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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. (KEN-13)For the past 20 years, Chogoria Hospital has run a steadily expanding clinic and community-based health service program in Meru District. This hospital, with its 32 satellite clinics and its catchment area, has been renowned for its high contraceptive prevalence and low fertility rate compared to the Kenyan national average and that of many sub-Saharan countries. Several factors have contributed to this success, including community-based distribution by family health educators (FHEs) and community health workers (CHWs). Through these community-based distributors, family planning (FP), child welfare, and antenatal clients who fail to turn up for appointments within a month after the default date are followed-up and encouraged to visit a clinic. Financial support for this default tracking system has been ensured through donor funds. Lately, however, the longterm sustainability and usefulness of the tracking system have been questioned. In response to this concern, the management at Chogoria Hospital asked The Population Council to evaluate the default tracking system. This study, which cost US $15,080, determined the extent to which the default tracking system is effective in identifying, tracking, and bringing defaulters back to the program. In addition, the cost of tracking down and bringing back a client was determined. A third component involved assessing the attitude of clients towards this activity and their consequent behavior when they visit Chogoria or other clinics. Data were collected from interviews with 654 defaulting clients using a general questionnaire and 3 other ones specific to FP, child welfare, and antenatal issues. 4 teams composed of local school teachers, with heads of schools acting as supervisors, identified and interviewed the defaulters over a period of 13 days. The teams, who had substantial previous experience in interviewing and data collection, received a week-long training session which included 2 days of fieldwork. A different questionnaire was used to collect information from CHWs. These data were supplemented by information received from field team observations. True defaulters were few, and the impact of CHWs and FHEs in bringing back these clients was low (11-17%). The benefits derived from bringing back a defaulter were negligible compared to the high cost of deploying the CHWs and FHEs. As a result, it was recommended that the default tracking system be discontinued. In addition, it was suggested that the CHWs and FHEs be supervised more effectively and that they concentrate their efforts on other community health activities such as primary health care counseling.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
In: Molnos A, ed. Social sciences in family planning. (Proceedings of the Meeting of the IPPF Social Science Working Party, Colombo, Sri Lanka, June 10-13, 1977). London, International Planned Parenthood Federation, 1978 Dec. 9-14.Kenya has a fairly well developed family planning program at the official government level along with an active voluntary Association. It is estimated that over 50,000 women are visiting family planning clinics annually, but as many women drop out of the program in each given month as are recruited. This discontinuation rate presents a major problem for family planning programs, and the underlying causes need to be determined. It is believed that, with the exception of those women who are highly motivated to use contraceptives on a continuous basis, the majority of women, particularly in rural areas, will fail to use contraceptives for long periods of time if the significant others in their lives do not support the idea. It is also probable that many women drop out of family planning programs due to the lack of reliable transport, high transport costs, varying weather conditions, and the family planning program policy which, with the exception of the IUD, provides only sufficient contraceptives to last for 3 months. There are several other reasons why a woman might want to stop using contraceptives: 1) a desire to become pregnant; 2) social pressure to withdraw from the family planning program; 3) the side effects of her method and without a suitable alternative method; 4) difficulty in obtaining contraceptive supplies; and 5) reaching menopause. A family planning campaign which ignores the men is destined for failure in Africa, for the women do not make many of the important decisions. The male must be persuaded to participate in decision-making concerning the use and non-use of contraceptives. Family planning programs should deliberately reduce their drop-out rates even if that means lowering acceptor rates.
London, International Planned Parenthood Federation, Evaluation and Social Sciences Department, May 1976. (Research for Action No. 2) 13 pThe Botswana government, now an affiliate member of the International Planned Parenthood Federation (IPPF), and the IPPF have collaborated since 1969 in the stablishment of family planning services within the maternal and child health programs. Evaluation of the family planning aspects of this program conducted between April 1972 and October 1973 focused on 3specific research studies: 1) a description of the Family Welfare Educator cadre in Botswana, their workload, problems, and training; 2) an analysis of service statistics generated by the Maternal and Child Health Family Planning programs; and 3) a follow-up survey to trace family planning acceptors. By April 1972, 60 women had been trained as family welfare educators. A weekly reporting system was introduced as a means of establishing contact between the family welfare educators and the Office for Maternal and Child Health/Family Planning, learning about the problems workers encountered, and assessing their work. In studying the service statistics it was learned that over the 5 years of this study period 72% of the clients received oral contraceptives, 16% IUDs, and 2% injections on their 1st visit to the clinic. The ratio of oral contraceptives to IUD acceptors changed from .75:1 in 1968 to 28:1 in 1972. It was found that nearly 1/3 of the clients discontinued contraceptive use within 3 months and nearly 2/3 within a year. It was recommended that greater emphasis be placed on the IUD as a method of contraception. Regarding the follow-up survey, a 100% sample of new acceptors in the selected months was drawn from the records of Gaborone and Serowe clinics and data were abstracted from the individual client cards at each clinic. It was learned that 20% of the women interviewed discontinued contraception within 6 months and 34% within a year. These continuation rates were lower than those derived from service statistics. It was recommended that follow-up surveys be repeated at regular intervals in order to monitor the acceptability of the program to new acceptors and to ensure client feedback to improve the program.
Seventh annual report of the St. Vincent Planned Parenthood Association, 1 January-31 December 1972.
Kingston, Jamaica, St. Vincent, 1973. 28 p.The activities during 1972 of the International Planned Parenthood Association on the island of St. Vincent, a 150 square mile dependency of Great Britain in the eastern Carribean with a population in 1972 of 92,000. Although supported by an annual Government grant, the IPPF program is the only one on the island. The events of Family Planning Week in June 1972, one of the IPPF's more important promotional activities, are described in the introductory section. Other social marketing activities of field nurses and fieldworkers, consisting primarily of visits to Government health clinics and maternity wards, as well as an average of 18 home visits a day by fieldworkers during the year, are emphasized. In addition, substantial follow-up efforts were conducted to get dropouts back into the program. Statistics are provided on the age groups and contraceptive method chosen by those who restarted. Other data are provided on the total number of active acceptors, contraceptive methods chosen by acceptors and the number of dropouts during 1972. Detailed financial statements of the St. Vincent Planned Parenthood Association, consisting of a balance sheet, revenue and expenditures, and fixed assets, are provided for the 1972 calendar year.