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Paris, France, MFPF, 1993 Jun. ii, 73 p. (Dossier Documentaire)The French Movement for Family Planning (MFPF) has compiled documents on female genital mutilation in France. The documents are presented with an introduction entitled Excision in Law and four sections addressing the last excision trials in France; action of the public powers; in the UK, family planning action and of IPPF; trials for excision in January and February 1993 (facts across the press); and family planning in Mali fighting against sexual mutilation. Interspersed in these sections are witness accounts, indictments, and counsel's speech. Some titles of newspaper and magazine articles in the MFPF collection include Five Years in Prison for Excision (Le Monde); For the First Time in France, an African is Condemned to a Year on a Prison Farm for Having Her Daughters Excised (Le Monde); Excision: The Pain of the Innocents (Nouvel Observateur); and Excision: The Word of Cut Women (Marie-Claire). The MFPF collection presents an IPPF report called Restoring to Women their Life Space which is about female genital mutilation. The collection ends with an interview in the Bulletin of the Malian Association for Family Planning (AMPPF) with an obstetrician-gynecologist serving on the AMPPF executive board who addresses excision and other traditional practices.
Moscow, Russia, RFPA, .  p.This pamphlet describes the goals and activities of the Russian Family Planning Association (RFPA) and its relationship with IPPF. The Russian government supports RFPA, but it is nonetheless a voluntary public organization. RFPA's goals include improvement of reproductive health, particularly among youth, and reduction of the rates of abortion and sexually transmitted diseases (STDs). Its activities revolve around promotion of family planning and modern contraception, sex education for youth, helping youth through medical and psychological counseling on sexual health and contraception, increasing awareness of safe sex and reproductive health care, family planning training for medical and nonmedical professionals, and setting up RFPA branches in Russia and supporting their efforts. In 1993, RFPA branches and units operated in the regions of Altay, Archangel, Ivanovo, Leningrad, Krasnodar, Magadan, Moscow, Novosibirsk, Primorsky, Rjazan, Samara, Sakhalin, Sverdlovsk, Smolensk, Stavropol, Tomsk, Tula, Udmurtia, Uljanovsk, and Khabarovsk; the cities of Miass, Orsk, and Surgut; and the republics of Burjatia and Carelia. RFPA works with state and public groups addressing family and youth sex education. It distributes IPPF publications on sex education and family planning; an international medical journal; and films, TV, and radio programs. RFPA arranges for eminent national and international family planning specialists to conduct seminar and training all over Russia. A training center operates out of RFPA headquarters in Moscow. RFPA is creating a computer data bank on family planning and reproductive health. It has established a network of its branches that follow sociodemographic, cultural, and national characteristics of Russian territories. RFPA adheres to the ideology and strategies of IPPF.
International Conference on Population and Development (ICPD), Cairo, Egypt, 5-13th September 1994. National position paper.
Lusaka, Zambia, National Commission for Development Planning, 1993 Dec. viii, 39 p.Zambia's country report for the 1994 International Conference on Population and Development opens with a review of the country's unfavorable economic and demographic situation. Population growth has been increasing (by 2.6% for 1963-69 and 3.2% for 1980-90) because of a high birth rate and a death rate which is declining despite an increase in infant and child mortality. The population is extremely mobile and youthful (49.6% under age 15 years in 1990). Formulation of a population policy began in 1984, and an implementation program was announced in 1989. International guidance has played a major role in the development of the policy and implementation plans but an inadequacy of resources has hindered implementation. New concerns (the status of women; HIV/AIDS; the environment; homeless children and families; increasing poverty; and the increase in infant, child, and maternal mortality) have been added to the formerly recognized urgent problems caused by the high cost of living, youth, urbanization, and rural underdevelopment. To date, population activities have been donor-driven; therefore, more government and individual support will be sought and efforts will be made to ensure that donor support focuses on the local institutionalization of programs. The country report presents the demographic context in terms of population size and growth, fertility, mortality, migration, urbanization, spatial distribution, population structure, and the implications of this demographic situation. The population policy, planning, and program framework is described through information on national perceptions of population issues, the role of population in development planning, the evolution and current status of the population policy, and a profile of the national population program (research methodology; integrated planning; information, education, and communication; health, fertility, and mortality regulatory initiatives; HIV/AIDS; migration; the environment; adolescents; women; and demography training). A description of the operational aspects of population and family planning (FP) program implementation covers political and national support, the national implementation strategy, program coordination, service delivery and quality of care, HIV/AIDS, personnel recruitment and training, evaluation, and financial resources. The discussion of the national plan for the future involves priority concerns, the policy framework, programmatic activities, and resource mobilization.
National report on population and development of Malaysia. International Conference on Population and Development, September, 1994, Cairo.
