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  1. 1

    The role of the traditional midwife in the family planning program. Report of National Workshop to Review Researches into Dukun Activities related to MCH Care and Family Planning.

    Indonesia. Department of Health; Indonesia. National Family Planning Coordinating Board [BKKBN]; Indonesian Planned Parenthood Association; Universitas Indonesia

    [Jakarta], Indonesia, Department of Health, 1972. 83 p.

    A number of studies conducted already have revealed that there are possibilities of using dukuns as potential helpers in the family planning programme. Bearing in mind that the number of dukuns at the present time is large, it is easy to imagine that they are capable of contributing a great deal towards progress in our family planning programme provided that the dukuns are assigned a role which is appropriate. In this respect, I am only referring to dukuns whose prime function is helping mothers during pregnancy and immediately afterwards, and who have close contact therefore, with the target of the family planning programme, i.e. the eligible couples. It would indeed be very helpful, if we could find out from the available data and from the results of applied research what exactly is the scope and usefulness of dukuns in the family planning programme. It seems to me that in this project we have to consider a twofold problem. The first aspect of the problem is that the dukuns are mostly of an advanced age and they are illiterate. The second aspect is that in spite of relationships with MCH centers extending over a period of years most of the dukuns still prefer their own way of doing things and they remain unaffected by modern ways of thinking. (excerpt)
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  2. 2

    Safe Motherhood Initiative: meeting of interested parties, World Health Organization, Executive Board Room, Geneva, Thursday, 7 July 1988.

    World Health Organization [WHO]. Division of Family Health

    [Unpublished] 1988. 25 p. (FHE/SMI/MIP/88.2)

    Given the multiple causes of maternal mortality, the World Health Organization's (WHO) Program of Maternal and Child Health addresses 4 factors: 1) social equality for female children and women; 2) universally accessible family planning to avert high-risk or unwanted pregnancies; 3) adequate prenatal care, including nutrition, with early recognition and referral of women with high-risk pregnancies; and 4) access to required obstetric care for women with emergencies that occur during pregnancy, delivery, or in the immediate postpartum period. WHO's Safe Motherhood activities are aimed at reducing maternal mortality by at least 50% by the year 2000. Toward this end, WHO is working to assist countries to determine the magnitude of their maternal mortality problem, identify the immediate underlying causes of maternal deaths, reach decisions about action priorities, evaluate innovations in maternal health care, conduct staff training, and support resource mobilization by national authorities so that programs can be implemented adequately. Research, information analysis and dissemination, technical support, and training comprise the foci of WHO's interventions in maternal health at present. If the Safe Motherhood Initiative is to be achieved, greater coordination and technical support at the global level and collaboration among agencies and national authorities at the country level will be required. The lack of sensitivity and responsiveness on the part of health staff to the perceived needs and perspective of women still comprises an obstacle to women's use of available maternal health services and must be addressed through training. To maintain the pace of its Safe Motherhood activities, WHO required US $4.5 million in extrabudgetary support.
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  3. 3

    Health education in health aspects of family planning.

    World Health Organization [WHO]. Study Group on Health Education in Health Aspects of Family Planning

    Geneva, World Health Organization, 1971. (Technical Report Series No. 483). 47 p.

    A WHO Study Group on Health Education in Health Aspects of Family Planning met in Geneva from December 15-21, 1970. A report of the group is presented. It is asserted that family planning contributes materially to 1 of the main aims of health services, by helping to ensure that every child, wherever possible, lives and grows up in a family unit with love and security in healthy surroundings, receives adequate nourishment, health supervision, and efficient medical attention, and is taught the elements of healthy living. The Study Group gave primary consideration to an analysis of the educational components fundamental to achieving the objectives of family planning services within the context of health services: the programming process, implementation, evaluation, methodology, coordination, and needs for studies and research. The Group noted that in many countries the integration of family planning care into health services not only has important educational implications but also brings many administrative and technical advantages. The contents of the report include sections on 1) family planning and its dependence on many services, 2) dependence of family planning on people, 3) some important requirements and difficulties, 4) objectives of education in health aspects of family planning, 5) a systematic approach to education in the health aspects of family planning, 6) importance of an organized health education service, 7) coordination of effort, 8) studies and research, and 9) recommendations.
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  4. 4

    Review of family planning aspects of family health with special reference to UNICEF/WHO assistance.


