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Targeting access to reproductive health: Giving contraception more prominence and using indicators to monitor progress.
Reproductive Health Matters. 2007 May; 15(29):186-191.Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourseand serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health. (author's)
New York, New York, Ford Foundation, 2003.  p.The connections between globalization and women’s reproductive health and rights are not straightforward, and as yet, there is little systematic evidence exploring these linkages. The following paper will examine more closely what is meant by globalization and attempt to analyze its broad implications for women’s health and well-being, albeit largely from first principles. (excerpt)
POPLINE. 2003 May-Jun; 25:3, 4.The president of the Population Institute contends that it would be "not only unacceptable but also morally reprehensible for the United States to back away" from commitments toward universal access to family planning and reproductive health. In testimony submitted to the foreign operations subcommittee of the House of Representatives Appropriations Committee, Werner Fornos, president of the Population Institute, was referring to apparent efforts by the Bush administration to reverse United States support of the Cairo Program of Action from the 1994 International Conference on Population and Development. (excerpt)
Population assistance and family planning programs: issues for Congress. Updated February 13, 2003. Programas de asistencia a la población y de planificación familiar: temas para el Congreso. Actualización al 13 de febrero de 2003.
Washington, D.C., Library of Congress, Congressional Research Service, 2003 Feb 13.  p. (Issue Brief for Congress)Since 1965, United States policy has supported international population planning based on principles of voluntarism and informed choice that gives participants access to information on all methods of birth control. This policy, however, has generated contentious debate for over two decades, resulting in frequent clarification and modification of U.S. international family planning programs. In the mid-1980s, U.S. population aid policy became especially controversial when the Reagan Administration introduced restrictions. Critics viewed this policy as a major and unwise departure from U.S. population efforts of the previous 20 years. The “Mexico City policy” further denied U.S. funds to foreign non-governmental organizations (NGOs) that perform or promote abortion as a method of family planning, regardless of whether the source of money was the U.S. government Presidents Reagan and Bush also banned grants to the U.N. Population Fund (UNFPA) because of its program in China, where coercion has been used. During the Bush Administration, a slight majority in Congress favored funding UNFPA and overturning the Mexico City policy but failed to alter policy because of presidential vetoes or the threat of a veto. President Clinton repealed Mexico City policy restrictions and resumed UNFPA funding, but these decisions were frequently challenged by some Members of Congress. On January 22, 2001, President Bush revoked the Clinton Administration population policy position and restored in full the terms of the Mexico City restrictions that were in effect on January 19, 1993. Foreign NGOs and international organizations, as a condition for receipt of U.S. funds, now must agree not to perform or actively promote abortions as a method of family planning in other countries. Subsequently, in January 2002, the White House placed a hold on the transfer of $34 million appropriated by Congress for UNFPA and launched a review of the organization’s program in China. Following the visit by a State Department assessment team in May, Secretary of State Powell announced on July 22 that UNFPA was in violation of the “Kemp-Kasten” amendment that bans U.S. assistance to organizations that support or participate in the management of coercive family planning programs. For FY2003, the President proposes no UNFPA funding, although there is a “reserve” of $25 million that could be used if the White House determines that UNFPA is eligible for U.S. support in FY2003. The Administration further requests $425 million for bilateral family planning programs, a reduction from the $446.5 million provided in FY2002. H.J.Res. 2, as passed by the Senate on January 23, 2003, includes the FY2003 Foreign Operations Appropriations. It provides $435 million for bilateral family planning aid and $35 million for UNFPA. Last year, the Senate Appropriations Committee (S. 2779) had recommended $450 million for bilateral activities and $50 million for UNFPA. The Senate bill further would have modified the Kemp-Kasten amendment and partially reversed the President’s Mexico City policy for some organizations. The House bill (H.R. 5410) last year provided $425 million for family planning and $25 million for UNFPA, but made no modifications to Kemp-Kasten or to the Mexico City policy. (excerpt)
Report: Second Conference of Asian Forum of Parliamentarians on Population and Development, 23-25 September 1987, Beijing, China.