[Kuala Lumpur], Malaysia, National Population and Family Development Board, Technical Working Group for ICPD, 1993. , 64 p.Malaysia considers its population policy an integral part of its overall social and economic policy planning. In order to achieve its goal of becoming an industrialized nation by the year 2020, Malaysia considers it imperative to create a quality population based around a strong family unit and a caring society. This report on population and development in Malaysia begins with a description of the demographic context in terms of past and current trends in population size, growth, and structure; fertility, mortality, and migration as well as the outlook for the future. The implementation of the population policy, planning, and program is described in the context of the following issues: longterm population growth, fertility interventions, women's labor force participation, aging, the family, internal and international migration, urbanization, and the environment. The evolution of the population policy is included as is its relationship with such other population-related policies as health, education, human resource development, regional development, and the eradication of poverty. Information is provided on the current status of the population policy and on the role of population issues in development planning. A profile of the national population program includes a discussion of maternal-child health services; family planning services and family development; information, education, and communication; data collection and analysis, the relationship of women to population and development; mortality; migration; the environment; human resources development, poverty alleviation; aging; and HIV/AIDS. The national action plan for the future is presented through a discussion of the emerging and priority concerns of population and family development and an outline of the policy framework. The summary reiterates Malaysia's efforts to integrate population factors into development planning and its commitment to promoting environmentally-sound and sustainable development. Appendices present data in tabular form on population and development indicators, population policies, incentives, and programs; program results; and the phase and area of implementation of the national population and family development programs.
National population report prepared in the context of the International Conference on Population and Development, ICPD, 1994, Cairo, Egypt.
Port Louis, Mauritius, National Task Force on Population, 1993 , 64,  p.Mauritius has one of the highest population densities in the world, and it can boast of one of the highest literacy rates among developing countries. Each of the development plans of Mauritius has contained a chapter devoted to population policy. This country report prepared for the 1994 International Conference on Population and Development borrows heavily from those plans. The first development plan (1971-75) emphasized employment creation to achieve growth with equity. By 1982-84, the emphasis shifted to productive employment, and, by 1987 nearly full employment was reached. The goal now is to achieve sustainable development and to dovetail the demands of a rapidly industrializing economy with the social needs of a slowly aging population. The country report presents the demographic context in terms of past trends, the current situation, and the outlook for the future. Demographic transition was achieved in a relatively short time and resulted in changes in the age structure of the population from "young" to "active." The population policy (which aims to maintain the replacement level gross reproduction rate and reduce fertility rates), planning, and program framework is described through information on national perceptions of population issues, the evolution and current status of the population policy, the role of population in development planning, and a profile of the national population program (maternal-child health and family planning services; information, education, and communication; research methodology; the status of women; mortality; population distribution; migration; and multi-sectoral activities). The description of the operational aspects of population and family planning (FP) program implementation includes political and national support, the national implementation strategy, evaluation, finances and resources, and the role of the World Population Plan of Action. The discussion of the national plan for the future involves emerging and priority concerns (reducing unwanted pregnancies and abortions, particularly among adolescents and unmarried women, an increase in teenage fertility rates, reducing the fertility rate which rose to 2.3 from 1.9 in 1986, and reducing infant, child, and maternal mortality rates), the policy framework, programmatic activities, and resource mobilization.
The International Conference on Population and Development, September 5-13, 1994, Cairo, Egypt. Nepal's country report.
Kathmandu, Nepal, National Planning Commission, 1993 Sep. vi, 49 p.Prepared for the 1994 International Conference on Population and Development, this country report from Nepal opens with a description of the geographic features and administrative regions, zones, and districts of the country. 91% of the population of Nepal is rural, and agriculture accounts for 57% of the gross domestic product. Nepal has made some socioeconomic gains from 1961 to 1991 which are reflected in improved life expectancy (from 34 to 54.4 years), a decline in the infant mortality rate (from 200 to 102), and an improvement in the literacy rate (from 9 to > 40%). However, the per capital income of US $180 and rapid population growth have impeded improvement in the standard of living. The new government of Nepal is committed to establishing a better balance between population and the environment. This report provides a discussion of population growth and structure; population distribution, urbanization, and migration; the environment and sustainable development; the status of women; population policies and programs (highlighting the population policy of the plan for 1992-97); the national family planning program and health programs; and intervention issues. A 15-point summary is provided, and details of the objectives, priorities, and major policy thrust in regard to population and development of the Eight Plan (1992-97) are appended.