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[Unpublished] 1988 Oct 26. Paper presented at the "Meet the Experts" panel sponsored by The World Federation for Voluntary Surgical Contraception, at the XII World Congress of Gynecology and Obstetrics sponsored by The International Federation of Gynecology and Obstetrics [FIGO], October 26, 1988, Rio de Janeiro, Brazil. 25 p. (ME62/ME21)Brazil, the largest country in area and population in Latin America, has not had the benefit of a government-sponsored family planning program and until recently such activities were sensitive and done with much constraint. The Centro de Pesquisas de Assistencis Integrada a Mulher e a Crianca (CPAIMC) which began offering family planning in its clinics in 1978, joined with Johns Hopkins Program for Education in Gynecology and Obstetrics (JHPIEGO), in 1980, to train medical doctors in the techniques of voluntary surgical contraception. It was followed by the support of the Association for Voluntary Surgical Contraception (AVSC) and Development Associates. During the years that followed the 1st project with JHPIEGO, AVSC and Development Associates, more than 125 courses were performed, 180 for nurses and 210 for auxiliary nurses and administrative personnel delivered by CPAIMC, ABEP and BEMFAM, and more than 350 institutions received technical assistance in voluntary surgical contraception. In recent national studies done by BEMFAM in contraceptive method prevalence, the most common methods were oral and surgical contraception. 65% of married women report they or their husbands are currently using contraceptives. Nationally, 27% of couples are using female sterilization and 25% oral contraceptives. Female sterilization is the most common method in all regions except the South, where pills are the most prevalent method. About 7% of the males have had vasectomies. Sterilization is more common in urban areas and increases in accordance with a woman's age, reaching prevalence rate of 73% between the age of 25 to 39. Average age was 31.4 years but 40% of the women were sterilized before age 29. Data is given on duration of marriage with sterilization, place of operation, complications, client profile, medical/surgical data, and sterilization failure. It was found that cumulative failure rates for sterilization in Brazil are comparable to or somewhat lower than those reported elsewhere; they decreased significantly as age at sterilization increases; failure during training periods are not significantly different, and cumulative failure rates increased, although not significantly, as the number of sterilizations per surgeon/day increased (author's modified)
Hong Kong, Family Planning Association of Hong Kong, 1984.  p.This 1983-84 Annual Report of the Family Planning Association of Hong Kong lists council and executive members as well as subcommittee members and volunteers for 1983 and provides information on the following: administration of the Association; clinical services; education; information; International Planned Parenthood Federation (IPPF) activities; laboratory services; library service; motivation; personnel resource development and production; the Sexually Assualted Victims Service; studies and evaluation; subfertility service; surgical service; training; the Vietnamese Refugees Project; women's clubs; the Youth Advisory Service; and youth volunteer development. In 1983, there was a total of 45,384 new cases; total attendance at clinics was 261,992. A series of thirteen 5-minute segments on sex education was produced as part of a weekly television youth program. An 8-session sexual awareness seminar continued to receive a very good response. To meet the increasing demand of young couples for better preparation towards satisfactory sexual adjustment in marriage, a 3-session seminar on marriage was regularly conducted every month during 1983. 13 seminars were held, reaching a total of 374 participants. Other education efforts included a family planning talk, the Kwun Tong Population and Family Life Education Week, and 39 sessions of talks and lectures on various topics related to family planning and sex education. The year-long information campaign was organized in response to the 1982 Knowledge, Attitude, Practice findings that many couples still fail to recognize the concept of shared responsibility in family planning. Laboratory services include hepatitis screening, premarital check-up examinations, pap smear, the venereal disease research laboratory test (VDRL), and seminal fluid examinations. Throughout the year, 256 interviews were given to sexually assaulted victims. To arouse the awareness of the public with regard to preventing rape through education, counselors conducted talks and gave radio and television interviews on the Sexually Assaulted Victims Service. The records of the 3 sub-fertility clinics showed that altogether in 1983 there were 1355 new cases and 561 old cases, with a total attendance of 6682. 144 pregnancies also were recorded. Training programs included sex education seminars for social workers, a sex education course for secondary school teachers, a sex education seminar for student guidance officers, and an advanced course on human sexuality for teachers and social workers.