New York, New York, United Nations Population Fund [UNFPA], 1987. , 72 p.The formal proceedings of the 1987 Asian (AFPPD) Conference of Parliamentarians on Population and Development (FPPD) are provided in some detail. 23 countries participated. The Asian Forum Beijing Declaration preamble, program of action, call to action, and rededication are presented. Background information indicates that these conferences have been ongoing since 1984 to exchange information and experience, to promote cooperation, and to sustain involvement of Parliamentarians in population and development issues. Official delegations represented Australia, Bangladesh, China, Korea, India, Iraq, Japan, Malaysia, Maldives, Mongolia, Nepal, Pakistan, Philippines, north and south Korea, Sri Lanka, Syria, Thailand, and Vietnam. Observers were from Bhutan, Cyprus, Indonesia, Kiribati, and Tonga. The UN Fund for Population Activities (UNFPA) was involved as Conference Secretariat as well as the Preparatory Committee of China. Other UN and nongovernmental organizations and Parliamentary Councils of the World, Africa, and Europe were involved. Summaries were made of opening conference addresses of Mr. Takashi Sato, Mr. Zhou Gucheng, Chinese Premier Zhao Zivang, Japanese Prime Minister Takeo Fukuda, Dr. Nafis Sadik from the UNFPA, Mrs. Rahman Othman for Mr. Sat Paul Mittal of AFPPD, Australian Prime Minister R.J.L. Hawke, India Prime Minister Rajiv Ghandi, Sri Lankan Prime Minister R. Premedasa, Philippine President Corazon Aquino, Pakistan President Mohammad Zia-ul-Hag, and Bangladesh President Hussain Muhammad Ershad. Election of officers was discussed. The plenary sessions reported on the present situation and prospects for Asian population and development, basic health services and family planning (FP), urbanization, population and food, and aging. Reports were also provided of an exchange among Parliamentarians, the adoption of conference documents and the AFPPD constitution, election of officers, and the closing speakers. Appendices provide a complete list of participants, the constitution which was adopted, and the addresses of Mr. Zhou Gucheng from China's National People's Congress; Mr. Zhao Ziyang, Premier of the State Council of the People's Republic of China; Mr. Takeo Fukuda of the Global Committee of FPPD, Dr. Nafis Sadik, Executive Director, UNFPA; and Mr. Sat Paul Mittal, Secretary General, AFPPD.
Copenhagen, Denmark, WHO, Regional Office for Europe, Sexuality and Family Planning Unit, 1986 May. 12 p.In 1965, the World Health Assemble gave the World Health Organization (WHO) a mandate to offer advice on family planning to member states and later states that family planning is an important part of basic health services. In 1884 the 33 members of the European region adopted a plan of action for a consolidated health policy. The goal of this plan and strategy, is for people to have access to health services that will make it possible to have socially and economically productive lives. There will be 4 main areas of effort including, promotion of healthy lifestyles, prevention medicine, better primary health care systems, and more effective political, managerial, technical, manpower, and research to ensure the above. There are ongoing studies to consider sexual health in a variety of cultures. These will assess changing sex roles, information interchange on lifestyle factors and demographic trends, ideas on childrearing styles, and recommendations on the development of healthy sexual relationships. There will be assessments of harmful sexual behavior and the reduction of sexually transmitted diseases. To improve basic health care systems, this program will help[ clarify concepts, investigate needs, analyze present services, get client input, compare information, and draw up guidelines. Methods will be examined to improve information exchange and the distribution of research and other pertinent material. There will be guidelines for legislative proposals in relation to lifestyles that promote better health by 1991. The development of ways to integrate family planning programs and services and connect them to key areas of society, is a goal to be reached by 1993. Also training programs to improve the various aspects of family planning and sexuality, including the attitudes of health professionals is needed.
[Republic of Zaire: report of mission on needs assessment for population assistance] Republique du Zaire: rapport de mission sur l'evaluation des besoins d'aide en matiere de population.
New York, New York, Fonds des Nations Unies pour les activities en matiere de population, 1985. ix, 63,  p. (Rapport No. 72)The UN Fund for Population Activities sent a needs assessment mission to Zaire in 1983. The mission recommends that the 1st priority be given to analyzing and exploiting the results of the 1984 census, Zaire's 1st census. It is recommended that the Institut National de la Statistique participate in data collection and analysis for the census. The lack of trained demographers is noted, and teaching statistics and demography should be made a priority. 3 areas of research in population matters are priorities: 1) the detailed analysis of the results of the census, 2) modern contraceptive usage, and 3) malnutrition in mothers and children. The creation of a national commission on human resources and population is recommended. Zaire has a rather large medical-health infrastructure that is badly adapted to the actual needs of the population. The problem is not only the lack of resources but also the absence of clear health policies. Population education does not currently exist in Zaire, but formal population education could be placed at all levels of the educational system. As regards population information and communication, radio coverage is very important in a country that is largely rural. Women are still undervalued in Zaire society. They participate actively in the country's economy, but they remain on the margins of the modern sector. The new department on female conditions and social affairs has 2 priorities: 1) improving the quality of life of rural women with income-generating projects and 2) creating adult female education centers in urban areas.