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (BOL-03)Longterm contraceptive methods, such as Norplant, are receiving broader acceptance, particularly among women who are not yet ready to consider sterilization. In countries such as Bolivia, where the availability of family planning (FP) methods remains limited, the introduction and diffusion of a culturally acceptable, safe, and effective method should contribute to an increase in contraceptive acceptance and prevalence. Therefore, in 1990, the Population Council allotted US $35,700 to a 3-year prospective clinical study of Norplant with the Hospital Obrero No. 1 of the Bolivian Caja Nacional de Salud (CNS). The project is intended to evaluate local experience in the use of Norplant to facilitate its introduction. Ultimately, it is hoped that a high quality FP clinic and training center will be established to facilitate expansion of Norplant. The project has 4 major objectives: 1) to assess the demand for Norplant; 2) to compare the sociocultural, health, and psychological characteristics of Norplant and IUD (CuT380A) acceptors; 3) to compare the clinical performance of Norplant with CuT380A; and 4) to compare the cost effectiveness of Norplant with CuT380A. The project entails 3 research components: 1) a preintroduction study to gather socioeconomic, medical, and previous contraceptive use data on all prospective and actual Norplant users (at periodic intervals, beginning when a sufficient number of volunteers have completed at least 6 months of use, statistical analysis of the method's performance will be undertaken); 2) a comparative study of Norplant and CuT380A performance; and 3) a comparison of the cost-effectiveness of the 2 methods. Results of this comparison are expected to provide the CNS with information to decide on the appropriateness of including Norplant within its FP service delivery program. It is hypothesized that the impact of this method on a FP program will be greater if Norplant does not replace other highly effective contraceptives and if acceptors are young and of low parity. Research to date indicates that the cost of Norplant insertion at CNS, including only materials and physician time, averages US $13.95, while the cost of an IUD insertion is estimated at $9.49. Adding product costs of US $22 for Norplant and $1.25 for the CuT380A yields a total insertion cost of $35.95 and $10.74, respectively. Based on these figures, the only point at which costs would approach parity is where IUD continuation averaged less than 2 years and Norplant continuation approached the maximum 5 years. Between the start-up of clinical activities in February and August 1991, 106 Norplant insertions had been performed by CNS (more than half the insertions projected for the project). The project will be expanded in 1992 to involve Servicios de Investigacion y Accion en Poblacion, a private program with extensive experience in social science research.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (PHI-01)In 1975, a USAID-Commission on Population (POPCOM) planning team reported that the key problem facing the National Family Planning (FP) Program in the Philippines was extending the program beyond its existing network of municipal-based clinics to the surrounding barrios. At that time, the number of new FP acceptors was declining, and there was a shift to less effective methods among current users. Because most clinics were urban-based, rural acceptors could not easily access FP services. The report recommended that supply depots be established in barrios and that motivators be used to distribute contraceptives and hygiene information and materials. An operations research project, which cost US $77,313, was developed to test the feasibility and cost-effectiveness of delivering FP/hygiene materials directly to households in rural areas. The Barrio Supply Point (BSP) operators were to visit and make available to every household free FP and hygiene materials. After the initial visit, BSP operators were to continue to serve as resupply agents. Although contraceptives were resupplied free, a nominal charge was required for hygiene materials. A quasi-experimental study design was employed. Pilot tests were conducted to determine what materials might be effectively distributed in addition to contraceptives. Project support was terminated in December 1978, before the project was fully implemented, because of the evolution of a national outreach program. Results of the pilot test showed that over 90% of households offered free condoms and oral contraceptives, or free contraceptives and bars of soap, accepted them. No data on use of these items were collected.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (EGY-01)Egypt's family planning (FP) program, active since 1966, has been facilitated by the country's population density, flat terrain, and extensive health infrastructure. Nevertheless, by the early 1970s, a substantial proportion of couples were still not using contraception because of minimal clinic outreach; high dropout rates for oral contraceptive (OC) users; lack of knowledge about side effects among clinic staff and clients; disruptions in clinical supplies; and unavailability of other methods, such as the IUD, especially in rural areas. In 1971, USAID supported the American University in Cairo's (AUC) FP research activities in rural Egypt, in which household fertility survey data, a follow-up of women attending FP clinics, the cultural context of FP, communication and education, and the implementation of services were studied. In 1974, AUC initiated a demonstration project (which cost US $224,000) of a low-cost way to provide FP services to all married women in a treatment population through a household contraceptive distribution system. The interventions were implemented in the Shanawan (rural) and Sayeda Zeinab (city of Cairo) communities of Menoufia Governorate. During an initial canvas in November 1974, married women 15-49 years of age, who were living with their husbands and were not pregnant or less than 3 months postpartum and breast feeding, were offered 4 cycles of OCs or a supply of condoms. During a second canvas in February 1975, acceptors were provided with an additional 4 cycles of OCs and referred to a local depot for resupply. Each distribution area was mapped, and each housing unit numbered. Data collected through canvassing consisted primarily of eligibility screening items and provided numbers of acceptors, refusals, ineligibles, not at homes, etc. To increase coverage, 2 attempts were made to reach women not at home. Of the 2,493 women canvassed in Sayeda Zeinab, 1713 (69%) were eligible to receive contraceptives. Of these, 58% accepted 4 to 6 cycles of OCs. At the time of initial household distribution, 45% of eligible women were already using OCs. As a result of the canvass, an additional 5% of the women became acceptors. The AUC did not expand the household distribution of contraceptives to other urban areas of Cairo, because women there evidently already had adequate access to FP information and supplies. In the 6,915 households canvassed in Shanawan, 1156 of the 1820 women (64%) were eligible to receive contraceptives. Of these, 45% accepted 4 to 6 cycles of OCs. 21% of eligible women were already using OCs at the time of initial household distribution. Although condoms were offered, few were accepted, apparently because it was not culturally acceptable for women to either distribute or accept condoms. One year after the initial household distribution, contraceptive use among married women of reproductive age had increased 69% from 18.4 to 31% among all age and parity groups and at all educational and occupational levels, and the incidence of pregnancy declined from 19.3 to 14.9%.