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CEYLON MEDICAL JOURNAL. 1990 Dec; 35(4):136-42.The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was <5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.
Geneva, WHO, 1984 Dec. ix, 152 p.88 recommendations were formulated by the International Conference on Population held in Mexico City in 1984. 4 of these dealt specifically with research requirements in the population field and are reproduced in this report in their entirety. As a result of the changing perspectives and requirements of the scientific fields in which the Special Program of Research, Development and Research Training in Human Reproduction operates and taking into account the various suggestions resulting from recent reviews of the Program, several new developments have occurred. First is the attempt to distinguish more clearly between activities related to research and development and those related to resources for research. These 2 distinct but closely connected activities will be reorganized to interact in a complementary fashion. In the research and development component, the most notable changes relate to the creation of new Task Forces on the Safety and Efficacy of Fertility Regulating Methods and on Behavioral and Social Determinants of Fertility Regulation. The Program has been actively promoting coordination with other programs which support and conduct research in human reproduction. The research and development section of this report provides a technical review of the activities and plans of the various task forces, covering the following: new and improved methods of fertility regulation (long-acting systemic methods, oral contraceptives, post-ovulatory methods, IUDs, vaccines, plants, male methods, female sterilization, and natural methods), safety and efficacy of fertility regulating methods, infertility, and service and psychosocial research. The section devoted to resources for research describes some features of the network of centers, reviews the Program's institution strengthening activities in the different regions, and also considers research training and the program of standardization and quality control of laboratory procedures. The section covering special issues in drug development focuses on relations with industry, patents, and the role of the Special Program in the drug regulatory process.
Geneva, WHO, 1982 Nov. 159 p.The World Health Organization's (WHO) 7th General Program of Work, covering the period 1984-89, includes the WHO Special Programme of Research, Development, and Research Training in Human Reproduction. Objectives of the latter include improving the health status of populations in developing countries by: 1) devising improved approaches to the delivery of family planning care in the primary health care context, 2) assessing the safety of existing methods of fertility regulation, 3) developing new contraceptive technology, and 4) generating the knowledge and technology required for the prevention and treatment of infertility. By 1989 the program aims to have devised the means of integrating family planning into primary health care, assessed the safety and efficacy of contraceptive methods used between 1970-77, and those introduced between 1977-85, developed at least 6 new methods of contraception, clarified the etiology of certain reproductive diseases, and strengthened at least 1 research facility in each of those developing countries that will have national policies on and services for family planning. Some findings of research included: 1) copper bearing IUDs with a minimum surface area of 200 mm are safe and effective for at least 4 years of use, 2) depot-medroxyprogesterone acetate (DMPA) has been shown to have no apparent adverse effect on the quantity of breast milk, and 3) mean delay of conception after DMPA use was 6 months for women 20-24 years, 6.2 months for women 25-29, and 8 months for women age 30 and over. Work has centered on developing new injectable contraceptives of 3 or more months' duration, biodegradable implants, and vaginal rings that release 20 mcg levonorgestrel/day for 3 months. Several non-isotopic techniques have been developed for predicting and detecting ovulation as well. Research on infertility has studied standardized investigation of infertile couples, prevalence in different populations, and etiology. Other areas of work have been in institution strengthening, dissemination of information, and relations with industry.