Sex education and family planning services for adolescents in Latin America: the example of El Camino in Guatemala.
[Unpublished] 1984. ix, 54,  p.This report examines the organizational development of Centro del Adolescente "El Camino," an adolescent multipurpose center which offers sex education and family planning services in Guatemala City. The project is funded by the Pathfinder Fund through a US Agency for International Development (USAID) population grant from 1979 through 1984. Information about the need for adolescent services in Guatemala is summarized, as is the organizational history of El Camino and the characteristics of youngg people who came there, as well as other program models and philosophies of sex education in Guatemala City. Centro del Adolescente "El Camino" represents the efforts of a private family planning organization to develop a balanced approach to serving adolescents: providing effective education and contraceptives but also recognizing that Guatemalan teenagers have other equally pressing needs, including counseling, health care, recreation and vocational training. The major administrative issue faced by El Camino was the concern of its external funding sources that an adolescent multipurpose center was too expensive a mechanism for contraceptive distribution purposes. A series of institutional relationships was negotiated. Professionals, university students, and younger secondary students were involved. Issues of fiscal accountability, or the cost-effectiveness of such multipurpose adolescent centers, require consideration of the goals of international funding agencies in relation to those of the society in question. Recommendations depend on whether the goal is that of a short-term contraception distribution program with specific measurable objectives, or that of a long-range investment in changing a society's attitudes about sex education for children and youth and the and the provision of appropriate contraceptive services to sexually active adolescents. Appendixes are attached. (author's modified)
[Unpublished] 1981. 9 p.Recognizing a need to provide help to mentally handicapped women with fertility related problems, the Family Planning Association of Hong Kong established a clinic for the mentally handicapped in May 1979. The basic rationale for the service was the United Nations 1971 proclamation of a Declaration on the Rights of Mentally Retarded Persons and its call for the protection of these rights. Articles of particular interest in the declaration are listed. After studying the situation, the Association began by introducing a series of educational activities and establishing the special clinic. Several pilot programs were conducted with the cooperation of the Pine Hill Village schools following the workshop organized for professionals working with mentally handicapped youths. Experience from those projects indicated that special skills and materials would be required in order to teach sex education to the mild to moderate grade mentally handicapped youths. 9 welfare agencies cooperated in a project to develop sex education. A monthly sex education course for parents of mentally handicapped children was initiated in September 1980 to help them understand aspects of the child's sexual behavior and how to cope with it. Since May 1979 the Association has been operating a pilot special clinic with a team made up of a gynecologist, psychiatrist, clinical psychologist, counselor, and nurse. Services include self-management skills in menstrual hygiene and preliminary assessment for determining appropriate birth control methods. The clinic has handled 92 cases thus far, and 4 case histories are presented to illustrate the nature and scope of the services.
A preliminary pharmacokinetic and pharmacodynamic evaluation of depot-medroxyprogesterone acetate and norethisterone oenanthate.
Fertility and Sterility. 1980 Aug; 34(2):131-9.2 populations attending WHO centers, one in Sweden and one in India, participated in a comparative, pilot trial of 2 increasingly popular injectable progestin-only female contraceptives, Depo-Provera and Norigest. The purpose of the study was to assess the pharmacokinetic and pharmacodynamic properties of the 2 formulations (depot medroxyprogesterone acetate and norethisterone enanthate). Differences were found between Swedish women and Indian women in their reactions to the 2 drugs: 1) Norigest was detectable in blood samples a significantly shorter time after injection of the agent in Indian women than in Swedish women; this difference was not apparent with Depo-Provera. 2) Although there was no difference at the 2 centers in the time of ovulation return for subjects receiving Norigest, 0 of 4 Swedish women ovulated more than 156 days after Depo-Provera injection, whereas all 4 Indian women ovulated within 73 days of Depo-Provera injection; in the Swedish women, the levels of medroxyprogesterone were undetectable at time of return to ovulation, whereas Indian women had levels of .6 ng/ml when ovulation resumed. 3) In both cultures, Depo-Provera users had significantly more episodes of bleeding and spotting than Norigest users. This preliminary report emphasizes the variety of responses possible to injection of different contraceptive progestins among various populations and points to the need for further culturally comparative studies.