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-10)This project grew out of the need to monitor the quality of care in the various community-based contraception distribution (CBD) projects which were subprojects of the Tulane Family Planning Operations Research Project. The objectives of this activity were to: 1) assure that women who use the services of CBD workers were properly screened for use of oral contraceptives (if that was the method they chose), that they received correct information about the methods and their use, and that they were referred to other levels in the health system when appropriate; 2) to strengthen the position of existing CBD programs if they were to come under attack in the future over the issue of quality of service; and 3) to develop a methodology that could be used in other CBD programs, including those outside of Zaire. The project consisted of a series of activities designed to improve the quality of care in CBD programs, including conducting workshops among project personnel and standardizing medical norms and program procedures. A system for evaluating distributor performance, based on a knowledge test, observation of interactions with clients, and a client survey, was developed and tested in the field. A guide for implementing contraceptive CBD programs and a manual for training CBD distributors were produced to standardize many of the procedures used in the CBD programs and to provide certain norms for service delivery. A methodology was subsequently developed for evaluating distributor performance which included: a knowledge test for distributors to assure that they were able to answer basic questions about the contraceptives and other medications they sold (correct use, side effects, contraindications); an observation guide consisting of a list of points which a distributor should cover during visits to a potential (new) client as well as to a continuing user; and a subjective measurement of rapport between distributor and client. A short questionnaire was prepared for clients to determine whether they knew the correct use of the method chosen and whether they were satisfied with the services of the distributor. This 3-pronged approach to the evaluation of distributor performance was tested at 2 sites: Kisangani and Matadi. The knowledge test was also administered in Mbuyi Mayi and Miabi. While the knowledge test proved to be a quick way to determine whether distributors were informed on key points, the full evaluation approach proved too labor-intensive to be practical as a tool for continuously monitoring distributor performance. Based on experience with the full model, a supervisory form was developed which included some of the same elements but was more practical for routine use in the field.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-03)This project, which cost US $97,000, is an extension of the original Tulane Family Planning (FP) Operations Research Project in Bas Zaire (known locally as PRODEF). PRODEF was initiated to increase the availability and acceptability of modern contraceptives in both an urban area (Matadi) and a rural area (Nsona Mpangu). The urban program is vertical (FP only), whereas in the rural program, FP is integrated with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The Matadi project was designed to: 1) increase knowledge and use of modern contraceptive methods in the target population; 2) test the cultural acceptability of community-based distribution (CBD) workers in an urban setting; 3) determine the preference for type of provider when services are available through both dispensaries and CBD posts; and 4) measure the cost per couple years of protection (CYP) over time. In treatment area A, dispensaries began distributing contraceptives in 1982; 3 rounds of household distribution were conducted in 1982-83. In area B, dispensaries distributed contraceptives, but there was no household distribution. The residential zone of Kananga served as a comparison. By 1984, prevalence had increased from 4-5% to 19% (in area A) and to 16% (in area B). While this represented a significant increase over the baseline rate, the difference between the 2 zones was not statistically significant. Thus, household distribution was discontinued in area A, and the 2 treatment areas became one. From 1986 to 1989, the project consisted of training CBD workers to sell contraceptives from their homes in Matadi. 40 women were recruited and trained; due to attrition, there have been approximately 25 active distributors in the project. Prevalence surveys were conducted in 1982 and 1984 under the original Matadi project; the third round of survey data were collected under this cooperative agreement in 1988. Service statistics on contraceptive sales and cost data were collected and analyzed to yield data on the cost per CYP in the Matadi project on an annual basis. An AIDS knowledge, attitude, and practice (KAP) module was included in the follow-up survey. Preliminary findings of the 1989 KAP follow-up survey show prevalence to be 23% in areas A and B, the highest in any city in Zaire. Kananga has achieved positive results based on strong clinic services and social marketing, even without community-based distribution. Analysis of choice of service provider is in progress.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-02)This project, which cost US $97,000, is an extension of the original Tulane Family Planning (FP) Operations Research Project in Bas Zaire (known locally as PRODEF). PRODEF was initiated to increase the availability and acceptability of modern contraceptives in an urban area (Matadi) and a rural area (Nsona Mpangu). The urban program is vertical (FP only), whereas in the rural program FP is integrated with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The Nsona Mpangu project is designed to: 1) increase knowledge and use of modern contraceptive methods among the target population; 2) assess whether villages having attained 10% prevalence tend to plateau once the "predisposed" are already reached; and 3) determine the effect of time on prevalence: do villages that enter the program later "catch up"? In treatment areas A and B, health posts began distributing contraceptives and drugs for children under 5 years of age in 1982; community-based distribution (CBD) was provided in villages without posts. In area A, 3 rounds of household distribution were conducted in 1982-83. At the close of the original project (1984), prevalence was 13% in area A and 10% in area B. The difference between A and B was not statistically significant, thus household distribution (which proved costly in the earlier project) was discontinued and treatment areas A and B became identical under this cooperative agreement. A third treatment area (C) was added in 1986 to determine the effect of time on prevalence: do villages that enter the program later "catch up"? Area D served as the comparison. The study employed a quasi-experimental design, with 3 treatment areas and a comparison area. A pre/post-intervention survey was conducted in all 4 areas to measure changes in contraceptive prevalence, service statistics were monitored to determine trends in contraceptive purchases, and the cost in the program as a whole per couple month of protection (CYP) was analyzed. An AIDS knowledge, attitude, and practice module was included in the follow-up survey. Preliminary findings from the follow-up survey indicate that 26.5% of women had ever used a modern method and 80% of women had ever used a traditional method. Among married women of reproductive age, current use of any method (traditional or modern) was 58.3%. Analysis of service statistics and cost per CYP is still in progress. CYP decreased from a 1985-87 annual average of 1,500 to 278 in 1988 due to the appointment of a regional medical officer who was not favorable towards CBD.