    Paper presented at the Nineteenth Session of the UNICEF/WHO Joint Committee on Health Policy, Geneva, February 1-2, 1972. 40 p

    Family planning is an integral part of the health care of the family and has a striking impact of the health of the mother and children. Many aspects of family planning care require the personnel, skills, techniques, and facilities of health services and is thus of concern to UNICEF and WHO. Once individual governments have determined basic matters of family planning policy and methods, UNICEF and WHO can respond to requests for assistance on a wide range of activities, with the primary goal being the promotion of health care of the family. Emphasis will be placed on achieving this by strengthening the basic health services that already have a solid foundation in the community. The past experience of UNICEF and WHO should provide valuable guidance for assistance to the health aspects of family planning, particularly as they relate to the planning and evaluation of programs; organization and administration; public education; the education and training of all medical personnel; and the coordination of family health activities both inside and outside the health sector. The review recommends that UNICEF and WHO first regard the capacity of the host country to absorb aid and maintain projects, and that specific family planning activities, such as the provision of supplies, equipment, and transport, be introduced only when the infrastructure is actually being expanded. Capital investment should be viewed in relation to the government's ability to meet budgetary and staff requirements the new facilities demand.
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  5. 5

    UNICEF / Nepal highlights on safe-motherhood.

    FPAN NEWSLETTER. 1997 Mar-Apr; 17(2):3-4.

    During the second day of the Family Planning Association of Nepal's (FPAN) 20th Central Council Meeting, and on behalf of UNICEF/Nepal, Indra Lal Singh stressed the importance and implication of the safe motherhood program relative to the family planning program. Singh also stressed the need to promote the two programs together with the aim of ensuring better results. UNICEF/Nepal looks forward to working with FPAN and preliminary talks to that end have already been held. Also at the meeting, a paper was presented upon safe motherhood, government health policy, and different levels of the health delivery system. 40% of pregnant women are not receiving the benefits of the safe motherhood program, indicative of the program's need for both government and nongovernmental organization priority. Other statistics aired during the meeting are that 44% of pregnant women receive only prenatal care services, 92% of deliveries are performed at home, 3% of women are attended by nurses or trained workers, 6% are attended by physicians, 33% of pregnant women receive 2 or more doses of tetanus toxoid, 29% of newly married nonpregnant women use contraception, 539 women out of 100,000 deliveries die due to unsafe motherhood, and 5000 women die each year due to pregnancy-related problems.
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  6. 6

    Collaboration between government and non-government organizations for maternal health and family planning programs.

    Haug MS

    MOTHER AND CHILD. 1992 Jan-Jun; 30(1-2):23-8.

    Efforts to improve maternal health, which were initiated for humanitarian purposes, are now recognized as important strategies to achieve economic development as well. Thus, the World Bank, other donor agencies, nongovernmental organizations (NGOs), and governments have begun to work together to further the goals of safe motherhood and family planning (FP) programs. The involvement of NGOs in this effort is vital as governments seek to learn from NGO experience and work in partnership with community health services. The World Bank encourages the work of NGOs through the provision of small community-level grants. In the southern Asian region, countries have developed programs to help prevent unplanned, high-risk pregnancies; manage unwanted pregnancies; reduce the likelihood of complications during pregnancy and labor; and improve the outcomes for women who develop such complications. With national governments developing priorities to meet their differing needs, national initiatives have revealed several lessons of relevance to the region as a whole: 1) FP is important to health and well-being; 2) areas needing improvement in maternal health interventions can be revealed by scrutinizing cost effectiveness and impact; 3) it is important to base education and services on women's actual circumstances; and 4) the involvement of NGOs is crucial to program success. The remaining challenge is to determine how best to develop joint partnerships between NGOs and governments.
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  7. 7

    [Comments on reproductive health and obligations since Cairo] Comentario. Salud Reproductiva y Obligaciones Dupues de El Cairo.

