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  1. 1

    Evaluation of the UNFPA support to family planning 2008-2013. Volume 1.

    United Nations Population Fund [UNFPA]

    New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016 Apr. 105 p.

    The purpose of the evaluation was to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not chance (2012-2020). The evaluation provided an overall independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The evaluation constituted an important contribution to the mid-term review of UNFPA strategic plan 2014-2017. The evaluation features five country case study reports: Bolivia, Burkina Faso, Cambodia, Ethiopia, and Zimbabwe.
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  2. 2

    International Symposium: For the Survival of Mankind: Population, Environment and Development.

    Mainichi Shimbun; Japan. National Institute for Research Advancement; United Nations Population Fund [UNFPA]

    Ann Arbor, Michigan, University of Michigan, Dept. of Population Planning and International Health, [1989]. xxxiii, 134 p.

    In August 1989, scientists and leaders of international and national groups met at the international symposium for the Survival of Mankind in Tokyo, Japan, to discuss ideas about the interrelationship between population, environment, and development and obstacles to attaining sustainable development. The President of the Worldwatch Institute opened the symposium with a talk about energy, food, and population. Of fossil fuels, nuclear power, and solar energy, only the clean and efficient solar energy can provide sustainable development. Humanity has extended arable lands and irrigation causing soil erosion, reduced water tables, produced water shortages, and increased salivation. Thus agricultural advances since the 1950s cannot continue to raise crop yields. He also emphasized the need to halt population growth. He suggested Japan provide more international assistance for sustainable development. This talk stimulated a lively debate. The 2nd session addressed the question whether the planet can support 5. 2 billion people (1989 population). The Executive Director of UNFPA informed the audience that research shows that various factors are needed for a successful population program: political will, a national plan, a prudent assessment of the sociocultural context, support from government agencies, community participation, and improvement of women's status. Other topics discussed during this session were urbanization, deforestation, and international environmental regulation. The 3rd session covered various ways leading to North-South cooperation. A Chinese participant suggested the establishment of an international environmental protection fund which would assist developing countries with their transition to sustainable development and to develop clean energy technologies and environmental restoration. Another participant proposed formation of a North-South Center in Japan. The 4th session centered around means to balance population needs, environmental protection, and socioeconomic development.
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  3. 3

    Strengthening of management of maternal and child health and family planning programmes. Report of an intercountry workshop, New Delhi, 27-31 August 1990.

    World Health Organization [WHO]. South-East Asia Region

    [Unpublished] 1991 Feb 14. [2], 20 p. (SEA/MCH/FP/99; Project No. ICP MCH 011)

    >20 participants from UNFPA/UNICEF/USAID and 23 participants from 10 countries from the WHO Southeast Asia Region attended the Workshop on Strengthening of Management of Maternal and Child Health (MCH) and Family Planning (FP) Programmes in New Delhi, India in August 1990. The workshop consisted of presentations and discussions of country reports, technical papers, dynamic work groups, and plenary consensus. The WHO/SEARO technical officer for family health presented a thorough overview on strengthening MCH/FP services in a primary health care setting. Issues addressed included regional status on population growth, urban migration and development. MCH status, management of MCH/FP services, strategic planning, and management information. In Bangladesh, the government integrated MCH services with FP services, but other child programs including immunization, control of diarrheal disease program, nutrition, acute respiratory infection remained with the health division. Obstacles of the MCH/FP program in the Maldives were shortage of trained human resources, preference of health providers to work in urban areas, inadequate logistics, and insufficient supervision in peripheral health centers. A nomadic way of life among the rural peoples posed special problems for the delivery of MCH services in Mongolia where large family size was encouraged. Other country reports included Bhutan, India, Myanmar, Nepal, and Sri Lanka. A case study of the model mother program in Thailand and the local area monitoring technique in Indonesia were shared with participants. District team work groups identified key MCH/FP management problems including organization, planning, and management; finance and resource allocation; intersectoral action; community participation; and human resource development. The workshop revealed the national health leaders with hopes for WHO technical assistance were developing a rapid evaluation methodology.
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  4. 4

    Annual report 88/89.

    Family Planning Association of Sri Lanka

    Colombo, Sri Lanka, Family Planning Association of Sri Lanka, 1989. 43 p.

