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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.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-03)This project, which cost US $97,000, is an extension of the original Tulane Family Planning (FP) Operations Research Project in Bas Zaire (known locally as PRODEF). PRODEF was initiated to increase the availability and acceptability of modern contraceptives in both an urban area (Matadi) and a rural area (Nsona Mpangu). The urban program is vertical (FP only), whereas in the rural program, FP is integrated with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The Matadi project was designed to: 1) increase knowledge and use of modern contraceptive methods in the target population; 2) test the cultural acceptability of community-based distribution (CBD) workers in an urban setting; 3) determine the preference for type of provider when services are available through both dispensaries and CBD posts; and 4) measure the cost per couple years of protection (CYP) over time. In treatment area A, dispensaries began distributing contraceptives in 1982; 3 rounds of household distribution were conducted in 1982-83. In area B, dispensaries distributed contraceptives, but there was no household distribution. The residential zone of Kananga served as a comparison. By 1984, prevalence had increased from 4-5% to 19% (in area A) and to 16% (in area B). While this represented a significant increase over the baseline rate, the difference between the 2 zones was not statistically significant. Thus, household distribution was discontinued in area A, and the 2 treatment areas became one. From 1986 to 1989, the project consisted of training CBD workers to sell contraceptives from their homes in Matadi. 40 women were recruited and trained; due to attrition, there have been approximately 25 active distributors in the project. Prevalence surveys were conducted in 1982 and 1984 under the original Matadi project; the third round of survey data were collected under this cooperative agreement in 1988. Service statistics on contraceptive sales and cost data were collected and analyzed to yield data on the cost per CYP in the Matadi project on an annual basis. An AIDS knowledge, attitude, and practice (KAP) module was included in the follow-up survey. Preliminary findings of the 1989 KAP follow-up survey show prevalence to be 23% in areas A and B, the highest in any city in Zaire. Kananga has achieved positive results based on strong clinic services and social marketing, even without community-based distribution. Analysis of choice of service provider is in progress.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-02)This project, which cost US $97,000, is an extension of the original Tulane Family Planning (FP) Operations Research Project in Bas Zaire (known locally as PRODEF). PRODEF was initiated to increase the availability and acceptability of modern contraceptives in an urban area (Matadi) and a rural area (Nsona Mpangu). The urban program is vertical (FP only), whereas in the rural program FP is integrated with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The Nsona Mpangu project is designed to: 1) increase knowledge and use of modern contraceptive methods among the target population; 2) assess whether villages having attained 10% prevalence tend to plateau once the "predisposed" are already reached; and 3) determine the effect of time on prevalence: do villages that enter the program later "catch up"? In treatment areas A and B, health posts began distributing contraceptives and drugs for children under 5 years of age in 1982; community-based distribution (CBD) was provided in villages without posts. In area A, 3 rounds of household distribution were conducted in 1982-83. At the close of the original project (1984), prevalence was 13% in area A and 10% in area B. The difference between A and B was not statistically significant, thus household distribution (which proved costly in the earlier project) was discontinued and treatment areas A and B became identical under this cooperative agreement. A third treatment area (C) was added in 1986 to determine the effect of time on prevalence: do villages that enter the program later "catch up"? Area D served as the comparison. The study employed a quasi-experimental design, with 3 treatment areas and a comparison area. A pre/post-intervention survey was conducted in all 4 areas to measure changes in contraceptive prevalence, service statistics were monitored to determine trends in contraceptive purchases, and the cost in the program as a whole per couple month of protection (CYP) was analyzed. An AIDS knowledge, attitude, and practice module was included in the follow-up survey. Preliminary findings from the follow-up survey indicate that 26.5% of women had ever used a modern method and 80% of women had ever used a traditional method. Among married women of reproductive age, current use of any method (traditional or modern) was 58.3%. Analysis of service statistics and cost per CYP is still in progress. CYP decreased from a 1985-87 annual average of 1,500 to 278 in 1988 due to the appointment of a regional medical officer who was not favorable towards CBD.
New York, New York, UNFPA, 1997. iv, 51 p. (Evaluation Report No. 8)This document presents an evaluation report made by the UN Population Fund (UNFPA) on the quality of family planning services in Botswana, Ecuador, Indonesia, Mexico, Niger, Pakistan, Turkey, and Vietnam. This thematic evaluation aimed to assess the extent to which UNFPA-supported family planning service programs are being complied based on the Guidelines for UNFPA Support with Family Planning Programs. The introductory part offers background information, purpose and methodology adopted in evaluating the services and presents summaries of case-study projects. Evaluation findings are discussed along six dimensions: choice of contraceptive methods; technical competence; information and counseling; interpersonal relations; mechanisms to encourage continuation; and appropriateness and acceptability of family planning services. Finally, this report outlines conclusions and recommendations concerning policy and programmatic issues.