    Aspilcueta Gho D

    In: IV Reunion Nacional sobre Poblacion, [sponsored by] United States. Agency for International Development [USAID], Asociacion Multidisciplinaria de Investigacion y Docencia en Poblacion, United Nations Population Fund [UNFPA]. Lima, Peru, PROPACEB, 1995 Sep. 127-8.

    The family planning programs of the 1950s and 1960s were vertical and stressed contraception, while in the 1970s a natural association was created with maternal-child health care. The accords of the Cairo conference on population incorporated socioeconomic development, the right of health, and reproductive and sexual health rights. Actions in the health sector deal with family planning (with a focus on men and adolescents); maternal health (from menarche to menopause, with a focus on adolescence); abortion (the high rate of induced abortion makes imperative prevention efforts in education, counseling, and increasing contraceptive use rates); reproductive tract infections (of concern are the increasing numbers of sexually transmitted disease and HIV cases, as well as the culture of silence among the poorest that permits pelvic pain, leukorrhea, and dyspareunia to be considered the normal and untreated afflictions of womanhood); and infertility (with its relationship to sexually transmitted diseases and tuberculosis).
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  8. 8

    A draft UNFPA policy note on reproductive health.

    United Nations Population Fund [UNFPA]

    [Unpublished] 1994 Jan 15. 3 p.

    The burden of reproduction-related morbidity and mortality falls largely on women. For example, only women face the hazards associated with pregnancy and childbirth, sexually transmitted diseases (STDs) have more serious long-term effects in women than in men, women are more susceptible to yet less able to protect themselves from human immunodeficiency virus (HIV), and the contraceptive methods available to women have more side-effects than those designed for men. For these reasons, efforts to improve women's health and status must address reproductive health care. UNFPA regards family planning as an essential component of reproductive health care programs, as long as it is based on the principle of informed and voluntary choice. Ideally, information and service delivery components of a reproductive health program should include: the full spectrum of family planning services aimed at all couples and individuals, including adolescents; treatment for contraception-related gynecologic problems; prenatal, delivery, and postnatal care of mothers at the primary health care level with appropriate referral; counseling regarding the prevention of STDs and condom distribution for HIV prevention; diagnosis and treatment of infertility and subfecundity; and routine screening such as Papanicolaou testing and follow up. Also supported by UNFPA is a coordinated and integrated approach to reproductive health.
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  9. 9

    A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.

    Rooks J; Winikoff B

    New York, New York, Population Council, 1990. x, 185 p.

    Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail
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  10. 10

    Essential elements of obstetric care at first referral level.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1991. vii, 72 p.

    Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.
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  11. 11

    In Sri Lanka, a clearer focus.

    POPULATION. 1991 Dec; 17(12):3.

    In order to improve maternal and child health and family planning services in areas of Sri Lanka that lag in health and social development, UNFPA has created a program called "More Focused." This program targets underserved places such as fishing villages, plantations, and slums. More Focused represents part of UNFPA's program package intended to help Sri Lanka reach its goal of replacement level fertility by the year 2000. The approach of More focused offers underserved regions more than simply contraceptive services. The program provides an array of services that address problems such as poor nutrition, low literacy levels, and cultural factors. For example, More Focus is attempting to improve the conditions and the self-confidence of women working in Sri Lanka's free-trade zones, which contain the heaviest concentration of malnourished women. The project gives women instruction on nutrition, money management, health, family planning, etc. The women have gained confidence and have organized themselves to discuss employment-related issues with their employees. For its 1992-96 country program, UNFPA has emphasized the "cafeteria approach" to family planning, which makes available a wide variety of contraceptives. In the past, many had complained that Sri-Lanka had concentrated too heavily on sterilization. The new approach makes contraceptive services more sensitive to specific social and cultural settings. Nonetheless, Sri Lanka still faces serious obstacles to achieving its goal for the year 2000. Years of civil war have interrupted the accomplishments of its once-legendary family planning program. Nonetheless, UNFPA remains optimistic that the country's continuing family planning effort will lead to replacement level fertility.
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  12. 12

    Focus on maternal mortality.