    The Family Planning Association of Sri Lanka (FPASL) is a member of the International Planned Parenthood Federation (IPPF). According to the FPASL the family planning (FP) acceptor rate in 1988 declined by 22% compared to 1987 and is primarily the result of civil war and an election year. Because of complex political and sociological factors, people have been more concerned with staying alive, than with FP. District level programs designed to improve the quality of life for mothers and children were often halted during the end of the year because of terrorist activities and counter security measures. The following contraceptive methods experienced declines in acceptors: sterilization 48%, IUD 12%, pill 12%, injectables 8%, foam tablets 22%. In 1988 there were 629 vasectomies, and 393 tubectomies. Of the new acceptors of temporary methods 57.8% chose depo provera, 21.3% IUD, 15.9% orals, and 5% Norplant. Sales of contraceptives have changed with condom sales down 3.6%, orals up 7.5%, and foam down 78.25%. The Community Managed Integrated Rural Family Health Programme (CMIRFH) has been recognized globally as a story of success. Since 1980 over 45,000 people have volunteered to help this program. In 1988 1676 programs were carried out by these enthusiastic young volunteers. Of the 25,000 estimated villages in Sri Lanka, the FPASL and CMIRFH program had reached 1689 villages through the end of 1988. The Youth and Population Committee is trying to reach the young people with the message that the population is growing out of hand. In July a seminar was conducted when the population of Asia reached 3 billion.
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  5. 5
    Peer Reviewed

    Making Cairo work.

    Potts M; Walsh J

    Lancet. 1999 Jan 23; 353(9149):315-8.

    The 1994 International Conference on Population and Development (ICPD) laid out the agenda needed to improve women's health and accelerate the trend toward lower fertility. Although fertility rates in many less developed countries have declined rapidly over the past 30 years, mainly because of increased access to family planning, that trend will not continue unless support for population activities increases. Funds available to implement the ICPD Plan of Action come from national budgets, the international donor community, and money spent by consumers. Allocations and expenditures by the relatively more wealthy countries are, however, far lower than those needed to meet ICPD targets. The demand for family planning in developing countries is large and almost certain to rise, while investment in HIV prevention is growing more urgent. It is unlikely that enough funds will be made available to accommodate what is needed to achieve the goals of the ICPD Plan of Action. The cost of providing family planning and reproductive health services in less developed countries is discussed. In the final analysis, pursuit of the cost-effective delivery of family planning services using whatever funds are available could still meet much of the need for family planning, and some progress can be made against the spread of STDs.
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  6. 6

    Meeting the needs. Policy.

    Mehra S

    INTEGRATION. 1998 Spring; (55):2-5.

    The current unsatisfactory status of reproductive health (RH) in the Philippines needs to be improved. Inadequate access to treatment for reproductive morbidity, unmet need for family planning, violence against women, inadequate access to and delivery of prenatal care, and inadequate care during delivery are some reasons why reproductive health care urgently needs to be promoted. The UN Population Fund (UNFPA) has been supporting the Philippines' population program since 1972. The current Fourth Country Program of Assistance to the Philippines for 1994-98 aims to help the government of the Philippines achieve population growth and distribution which are consistent with sustainable development. The current UNFPA-assisted program has the following sub-programs: reproductive health (RH) and family planning (FP); population and development strategies; gender, population, and development; and adolescent health and youth development. Total program budget is US$35 million. The RH/FP program is discussed, followed by consideration of the difficulties which must be overcome and the Sustainable Community-based RH/FP Project Emphasizing Quality of Care.
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  7. 7

    Challenges in India and Bhutan.

    Zaman W

    JOICFP NEWS. 1997 Dec; (282):4.

    While India is making overall progress in maternal and child health and reproductive health (MCH/RH), all states are not moving ahead. In fact, it is the states with the larger populations which are lagging behind. Primary education, women's status, and literacy remain problematic. UNFPA has worked in India for a long time, helping to realize the decline in total fertility rate from 6 to 3.5 over the past 20-30 years. India's population, however, is still growing at the annual rate of 1.8%. UNFPA's program in India for the period 1997-2001 will stress women's health as a matter of overall reproductive health, a new approach in India which has long relied upon sterilization. Attention must be given to meeting the needs of the poor in India as the country continues to grow in size and wealth. While Bhutan's estimated population is just over 1 million, the annual population growth rate of 3.1% threatens development over the long term. With a mountainous terrain and a low resource base, Bhutan cannot sustain a high population growth rate. Significant improvements have been made and women's status is good, the infant mortality rate has been reduced, and the health infrastructure is not bad. UNFPA's 5-year program beginning in 1998 will mainly address RH, especially adolescent RH.
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  8. 8

    Beyond Cairo: the politics of Indian population policy.

