized Sector--motivation of leaders, training of educators, and in-plant workers' education. The project laid the groundwork for a major expansion of education and services at the workers' level. It has also led to a National Population Policy formulation. 18 recommendations are suggested with priority given to factory-level education and family planning service delivery. Additional funding for companies to motivate and educate workers regarding acceptance of family planning services is suggested, as well as increased training for economics, teachers, psychology teachers, and social workers to enable them to incorporate population education into their curriculums. Training activities were a major focus of the project. Increased training and educational materials about family planning, in the form of posters and handouts, should be produced and disseminated at the factory level, as well as to medical personnel. UNFPA, in accord with the Ministry of Health of Zambia, should ensure an adequate supply of contraceptives to the factories. Existing record keeping, reporting and scheduling practices should be improved, as well as the International Labor Organization (ILO) disbursement system. Short-term ILO consultants should be recruited to improve the project and its management, and 2 additional staff members, provided by the government, could help to implement the program at the plant level. 2 new vehicles should be purchased for full-time field staff to ensure availability to carry out project activities. In addition, the present accounting and recordkeeping of the ILO Lusaka office should be restructured to achieve more accurate monitoring of the use of project funds.
PEOPLE. 1987; 14(2):33.3 agencies in Turkey are placing family planning centers in factory settings: the Family Planning Association of Turkey (FPAT), the Confederation of Trade Unions (TURK-IS), and the Family Health and Planning Foundation, a consortium of industrialists. The FPAT started with 27 factories 7 years ago, educating and serving 35,000 workers. The 1st work with management, then train health professionals in family planning, immunization, infant and child care, maternal health, education, motivation techniques, record-keeping and follow-up. Worker education is then begun in groups of 50. New sites are covered on a 1st-come-1st-served basis. This program is expected to be successful because newcomers to city jobs are beginning to see the need for smaller families, and accept family planning. TURK-IS has conducted seminars for trade union leaders and workers' representatives and provided contraceptives in 4 family planning clinics and in 20 hospitals run by Social Security, a workers' health organization. They have distributed condoms in factories and trained nurses to insert IUDs in factory units. The businessmen have opened family planning services in 15 factories, with support from the Pathfinder Fund, and hope to make the project self-supporting.
JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION. 1986 Feb; 79(2):75-6.275 laparoscopic tubal ligations were done safely and economically at the Planned Parenthood of Memphis outpatient clinic from May 1983 to June 1985. Patients were carefully selected and counselled, eliminating those with previous abdominal surgery, excluding cesarean section, and those with ongoing pregnancy or serious gynecological or medical problems. The trained staff of experienced laparoscopic surgeons and certified registered nurse anesthetists practiced emergency procedures before surgery. Anesthesia was a minimal amount of nalbuphine (Nubain) 20 to 40 mg and droperidol (Inapsine) 1.25 to 2.5 mg; or fentanyl 0.1 to 0.25 mg and droperidol 1.25 to 2.5 mg; occasionally nitrous oxide inhalation. Some women received droperidol 1.25 to 2.5 mg or diazepam 2.5 to 5 mg beforehand. The laporoscopic procedure, performed through a small intraumbilical incision, employed the fallop ring. The incision was closed with 000 Dexon subcuticular sutures. There were minor side effects in 23: nausea in 20, vomiting in 2 and wound infection in 1. Two pregnancies occurred: 1 was not detected in the preliminary pregnancy test and the other was a procedure failure. The sterilization program is considered safe and resonably priced, $450 compared to $1150 to 1469 in area hospitals outpatient clinics.
PUBLIC HEALTH REPORTS. 1987 Jul-Aug; 102(4):420-7.A marketing study was conducted for Planned Parenthood of Louisiana to provide information on product needs, placement of health facilities, reasonable prices for family planning services, and promotional needs. It illustrates the role that marketing research can play in the development of family planning program strategies, even for relatively small organizations. Data from telephone interviews among a random sample of 1000 women 15-35 years old in New Orleans before the clinic opened confirmed that the need for services was not entirely satisfied by existing providers. Clinic hours and cost of services were in line with client interests. The most useful findings for developing promotional strategy were the relatively low name recognition of Planned Parenthood (only 51% of respondents had ever heard of the organization) and a higher-than-expected level of interest in using the service expressed by young, low-income black women.