    Yinger N

    POPULATION TODAY. 1990 May; 18(5):6-7, 9.

    Maternal mortality in the developing world may be less of a concern since the avalanche of concern about high infant mortality. Some programs, such as family planning, can reduce both infant and maternal mortality, however causes for maternal death are different from those for child bearing. Information on the levels and trends of maternal mortality is of poor quality due to incomplete data and inconsistent definitions. The total number of maternal deaths is a function of 2 variables, fertility and maternal mortality, and a reduction of either one can effect the number of dying women. There are large differences in the rates between the developing and the developed world. Of the 500,000 maternal deaths each year only 6,000 occur in the developed world, or about 1%. In contrast 11% of the infant deaths take place in the developed world. There are 5 primary complications that lead to obstetric death: hemorrhage, toxemia, sepsis, septic abortions, and obstructed labor. Approaches that have been recommended by the Safe Motherhood Conference in 1987 include a stronger community based health care system that screens pregnant women, refers high risk cases for immediate help, and provides preventive services such as family planning. There should also be stronger referral services to backup community care. In addition, an alarm and transport system to get women with high risk pregnancies to a referral facility for effective treatment in time is needed.
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  13. 13

    Maternal care for the reduction of perinatal and neonatal mortality. A joint WHO/UNICEF statement.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 1986. 22 p.

    Maternal care is the most appropriate target for reducing the high perinatal and neonatal mortality typical of the least developed countries. The principles formulated by the 25th session of the WHO/UNICEF Joint Committee on Health Policy in 1985 are outlined here. Perinatal mortality is defined as infant death from 1000 g, even if intrauterine or stillborn, to 1 week of age. Neonatal mortality is that occurring in the 1st month of life. Half of infant mortality (up to 1 year of age) occurs in the 1st month, most of that during the 1st week, and these deaths are directly related to maternal care during pregnancy and delivery. They are caused by low birth weight, intrauterine or birth asphyxia, birth trauma, or infections, usually of the cord or amniotic fluid. Tetanus is the primary lethal infection. Tetanus can be prevented by immunizing women, or giving tetanus toxoid to pregnant women, but also very effectively by training birth assistants in hygiene. Traumatic deaths can best be prevented by training midwives and strengthening the support system for referral to clinics. The most cost-effective strategies for improving maternal health are nutritional intervention, malaria prevention, treatment of infections and of toxemia, reducing heavy workload of pregnant women, and family planning services. Points where community involvement is effective are discussed. WHO and UNICEF will increase support in health education, tetanus immunization, training of birth attendants, equipping birth facilities, appropriate technology, and operational research.
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  14. 14

    Statement by the Head of Delegation of the Republic of Korea at the International Conference on Population (ICP).

    Korea, Republic of. Ministry of Health and Social Affairs

    [Unpublished] 1984 Aug. Presented at the International Conference on Population, Mexico City, August 6-13, 1984. 3 p.

    In a 5-year plan, the Korean government has integrated family planning programs, including maternal and child health, medical insurance, and social welfare programs, into its primary health ervices in order to reach its hard-core low-income residents in both urban and rural areas. The Korea Women's Development Institute was established in 1982 to enchance the status of women, and the Labor Standard Law has been revised to try to overcome deep-rooted son-preference among Korean parenst. Migration out of rural areas is creating rural manpower problems, and stepped-up rural community development programs are planned. Population predictions by the mid-21st century stand at 61 million, too great for a country with such limited natural resources to support. Korea recommends an exchange of information on population and development between all countries, the setting aside of 1% of each country's annual budget for national population programs, and convening the world population conference every 5 instead of every 10 years so that more progress can be made in solving the problem.
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  15. 15

    Innovative projects--Companigonj health project, Noakhali.

    Chowdhury SA

    [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.
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  16. 16

    World Plan of Action: item 11 of the provisional agenda.

