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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. (BOL-03)Longterm contraceptive methods, such as Norplant, are receiving broader acceptance, particularly among women who are not yet ready to consider sterilization. In countries such as Bolivia, where the availability of family planning (FP) methods remains limited, the introduction and diffusion of a culturally acceptable, safe, and effective method should contribute to an increase in contraceptive acceptance and prevalence. Therefore, in 1990, the Population Council allotted US $35,700 to a 3-year prospective clinical study of Norplant with the Hospital Obrero No. 1 of the Bolivian Caja Nacional de Salud (CNS). The project is intended to evaluate local experience in the use of Norplant to facilitate its introduction. Ultimately, it is hoped that a high quality FP clinic and training center will be established to facilitate expansion of Norplant. The project has 4 major objectives: 1) to assess the demand for Norplant; 2) to compare the sociocultural, health, and psychological characteristics of Norplant and IUD (CuT380A) acceptors; 3) to compare the clinical performance of Norplant with CuT380A; and 4) to compare the cost effectiveness of Norplant with CuT380A. The project entails 3 research components: 1) a preintroduction study to gather socioeconomic, medical, and previous contraceptive use data on all prospective and actual Norplant users (at periodic intervals, beginning when a sufficient number of volunteers have completed at least 6 months of use, statistical analysis of the method's performance will be undertaken); 2) a comparative study of Norplant and CuT380A performance; and 3) a comparison of the cost-effectiveness of the 2 methods. Results of this comparison are expected to provide the CNS with information to decide on the appropriateness of including Norplant within its FP service delivery program. It is hypothesized that the impact of this method on a FP program will be greater if Norplant does not replace other highly effective contraceptives and if acceptors are young and of low parity. Research to date indicates that the cost of Norplant insertion at CNS, including only materials and physician time, averages US $13.95, while the cost of an IUD insertion is estimated at $9.49. Adding product costs of US $22 for Norplant and $1.25 for the CuT380A yields a total insertion cost of $35.95 and $10.74, respectively. Based on these figures, the only point at which costs would approach parity is where IUD continuation averaged less than 2 years and Norplant continuation approached the maximum 5 years. Between the start-up of clinical activities in February and August 1991, 106 Norplant insertions had been performed by CNS (more than half the insertions projected for the project). The project will be expanded in 1992 to involve Servicios de Investigacion y Accion en Poblacion, a private program with extensive experience in social science research.
Increasing the availability and acceptability of contraceptives through community-based outreach in Bas Zaire Programme d'Education Familiale (PRODEF). Original.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-01)The Tulane Family Planning (FP) Operations Research (OR) Project in Bas Zaire (known locally as PRODEF) aims to increase the availability and acceptability of modern contraceptives in an urban and a rural area. The urban program offers FP only, whereas the rural program integrates FP with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The objectives of this project, which cost US $623,504, were to: increase knowledge and use of modern contraceptives; improve attitudes toward FP; decrease "ideal" family size; and increase appropriate treatment for children under 5 years of age who have malaria, intestinal helminths, and dehydration due to malaria. The project tests 2 alternative strategies for the delivery of FP services. In treatment area A, dispensaries distribute contraceptives (and the rural children's drugs) and outreach activities are conducted. In area B, dispensaries distribute contraceptives (and the rural children's drugs), but there are no outreach activities. In the rural villages that do not have a dispensary, a matrone selected by the villagers is trained by PRODEF to serve as a distributor. Pre/post-intervention surveys were conducted in all project areas to measure changes in FP knowledge and practice and the relative effectiveness of the 2 approaches. Service statistics were used to monitor project activity, and cost/couple month of protection (CMP) was compared. The promotion of modern contraceptives was found to be culturally acceptable. Offering FP services only was acceptable in the urban area. The number of ever-married women who had ever used a modern contraceptive rose from 10 to 48% among women in area A and to 44% among women in area B. The child health interventions greatly enhanced the value of the program for the rural communities. Ever use of modern contraceptives increased from 8 to 34% in area A and from 7 to 27% in area B. The matrones were an efficient and culturally acceptable distribution channel. Simply making the contraceptives available increased contraceptive prevalence. However, the level of contraceptive prevalence was greater in area A, which also received outreach. Current use of modern methods in the urban area increased from 4 to 19% in area A and from 5 to 16% in area B. In the rural area, modern method use increased from 5 to 14% in area A, and from 2 to 10% in area B. The number of women using a traditional method decreased from 60 to 48% in area A and from 65 to 53% in area B; however, traditional methods are still used more than modern methods by a factor of 2:1 in the urban area and by over 3:1 in the rural area. The baseline survey showed that 95% of all women know at least one traditional fertility control method and about 80% had heard of at least one modern method. At follow-up, almost all urban respondents knew at least one modern and one traditional method. In the rural area, 90% knew at least one modern method. In the urban region, cost per CMP was US $7.11 in area A and $6.18 in area B; in the rural region the respective costs were US $11.22 and $7.95.
[Unpublished] 1979. Presented at the International Symposium Medicated IUDs and Polymeric Delivery Systems, Amsterdam, Holland, 1979 June 27-30. 23 p.After almost 20 years of worldwide availability and use of IUDs, assessment of their future role for family planning remains difficult. There are differences concerning the success of IUDs in different programs, and there is also wide variation among individual women in the acceptability and utility of the IUD. Successful IUD use seems to depend upon a complex interplay of factors which include the technology of the IUD itself, biological variation among women, individual and cultural differences in tolerance of IUD caused side effects, and the nature and quality of the available medical care and follow-up services. The principal difficulties encountered in IUD use are discomfort and increased bleeding, spontaneous expulsions, increased frequency of uterine and pelvic infection, and pregnancy failures. In the early years of mass programs for family planning in developing countries the IUD was often emphasized. Inadequate data exists to obtain an accurate world picture of IUD usage and demographic impact at this time. IUDs are available in most countries through a number of channels, and figures on distribution and usage through sales and service programs are incomplete. The best measurement of prevalence of use of IUDs comes from special surveys selected in order to provide a representative sample of the nation's or an area's population. The usage of IUDs in China and India is reviewed. When fertility effects on acceptors are examined, the experience with the IUD seems to be favorable compared with other means of fertility control, but the programmatic impact of IUD use has not been so favorable. Many countries have either added additional means of fertility control or switched emphasis to other methods.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
In: Watson, W.B., ed. Family planning in the developing world: a review of programs. New York, Population Council, 1977. p. 54-55The government of Honduras included a population policy in its National Development Plan for the period 1974-1979. This policy will be implemented by providing information regarding responsible parenthood, by using natural and technical resources to produce a well-nourished and creative population, and by applying the principles of voluntary participation in family planning programs. The 2 family planning programs in Honduras are the government maternal and child health program and the Family Planning Association of Honduras program. The government program, initiated in 1968, operates 34 clinics which offer family planning along with prenatal and postnatal care, child care, and nutrition education services. The Family Planning Association, established in 1961, operates 2 clinics and served 42,000 people during 1975. 9000 of this group were 1st acceptors. Oral contraceptives were chosen by 80% of the new acceptors; 13% chose IUDs and 5% chose injectables. The Association's information and education activities included conferences, talks, courses, seminars, and home visits. Additionally, the Association is operating a demonstration community-based distribution program with financial assistance from the International Planned Parenthood Federation. 40 workers in each of 2 cities provide contraceptives in their own neighborhoods.