    Desai S

    In: Comparative perspectives on fertility transition in South Asia. Based on the seminar organized by the Committee on Fertility and Family Planning of the International Union for the Scientific Study of Population (IUSSP) and the Population Council, Islamabad, Rawalpindi / Islamabad, 17-19 December 1996. Papers. Volume II. Liege, Belgium, International Union for the Scientific Study of Population [IUSSP], [1997]. 18 p.

    The International Conference on Population and Development held in Cairo in September 1994 was one of the most important events in the field of population. A shift in policy was adopted from a societal welfare rationale for population control to an individual needs rationale for the provision of family planning services and reproductive health services in order to satisfy the unmet need. The history of the Indian population policy starts in 1951 when such a policy was announced. In 40 years the crude birth rate fell from 44/1000 population in 1951 to under 30/1000 in 1991. The total fertility rate (TFR) of 5.95 in 1972 decreased to 3.4 by 1991. Nevertheless, the fertility decline has been modest compared to the achievement of Bangladesh in a much shorter period of time. In 1993 the health and family welfare programs were placed under the control of the local governments in tandem with economic liberalization measures. Foreign population assistance has increased recently. USAID chose the state of Uttar Pradesh for a large-scale population project in 1994 which is scheduled to run for 10 years. The Family Welfare Program has supplied contraceptives through the government's program: 79% of users of modern methods obtained them publicly in 1992-93. Information, education, and communication activities are also undertaken and demand for contraceptives is encouraged by other promotional activities. While population control has been endorsed by leading scientists, scholars, and policy makers, the exact means of achieving fertility decline has been neglected. Despite this India is clearly in the middle of a fertility transition. There is a disjunction between the public and private receptiveness to contraception, as Indian society sees contraceptive use as a favor done for the government. Because of the legacy of emergency excesses there is still distrust of the family planning program among people. The challenge is to regain legitimacy and stem bureaucratic expansion when delivering services.
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  9. 9

    Summary report of: Updating Service Delivery Guidelines and Practices: a Workshop on Recent Recommendations and Experiences, Guatemala City, Guatemala, March 6, 1995.

    Keller S

    Research Triangle Park, North Carolina, Family Health International [FHI], 1995 Aug. [2], 26 p. (MAQ: Maximizing Access and Quality)

    In March 1995, Family Health International (FHI), JHPIEGO Corporation, and seven collaborating agencies hosted an international workshop in Guatemala City so 60 family planning specialists from 23 countries could discuss how national guidelines for the use of contraceptives can be developed and implemented that are universally agreed upon and accepted. This workshop was held because a key obstacle of achieving high-quality family planning services is the lack of such guidelines. The participants reviewed the international recommendations developed by USAID and the World Health Organization (WHO). They also discussed the merits of the guidelines principle and learned from the pioneering countries in this initiative. The pioneering countries were presented in Session II as country case studies and included Mexico, Tanzania, and Turkey. The first session addressed the international initiative to update service delivery guidelines and practices, specifically how medical barriers stand in the way, and the WHO and USAID guidance documents. Session III involved working groups on contraception for young adults, contraception in postpartum care, contraception in postabortion care, progestin-only methods, and client perspectives. Participants suggested that the workshop be adapted into an easily replicated format to introduce the guidelines worldwide. The next step would be to translate the documents into national guidelines and convert them into changes in practice. One way would be to publish training materials for all levels of family planning providers. JHPIEGO has already published a user-friendly pocket guide in five languages to simplify the USAID and WHO documents. FHI has developed Contraceptive Technology Modules to educate policymakers and providers on the latest scientific information. JHPIEGO and FHI have created expert slides to accompany the modules.
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  10. 10

    Access, quality of care, and medical barriers in international family planning programs.

    Bertrand J; Magnani R; Hardee K; Angle M

    [Unpublished] 1994. Presented at the meeting of the USAID cooperating agencies, Washington, D.C., February 22-24, 1994. 6, [4] p.