Increasing the availability and acceptability of contraceptives through community-based outreach in Bas Zaire Programme d'Education Familiale (PRODEF). Original.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (ZAI-01)The Tulane Family Planning (FP) Operations Research (OR) Project in Bas Zaire (known locally as PRODEF) aims to increase the availability and acceptability of modern contraceptives in an urban and a rural area. The urban program offers FP only, whereas the rural program integrates FP with 3 interventions for children under 5 years of age: anti-malarial drugs, anti-helminthic drugs, and rehydration salts. The objectives of this project, which cost US $623,504, were to: increase knowledge and use of modern contraceptives; improve attitudes toward FP; decrease "ideal" family size; and increase appropriate treatment for children under 5 years of age who have malaria, intestinal helminths, and dehydration due to malaria. The project tests 2 alternative strategies for the delivery of FP services. In treatment area A, dispensaries distribute contraceptives (and the rural children's drugs) and outreach activities are conducted. In area B, dispensaries distribute contraceptives (and the rural children's drugs), but there are no outreach activities. In the rural villages that do not have a dispensary, a matrone selected by the villagers is trained by PRODEF to serve as a distributor. Pre/post-intervention surveys were conducted in all project areas to measure changes in FP knowledge and practice and the relative effectiveness of the 2 approaches. Service statistics were used to monitor project activity, and cost/couple month of protection (CMP) was compared. The promotion of modern contraceptives was found to be culturally acceptable. Offering FP services only was acceptable in the urban area. The number of ever-married women who had ever used a modern contraceptive rose from 10 to 48% among women in area A and to 44% among women in area B. The child health interventions greatly enhanced the value of the program for the rural communities. Ever use of modern contraceptives increased from 8 to 34% in area A and from 7 to 27% in area B. The matrones were an efficient and culturally acceptable distribution channel. Simply making the contraceptives available increased contraceptive prevalence. However, the level of contraceptive prevalence was greater in area A, which also received outreach. Current use of modern methods in the urban area increased from 4 to 19% in area A and from 5 to 16% in area B. In the rural area, modern method use increased from 5 to 14% in area A, and from 2 to 10% in area B. The number of women using a traditional method decreased from 60 to 48% in area A and from 65 to 53% in area B; however, traditional methods are still used more than modern methods by a factor of 2:1 in the urban area and by over 3:1 in the rural area. The baseline survey showed that 95% of all women know at least one traditional fertility control method and about 80% had heard of at least one modern method. At follow-up, almost all urban respondents knew at least one modern and one traditional method. In the rural area, 90% knew at least one modern method. In the urban region, cost per CMP was US $7.11 in area A and $6.18 in area B; in the rural region the respective costs were US $11.22 and $7.95.
Community-based distribution (CBD) of low cost family planning and maternal and child health services in rural Nigeria (expansion).
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (NGA-02)A community-based distribution (CBD) project has been in operation since 1980 in Oyo State, Nigeria. As a result of word-of-mouth communication among health professionals, television coverage of graduation ceremonies, and positive political feedback from the pilot area, the state government requested assistance in expanding the program. In collaboration with the State Health Council, the Pathfinder Fund, University College Hospital, and the Center for Population and Family Health of Columbia University, the program was expanded in 1982 at a cost of US $237,517. In each of the 4 health zones of the expansion area, a Primary Health Center (PHC) became the training and supervisory center. The expanded program was modified in light of experience in the pilot area. Monthly stipends to CBD workers were eliminated and, because of government policy, no fees were to be charged for services. (This policy was later reversed.) Also, a full-time CBD supervisor was assigned to each zone, rather than relying on individual maternity staff members for supervision. Each zone was limited to 100 CBD workers. Data collection included baseline and post-intervention knowledge, attitudes, and practice surveys and a village documentation survey to estimate the service population. The project also carried out in-depth CBD worker interviews, structured observations of training, mini-surveys, analyses of supervision records and service statistics, and a case study of the impact of the CBD program in which villagers were interviewed about the educational and clinical roles of the CBD workers. Although initial family planning (FP) acceptance was low, ever use of a modern method has increased from 2 to 25% in the pilot area. About half of the married women of reproductive ages in the project area are not sexually active at any one time because of postpartum abstinence. Most of the acceptance of modern contraceptives replaces use of traditional abstinence. Male promoters have proved to be an asset to male acceptance of FP services. Individual monetary incentives are not required to motivate CBD workers; however, once incentives are given, difficulties are created if they are stopped, as they were in the pilot area. The CBD approach has changed the concept of health care from that of providing services to clients who come to a fixed site to reaching out to provide services to all people living within a particular catchment area. The expanded project was subsequently extended into additional areas of Oyo State by the State Health Council. In addition, a conference to discuss the project, held in January 1985, was attended by health program managers and policymakers from all parts of Nigeria. The conference stimulated planning by State and Federal Ministries of Health to undertake CBD as a major strategy for primary health care in rural areas.
