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  1. 1
    Peer Reviewed

    Keeping up with evidence. A new system for WHO's evidence-based family planning guidance.

    Mohllajee AP; Curtis KM; Flanagan RG; Rinehart W; Gaffield ML

    American Journal of Preventive Medicine. 2005; 28(5):483-490.

    The World Health Organization (WHO) is responsible for providing evidence-based family planning guidance for use worldwide. WHO currently has two such guidelines, Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which are widely used globally and often incorporated into national family planning standards and guidelines. To ensure that these guidelines remain up-to-date, WHO, in collaboration with the Centers for Disease Control and Prevention and the Information and Knowledge for Optimal Health (INFO) Project at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, has developed the Continuous Identification of Research Evidence (CIRE) system to identify, synthesize, and evaluate new scientific evidence as it becomes available. The CIRE system identifies new evidence that is relevant to current WHO family planning recommendations through ongoing review of the input to the POPulation information onLINE (POPLINE) database. Using the Meta-Analysis of Observational Studies in Epidemiology guidelines and standardized abstract forms, systematic reviews are conducted, peer-reviewed, and sent to WHO for further action. Since the system began in October 2002, 90 relevant new articles have been identified, leading to 43 systematic reviews, which were used during the 2003–2004 revisions of WHO’s family planning guidelines. The partnership developed to create and manage the CIRE system has pooled existing resources; scaled up the methodology for evaluating and synthesizing evidence, including a peer-review process; and provided WHO with finger-on-the-pulse capability to ensure that its family planning guidelines remain up-to-date and based on the best available evidence. (author's)
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  2. 2

    WHO recommendations [letter]

    Mansour D

    Journal of Family Planning and Reproductive Health Care. 2004 Apr; 30(2):131.

    May I congratulate the Journal and the Clinical Effectiveness Unit for continuing to produce excellent Guidance for those of us working in the field of reproductive health. The wide dissemination of these articles will ensure uniformity and quality in contraception provision in primary and secondary care. I have, however, one concern. This has been alluded to in a recent article describing the consensus process for adapting the World Health Organization (WHO) Selected Practice Recommendations for UK Use. As a result of the relaxation of some of the more cautious rules a very small number of women may become pregnant. An obvious example is giving Depo- Provera injections 2 weeks late (i.e. at 14 weeks) without any precautionary measures. The Selected Practice Recommendations for Contraceptive Use were developed to improve and extend contraceptive provision in developing countries. In developed countries, however, those becoming pregnant may take a more litigious view particularly when patient information leaflets and the Summaries of Product Characteristics (SPCs) state contrary and more cautious advice. In addition, new evidence regarding follicular development potential suggests that more, rather than less, caution may be advisable. Could the Faculty of Family Planning and Reproductive Health Care or the University of Aberdeen be sued? (excerpt)
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  3. 3

    Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: country reports.

    Corona E; Epps RP; Kodagoda N; Simonen M

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xiv, 89 p.

    UNFPA has provided funding for various family life education (FLE) projects with particular emphasis on youth in the English-speaking Caribbean since the mid-1970s; this report is an independent evaluation of the projects in Antigua, Barbados, Dominica, Jamaica, St. Lucia, and St. Christopher and Nevis. Although birth rates are relatively low in the English-speaking Caribbean, the incidence of adolescent pregnancy and the number of births to women under the age of 20 is an important problem in the region. The Mission concluded overall that the projects have contributed to pioneering and groundbreaking efforts demonstrating that it is possible to initiate and make considerable progress in the implementation of FLE/FP programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues and when there are no official policies in favor of such programs. The Mission concluded also that project design had improved over the years and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. All the projects included in the evaluation have contributed to the training in FLE/FP of a large number of family life educators, teachers, and nurses and, as a result, have significantly strengthened professional national capability. The projects have shown that despite the lack of official policy approving FLE in schools and generally overcrowded curricula, FLE can be introduced into schools. In the area of FP service delivery, the projects included in the evaluation have contributed to making FP services generally available through integration with the government maternal and child health services. The main management issues across the projects were similar and included staffing, coordination, supervision, monitoring and evaluation. There is a need to adjust project design so that gender separation is minimized and that the FLE content deals better with issues such as self-awareness, sex roles, and self-esteem. The wider impact of the projects included in this evaluation, to be reflected, for example, in reduced incidence of teenage pregnancy, reduced maternal and infant/child morbidity and mortality, and more generally in the life patterns of women, cannot yet be measured.
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  4. 4

    Country case study: Korea.

    Kim TI; Cho NH

    In: Jain SC, Kanagaratnam K, Paul JE, ed. Management development in population programs. Chapel Hill, University of North Carolina, School of Public Health, Dept. of Health Administration and Carolina Population Center, 1981. 113-51.