    Elements of quality of care according to the Bruce/Jain framework include: choice of methods, information given to clients, technical competence, interpersonal relations, mechanisms to ensure follow-up, and appropriateness of services. Access to family planning (FP) services and quality of care shape the image of the FP program in the eyes of potential clients. There are 4 barriers to seeking out services: 1) economic (the cost to the client of reaching the service delivery point and obtaining the contraceptive services and supplies); 2) administrative (unnecessary rules and regulations that can inhibit contraceptive choice and use, e.g., restricted clinic hours for family planning services, age/parity criteria for the use of certain methods, spousal consent); 3) cognitive (lack of knowledge of the existence of FP services, of the location of such services, or of the methods available); 4) psychosocial (psychological, attitudinal, or social factors that inhibit motivated potential clients in seeking out family planning services); 5) elements of quality of care (choice of methods, information given to clients, technical competence, interpersonal relations, mechanisms to ensure follow-up, continuity, appropriate constellation of services). In addition, there are medical barriers as a subset of access and quality: inappropriate contraindications (quality), process/scheduling hurdles (access), eligibility criteria, such as age, parity, spousal consent (access), limits on providers to provide certain methods (access), provider bias (quality), regulatory barriers (access), location of services (access), and how side effects are managed (quality). Other concerns about quality of care and medical barriers are: demedicalizing FP may remove protective safeguards to health; the removal of medical barriers may inadvertently limit reproductive health care for some women; the focus on access could orient managers to quantity (of clients generated) rather than quality (of services provided); and medical barriers could consume resources that should be used for improving quality of care.
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  11. 11

    Recommendations from the ad-hoc committees.

    FORUM. 1993 Dec; 9(2):35.

    Volunteers and representatives from member family planning associations (FPAs) during the Regional Council of IPPF's Western Hemisphere Region (IPPF/WHR) were divided into 3 committees to study the goals for the 21st century. The goals are grouped under Strategic Plan "Vision 2000", Young People, and Human Reproductive Rights. Each member association, including its board of directors, should review the significance of Vision 2000 and develop its own plan based on its own needs. IPPF/WHR needs to always examine FPA activities implementing Vision 2000. Each association could submit information on its accomplishments, progress, and constraints. FPAs should include youth in launching, developing, implementing, and evaluating research, policies, and programs affecting them. FPAs should emphasize the necessity of empowering young women and of developing programs to deal with young women's fewer opportunities for health care, education, and employment. FPAs need to help health providers, teachers, youth workers, and FPA staff and volunteers to appreciate the sexual and reproductive health needs of youth. They should identify and cooperate with key groups and people involved with youth at all levels (local to international), particularly those whose goals and objectives correspond with those of IPPF and its members. FPAs should concentrate on rights associated with delivery of reproductive health services. Some FPAs could set up local committees to identify, oversee, and rectify complaints about their services. Each FPA could also establish a committee to develop a comprehensive approach to reduce possible abuses of human reproductive rights.
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  12. 12

    Graduating NGOs to self-sustaining status and stagnating national family planning programs.

    AmaraSingham S

    [Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. [6] p.

    External donors provided plenty of funds to nongovernmental organizations (NGOs) in developing countries, hoping the governments would eventually support a national family planning (FP) policy. Lower levels of funding for population programs caused external donors to force NGO FP programs to become self-sustaining. Yet, it is likely to be difficult for them to improve the quality of services, expand coverage, and increase program sustainability all at the same time. External donors consider the 35-50% contraceptive prevalence rates that NGO FP programs are achieving to represent the early stages of sustainability at which time they divert funds to government programs. This loss of funds shifts the NGO program's focus from poor women to income-generation, made possible by targeting middle and upper income women. When diversion of funds resulted in a decline of contraceptive prevalence rates in Sri Lanka and stagnant rates in Pakistan and the Philippines. FP programs in Sri Lanka, Pakistan, and the Philippines first provided physician-controlled, reversible, clinical methods. Those in Sri Lanka and the Philippines next provided contraceptives through a widespread rural community-based distribution system. Pakistan held mass sterilization campaigns to address rapid population growth and high fertility. The management system of the national FP program in Sri Lanka is slow, and disruption of service delivery and supply systems is common Physician-trained nonphysician FP workers and the vertical national health and population sectors caused the stagnation in the public sector. The Philippines has trouble implementing public policy-based FP programs.
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  13. 13

    Pakistan, South Asia region.