The impact of strengthening clinic services and community education programs on family planning acceptance in rural Madagascar.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (MAD-01)The government of Madagascar and donors are planning substantial increases in family planning (FP) services; at present the Ministry of Health (MOH), with UN Population Fund support and local Planned Parenthood collaboration, offers FP services in only 5-10% of the country's 2000 clinics. Initial efforts by JIRAMA (the Water and Power Company) to use a mobile clinic to offer FP services in the rural areas of the central province demonstrated some demand for FP services and achieved an estimated prevalence rate of 5-6% in the first 2 years, compared to an estimated 1-2% nationally (in 1989). The mobile approach has several weaknesses, however, and its implementation has entailed problems. For example, JIRAMA added no new staff to already busy government MCH clinics when it began to offer FP services, and contraceptives and equipment were in short supply during the first 2 years. Training for collaborating MOH staff was minimal, and educational efforts were sporadic. Also, costs were relatively high. This study, which cost US $35,259, investigated the impact of a new approach by comparing 2 different levels of program intensity with a control group. In 3 rural clinics, a more intense and higher quality program, consisting of new, locally-based, nurse-midwife staff, as well as increased training, supplies, and equipment and increased clinic and community educational efforts, was compared to the mobile-based program. Data were collected over 2 years, after which a sample survey will measure results. The study will determine the relative cost and effectiveness of recruiting new FP clients and maintaining them on a contraceptive method for a period of at least 3 months in an intensive clinic program compared to a less-intensive program of 24 mobile clinic sites in the same general area. The high-intensity program enrolled 17.4 new acceptors per month, compared to 12.8 in the medium-intensity program and 3.2 in the mobile program, about the same as all the mobile clinics prior to the intervention. Service delivery costs/new acceptor were $4.33 in the medium-intensity, $5.14 in the high-intensity, and $15.75 in the mobile program. Continuation rates improved in both the high- and medium-intensity program clinics, but deteriorated in the mobile program, perhaps partly due to the disturbed social and political climate in the latter half of 1991, which interfered with all program activities. While uncontrolled factors in the study deserve additional consideration and analysis, researchers recommended that the mobile clinics be converted to the medium- or high-intensity program and drew possible lessons for the forthcoming expansion of the national FP program. The final data analysis and report remain to be completed. A dissemination seminar will be held as soon as possible.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (IVO-05)The number of family planning (FP) service delivery points (SDPs) in Cote d'Ivoire is increasing rapidly with the assistance of several USAID projects: SEATS for overall management assistance, INTRAH for clinical training, Johns Hopkins University/PCS for information, education, and communication (IEC), and the Africa operations research/technical assistance (OR/TA) project for the management information system (MIS). For example, during 1991, the Association Ivoirienne pour le Bien-Etre Familial (AIBEF) increased its SDPs from 3 to 19. By the end of 1992, 33 AIBEF-assisted public sector maternal and child health centers will become FP SDPs. This is the first step in a longterm program to increase the government's FP service delivery capacity and is a model for future activities. This study, which cost US $29,392, will monitor the management information system (MIS) to define its impact and role in the expansion. The MIS project will provide data on contraceptive use, reproductive intentions, and community flow but it will not describe several service delivery functions or information relative to the client, such as provider relations and IEC activities. The MIS data, therefore, must be complemented by data on 1) the quality of provider-client interactions, 2) the SDPs functional capacity for providing FP services (both physical and human resources), and 3) the user's experiences with FP services. This study will adapt a situational analysis methodology developed by The Population Council. Information will be collected from all operational SDPs (approximately 20). Of the 13 SDPs observed, 4 serviced 1200 to 1800 new and continuing users in 3 months. 3 other clinics serviced between 22 and 37. 24,221 clients accepted modern methods during that time, with 19% (mainly men) choosing condoms and 81% selecting prescription methods (85% oral contraceptives (OCs), 11% injectables, and 3% IUD). All clinics had a system for ordering contraceptives, yet all experienced stock-outs. Only 8% of clinics had an appropriate storage system. 55% of clinics held discussions about FP and reproductive health with service providers and clients. The study also revealed that 25% of all clients interviewed had had an abortion. In terms of personnel, there was a lack of FP educators disseminating IEC, and most clinics needed updated IEC materials. The record-keeping land logistics departments needed improvement as stock-outs were common. International management meetings and external supervisory visits were infrequent. For the most part, clients were satisfied with the FP services, although some mentioned a long wait and a lack of privacy. Numerous recommendations were made in order to provide FP services in clinics including: development of FP activities, improvement of quality of services, and development of counseling and interpersonal communication skills.