IPPF Medical Bulletin. 1977 Oct; 11(5):1-2.Lancet recently published 2 papers which reported research fundings indicating that oral contraceptive users, over 35 years of age, are at greater risk of death from cardiovascular disease than nonusers. The findings also suggested that oral contraceptive users who have taken the pill for more than 5 years, who smoke, or who have diabetes, hypertension, or obesity are also at increased risk of death than nonusers. In view of these findings the Presidents of the Royal College of General Practitioners and of the Royal College of Obstetricians and Gynaecologists revised oral contraceptive prescribing recommendations. According to the new recommendations 1) women, who are under 30 years of age, can continue to use the pill but if they smoke they should be advised to quit smoking; 2) women, between 30-35 years of age, can continue to use the pill but if they have taken the pill for 5 or more years and if they smoke they should be advised to switch to other contraceptive methods; and 3) women, over 35 years of age, should be advised to use other contraceptive methods. The British Committee on Safety of Medicines did not issue new prescribing instructions. The International Planned Parenthood Federation, noting the findings of both U.S. and British studies, said that physicians should be aware that the risk of death from cardiovascular disease may be enhanced for oral contraceptive users over the age of 40. The Federation also recommended that couples with completed families should consider sterilization or other alternative forms of contraception.
Overview: 1975. Contraceptive services of the family planning programs of IPPF in the Western Hemisphere.
New York, International Planned Parenthood Federation, Western Hemsisphere Region, Medical Department, Nov. 1976. 28 pAdd to my documents.
[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.
Medical Journal of Australia. November 18, 1978; 2(11):531.The report of the World Health Organization's (WHO's) Scientific Group on the subject of the risk of neoplasia associated with the use of steroid contraception was published in 1978. Regarding the association between liver tumors and the use of OCs, the Scientific Group reached the following conclusions: 1) current evidence demonstrates a marked increase in the relative risk of hepatocellular adenoma of the liver among women who have used OCs for longer than 3 years; 2) the magnitude of the risk increases with the dose of steroid, the duration of use, and the age of the user; 3) preliminary calculations based upon the results of 2 recent studies suggest that, despite the extremely large relative risk estimate, the attributable risk of hepatocellular adenoma among women under 30 years of age is no more than 3/100,000 OC users per year, regardless of length of use; and 4) these data apply more to OCs containing high doses of steroids.
(Description of the World Health Organization Special Programme of Research, Development, and Research Training in Human Reproduction.) (Statement, May 2, 1978))
In: United States. Congress. House of Representatives. Select Committee on Population. Population and development: research in population development: needs and capacities. Vol. 3. Hearings, May 2-4, 1978. Washington, D.C., U.S. Government Printing Office, 1978. p. 213-286The World Health Organization's Special Programme of research, Development, and Research Training in Human Reproduction is supported by 150 member governments spending over 15 million dollars on 5 specific areas of research: 1) effectiveness of existing birth control methods; 2) development of new methods; 3) psychosocial factors and health service delivery; 4) health rationale for family planning; and 5) infertility. A primary goal of the program is to strengthen fertility research within the developing country. Some results of WHO research on specific contraceptive practices found the following. Depo-Provera was frequently discontinued because the amenorrhea percentage over 90 days increased from 13% to 35% during the 4th injection interval. Male contraceptives are acceptable to 50% of men in Fiji, India, Korea, Mexico and the United States with a daily pill more desirable than a monthly injection. A majority of women believe that menstruation is the removal of impure blood, and that intercourse should not occur at that time.