    International Planned Parenthood Federation [IPPF]

    IPPF COUNTRY PROFILES. 1992 Aug; SAR 19-24.

    In 1984 in Pakistan, the government's Council of Islamic Ideology banned contraception unless pregnancy would jeopardize a woman's life. The government soon realized that its 2.9% population growth rate was too high to achieve social and economic development, so it implemented a national population policy, hoping to reduce population growth to 2.5% by 2000. The policy calls for a multisectoral approach, emphasizing mobile services to promote birth spacing and maternal and child health and providing family planning services through the public and private sector and family welfare centers. The policy also aims to increase literacy, reduce unemployment, and improve health care. It targets rural areas where 72% of the population lives. In 1989, only 9.1% of 15-49 year old married women used contraceptives and 58.6% wanted to control their fertility but did not have access to family planning information and services. Pakistan depends greatly on the family planning services of the nongovernmental organization. Family Planning Association of Pakistan (FPAP). FPAP introduced family welfare centers, social marketing, and reproductive health centers to Pakistan. It continues to introduce new contraceptives. FPAP's major projects include educational programs in population, family planning, and nutrition; family planning training; promotion of family planning and maternal and child health; programs emphasizing male involvement in family planning; information, education, and communication; and lobbying Parliament for more funding for family planning and for improvement in women's status.
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  14. 14

    Study of sustainability for the National Family Planning Board in Jamaica.

    Clyde ME; Levy TD; Bennett J

    [Unpublished] 1992 Apr 2. iv, 37, [24] p. (PN-ABL-448)

    The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.
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  15. 15
    Peer Reviewed

    Medical barriers to contraceptive use.

    Cottingham J; Mehta S

    REPRODUCTIVE HEALTH MATTERS. 1993 May; (1):97-100.

    Various practices keep women from receiving and using contraception. These medical barriers include those pertaining to eligibility, process, and regulatory and provider bias. Eligibility barriers place too strict criteria on what women may use a particular contraceptive. For example, severe migraine headaches are a relative contraindication for oral contraceptives (OCs), but some community-based distribution programs include headaches without being specific on their checklist, resulting in denying OCs to women who have had a recent headache. Blood tests to rule out liver and cardiovascular diseases as a prerequisite for a prescription of combined OCs in some West African countries represent a process hurdle. Yet, just a brief medical history can identify women at risk of these diseases. Restricting IUD insertion to physicians in some countries is another example of a medical barrier. Family planning providers or program managers sometimes determine themselves what methods are best suited for various women. This provider bias essentially eliminates women's choice of methods. Until 1992, the US Food and Drug Administration (FDA) had not approved the 3-month injectable contraceptive method, Depo-Provera, despite many studies confirming its safety. The lack of FDA approval prevented other countries from approving it. Despite 30 years of OC use worldwide, Japan still does not allow OC use. According to a WHO survey of 50 collaborating centers, the most common medical barrier to contraceptive use is requiring women who use OCs and IUDs to return for follow-up examinations more often than is necessary. This recent survey concludes that no overall standardized information about contraceptives, their side effects, and who can and cannot use them safely exists. WHO and other groups are developing internationally accepted guidelines to counteract conflicting information and outdated criteria for contraceptive delivery.
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  16. 16

    Programme review and strategy development report: Botswana.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. vii, 71 p.

    The Government of Botswana followed good economic policies during the 1970s-80s and received considerable revenues from minerals which it invested in its social and economic infrastructure. this resulted in more employment and improved health, education, and skills of the population. Even though these actions were a good start in dealing with population issues, the population continues to grow rapidly (3.45%) and total fertility is high (6.39). Despite the country's small population size (1.3 million; population density=2/square km), it strains Botswana's limited resource base. In the future, the water supply will be Botswana's most serious problem. It is now facing increased teenage and unwanted pregnancies, malnutrition, overcrowding, and street children. Yet Botswana has no official population policy. Maternal and child health (MCH) programs provide family planning (FP) information, services, and supplies, but based on the growth rate, women tend to use contraceptives to space births. Contraceptive prevalence is around 32%. The government does not have a definite information, education, and communication (IEC) strategy that targets populations not served by MCH/FP programs. UNFPA recommends that the government of Botswana begin formulating a population policy and implementation strategy. It suggests that the strategy include an institutional framework; a policy document; the organization of a national population program as soon as possible; IEC; a component addressing women, population, and development; FP services; a framework for data collection and analyses; and mechanisms to improve date quality, analyses, and dissemination of findings.
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  17. 17

    Effective family planning programs.