Family Planning Perspectives. 1985 Nov-Dec; 17(6):255-9.Many family planning clinics have adopted an individual approach to educating patients. A class offered in Milwaukee, Wisconsin can be considered typical of most traditional classes. It consistes of a 45 minute lecture attended by 8-10 new patients and a few significant others. In 1980, however, the Greater Milwaukee Chapter of Planned Parenthood decided it was time for a change. A pilot program of individualized education went into effect. 4 months after the initial program was implemented, 18 of 23 nurses and counselors thought that individualized education was better than group education. The remaining 5 thought group education did just as well. A significant result of individualized education was its impact on patient flow, since patients could now schedule appointments throughout the day and evening, eliminating afterclass bottleneck.
Billings, Montana, Planned Parenthood of Billings, 1981. 15 p.Using a population of 59 minor women who came to the Planned Parenthood Clinic of Billings, Montana in 1980 and 1981 for the first time, this paper isolates factors which are critical in the decision making process the minor experiences before coming to the clinic. In depth interviews were conducted on each adolescent ranging from 13 years to 17 years. Background information shows that: 1) 1/2 of the adolescents interviewed have parents who are divorced; 2) only 50% live with their father while 72% live with their mother; and 3) most of the parents do not have much education. Counselors can never assume that an adolescent comes from any particular kind of household. Characteristics of sexual experiences reveal that: 1) 96% of the adolescents had already had sexual intercourse before they came to the Planned Parenthood Clinic for the first time; 2) the average age of 1st sexual intercourse is 15.18; 3) for all but the 16 year age group, the greatest percentage of adolescents have intercourse for the first time during the year that they 1st come to the clinic; 4) 62% of the adolescents have intercourse with more than 1 person, and usually within a few months to 4 years before they come to Planned Parenthood; 5) most adolescents have an unpleasureable sexual experience their first time; 49% were reported as violent experiences; and 6) the significance of sex as expressed by the adolescent women is that of an expression of closeness and love for their boyfriend. When the adolescents come to the clinic for the 1st time they already know what kind of contraceptive they want to use; 88% specifically requested oral contraceptives. Data demonstrate that people or an individual person in the adolescent woman's social network play a key part in the decision of the adolescent to come to the clinic for the 1st time; the adolescent herself, the adolescent and her boyfriend, a parent, a boyfriend alone, a girlfriend, and a sibling, in this descending order, are the persons who initiate the idea. Recommendations for more effective birth control of adolescents are: 1) males should be educated to encourage and show approval towards their partner's contraceptive use; 2) educational programs for parents to deal directly with their child's sexual experiences; 3) all children in the family should be talked to about sex and birth control; and 4) adolescents who do come to clinics should be encouraged by counselors to tell their friends about their experiences there. Studies show that there are direct correlations between high self esteem and adolescent contraceptive use; counselors can link the pragmatic concerns of adolescents for future prospects with the consequences of pregnancy. This, along with workshops which help prepare mothers to talk to their daughters about sex and contraceptives, can help adolescent women get the contraceptive information they need in order to achieve their future goals by reducing the risk of pregnancy.
Family Planning Perspectives. 1981 Jan-Feb; 13(1):19-22.Nurse practitioners have become a major and virtually indispensable resource for women coming to clinics for family planning services. This new study of Planned Parenthood clinics shows that nurse practitioners serve more than 3/5 of all patients, at a cost considerably below that of physician care. (An estimated 3 million dollars a year is saved by using nurse practitioners.) These health workers insert IUDs and prescribe oral contraceptives and various other medications. Most have had between 12 and 18 weeks of formal training in family planning in addition to their nursing education. Salaries of nurse practitioners are only about 1/2 those of physicians in Planned Parenthood clinics. (Author's)
[Unpublished] 1980. Presented at the Annual Meeting of the Population Association of America, Denver, Colorado, April 10-12, 1980. 34 p.The Calabar Rural Maternal and Child Health/Family (MCH/FP) Project ran from July 1975 to December 1980 funded by the Cross River State Government Ministry of Health with assistance from the Population Council (New York) and the UN Fund for Population Activities. Calabar met the following requirements: it is rural; population between 200,000-500,000; family planning and maternal and child health is integrated from the top level of administration to the delivery of services to the clients; the target population is all women who deliver within the area and their children up to 5 years; services are at levels that can be expanded to larger areas of the country; and attention is given to evaluation of both health benefits and results of family planning services. As a model of health care delivery services to be used throughout the developing world, maternal health services are most important because the level of preventable deaths is highest in preschool children and in women at childbirth and MCH is the most appropriate an effective vehicle for introducing family planning. At the end of the Calabar Rural MCH/FP Project, the office will be closed but the services will continue under the direction of the local governments in Cross River State. 6 health centers and 1 hospital served 275 villages. Knowledge of contraception was low but positively associated with education.