[Mali: report of mission on needs assessment for population assistance] Mali: rapport de mission sur l'evaluation des besoins d'aide en matiere de population.
New York, New York, Fonds des Nations Unies pour la Population, 1988. x, 67 p. (Rapport No. 95)The UN Fund for Population Activities sent a 2nd needs assessment to Mali in September 1985. Mali is a vast Sahelian country, characterized by vast deserts. Only 16.8% of the population is urbanized. Mali is essentially agricultural. The 3rd 5-year development plan covered the years 1981-1985. Population factors do not occupy the place they deserve in development planning in Mali. Recommendations for population and development planning include forming an organization to promote population policy and territorial resource management. Recommendations on data collection include creating a national coordinating committee for demographic statistics, analyzing census data from 1976 and planning for the census of 1987, and reorganizing the vital statistics system. The mission recommends the creation of a national organization to coordinate research activities in the country. Recommendations on health and family planning services include examining bottlenecks in the national health system, redistributing health personnel, and improving planning and administration. The mission recommends extending the educational system in Mali. Materials on population must be included in educational materials. Facts on the condition of women and their participation in economic life are insufficient. The mission recommends the creation of a section for women in the Ministry of State to gather social, economic, and demographic information on women.
[Cape Verde: report of mission on needs assessment for population assistance] Cap-Vert: rapport de mission sur l'evaluation des besoins d'aide en matiere de population.
New York, New York, Fonds des Nations Unies pour la Population, 1988. ix, 66 p. (Rapport No. 93)The Un Fund for Population Activities sent a mission to Cape Verde in 1986 to evaluate their need for population assistance. Small and densely populated, Cape Verde is a poor country which counts on large amounts of international assistance for economic and social development. Demographic data has been collected in Cape Verde for a long time, but it is necessary to improve data collection so that the results can be better used by the government to plan demographic policy. The census of 1990 will be the 2nd one since independence. The big problems of Cape Verde constitute fertility and migration. Institutional support for the Direction Generale de la Statistique will help them take charge of a national system of data collection. In development planning, the mission recommended 2 projects; 1) the support of the organization Unity for analyzing existing data, and 2) a scheme of national territorial resource management. The mission recommends financing a research program to promote national development. The health situation in Cape Verde is better than that of many African countries. However, there are still many public health problems, such as infectious diseases, malnutrition, high fertility, a lack of health education programs, and insufficient health personnel and training for them. Therefore, the mission recommends decentralization of health services, health education, taking advantage of popular organizations, prenatal care, training for traditional midwives, preventive health measures for children, oral rehydration therapy for diarrhea, and family and sex education. Information, education, and communication activities are extremely limited. To extend the integration of women in the process of development, the mission recommends collecting statistics on women, especially in work and employment, and developing productive activities for women.
Health systems research in maternal and child health including family planning: issues and priorities. Report of the meeting of the Steering Committee of the Task Force on Health Systems Research in Maternal and Child Health including Family Planning, New Delhi, 12-15 March 1984.
[Unpublished] 1985. 23 p. (MCH/85.8)In a series of general discussions aimed at establishing health systems research priorities, the Steering Committee of the Task Force on the Risk Approach and Program Research in Maternal-Child Health/Family Planning Care identified 9 major issues: 1) health services and health systems, 2) research and service to the community, 3) involving the community, 4) evaluation, 5) information systems, 6) interdisciplinary nature of health systems research, 7) appropriateness in technology and research, 8) funding and collaboration between agencies, and 9) implications for research program strategies. Background considerations regarding subject priorities for health systems research include the policies, goals, and programs of WHO, especially the goal of health for all by the year 2000. Of particular importance is the joining of training in health systems research with the research itself given the shortage of workers in this area. The sequence of events in the management of research proposals includes approach by an applicant, the WHO response, information to the appropriate WHO regional office, the beginning of technical dialogue, development of protocol, submission of grant application, contractual agreement, initial payments, regular monitoring of progress, proposed training strategy, annual reports, final report, and assistance in disseminating results. 3 subject areas were identified by the Steering Committee for additional scrutiny: 1) the dissemination of results of health systems research in maternal-child health/family planning, 2) the implementation of health services research and the studies to be funded, and 3) the coordination and "broker" functions of the Steering Committee.