    United Nations

    New York, UN, 1975. 47 p. (E/CONF.66/5)

    The 1975-1985 World Plan of Action to promote women's rights was presented at the World Conference of the International Women's Year in 1975. The Plan contained recommendations for actions to be taken by national governments, the mass media, researchers, and international and regional organizations. Recommendations for national action were 1) special government bodies to promote equality for women should be established in each country; 2) women should be given the opportunity to participate in the development, implementation, and operation of development programs and should share equally with men in the benefits stemming from these programs; 3) women's participation in the international political and economic arena should be encouraged; 4) women should be encouraged to take part in national politics and should be educated about the political process; 5) free and compulsory education should be provided for both sexes and both formal and nonformal educational programs should be developed to serve the needs of women; 6) where needed special legislation should be passed to insure equal employment opportunities, working conditions, and pay for women; 7) women should be given the opportunity to determine the number of children they want; 8) health programs should provide for the special needs of women; 9) marriage laws should set minimum marriage ages for women which insure they have ample time to complete their education prior to marriage; and 10) the signficant contribution to society made by women who play traditional roles should be recognized. The mass media should contribute toward enhancing the status of women by projecting a more positive image of women. International agencies should examine how they can help promote the Plan, especially in the areas of 1) research; 2) training and technical assistance; 3) the development of international standards; 4) information exchange; and 5) coordinating activities. Regional commissions and organizations should develop the machinery necessary for implementing the Plan and should play a leadership role in encouraging national governments to act on the Plan.
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  17. 17

    World Conference of the United Nations Decade for Women: equality, development and peace, Copenhagen, Denmark, July 14-30, 1980.

    United Nations Decade for Women. Secretariat

    New York, UN, 1980. 32 p. (A/CONF. 94/9)

    This report reviews and evaluates efforts at the national level to implement the world Plan of Action for the Implementation of the Implementation of the Objectives of the International Women's Year and is based on replies of 86 governments to questionnaires prepared by the Advancement of Women Branch in the Centre for Social Development and Humanitarian Affairs. It contains an analysis of the progress made and obstacles overcome in the field of health. Using as indicators increases in female life expectancy and declines in maternal and infant mortality rates, improvements have occurred in the health status of women. However, wide disparities are seen between high and low socioeconomic groups, between rural and urban women, and between minority groups and the rest of the population. Lack of financial resources is a major obstacle, compounded by inflation. The excessive physical activity of working rural women not only precludes their participation in health programs but also adversely affects their health. Additional problems are inadequate training and supervision of health administrative personnel, a lack of defined policies, and a lack of coordination between agencies. Social, religious, and cultural attitudes that no longer have validity, lack of political commitment, and an inadequate perception of the long-term health benefits of family planning, rather than its demographic aspects, restrict access to family planning for many groups of women.
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  18. 18

    Study findings on evaluation of integrated family planning programme performance.


    In 1976 the United Nations's Economic and Social Commission for Asia and the Pacific launched a comparative study on integrated family planning programs in a number of countries in the region. In November 1979 the study directors from the participating countries meet in Bangkok to discuss the current status of the studies in their countries. The Korean and Malaysian studies were completed, the Bangladesh study was in the data collecting phase, and the Pakistani research design phase was completed. The meeting participants focused their attention on the findings and policy implications of the 2 completed studies and also discussed a number of theorectical and methodological issues which grew out of their research experience. The Malaysian study indicated that group structure, financial resources, and the frequency and quality of worker-client contact were the most significant variables determining program effectiveness. In the Korean Study, leadership, financial resources, and the frequency and quality of contact between agencies were the key variables in determining program effectiveness. In the Malaysian study there was a positive correlation between maternal and child health service performance measures and family planning service performance measures. This finding supported the contention that these 2 types of service provision are not in conflict with each other but instead serve to reinforce each other. Policy implications of the Korean study were 1) family planning should be an integral part of all community activities; 2) family planning workers should be adequately supported by financial and supply allocations; and 3) adequate record keeping and information exchange procedures should be incorporated in the programs.
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  19. 19

    A working paper on status, present and future utilisation of the TBA in 15 countries in the Middle East and Asia and a Regional Summary of the Far East and Africa.

    Kamal I

    [Unpublished] 1979. 27 p.