Ivory Coast: diagnosing the quality of care through an improved management information system. Final report (condensed).
[Abidjan, Cote d'Ivoire], Association Ivoirienne pour le Bien-Etre Familial [AIBEF] 1993 Jan. , 19,  p. (USAID Contract No. DPE-3030-Z-00-8065-00)AIBEF, the Cote d'Ivoire's IPPF affiliate, is expanding its family planning program and wants to maintain quality control. The organization has a management information system in place upon which it depends to monitor program effectiveness and efficiency. The system employs the following components to garner program-pertinent data: clinic consultation cards which are filled out by each new acceptor and updated during each subsequent visit, monthly clinic service statistics reports from each clinic, and client daily log books. A cohort sample of 1000 new acceptors was followed for 6 months in 1992 to obtain preliminary indications of their experience relative to the quality of care received. It was found that AIBEF clients have an average of 3 living children and 41% were breast feeding at the time of 1st visit to a clinic. With the exception of women who stated that they desired to bear no more children, no clear association was found between clients' reproductive intentions and contraceptive methods chosen. 66% of all women sampled were using oral contraceptives. 45% of women who were breast feeding, however, were receiving oral contraceptives contraindicated to this practice. Moreover, with 63% of acceptors of oral contraceptives ceasing to return to the same clinic for services after 6 months, it is suggested that a large proportion abandon services within a short period of time. On the basis of these findings, it is recommended that greater effort be given to develop informed choice among clients based on method availability; guidelines be issued to staff regarding informing new acceptors of potential method side effects and the counseling of appropriate contraceptives for breast feeding women; greater emphasis be given to nonhormonal methods; and community outreach services such as community-based distribution be developed to reach acceptors who do not return for follow-up.
WOMEN'S GLOBAL NETWORK FOR REPRODUCTIVE RIGHTS NEWSLETTER. 1992 Apr-Jun; (39):25-6.Indonesia is an international showpiece of successful population control. The number of desired acceptors of family planning is fixed by a coordinating board in cooperation with international advisers including the World Bank. More than 95% of the actual acceptors or users of contraceptives are women rather than couples. Numerical targets are set for districts, subdistricts, villages and hamlets; and local administrators are charged with the execution of the program. Ambitious village or district leaders use a variety of incentives and disincentives to comply with these directives issued by superiors. "2 children is enough" is the slogan on ubiquitous posters in the archipelago. A woman who is pregnant for a 3rd time may face scorn in her village. Although family planning has succeeded in averting births, maternal mortality rates in Indonesia are among the highest in the world. 55% of Indonesian women suffer from anaemia, particularly pregnant or breast feeding women. In principle there is free choice of contraceptives, but effective means such as hormonal implants, IUDs, and sterilization are promoted instead of pills and barrier methods. Thus, a program originally designed to be sensitive to community concerns runs the risk of becoming an oppressive system. Under the rhetoric of human development the quality of family planning services should be improved, the status of women raised by better education and more employment opportunities, no discrimination, and better health services. The aim of United Nations Population Fund (UNFPA) is to extend modern family planning services to 567 million couples, 59% of all married women of reproductive age, by the age 2000. The contraceptive needs of unmarried women have been ignored again, while the plight of unmarried pregnant women has probably increased by increasing violence and wars.
[Kuching, Malaysia, SFPA, 1991]. ii, 35 p.The Sarawak Family Planning Association's (SFPA's) main focus in 1990 was the strengthening of the Family Planning Clinic Service Program. Although the number of clinics has remained at 8, the number of resupply points increased from 50 in 1989 to 112 in 1990. These resupply points are set up in areas where transportation, financial, or social factors impede the ability of established acceptors to attend the static clinics. In part because of the increased availability of contraceptive services, the number of acceptors increased by 3352 over 1989, to reach 28,996 in 1990. The remaining 31, 847 acceptors in the country are serviced by the Ministry of Health. The SFPA utilizes a "cafeteria approach" to contraceptive choice; methods available are oral contraceptives, IUD, condom, injectable, spermicides, vasectomy, and natural family planning. At SFPA's clinic sites, the pill accounts for 57-93% of total contraceptive acceptance. The physicians at the 8 clinics also provide clients with cervical and breast cancer screening, pregnancy testing, infertility counseling, gynecological examinations and referral, and premarital advice. An extension of the Clinic Service Program, the Community Clinic Extension Family Planning Program, operates in the main towns. Involved in this program are 41 physicians, who distributed largely hormonal forms of contraception to 3587 acceptors, and 76 non-medical workers, who distributed condoms to 289 acceptors. As the major source of family planning information in Sarawak, the SFPA has an extensive IEC program that uses talks, home parties, fieldwork motivation, mass media campaigns, and community meetings to recruit new acceptors. Finally, the Family Life Education Project sought, in 1990, to increase the involvement of young people in determining their own programs and activities.