[Unpublished] 1979. Paper prepared for the Technical Workshop on the Four Country Maternal and Child Health/Family Planning Projects, New York, Oct. 31-Nov. 2, 1979. (Workshop Paper No. 2) 10 p.An integrated health care system which combined the maternal/child health with other services was undertaken in the Yozgat Province of Turkey from 1972-77. The objective was to train midwives in MCH/FP and orient their activities to socialization. The first 2 years of the program was financed by UNFPA. 52 health stations were completed and 18 more are under construction. The personnel shortage stands at 33 physicians, 21 health technicians, 30 nurses, and 67 midwives. Yozgat Province is 75% rural and has about a 50% shortage of roads. The project was evaluated initially in 1975 and entailed preproject information studies, baseline health practices and contraceptive use survey, dual record system, and service statistics reporting. The number of midwives, who are crucial to the program, have increased from an average 115 in 1975 to 160 in 1979. Supervisory nurses are the link between the field and the project managers. Their number has decreased from 17 to 6. Until 1977 family planning service delivery depended on a handful of physicians who distributed condoms and pills. The Ministry of Health trained women physicians in IUD insertions. The crude death rate in 1976 was 13.2/1000; the crude birth rate was 42.7/1000. The crude death rate in 1977 was 14.8/1000; birth rate, 39.9/1000. Common child diseases were measles, enteritis, bronchopneumonia, otitis, and parasitis.
Kenya's project for the improvement of rural health services and the maternal child health and family planning programme.
In: Korte R, ed. Nutrition in developing countries. Eschborn, Germany, German Agency for Technical Cooperation, 1977. 29-37.This report focusses on a project for the improvement of rural health services and development of 6 rural health training centers in Kenya. The Ministry of Health has the responsibility of managing the health centers and dispensaries throughout the country. After a study by experts and funding by international agencies, a project to provide postbasic training to health center staff was undertaken. The major health conditions affecting the community were: family health problems; communicable disease; inadequate sanitation diseases; and, malnutrition and undernutrition. The most overwhelming problem was family health which necessitated a maternal and child/family planning project. The program is directed at women aged 15-49 with a "Super-Market" approach whereby all services (antenatal care, maternity care, postnatal care, child welfare, family planning and health education) will be available on a daily basis in an integrated system. 5 new training schools for nurses are being built. Education in both health and family planning will be emphasized in the project in the future. With a view to uplifting the general quality of life, the Kenya projects are seen as part of the total socioeconomic development of the country as a whole.
JOURNAL OF THE INDIAN MEDICAL ASSOCIATION. 1979 Mar 16; 72(6):137-43, 148.The International Conference on Primary Health Care called for urgent and effective national and international action to develop and implement primary health care throughout the world. All government agencies should support primary health care by channelling increased technical and financial support to health care systems. Any national health policy designed to provide for its people should recognise the right to health care as a fundamental right of people. The sociocultural environment of the people should be upgraded as a part of health care. The government's expenditure on health should be regarded as an investment, not as a consumption. Health should be a purchasable commodity. Medical education should be reoriented to the needs of the nation. The government should establish as its ultimate goal the provision of scientific medical service to every citizen. Industrial health and mental health disciplines should establish clear-cut methodologies to achieve the same objectives as medical science. Practitioners of indigenous systems of medicine should be allowed to practice only those systems in which they are qualified and trained. Integration of the modern and traditional systems has failed. In order to encourage people to adopt small family size, facilities for maternal and child welfare clinics, coupled with immunisation and nutrition programs, are needed.
Family Planning Perspectives. March-April 1979; 11(2):122, 126.Disparity in operative procedures and postoperative tests (in establishing sterility) was the main finding of a survey of 50 vasectomy clinics (37 responded) which performed more than 10,800 of the 25,000 clinic vasectomies in 1977. The surveyed clinics used at least 10 different techniques to cut the vas, with excision and ligation accounting for only 27% of all procedures. Bilateral vertical incision under local anesthesia was the most common method used in clinical vasectomies; midline vertical and horizontal incisions were also used. Length of resected vas ranged from 5-10 mm. to 40-50 mm. Although all clinics utilized postoperative microscopic examination of the semen to determine sterility, clinic standards for determining when and under what conditions the examination should be performed were not uniform. The Planned Parenthood Federation of America (thru its National Medical Advisory Committee) formulated a standard protocol for evaluating sterility. The protocol requires the man to have 15 postoperative ejaculates before his semen can be analyzed for sterility; at least 1 specimen should exhibit azoospermia (absence of living sperm) before contraception can be discontinued. The presence of motile sperm after 25 ejaculations or nonmotile sperm after 50 ejaculations, may require a second operation.