PP News. 1978 Jun-Sep; 1(3):4.One of Planned Parenthood of America's 1st formal clinic courses in the ovulation method of birth control has seen more than 350 clients, and has resulted in encouraging preliminary figures on contraceptive success, in addition to winning the support of the clinic staff, and a favorable community reaction. The ovulation method utilizes periodic abstinence from coitus, based on the way the woman's cervical mucus varies at different stages in the menstrual cycle. Clients were 1st given background information and a chart, and after recording a complete cycle, returned for a follow-up interview. From January-September 1978, out of 292 women attending the 1st session, 120 continued through the 2nd follow-up. Of these 120, there were 3 pregnancies, but no method failures because all 3 women knew they were fertile at the time of coitus. The role of the man in the program is emphasized and supported. The author, who was also the instructor, concludes that Planned Parenthood clinics should be aware and take advantage of growing interest in this form of fertility awareness.
New York, International Planned Parenthood Federation, Western Hemisphere Region, September 1975. 149 pThe primary focus in this 4th edition in the series of annual "overviews" of the contraceptive services in the Western Hemisphere Region of the International Planned Parenthood Federation is on clinical facilities, medical and paramedical services, and on the delivery of contraceptive methods by family planning programs. Family planning services link information on methods for spacing or limiting children to their availability, and they provide education on the advantages of contracepting. They seek to motivate acceptors to continue their chosen method. Counseling and information and education activities, although an integral component of family planning programs, are not included among the topics considered in the "Overview." In the Western Hemisphere Region, the most notable innovation has involved the community-based distribution of contraceptives (CBD), and for the 1st time, non-clinical distribution of contraceptives by associations in the region is a part of the "Overview." The Annual Reports submitted by IPPF affiliates and published and unpublished data from other programs are the primary sources of statistics for this report. Information for 1973 encompassed 29 associations related to IPPF and 4 other programs, and for 1974, 28 associations and 5 other programs could be covered. As for clinical input of family planning programs, the affiliates reported to the Regional Office of IPPF the number and types of clinics, weekly session hours, hours of medical and paramedical personnel. Data on the output of clinical activities of family planning programs for the calendar year were limited to 1st visits or new acceptors by methods, 1st revisits of the year or continuing (old) acceptors by method, number of revisits by old and new acceptors by method, demographic characteristics of new acceptors by method, and voluntary male and female sterilization performed or referred. Data on contraceptive services and clinical activities are summarized and presented in the form of tables.
San Francisco, San Francisco Press, 1974. 292 p.Despite its high effectiveness, lack of side effects, ease of use, and low cost, condom utilization has declined in the U.S. from 30% of contracepting couples in 1955 to 15% in 1970. The present status of the condom, actions needed to facilitate its increased availability and acceptance, and research required to improve understanding of factors affecting its use are reviewed in the proceedings of a conference on the condom sponsored by the Battelle Population Study Center in 1973. It is concluded that condom use in the U.S. is not meeting its potential. Factors affecting its underutilization include negative attitudes among the medical and family planning professions; state laws restricting sales outlets, display, and advertising; inapplicable testing standards; the National Association of Broadcasters' ban on contraceptive advertising; media's reluctance to carry condom ads; manufacturer's hesitancy to widen the range of products and use aggressive marketing techniques; and physical properties of the condom itself. Further, the condom has an image problem, tending to be associated with venereal disease and prostitution and regarded as a hassle to use and an impediment to sexual sensation. Innovative, broad-based marketing and sales through a variety of outlets have been key to effective widespread condom usage in England, Japan, and Sweden. Such campaigns could be directed toward couples who cannot or will not use other methods and teenagers whose unplanned, sporadic sexual activity lends itself to condom use. Other means of increasing U.S. condom utilization include repealing state and local laws restricting condom sales to pharmacies and limiting open display; removing the ban on contraceptive advertising and changing the attitude of the media; using educational programs to correct erroneous images; and developing support for condom distribution in family planning programs. Also possible is modifying the extreme stringency of condom standards. Thinner condoms could increase usage without significantly affecting failure rates. More research is needed on condom use-effectiveness in potential user populations and in preventing venereal disease transmission; the effects of condom shape, thickness, and lubrication on consumer acceptance; reactions to condom advertising; and the point at which an acceptable level of utilization has been achieved.