    Data on status and present and future utilization of the traditional birth attendants in countries of East and South Asia and Africa were collected through a questionnaire sent to countries of the Middle East and North Africa Region of the International Planned Parenthood Federation. There are 2 categories of traditional birth attendants (TBAs) in the Middle East and Asia: these are the "untrained midwife" who practices midwifery for a living and the birth attendant who is usually an elderly relative or neighbor and who does not earn her living from midwifery. The urban TBA fits into the 1st category; the rural TBAs are a mixture of both categories. The information provided by the questionnaire indicated that TBAs exist in all but 1 country of the region. The TBAs are employed mostly by the pregnant woman directly, and both rural and urban women use them. In most of the countries training facilities are available. The majority of the countries train only those TBAs who are already practicing midwives. Training duration ranges from 1 week to 1 year. Illiteracy appears to be the primary problem related to training. In regard to training, there needs to be careful selection, proper training, and good supervision and follow-up. Existing curricula are in need of revision.
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  20. 20


    Mallick SA

    In: Bloch LS, ed. The physician and population change: a strategy for Africa, the Middle East and Europe. Bethesda, Maryland, World Federation for Medical Education, 1979 Mar. 149-67.

    The family planning program in Pakistan began in 1953 with the formation of the Family Planning Association of Pakistan. In 1960 the Second 5-Year Plan allocated 30.5 million rupees and attempted to provide services to 600,000 couples. The 1965 Plan attempted to reduce the crude birth rate from 50/1000 to 40/1000. 148.2 million rupees was allocated and indigenous midwives were incorporated into an autonomous 3-tiered administration with the district the main unit of operation. This program was the most successful, and the basic structure continues unchanged, with the addition of a "Continuous Motivation System" which has male-female teams assigned to local areas who contact clients and prospective clients. Population education has been introduced into school curricula. The 5th Plan hopes to deliver more services to rural areas. All MCH centers are involved in motivation, education, and providing contraceptives. Family planning clinics have been set up in established hospitals. Paramedical personnel man clinics in rural areas where services include family planning, MCH, and treatment of minor ailments. In 1978 the population of Pakistan was 75.6 million; the crude birth rate was 43.6, the death rate, 13.6. The sex ratio is 876 females to 1000 males. Approximately 19% of women are in the reproductive age group. The maternal mortality rate is 6.0/1000 females giving birth; the infant mortality rate is 115/1000 live births.
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  21. 21

    Women, health and human rights.

    Sipila H

    World Health. 1979 Aug-Sep; 6-9.

    The United Nations General Assembly adopted and proclaimed in their Universal Declaration of Human Rights that everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services. Also, motherhood and childhood are entitled to special care and assistance. Under certain conditions in developing countries food is not available for each child or adult to receive minimum requirements. Women often labor long hours in the field, which, coupled with the responsibility of family raising, leaves them tired and susceptible to disease affecting the entire family. 1975 was offically declared the International Year of the Woman by the United Nations. The objectives were equality of men and women, women's full involvement in societal development, and women's contributions to world peace. Economic development has become the top priority in the last 2 decades, but development cannot be accomplished by unhealthy individuals. The World Plan of Action of 1975 calls for governments to pay special attention to women's special health needs by provideng prenatal, postnatal, and delivery services; gynecological and family planning services during the reproductive years.
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  22. 22

    Yozgat MCH/FP Project: Turkey country report.

    Coruh M

    [Unpublished] 1979. Paper prepared for the Technical Workshop on the Four Country Maternal and Child Health/Family Planning Projects, New York, Oct. 31-Nov. 2, 1979. (Workshop Paper No. 2) 10 p.