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (BKF-05)The family planning (FP) program in Burkina Faso has grown steadily since its introduction in 1985, but information and service provision still occur primarily at the clinic level. One way of decentralizing the provision of FP information is to train traditional birth attendants (TBAs) in FP and encourage them to promote FP during their maternal and child health (MCH) care activities. Therefore, a TBA training project was implemented by the Ministere de la Sante de l'Action Sociale et de la Famille (MSASF), with support from the American College of Nurse-Midwives (ACN-M). This operations research study, which cost US $28,608 and was conducted by the MSASF's Family Health Division (DSF) with support from the Population Council's Africa operations research/technical assistance (OR/TA) project, assessed the training project's effect on the training and supervisory capabilities of clinical staff with responsibilities for the TBAs, on the ability of TBAs to promote FP, and on the FP knowledge, attitude, and practice (KAP) of women of reproductive age (WRA) in the target villages. The goal was to assist MSASF in improving the capacity of TBAs to provide high quality FP/MCH care at the community level. The 20-month evaluation used a quasiexperimental design to test the effects of the intervention. The clinical staff was assessed for its ability to train and supervise the TBAs, and 45 TBAs were followed before and after training to assess their ability to promote FP within their communities. A random sample of 20 WRA with children under the age of 5 years was interviewed in the village of each TBA to evaluate the effect on the communities' FP/KAP. The results will be presented in a written report and at a seminar for those responsible for the national FP program. Project activities began in March 1991. The baseline study for the evaluation showed that most of the supervisors have been FP providers and were generally knowledgeable about modern contraceptive methods. At the village level, the baseline study indicated that, while modern FP methods were largely unknown, WRA were interested in birth spacing and generally disapprove of an immediate resumption of sexual relations after delivery (64% would wait at least a year). When asked about their first source of information on birth spacing, 37% of the women mentioned the health clinics and only 2% TBAs. However, 17% of the women had discussed birth spacing with a TBA. Following the training, 2 supervision strategies evolved. In one province, an "integrated" approach combined supervision of the TBAs' MCH/FP activities with periodic immunization campaigns to avoid some of the problems relating to lack of supervisory resources. The second province relied on a traditional, project-specific supervisory approach. Preliminary results indicate that TBAs could play a vital role in sensitizing the population to FP activities.
Singapore, Singapore Planned Parenthood Association, . , 38 p.The 1992 Annual Report of the Singapore Planned Parenthood Association contains an account of the history and organization of the association, a list of members of the executive council and of the management, program, and fund-raising committees and staff for 1992-93. A message is relayed from the president and reports are given by the honorary secretary, the honorary treasurer, the executive director, and the chairman of the program committee. A list is included of members of the International Planned Parenthood Federation. Programs and activities for 1992 included 1) training workshops and teaching programs, 2) parent education programs, 3) Family Week and special events, 4) family life education programs, 5) youth forums and seminars, 6) public education programs, and 7) a counseling and referral service. Program outputs for 1991 and 1992 are compared in a statistical summary of number of activities and number of participants; a profile of clients by sex, language, age, race, religion, marital status, and occupation; and a summary of presenting problems (contraception and conception, sexual matters, physical changes and development, interpersonal relationships, and others including venereal diseases and AIDS). A similar profile of the telephone counseling service is given. The financial report contains the auditors' report, balance sheet, and statements of income, expenses, and functional expenses. Appended are lists of donors; participating schools, institutions, ministries, organizations, and agencies; and new members.
Evaluation FINDINGS. 1993 Jul; (1):1-6.This thematic evaluation included in-depth studies of seven projects in six countries-Egypt, Ghana, India, Kenya, Paraguay, and the Philippines-and desk reviews of other micro-enterprise projects in China, Indonesia, Jordan, Mali, Mauritius, Morocco, Nepal, Nigeria, Senegal, and Uruguay. It found that a dual focus on women's productive and reproductive roles can lead to a viable strategy for improving the situation of women as well as reducing fertility rates. In addition, increases in women's income can have a catalytic effect on the demand for family planning and maternal and child health.
IPPF COUNTRY PROFILES. 1993 Jul; 23-7.Indonesia comprises 13,677 islands, 6000 of which are inhabited. 61% of the country's total population lives on the island of Java. The 1990 Indonesian census indicated a national population of 179.3 million. In 1993, Indonesia's estimated population of 189.46 million was growing at the annual rate of 1.6%. The current annual rate of population growth is significantly lower than the average 2.3% rate of growth during 1970-80. This decrease in population growth occurred concurrently with a decrease in mortality rates, especially for infants and children. Family planning is an integral part of government policy, with a strong family planning program aimed at increasing maternal and child welfare, decreasing infant and child mortality rates, and decreasing the national birth rate. The Indonesian Planned Parenthood Association (IPPA) has grown rapidly over the past 3 years, implementing various programs such as comprehensive family planning service delivery and family life education programs. The IPPA has also been able to raise funds and conserve its own resources, with emphasis upon self-reliance.