New York, International Planned Parenthood Federation, Western Hemisphere Region, Medical Division, September 1975. 49 pThis is a compilation of family planning services provided by associations operating in the Western Hemisphere Region. Separate tables are compiled for 1973 and 1974. A list of each family planning program included in the study is appended to the report. The report does not guarantee the completeness or accuracy of the data; problems with reliability of data point up the necessity for a system of standardized record-keeping. Tables cover program input in the form of clinical facilities, medical and paramedical services, and the delivery of contraceptive methods by family planning programs and community-based distribution systems. Charts on program output include information on acceptor characteristics, numbers of new and continuing acceptors, numbers of voluntary sterilizations, and percentages of other methods in use.
[Family planning: Organization, experiences, suggestions] Familienplanung: Organisation, Erfahrungen, Vorsclage.
In: Staemmler, H.-J., ed. Geburtenplannung. Statistik, Erfahrungen und Konsequenzen. (Birth control. Statistics, experiences and results.) Stut tgart, Georg Thieme Verlag, 1974. p. 81-85The activities of Pro Familia, the West German Society for Sexual Co unseling and Family Planning, are described. The Society participates in the activities of many international organizations of medical and social interest as a member of the International Planned Parenthood Federation. In Germany, Pro Familia offers courses for physicians, counselors and day people, and a variety of educational progrmas for all ages. Physicians working with Pro Familia receive a 5-day training course, and are encouraged to complete deficient aspects of their education in sexuality, family planning, and reproduction. The Society maintains 45 centers and several mobile units to carry programs to underprivileged neighborhoods. The age of clients has declined steadily from a minimum of 16 5 years ago to 13-14 years now; 12-year-olds are sometimes seen. Help is sought not only in questions of fertility and contraception, but also in marital, sexual, and emotional problems of all types.
[Unpublished] 1973 Jul. 20 p.The booklet provides an introduction to Indonesia's national family planning program, and summarizes USAID's assistance to this program. Data are included on the following topics: 1) demographic and economic synopsis; 2) population projections, 3) distribution of land and people, 4) age-specific fertility, 5) family planning program economic benefits, 6) legislative history of family planning, 7) Indonesian family planning structure, 8) major Government and donor program activities, 9) IDA/UNFPA joint project, 10) program results 1971-1973, 11) new acceptor s' characteristics, 12) program impact, 13) program financial resources, 14) USAID population program assistance 1968-1973 -- its primary components and a program description.(AUTHOR'S, MODIFIED)
Honolulu, Hawaii. 1974. n.p.A series of charts produced by Hawaii Planned Parenthood, Inc., provide statistical data on the numbers of minors given contraceptive assistance and counseling by 15 Planned Parenthood clinics. Information provided by the charts includes: 1) Patient characteristics; 2) Method of contact preferred by the patients; 3) Contraceptive methods, past and present; 4) Levels of education; 5) Family size and income of patients; 6) Numbers of fetal deaths and live births; 7) Patients' marital status; 8) Clinic medical services; 9) Patient load by clinic, age, and length of residence in Hawaii; 10) Welfare status of patients; and 11) Reasons given by patients for and against the practice of contraception.