[Unpublished] 1985. 114 p.This document is a practical guide to help those Planned Parenthood Associations which want to establish contraception and counseling services for young people. It draws its examples from the considerable experience of selected European countries in what can be controversial and difficult areas. In the section devoted to adolescent sexuality and contraception, contributors cover culture and subculture, health and sexuality, sexual behavior and contraceptive services, the adolescent experience, the question of opposition to services for adolescents, and statistical indices. 1 section is devoted to examples of contraceptive counseling services for adolescents in Sweden, Italy, France, the UK, and Poland. Another section summarizes service provision examples. The 5th section presents methodology for the establishment of adolescents services and the final section discusses methodology testing of new projects. This report contends that the case for the rapid development of contraceptive/counseling services, tailored to the needs and desires of young people, is justified on moral as well as on sociological, psychological, and health grounds. It rejects totally the argument that any measure which could facilitate the sexual debut of the unmarried or legally dependent adolescent should be resisted. It does recognize public concern about family breakdown and the potential health risks of sexual activity but considers the examples given as measures designed to combat rather than ignore these. Taking into account sociological, psychological, and medical evidence, the contributors to this report challenge the following presumptions: sexual activity among the young is always and necessarily morally unacceptable and socially destructive; adolescents will resort to promiscuous sexual activity in the absence of legal deterrents such as refusal of access to contraceptive/counseling services; the potential health risks of sexual activity and use of contraceptives during adolescence provide sufficient justification for deterrent measures, including refusal of contraceptive/counseling services; and the scale of sexual ignorance and prevalence of unplanned pregnancy among adolescents can only be reduced by disincentives and deterrents to sexual activity itself. The case for the provision of contraceptive/counseling services rests on their potential to help adolescents to recognize and resist repressive forms of sexual activity, which are destructive of humanmanships. Evidence suggests that it is not difficult to attract a large cross-section of an adolescent public to use contraceptive/counseling services, where established.
Report of the second advisory group meeting held in Kuala Lumpur at the Hotel Majestic on the 18-19 September 1972.
[Unpublished] 1972. 67 p.This report of the proceedings of the 2nd Advisory Group Meeting covers the following: the workshop sessions; the progress report; the role and functions of the Intergovernmental Coordinating Committee (IGCC); and the speech of Encik Mohd. Khir Johardi. The progress report reviews all the projects and programs that will be initially implemented by the Secretariat IGCC: the regional program for observation and exchange of information; the regional program for exchange of experience through workshop in the various activities of family and population planning; clearinghouse activity; regional research project on thromboembolic disease; the special project to assist member countries without a national family planning program (Laotian Seminar, consultants for Khmer Republic, training 12 Khmers in the Philippines, the contraceptive supplies for the Khmer Republic); population and development planning workshop; joint ECAFE/IGCC/Government of Malaysia Training Course for Statisticians and Demographers; workshop on adult education and family planning; regional incentive program; Second Ministerial Conference and Third IGCC Meeting; and first obstetrician and gynecological meeting within the IGCC Member Countries. Member of the senior government officials who met at the 1st and 2nd Meeting were keen on the idea of exchange of professional staff among member countries for a short period of time. Some of the participants particularly at the 2nd Senior Government Officials Meeting felt that it is necessary to set up IGCC Regional Training Center to be utilized for the training of all facets of family planning program within the IGCC Region. Appendixes review backgrounds and objectives of the visits to Singapore, Indonesia, and the Philippines; report on the 1st Regional Training Workshop in Jakarta during December 1972, progress to date on clearinghouse activities, the ECAFE trip during August 1972, and the First National Seminar on Population and Family Well Being during August 1972; and discuss the population and development planning workshop proposal, the proposed workshop by IGCC on adult education and family life planning, and the proposed meeting of panel of regional advisers on sexual sterilization.