    Bulatao RA; Levin A; Bos ER; Green C

    Washington, D.C., World Bank, 1993. vii, 103 p.

    The World Bank has conducted an assessment of the performance of family planning (FP) programs in developing countries. The first part examines their contributions and costs. It concludes that FP programs have played a key role in a reproductive revolution in these countries. Specifically, all developing regions have experienced a transition to lower fertility (e.g., in the last 20 years, fertility has fallen 33%), resulting in lower infant, child, and maternal mortality. One chapter looks at experiences in East Asia, South Asia, Latin America, and sub-Saharan Africa. World Bank staff use research to present a broad summary of what methods and characteristics achieve effective programs. The book addresses other social development interventions that contribute to a lasting reproductive revolution. Despite the positive results of FP programs, maternal mortality in developing countries is still much higher (10 times) than it is in developed countries and 25% of married women in developing countries report an unmet need for FP. Government commitment to FP programs needs to be strengthened and donor support should keep up with needs to expand successful FP programs. FP programs can satisfy these needs if they provide quality services, including a solid client focus, effective promotion, and strong encouragement of the private sector to increase their participation. Indeed, program quality must be the top priority. Strategic management of FP programs is also crucial. Programs need to integrate and coordinate effective promotion of FP, e.g., social marketing, with other activities.
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  18. 18

    Male participation in family planning: a review of programme approaches in Africa.

    Hawkins K

    London, England, International Planned Parenthood Federation [IPPF], 1992 Sep. 93 p.

    20 participants from 9 sub-Saharan countries and the UK discuss men's negative attitudes towards family planning (the leading obstacle to the success of family planning in Africa) at the November 1991 Workshop on Male Participation in Family Planning in The Gambia. Family planning programs have targeted women for 20 years, but they are starting to see the men's role in making fertility decisions and in transmitting sexually transmitted diseases (STDs). They are trying to find ways to increase men's involvement in promoting family planning and STD prevention. Some recent research in Africa shows that many men already have a positive attitude towards family planning, but there is poor or no positive communication between husband and wife about fertility and sexuality. Some family planning programs (e.g., those in Sierra Leone, Nigeria, Ethiopia, and Zimbabwe) use information, education, and communication (IEC) activities (e.g., audiovisual material, print media, film, workshops, seminars, and songs) to promote men's sexual responsibility. IEC programs do increase knowledge, but do not necessarily change attitudes and practice. Some research indicates that awareness raising must be followed by counseling and peer promotion efforts to effect attitudinal and behavioral change. The sub-Saharan Africa programs must conduct baseline research on attitudes and a needs assessment to determine how to address men's needs. In Zambia, baseline research reveals that a man having 1 faithful partner for a lifetime is deemed negative. Common effective needs assessment methodologies are focus group discussions and individual interviews. Programs have identified various service delivery strategies to meet these needs. They are integration of family planning promotion efforts via AIDS prevention programs, income-generating schemes, employment-based programs, youth programs and peer counseling, male-to-male community-based distribution of condoms, and social marketing. Few programs have been evaluated, mainly because evaluation is not included in the planning process.
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  19. 19

    Selected UNFPA-funded projects executed by the WHO/South East Asian regional office (SEARO).

    Sobrevilla L; Deville W; Reddy N

    New York, New York, UNFPA, [1992]. v, 69, [2] p. (Evaluation Report)