Singapore, 1972 (xi). 60 pThis report presents a detailed analysis of the demographic situation in Singapore, tracing trends in birthrates, fertility rates, and population growth. Family planning services available during 1970 are thoroughly explored, including their funding, birth control methods, and organization and administration. Detailed analyses are given of acceptors of birth control methods by method accepted as well as by acceptor characteristics such as age, parity, education, and race. The Family Planning and Population Board recruited 162,485 acceptors between 1966 and 1970. During that period there was a dramatic decline in the crude birthrate, which was 28.6/1000 in 1966 and 22.1/1000 in 1970. Fertility continued to decline in all age groups and in all ethnic groups during 1970.
IPPF Situation Report, September 1972. 7 pHong Kong, with 3858 people/sq km, is 1 of the world's most densely populated areas. Family planning was introduced in 1936 by the Hong Kong Eugenics League and 5 clinics were operating by 1940. The Family Planning Association (FPA) was formed in 1950 and was a founder member of IPPF in 1952. Interest in family planning increased as massive immigration from China added to overcrowding. The government supports FPA (in 1972 the grant was U.S.$254,545) and houses 80% of the FPA clinics in government properties. At present there are 46 female clinics providing 189 sessions per week and 2 male clinics operating eac h week. The decline from 54 to 48 clinics is due to the new emphasis on full-time rather than part-time clinics. In 1971 there were 347,894 attenders, an increase of 18% over 1970, and 31,898 new acceptors, an increase of 4%. There has been continued increase in the number of patients requesting oral contraceptives (70.6% in 1971). The IUD began to decline after bad publicity surrounded a large number of loops which had broken in the uterus; in 1971 only 6% of acceptors asked for IUDs. Condoms account for 11.5% and injectables, 3.6%. FPA offers subfertility and marriage guidance services and is extending its Papanicolaou smear service. An active media campaign, exhibitions, and seminars are conducted. Until 1967 fieldwork consisted of random home visits. An efficiency study led to concentration on maternal and child health clinics, postnatal clinics, and follow-up home visits. Home visi ts are still made on request. A number of international trials for various contraceptives have been run in Hong Kong. Many church and international organizations are helping to finance family planning activities, both through FPA and through their own organizations.
London, International Planned Parenthood Federation, September 1966. 102 pThis report is based on questionnaires answered by 43 family planning associations in 42 countries. Most of the questions concerned the year 1964, which is considered the end of a chapter in family planning: It was the year before the loop and the year before the world woke up to the implications of family planning. The questionnaire and report cover 4 broad areas: 1) sources of income, 2) types of publicity, 3) clinic structure and personnel, including the usefulness of mobile vans, and 4) family planning methods available at clinics (their advantages and disadvantages, the type of patient, and methods of recruitment). Among the findings is that the amount of help an association is likely to get from outside sources varies directly with the status it holds in its own country. IPPF was the greatest source of outside training. Associations were particularly interested in training that emphasized the IUD and health and sex education. In publicity, religious and political factors were the most important influences. In addition, the amount and type of publicity depended upon money and on multiple-language problems, illiteracy, and the availability of the mass media. Most patients came from urban areas and belonged in the middle of the socioeconomic stratum. Figures showed that many new patients accepted foam tablets and vaginal foam, but that oral contraceptives and IUDs seemed to be the wave of the future.
Country Profiles, July 1970. 8 pFamily planning programs in Malaysia are firmly backed by government policy based on the Family Planning Act of 1966. The estimated population at the end of 1968 was 10 million. The country has a growth rate of 2.8%, a birthrate of 35.2, a death rate of 7.5, and per capita income of U.S.$1056, 1 of the highest in Asia. While the government provides budgetary support, the National Family Planning Board is able to function independently and receives cooperation from a number of Ministries. A strong voluntary Family Planning Association which has existed for many years continues to provide services and cooperates with the government program. The population is highly motivated, and all 3 major ethnic groups accept family planning services. Informational and motivational efforts are being advanced with the setting up of Regional Information Offices staffed by a full-time Information Officer and equipped with vehicles and audiovisual materials. The country's demographic characteristics, socioeconomic development, organization and administration of population programs, research and evaluation, the private sector, educational efforts, and foreign assistance are described.