Paper presented at the Nineteenth Session of the UNICEF/WHO Joint Committee on Health Policy, Geneva, February 1-2, 1972. 40 pFamily planning is an integral part of the health care of the family and has a striking impact of the health of the mother and children. Many aspects of family planning care require the personnel, skills, techniques, and facilities of health services and is thus of concern to UNICEF and WHO. Once individual governments have determined basic matters of family planning policy and methods, UNICEF and WHO can respond to requests for assistance on a wide range of activities, with the primary goal being the promotion of health care of the family. Emphasis will be placed on achieving this by strengthening the basic health services that already have a solid foundation in the community. The past experience of UNICEF and WHO should provide valuable guidance for assistance to the health aspects of family planning, particularly as they relate to the planning and evaluation of programs; organization and administration; public education; the education and training of all medical personnel; and the coordination of family health activities both inside and outside the health sector. The review recommends that UNICEF and WHO first regard the capacity of the host country to absorb aid and maintain projects, and that specific family planning activities, such as the provision of supplies, equipment, and transport, be introduced only when the infrastructure is actually being expanded. Capital investment should be viewed in relation to the government's ability to meet budgetary and staff requirements the new facilities demand.
In: Eye to eye, [compiled by] International Planned Parenthood Federation [IPPF]. London, England, IPPF, 2001. 16-21.Through the use of clinics, youth centers, retail outlets, integrated facilities and other means, International Planned Parenthood Federation (IPPF) is ensuring that for the first time in many countries, young people can now access youth- friendly sexual and reproductive health services designed for young people where no other organization is providing them. There are a number of strategies to attract young people to services or to take services to young people but in each case the factors for success are linked to quality and the attributes of youth friendliness. IPPF affiliates have also shown how a broader approach to youth development can be used to achieve sexual and reproductive health related goals. (excerpt)
Journal of Biosocial Science. 2002 Jul; 34(3):379-94.This article examines the provision of family planning (FP) services in selected countries in the Caribbean. The potential impact of the funding shortfall resulting from the phasing out of funding by the International Planned Parenthood Federation (IPPF), and the strategies being adopted by the selected countries to cope with this, are considered. Stratified random sampling methods were employed to select eight Caribbean countries and a pre-designed questionnaire was administered to the agency responsible for FP services in each country. The sample was stratified geographically to include countries from different parts of the Caribbean. The questionnaire was designed to collect information on the services provided, the name of the agency responsible for the provision of services and, where possible, the number of users of each type of service in 1998 and 1997. Vast disparities were found in the provision of FP services in different Caribbean countries, in terms of the groups involved, the services available in each country, as well as methods of data collection and compilation. Anguilla and Bermuda were found to provide only limited FP services, while Barbados, Jamaica and Grenada provide much more sophisticated services. A salient finding was the innovative approaches that various countries in the region have adopted to fund FP programs in anticipation of the phasing out of IPPF funding. The standpoint taken in the study is that countries such as Anguilla and Bermuda must strive to improve their provision of FP services, and that they could learn from Barbados, Grenada and Jamaica, which provide much more comprehensive services. It is also concluded that, unless alternative funding sources are identified and accessed, the provision of FP services in the Caribbean is likely to decline in the future. (author's)
Forum. 2001 Jan; 15(1):6.Profamilia of Colombia was one of International Planned Parenthood/Western Hemisphere Region's first affiliates to make a concerted effort in reaching out to male clients. Recognized as one of the largest health care providers in Colombia, it could play a key role in meeting men's health needs and breaking down inequalities. By catering to male clients, Profamilia hoped to learn more about men's needs and to educate them to improve both men's and women's attitudes towards gender roles and family planning. Furthermore, by creating and marketing services for men, the association has helped to change stereotypes about male roles and responsibilities in family planning, and sexual and reproductive health. The association's clinics offer services in urology, infertility, sex therapy, general medicine, outpatient surgery, laboratory services, testing and treatment for sexually transmitted diseases, and family planning services like vasectomy. It is noted that the quality and variety of services offered by the association has contributed well in the expansion of its male clientele.