IPPF COUNTRY PROFILES. 1992 Jan; 19-24.A country profile of demographic/statistical data, social and health aspects, and government policies and program in Pakistan particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). Finding current population growth too high and impeding of development, the government enacted a population policy in 1991 aimed at reducing population growth to 2.5% in 10 years. An integrated approach will stress population education in secondary schools, the use of mobile services to promote birth spacing and provide maternal-child health care, and the provision of services through government facilities and family welfare centers. The Family Planning Association (FPA) of Pakistan was created in 1953, and became a member of the IPPF in 1954. It promotes family planning through education, clinics, and the use of male community institutions, and is the main provider of services. The organization also campaigns for both more government involvement in family planning and improvements in the status of women. 16% of married women practice contraception. Female sterilization is the most popular method, followed by condoms. with husband's consent, sterilization is permitted for married women with at least 2-3 children. Abortion is legal only to save a woman's life. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
IPPF COUNTRY PROFILES. 1992 Jan; 25-30.A country profile of demographic/statistical data, social and health aspects, and government policies and programs in Sri Lanka particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). The government regards current population growth as too high, and provides subsidized clinics, contraceptives, and monetary incentives for sterilization. The Family Planning Association (FPA) of Sri Lanka was created in 1953, and became a member of the IPPF in 1954. It emphasizes motivation and contraceptive distribution, operates 2 clinics, a rural family health project, and provides for educational, contraceptive social marketing, and sterilization programs. The organization generally plays a limited role in the delivery of family planning, with these projects serving to supplement government programs. 62% of married women practice contraception, with 40% using modern methods. Female sterilization is the most popular method, followed by male sterilization and oral contraceptives. Abortion is legal only to save a woman's life. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
IPPF COUNTRY PROFILES. 1992 Jan; 1-6.A country profile of demographic/statistical data, social and health aspects, and government policies and programs in Bangladesh particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). The government regards current population growth as too high, and has launched a National Population Program to reduce fertility through the integration of health care services an socioeconomic programs with legislation. Overall, the government provides family planning services, is attempting to improve the status of women, and encourages NGO involvement in service delivery and education. The Family Planning Association (FPA) of Bangladesh was created in 1953, and became a member of the IPPF in 1975. Providing approximately 10% of family planning services while supplementing those of the government, the FPA uses religious leaders, hawkers, traditional healers, general education, and clinics to promote family planning, while also trying to improve women's status. 31% of married women practice contraception, with 22% using modern methods. Female sterilization is the most popular method, followed by oral contraceptives. Abortion is legal only to save a woman's life. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
IPPF COUNTRY PROFILES. 1992 Jan; 7-12.A country profile of demographic/statistical data, social and health aspects, and government policies and programs in India particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). The government finds current high population growth obstructive to reducing poverty, and has combined family planning, family welfare, maternal-child health (MCH), and nutrition with development, female education, and women's rights. The government offers family welfare and primary health centers which provide contraceptive services through the National Family Welfare Program. The Family Planning Association (FPA) of India was created in 1949, and became a member of the IPPF in 1952. The FPA provides education, family planning, MCH, and counselling services through funding from the government, MCH, and counselling services through funding from the government. In addition to working to improve women's status, it also attempts to involve more women and youth in development. Almost 43% of married women practice contraception, with the overwhelming majority using modern methods. Sterilization is the most popular method, followed by the IUD. Abortion is legal to save the woman's life, protect maternal health, for social-medical reasons, for genetic defects, in cases of rape and incest, and occasionally for contraceptive failure. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