    In 1991, a mission in India, Bhutan and Nepal evaluated UNFPA/WHO South East Asian Regional Office (SEARO) maternal and child health/family planning (MCH/FP) projects. The Regional Advisory Team in MCH/FP Project (RT) placed more emphasis on the MCH component than the FP component. It included all priority areas identified in 1984, but did not include management until 1988. In fact, it delayed recruiting a technical officer and recruited someone who was unqualified and who performed poorly. SEARO improved cooperation between RT and community health units and named the team leader as regional adviser for family health. The RT team did not promote itself very well, however, Member countries and UNFPA did request technical assistance from RT for MCH/FP projects, especially operations research. RT also set up fruitful intercountry workshops. The team did not put much effort in training, adolescent health, and transfer of technology, though. Further RT project management was still weak. Overall SEARO had been able to follow the policies of governments, but often its advisors did not follow UNFPA guidelines when helping countries plan the design and strategy of country projects. Delays in approval were common in all the projects reviewed by the mission. Furthermore previous evaluations also identified this weakness. In addition, a project in Bhutan addressed mothers' concerns but ignored other women's roles such as managers of households and wage earners. Besides, little was done to include women's participation in health sector decision making at the basic health unit and at the central health ministry. In Nepal, institution building did not include advancement for women or encourage proactive role roles of qualified women medical professionals. In Bhutan, but not Nepal, fellowships and study tours helped increase the number of trained personnel attending intercountry activities.
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  20. 20

    Guidelines on improving delivery and evaluation of population and family planning programmes in African countries.

    United Nations. Economic Commission for Africa

    Addis Ababa, Ethiopia, United Nations Economic Commission for Africa, 1991 Dec. vi, 82 p. (ECA/POP/TP/91/2 [1.2(ii)])

    In December, 1991, the UN Economic Commission for Africa (UNECA) released guidelines geared toward professionals involved in population and family planning programs in Africa. By this time, many African countries had adopted such programs either for health and human rights reasons or to influence demographic trends. Yet several countries still had laws against family planning from the colonial days. UNECA stressed that programs should be central to socioeconomic development planning, since changes in population affect socioeconomic development and vice versa. It also emphasized the importance of planning and formulation of programs and policies. This included political commitment and leadership; involvement of women, men, youth, and communities; consideration of resource allocation, institutional arrangements, and infrastructure; and wide discussion of policies and programs at all levels including the grass roots levels. UNECA pointed out the need for policy makers and program managers to clearly state objectives and that the objectives be tied with socioeconomic development and improvement of the welfare of the people. It encouraged population and family planning professionals to give consideration to the delivery and evaluation of programs. For example, they should incorporated information, education, and communication efforts designed to improve attitudes and encourage quality services into these programs. Leaders should strive to reform legislation which acts against population and family planning programs. UNECA also stressed the need to integrate evaluation activities into these programs. The guidelines ended with experiences on implementation of programs from Botswana, Ghana, Kenya, Mauritius, Tunisia, Zimbabwe, China, and Thailand.
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  21. 21

    From abortion to contraception in Romania.

    Pierotti D

    WORLD HEALTH. 1991 Nov-Dec; 22.

    The experiences of Romania show that legal decrees will not deter a woman determined to end her pregnancy, and that it is easier to switch from illegal to legal abortion than it is to introduce the practice of modern contraception. On Christmas Day 1989, Romania abrogated a 1966 that banned abortion and all modern contraceptive methods. Through the 1966 law, the former regime had hoped to raise the birth rate, which at the time stood at 15.6/1000. Succeeding briefly, the law ultimately failed to its objective, since by 1985 the birth rate had fallen to the initial 1966 level. If year following the abrogation of the decree, 992,265 abortions were carried out, 92% of them legally. The number of abortions is expected to top 1 million in 1991. Maternal death due to abortion has fallen by more than 60%. Romania has also witnessed the establishment of the Society for Education in Contraception, a private family planning association. UN and donor assistance has begun to arrive in Romania. 20,000 women attended family planning clinics in 1990, a figure that increased to nearly 50,000 in 1991. Nonetheless, the case of Romania illustrates the complexities involved in introducing the practice of modern contraception. In addition to commitment from national authorities, setting up a program of modern contraception will require the following: convincing physicians and clients as to the superiority of contraception over abortion; ensuring the training of health professionals; developing public information programs; creating acceptable conditions for women to seek services; and making contraceptives available and affordable. In order to facilitate the transition from abortion to contraception, UNFPA and the WHO have initiated an emergency family planning program.
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  22. 22

    Midterm evaluation of the Centre for African Family Studies (CAFS) Project.