Washington, D.C., USAID, 2000 Apr. 12 p.This paper documents the US global leadership in family planning in response to the challenge of saving women’s lives and protecting women’s health. Backed by a strong bipartisan consensus in Congress, the US support for voluntary family planning and related health programs in developing countries began in the 1960s. Since then, profound changes have occurred in reproductive behavior throughout most of the world. The other programs include enabling couples to make reproductive choices and enhancing quality of life and development. In addition, the US government provides family planning assistance to developing countries through the Agency for International Development, and the UN Population Fund. These partnerships seek to: provide comprehensive assistance; integrate family planning and other reproductive health services; expand access to services through partnerships with nongovernmental organizations; focus on quality care and the battle against HIV/AIDS; save women's lives by replacing abortion with contraception; and empower women through integrated approaches. Despite the above initiatives, special efforts are needed to expand access to those needing the family planning services in both public and private sectors.
[Unpublished] 1997 May 7. 6 p.This article discusses the role of the UN Population Fund (UNFPA) with populations affected by disasters. It is estimated that there are 50 million people affected by natural or man-made disasters worldwide, including refugees and returnees, internally displaced persons, and a less well-defined group of persons in refugee-like situations. These persons are in need of shelter, protection against violence and abuse, food and safe drinking water, and basic health services. In response, the UNFPA issued a policy framework, stating that in an emergency situation UNFPA assistance will focus on providing reproductive health (RH) and family planning counseling and services within the health care mechanisms available during relief operations. The agency also gives support to operational activities, collaborating with other international agencies to provide maximum services to this population. In terms of the future role of UNFPA, it is noted that the agency will support the documentation of the nature, incidence, and severity of RH rights abuses through project support. Improvements planned in the Fund's emergency-response mechanisms include a greater participation in needs assessment mission; increased resource mobilization at all levels; improved RH health kit; greater availability of information and equipment for service providers; accelerated project approval; and continued attention to oversight and accountability.
COOPERATION SOUTH. 2000; (2):118-34.Building community services that cover the full range of people's reproductive health needs and choices, not just family planning, is still a new and complex idea for many developing countries. This places a premium on South-to-South experience exchanges about how to organize and manage such services, and on convincing many agencies both in developing and donor countries to support such cooperation. In this paper, Balla Musa Silla, Executive Director of Partners in Population and Development, discusses these needs and suggests responses in the context of the aftermath of the International Conference on Population and Development (ICPD). She states that developing countries by definition do not have the resources available that developed countries do to experiment with many different ways to provide high-quality, integrated health services in the time-frame specified at ICPD. Despite considerable progress made on the ICPD agenda, much remains to be done to meet reproductive health needs. To address them requires mobilizing considerable resources, strong institutions, capable and skilled professionals, political will and tackling sensitive social and cultural issues.
[Unpublished] .  p.This paper presents a summary of the key points of a statement on quality of care that was developed jointly by the International Planned Parenthood Federation (IPPF) technical expert panels. Quality of care is an essential element of the IPPF Strategic Plan, called Vision 2000, which places the following challenge before the IPPF: successfully addressing the need for quality of care is the key to the future viability and continued credibility of IPPF and family planning associations (FPAs) as the conscience of the family planning movement. In order to provide quality of care, the clients' rights and the providers' needs have to be addressed. Following this framework recognizes the rights of clients to information, access, choice, safety, privacy, confidentiality, dignity, comfort, continuity, and self-expression. Providers, for their part, should have the following needs met: training, up-to-date information, adequate physical infrastructure and family planning supplies. Quality of care at the strategic level should involve aspects of advocacy, access to education and services, as well as monitoring. The role of IPPF and FPAs in demonstrating quality of care is discussed. In brief, it is the responsibility of FPAs to ensure that quality of care is provided within whatever is available, and to devise an effective, permeating and sustained environment and system for improved quality of care.
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.
Washington, D.C., Futures Group International, POLICY Project, 1998 Sep. vii, 69 p.This report presents case studies of reproductive health (RH) and family planning programs and policies in Bangladesh, India, Nepal, Ghana, Jordan, Senegal, Jamaica, and Peru. Data were obtained from in-depth interviews among 20-44 individuals in each country who were key representatives of population and RH government ministries, parliaments, academia, nongovernmental organizations, women's groups, donor agencies, and health care staff. Findings focus on the following topics: RH context; the policy process; participation, support, and opposition; policy implementation; financial resources; and general implementation. Progress is gauged based on improving knowledge of stakeholders; planning for integrated and decentralized services; developing human resources; improving quality of care; addressing legal, social, and regulatory issues; clarifying donors' role; and maintaining long-term aims. All countries made considerable, though limited, progress according to the mandates of the 1994 Cairo Plan of Action. Population size ranges from 2.6 million in Jamaica to nearly 1 billion in India. The countries vary in level of urbanization, literacy, fertility, contraceptive prevalence, infant mortality, maternal mortality, and prenatal care and delivery. Although the social, cultural, and economic contexts vary, all countries have a subordinate role for women. All countries struggled with setting priorities, financing, and implementation. Bangladesh made the greatest progress. Jordan still emphasizes mostly family planning. India, Nepal, Jordan, Senegal, and Peru will need donor funding to advance a broad constellation of services.