IPPF COUNTRY PROFILES. 1992 Jan; 13-8.A country profile of demographic/statistical data, social and health aspects, and government policies and programs in Nepal particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). The government regards current population growth as too high, and has taken steps to provide family planning services to the population including the establishment of a Mother and Child Health Project in 1968 and a National Population Strategy in 1983. Health care and development are integrated with economic, social, and education reforms including attempts to improve the status of women. The Family Planning Association (FPA) of Nepal was created in 1958, and became a member of the IPPF in 1960. Providing approximately 20% of family planning services and supplementing those of the government, the FPA operates clinics, educational programs, rural family health projects, sterilization programs, and natural family planning programs, while also working to improve women's status. 15% of married women practice contraception, with nearly all of them using modern methods. Female sterilization is the most popular method, followed by male sterilization. Birth control pills and condoms are widely available free of charge, and pills may be obtained without prescription. Abortion is legal only to save a woman's life and for other unspecified medical reasons. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
Joicfp Review. 1985; (9):12-7.In 1970, a Dutch medical team began work in the city of El Kef in Tunisia on a project designed to bring family planning into rural areas. The project aimed to persuade the rural people to use urban health centers, but this approach failed partly because of the remoteness of the communities and their reluctance to discuss personal matters with strangers. Funded by UNFPA, a new project began to recruit and train local girls as home health visitors or aides-familiales, an approach which became the central focus of the El Kef project. The International Planned Parenthood Federation (IPPF) took over the project and expanded it to include nutrition, health care, health education, family planning, disease prevention and domestic crafts. 4 goals were fixed for the project: total vaccination coverage for children; elimination of severe malnutrition; reduction of infant mortality; and use of family planning practice by at least 1/2 the women of childbearing age. An efficient recordkeeping system enabled the project to be carefully evaluated and provides much-needed data, showing where it has achieved its aims and where new efforts should be directed. The project resulted in large numbers of women receiving ante-natal advice, child care and family planning from their local health centers. 860 pregnant women were followed up during the 3-year study period. Some 57% of pregnant women went for advice; only 15% went for postnatal care, but 50% of the women under 50 attended child welfare sessions during the study period for weight checks, nutrition advice, vaccination and treatment for minor ailments. Over the 3 years, the number of contraceptive users more than trebled, from 14% to 54%. The IUD was the most popular method. The most successful aspect of the project was the emphasis on maternal and child health, and the home visits were the most motivating feature. Vaccination became more popular. A further aspect of the project was the training in home improvement skills, like sewing, knitting and gardening. After 4 years in the field the aides familiales were a valuable resource of skill and experience. Family planning was integrated with maternal and child health in the government program through the health infrastructure.
[Unpublished] 1978. Paper presented at National Workshop on Innovative Projects in Family Planning and Rural Institutions in Bangladesh, Dacca, Bangladesh, Feb. 1-4, 1978. 21 p.The author describes the establishment of a rural health service in Companigonj thana in Bangladesh done jointly by the government and international relief agencies. Provision was made for integrated health services including family planning, child health services, maternal health services, nutrition programs, and both curative and preventive medicine. Field workers, mostly female, were trained to provide medical services not requiring a doctor's presence. The author finds a marked increase in attendance at the health service over a period of years. The government should intensify its participation in the health service component for the program to have a chance of taking hold. Tables to illustrate the experience of the program in money expended; numbers of patients; cost per patient; clinic attendance by age, sex; hospital deliveries; new family planning acceptors; contraceptive usage; mortality and birth rate and causes of death by age; and antenatal follow up.
Overview of the medical and clinical activities performed by the family planning associations of the Western Hemisphere Region.
N.Y., International Planned Parenthood Federation Western Hemisphere Region, 1973. 103 pAdd to my documents.
N.Y., Ford Foundation, June 1977. 33 p. plus appendixes. Restricted useAdd to my documents.
People without choice: report of the 21st Anniversary Conference of the International Planned Parenthood Federation.
London, IPPF, 1974. 68 p.Add to my documents.
[Latin America: the state of family planning programs since 1973] America Latina: situacion de los programmas de planificacion de la familia hasta 1973.
Santiago, Centro Latinamericano de Demografia, April 1975. 73 p. (Serie A, No. 130).Add to my documents.
Draper World Population Fund Report. 1977 Summer; 4:23-25.Sri Lanka has undergone a classic demographic transition over the last 30 years. In 1971, the country was 1 of the most densely populated agricultural countries in the world. By 1975, Sri Lanka's birthrate had declined to 27.2, the lowest rate in South Asia. This decline in fertility is attributed to increased contraceptive use, due to a greater awareness of modern family planning methods and easier access to contraceptive facilities. A brief history of the family planning movement in the country is presented. The Sri Lanka family planning program today illustrates a cooperative venture between private organizations and government programming. High levels of celibacy and late marriage in Sri Lanka, caused by demographic, economic, and educational factors, have also resulted in a declining percentage of married women in the under-30 age group.