    An integrated health care system which combined the maternal/child health with other services was undertaken in the Yozgat Province of Turkey from 1972-77. The objective was to train midwives in MCH/FP and orient their activities to socialization. The first 2 years of the program was financed by UNFPA. 52 health stations were completed and 18 more are under construction. The personnel shortage stands at 33 physicians, 21 health technicians, 30 nurses, and 67 midwives. Yozgat Province is 75% rural and has about a 50% shortage of roads. The project was evaluated initially in 1975 and entailed preproject information studies, baseline health practices and contraceptive use survey, dual record system, and service statistics reporting. The number of midwives, who are crucial to the program, have increased from an average 115 in 1975 to 160 in 1979. Supervisory nurses are the link between the field and the project managers. Their number has decreased from 17 to 6. Until 1977 family planning service delivery depended on a handful of physicians who distributed condoms and pills. The Ministry of Health trained women physicians in IUD insertions. The crude death rate in 1976 was 13.2/1000; the crude birth rate was 42.7/1000. The crude death rate in 1977 was 14.8/1000; birth rate, 39.9/1000. Common child diseases were measles, enteritis, bronchopneumonia, otitis, and parasitis.
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  23. 23

    Kenya's project for the improvement of rural health services and the maternal child health and family planning programme.

    Kanani S

    In: Korte R, ed. Nutrition in developing countries. Eschborn, Germany, German Agency for Technical Cooperation, 1977. 29-37.

    This report focusses on a project for the improvement of rural health services and development of 6 rural health training centers in Kenya. The Ministry of Health has the responsibility of managing the health centers and dispensaries throughout the country. After a study by experts and funding by international agencies, a project to provide postbasic training to health center staff was undertaken. The major health conditions affecting the community were: family health problems; communicable disease; inadequate sanitation diseases; and, malnutrition and undernutrition. The most overwhelming problem was family health which necessitated a maternal and child/family planning project. The program is directed at women aged 15-49 with a "Super-Market" approach whereby all services (antenatal care, maternity care, postnatal care, child welfare, family planning and health education) will be available on a daily basis in an integrated system. 5 new training schools for nurses are being built. Education in both health and family planning will be emphasized in the project in the future. With a view to uplifting the general quality of life, the Kenya projects are seen as part of the total socioeconomic development of the country as a whole.
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  24. 24

    The International Confederation of Midwives: an overview.

    Hardy FM


    A brief summary of the historical development of the International Confederation of Midwives (ICM) and a review of the organization's recent activities was presented. Efforts to develop an international association of midwives began in 1922. The 1st World Congress of Midwives was held in 1954 and since that time the Congress has met once every 3 years. National midwife associations from 51 countries belong to the ICM. The goals of the organization are 1) to improve the knowledge, training, and professional status of midwives; 2) to promote improved maternal and child care in member countries; and 3) to further information exchange. Since 1961 the ICM and the International Federation of Gynecology and Obstetrics have cooperated in a joint study of midwife training and practice. In 1966 the study group completed its 1st report on the status of maternal care around the world and made a number of recommendations for improving the training of midwives and for establishing uniform licensing requirements. It soon became apparent that these problems could not be dealt with on a worldwide basis, and 12 working parties in different regions were established to investigate the problem at the local level and also to make recommendation in regard to providing family planning services in the context of maternal and child health programs. Each working party has a Field Director who seeks to implement the recommendations of the group. Field Directors have also arranged seminars in reproductive health for rural health workers and especially for traditional birth attendants. The ICM also works in cooperation with the European Economic Community, WHO, IPPF, and several other international agencies. The activities of the working parties have received financial support from USAID.
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  25. 25

    Where population planning makes a dent: (Indonesia).


    Front Lines 17(6):4-5. March 15, 1979.

    In 1969, the government of Indonesia threw its full support behind a family planning program for the country. Since that time, more than 1/2 the women on the islands of Java and Bali have accepted family planning. In 1978, more than 1/4 of the married women of child-bearing age on the 2 islands were practicing some form of contraception. The fertility rate has dropped by 15% and planners hope for 50% acceptance by 1982. These successes are more remarkable when the poverty and cultural backwardness of the country is considered. Reasons for the extraordinary success of the program are: 1) total commitment of the government with interdepartmental organization; 2) adequate financing and technical support from outside sources; 3) detailed organization; 4) local involvement; 5) support of the country's major religious groups; and 6) the flexibility of the program's young administrators. Outside financing, especially by USAID, is discussed. Population density in Indonesia is so severe that success of the program is indispensable to future development of the country.
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