    Jewell NC; Fisken B; Wright MW

    Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Dec 5. vii, 41, [28] p. (Report No. 91-127-127; USAID Contract No. DPE-3024-Z-00-8078-00; PIO/T No. 623-0004-00-3-10002)

    In 1975, International Planned Parenthood Federation (IPPF) founded the Centre for African Family Studies (CAFS) in nairobi, Kenya to train family planning program personnel in service delivery management skills and technologies. A USAID funded 4 year CAFS Project Grant, scheduled to end in June 1993, consisted of training courses with incountry follow up to make sure courses were applicable to the changing situation of family planning programs in Africa. CAFS was to become totally self sufficient by June 1993. It planned to recover direct training costs from participants. CAFS experienced considerable difficulties in organization and management (a new director and loss of IPPF funding), during the project. The evaluation team found the training courses to be of high quality. Further former participants wished to continue receiving CAFS services and would recommended CAFS courses to colleagues. New financial procedures and addition of experienced financial staff had set CAFS on its way to financial self sufficiency, but these changes would not bring about self sufficiency by June 1993. Further CAFS restructured management and its organizational structure thereby moving it towards decentralization of authority and decision making. Even though CAFS was the only African regional institution providing training services for family planning personnel, it could lose its competitive edge since it had problems in providing francophone courses, inadequate incountry follow up visits, and insufficient research and evaluation skills in developing training programs. CAFS needed to address these obstacles. The team highlighted the need for CAFS to no longer depend on individual staff to maintain high quality courses so courses would not suffer from staff turnover. In conclusion, the team recommended that USAID continue to support CAFS.
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  23. 23

    1990 annual report.

    International Planned Parenthood Federation [IPPF]. Western Hemisphere Region [WHR]

    New York, New York, IPPF/WHR, 1990. 36, [60] p.

    This report describes the accomplishments of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) during 1990, and examines the challenges still present in the region. As IPPF/WHR President Fernando Tamayo explains, Latin American and the Caribbean have the highest use of family planning than any other developing region in the developing world: almost 45% of all married women use a modern contraceptive. However, many women still lack access -- or easy access -- to family planning services. Chairperson Jill Sheffield echoes Tamayo's view, noting that 30 million people in the region want family planning but cannot get it. She discusses the risks that unwanted or multiple pregnancies pose to a woman's health. The incidence of unsafe abortion, she notes, is highest in WHR than in any other region. The report goes on to describe the service expansion that took place in 1990 and the challenges that remain. Looking for innovative ways to reach marginalized communities, IPPF/WHR initiated a number of services for men and for adolescents. The organization also explored ways of reaching people living in remote rural areas or in urban slums, using traveling promoters or encouraging doctors to establish practices in areas that lack health services. In order to confront the growing threat of AIDS, the organization conducted a series of activities to raise public awareness. IPPF/WHR also introduced management information systems in 11 countries which helped increase productivity. The report goes on to discuss the following issues: the increasing gap between knowledge and use of contraception; clinical services and cost effectiveness; institution building; quality of care; strategic planning; the involvement of women; and financial support. A special feature, the report contains a pictorial section which describes the impact of family planning on the lives of indigenous women in Guatemala.
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  24. 24

    Interview: Mr. George Walmsley: UNFPA Country Director for the Philippines.

    ASIA-PACIFIC POPIN BULLETIN. 1991 Jun; 3(2):7-11.

    George Walmsley, UNFPA country director for the Philippines, discusses demographic and economic conditions in the Philippines, and present plans to revitalize the national population program after 20 years of only modest achievements. The Philippines is a rapidly growing country with much poverty, unemployment and underemployment, uneven population distribution, and a large, highly dependent segment of children and youths under age 15. Initial thrusts of the population program were in favor of fertility reduction, ultimately changing to adopt a perspective more attuned to promoting overall family welfare. Concurrent with this change also came a shift from a clinic-based to community-based approach. Fertility declines have nonetheless grown weaker over the past 8-10 years. A large gap exists between family planning knowledge and practice, with contraceptive prevalence rates declining from 45% in 1986 to 36% in 1988. Behind this lackluster performance are a lack of consistent political support, discontinuities in program implementation, a lack of coordination among participating agencies, and obstacles to program implementation at the field level. The present government considers the revitalization of this program a priority concern. Mr. Walmsley discusses UNFPA's definition of a priority country, and what that means for the Philippines in terms of resources nd future activities. He further responds to questions about the expected effect of the Catholic church upon program implementation and success, non-governmental organization involvement, the role of information and information systems in the program, the relationship between population, environment and sustainable development, and the status of women and its effect on population.
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  25. 25

    Pakistan. South Asia Region.

    International Planned Parenthood Federation [IPPF]

    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.
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