Measuring the achievements and costs of reproductive health programs. Report of a meeting of the Working Group on Reproductive Health and Family Planning, the World Bank, June 24-25, 1996.
[Unpublished] 1996.  p.The Working Group on Reproductive Health and Family Planning is a joint project of the Health and Development Policy Project and the Population Council. On June 24, 1996, members of the Working Group met to discuss ways of measuring the achievements and costs of family planning and reproductive health programs. It is particularly important to revise family planning program evaluation methods so that they are consistent with a client-centered, reproductive health approach, and to develop ways of evaluating the costs and effectiveness of the components of comprehensive reproductive health care. This report is comprised of papers on the following topics: performance indicators with regard to making the transition from a demographically-oriented family planning program to a client-centered reproductive health paradigm; monitoring and evaluating reproductive health and family planning programs; incorporating indicators into reproductive health projects; disability adjusted life years and reproductive health; assessing the costs of reproductive health programs; and the cost of reproductive health. A summary is presented of the technical group meeting discussion.
Addis Ababa, Ethiopia, Pathfinder International, .  p.This booklet describes how Pathfinder International is collaborating with the Ethiopian government and nongovernmental organizations (NGOs) to expand the availability of high-quality family planning (FP) and reproductive health services. The introduction notes that Ethiopia is struggling to overcome poverty and that the government has instituted a progressive population policy to overcome the country's high rate of maternal, infant, and child mortality and high population rate. Next, various aspects of the services and leadership offered by Pathfinder since it began work in Ethiopia in 1964 are reviewed, especially the first community-based reproductive health services program in the country and specific integrated reproductive health and FP projects carried out in partnership with several local nongovernmental organizations. The introduction of community-based service delivery methods as a way to improve access to services is then discussed as is Pathfinder's commitment to quality and program sustainability. The booklet also relays Pathfinder's response to the fact that the reproductive health needs of adolescents require a different approach, which once again relies on collaboration with NGOs through the creation of three new youth centers that offer recreational activities as well as reproductive health services and information. Throughout the booklet, case histories are presented of individuals helped by activities supported by Pathfinder. The booklet closes with a look at an effort to train former prostitutes to generate income as hairdressers and tailors and to become community-based reproductive health agents.
FORUM. 1997 Jul; 13(1):6-7.This article describes a UNFPA-funded program for PLAFAM, a family planning (FP) association in Venezuela. The small grant allowed for the expansion of FP and reproductive health services in Ocumare and Cua, both outside Caracas. The locations each had a population of almost 100,000 persons who were mostly below the poverty level. In the entire country, it is estimated that 7.7 million people live in relative poverty and 8.2 million live in critical poverty. Almost 3 million are of middle class, and 1.6 million are of upper class. The Ocumare clinic opened in May 1995. A campaign, with information about hours of operation, location, and services provided, preceded the opening. Loudspeakers announced its opening in nearby neighborhoods. The municipal government cooperated by providing space next to a Red Cross center and purchasing necessary equipment. During the first 2 years of operation, the clinic registered 1371 new FP acceptors and provided 3535 consultations, 382 cytological exams, 20 biopsies for cancers, and 529 referrals. PLAFAM also organized a series of talks and seminars for the local community. The establishment of the Cua Clinic was not as smooth. The location was changed due to public transportation problems, staff problems, and lack of local support. The new location was within a women's organization, which offered a variety of income-generation courses serving about 25,000 community women/year. The community learned about the new clinic from volunteer promoters, the local mass media, and women's groups. Client interest in the services was significantly improved with the new location. Funding for both clinics ended in November 1996. The clinics set up a fee system and are partially self-sustaining, but need the help of local agencies.