IPPF COUNTRY PROFILES. 1993 Jul; 19-22.In 1993, Hong Kong had an estimated population of 5.8 million growing at the annual rate of 0.8%. There is a high level of contraceptive acceptance and prevalence in Hong Kong, with a 1987 survey of family planning practice finding 80.8% of married women aged 15-49 years using contraception. The government does not see the need for any official population policy given the high acceptance of family planning and the declining birth rate. Moreover, the population is emigrating from Hong Kong at the estimated rate of 62,000 people/year amid fears of political uncertainty following the return of Hong Kong to Chinese rule in 1997. The Family Planning Association of Hong Kong (FPAHK) has been a pioneer in family planning since the 1950s and was a founding member of the International Planned Parenthood Federation. The organization has a reputation for providing high-quality services and innovative information, education, and motivation programs. FPAHK's efforts in health promotion campaigns have generated a growing demand for programs which combine family planning and health with educational components such as the premarital package service. FPAHK now provides one of the highest quality and most sophisticated reproductive health programs in the region.
IPPF COUNTRY PROFILES. 1993 Jul; 33-7.In 1993, South Korea had an estimated population of 44.05 million. South Korea is one of the most densely populated countries in the world, with 445 inhabitants/sq. km and 74% living in urban areas. South Korea's population, however, is growing at the annual rate of only 0.9%. Now that the government has successfully reduced the annual population growth rate to less than 1%, it has proposed changes to its family planning program to address the problems of urbanization, population aging, and the maintenance of a healthy and high standard of living. The Planned Parenthood Federation of Korea (PPFK) was founded in 1961. It is one of the three major organizations involved in implementing the national family planning program and is mainly responsible for the information, education, and motivation component in support of the national family planning and maternal-child health program. PPFK also helps to provide comprehensive contraceptive service delivery to special target groups. PPFK excels in training and mobilizing community leaders and other agency personnel in the promotion of family planning and maternal and child health. A strong preference for sons is a major obstacle to the practice of family planning in South Korea.
IPPF COUNTRY PROFILES. 1993 Jul; 39-42.The government of Malaysia emphasizes family development and welfare, directing health and social services programs toward improving the overall quality of life, especially in the less developed states. Malaysia's population is expected to grow at the average annual growth rate of 2.3% from 19.24 million in 1993 to more than 26 million by the year 2010. The government's family planning program, first launched in 1966, has recently shifted from the clinic-based delivery of contraceptives to a multidisciplinary approach and community-based programs. The Federation of Family Planning Associations, Malaysia (FFPAM), is a federation of autonomous state family planning associations and one of the three main implementing agencies of the national family planning program. FFPAM is the only nongovernmental organization involved in the effort. FFPAM follows a proactive, proadvocacy path in looking ahead to plan programs and anticipate the effects of public and social policies upon fertility decisions. The organization greatly contributed to the recruitment of new family planning acceptors under the national program in 1991 and looks forward to even more success in 1991-95.
IPPF COUNTRY PROFILES. 1993 Jul; 49-52.Papua New Guinea comprises the eastern part of the island of New Guinea as well as 600 smaller islands in the Pacific Ocean. In 1993, the country's estimated population of 4.15 million was growing at the annual rate of 2.3% under a total fertility rate of 4.8 children/woman. This rapid growth rate most likely results from the traditional practice of bearing many children who will provide labor in the future. The Family Planning Association of Papua New Guinea (PNGFPA) and the National Health Department are concerned with the health and welfare of mothers and children. The government would like to reduce the rate of population growth. The government and the PNGFPA have jointly undertaken an education campaign emphasizing the importance of child spacing and the need to better plan for the future with regard to resource availability. The PNGFPA was also instrumental in formulating and launching the national government's Integrated National Population Policy for Progress and Development in 1991. The policy stresses the need for family planning services and other related concerns.
IPPF COUNTRY PROFILES. 1993 Jul; 63-6.The Solomon Islands is a scattered archipelago of mountainous islands and coral atolls spanning more 1800 km of ocean from east to west and almost 900 km north to south. The 1993 estimated population of 354,000 is unevenly distributed among the country's nine provinces. The island of Guadacanal is the most densely populated. The Solomon Islands' annual population growth rate of 3.3% is one of the highest in the Pacific. This rapid population growth has adversely affected health services, education, agriculture, and the labor market. The government is committed to the promotion of family planning and a gradual reduction in the rate of population growth. To that end, a national population policy was passed in November 1988 designed to strengthen family planning services provided by government hospitals and clinics as well as by nongovernmental organizations which support family planning services. Family planning programs in Solomon Islands face religious, cultural, and financial constraints, as well as opposition from individuals. The Solomon Islands Planned Parenthood Association and the Ministry of Health have nonetheless launched a joint 5-year population education and youth family life campaign.