    This case study examines the management development aspect of the Korean national family planning program which was initially adopted in 1962. The nation's goal in the 1st 10 years of the program was to reduce the rate of population growth from 2.9-2.0%. Subsequent targets were established to reduce the growth rate to 1.5% by 1976 and 1.3% by 1981. Recent census figures indicate that these latter figures were not reached. The total fertility rate declined from 6.0 in 1960 to 2.7 in 1978, a 55% decline. The age specific fertility rate also declined except for women between 25-29 years of age. Program costs during the last 18 years totaled about $126.7 million; 80% of these funds came from the government and the rest from foreign assistance. 3811 full time employees were engaged in the program in 1979; 4.9% at the central level, 8.1% at the provincial level, and 87% at the urban and county level. 69% are considered family planning workers. Between 1962-79, 6.1 million cumulative acceptors have received contraceptive services. The IUD was the principal method of contraception until 1976 when female sterilization services were introduced. The contraceptive practice rate has increased from 9-49% between 1964-78. Organization of the program is structured on a national, provincial, and local basis. Assessment of the program indicates that there has been success but the following problems still remain in the, 1) rural oriented program structure, 2) high discontinuation rates of contraceptive usage and inadequate follow-up, 3) high turnover of field workers, 4) difficulties in using local civil administration services, 5) poor quality research, 6) weak management training, and 7) poor relationships among special projects. Other program management problems exist in planning, resource allocation, training, use of private clinics, coordination, interagency coordination, program supervision, recording systems, and overall program evaluation. Emphasis is placed on the operational and managerial capacity of the program managers to successfully implement family planning programs. Improvements in the current managerial system and the role of international agencies are discussed.
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  5. 5

    Post partum return of fertility: ovulation method initiated after childbirth. Preliminary report.

    Perez A

    [Unpublished] 1980. Presented at the Second International Congress of the International Federation for Family Life Promotion, Navan, Ireland, September 24-October 1, 1980. 13 p.

    Results of a research program on puerperium physiology are discussed in terms of their relationship to return of fertility during the postpartum period and possible applications to natural family planning (NFP) during this period. Correlation between nursing and first postpartum menstruation has been found. Of especial importance is the finding of the probability of ovulation occurring during the first 10 postpartum weeks being practically nil (=.0008) and chances of ovulation increasing after 12th week postpartum if full nursing is maintained (=.047). Therefore, in terms of Billings' method, nonnursing mothers or those nursing for less than 28 days must wait until first postpartum menstruation (40-80 days) before learning the method, if abstinence is maintained during the postpartum. Mothers in full nursing can reinitiate intercourse between 25-30 days postpartum. A WHO-sponsored training program of teachers of the Ovulation method in Santiago, Chile, trained 70 couples, and use-effectiveness postpartum was particularly studied. 82 couples were recruited as students. The women were all white and of low socioeconomic class. 51 were fully nursing, 25 partially, and 6 had suspended nursing upon entrance to the program. 82 couples completed 655 months of use during the 16-month study. 4 pregnancies occurred, and 2 couples changed methods. Pearl Index was 7.3/100 years of use. When 130 postpartum amenorrheic months were subtracted, Pearl Index was 9.1. 1 pregnancy was in a user under nonovulatory conditions; 2 were method failures; and 1 was the result of faulty teaching. All of the couples are continuing with NFP, and 97.8% were considered to have learned to recognize mucus patterns during postpartum period.
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  6. 6

    Family fertility education learning package.

    World Health Organization [WHO]

    [Unpublished] 1981. 21 p. (WHO Project 77908)

    The World Health Organization's (WHOs) Task Force on Methods for the Determination of the Fertile Period became involved in evaluating and improving the educational aspect of natural family planning (NFP) methods. The educational component of such methods plays a more important role than in other methods of family planning. Eventual success and use-effectiveness of the method depends on how well the users have been taught to recognize significant symptoms and modify their behavior accordingly. The Task Force saw its purpose in the improvement of service delivery of NFP methods as the development, field testing, and evaluation of educational materials for use by NFP teachers and user-couples. This discussion focuses on the historical background of the project, the project design, and selection criteria for countries, teachers, and couples. Instructional materials for the ovulation and sympto-thermal methods are included. Once field results are evaluated, the final version of the learning package will be produced. Several sites in Canada, Kenya, Colombia, Korea, the Philippines, and Great Britain were selected for the field tests. Each step in the process, e.g., selection and training of the teachers, selection and training of the couples, and evaluation procedures is discussed briefly. A timetable for the testing phase is provided along with a description of the learning materials to be used.
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