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The role of international agencies, governments, and the private sector in the diffusion of modern contraception.
TECHNOLOGY IN SOCIETY. 1987; 9(3-4):497-520.This paper views diffusion as encompassing three processes: the acceptance of the idea and practice of contraception by consumers; the establishment of the institutions or programs to provide services; and the development of technical capability in research and development and in the production of contraceptives. The historical development of the family planning movement is described, and the contribution of international agencies, governments, and private sectors is discussed in the context of changing development approaches. Substantial achievements have been made, but, in view of future needs and the uncertainty of political and financial commitment to family planning on the part of donors, the future presents a continuing challenge. (EXCERPT)
Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2, Background documents.
Copenhagen, Denmark, Scriptor, 1983. 2 986 p.Volume 2 of papers from an international symposium starts with chapter 7--available methods of fertility regulation; problems encountered in family planning programs of developing countries. Natural family planning is discussed here, as well as contraceptives and male and female sterilization. Chapter 8 covers research problems with regard to epidemiological, service, and psychosocial aspects of fertility regulation. Family planning is stressed in this chapter. Chapter 9 discusses future methods of fertility regulation: progress in selected areas. New contraceptive agents are discussed, such as luteinizing hormone releasing hormone and its analogues, gossypol for men, and immunological methods of fertility regulation. Chapter 10 also discusses future methods of fertility regulation, but from the point of view of research needs and priorities as viewed by program directors and advisers. Views and research priorities of the Population Council, and the Indian Council of Medical Research are given. Research needs and priorities in China are discussed, as is the role of the World Health Organization's Special Program of Reseach, Development and Reserch Training in Human Reproduction. Lastly, chapter 11 covers the role of governments, agencies and industry in reseach on fertility regulation. The role of the Agency for International Development, the US National Institutes of Health; and the World Bank, among others, are discussed.
[Introduction: community and commercial programs in Latin America] Introduccion: programas comunitarios y comerciales en America Latina.
In: Estrada A, ed. [Family planning in Latin America: community and commercial programs]. Planificacion familiar en America Latina: programas comunitarios y comerciales. Washington, D.C., Batelle, Aug. 1981. 3-41.Introduces the importance of bilateral family planning programs in Latin America. These programs, both community and commercial, provide permanent and reversible methods of birth control. Female sterilization, vasectomy, condoms and the pill are the methods of choice provided by these organizations. The difference between the commercial and community programs lies in the method of distributing birth control. The commercial enterprises are connected with clinics, and pharmacies and supermarkets. Clients must receive some form of instruction in order to procure birth control devices at a nominal cost. The community programs are primarily operative outside the urban areas, in isolated mountain villages where no clinics are located. Representatives of PROFAMILIA set up informal offices to prescribe and distribute birth control. These representatives, while not usually medical personnel, are trained as counselors and either provide a temporary and reversible method of birth control or arrange to accompany the client to a city where appropriate sterilization procedures may be provided. The various branches of PROFAMILIA in Colombia, Guatemala, Mexico, Peru, Brazil and Haiti are financed through the UN Family Planning Association. The pill, diaphragms, spermicides and condoms are supplied through Syntex, Emko and Akwell Companies of the United States, Eisai of Japan and Schering, Wyeth and Norwich of Colombia.
[Unpublished] 1975. 11 p.The United Nations Fund for Population Activities (UNFPA) convened a meeting of technical representatives of interested population assistance agencies in Geneva during September 1975 for the purpose of discussing the technical aspects of the findings and recommendations of the International Contraceptive Study Project (ICOSP). The additional information presented include: 1) the need for the recommended contraceptive data system is highlighted by the poor quality of data in the responses received from 26 of about 40 countries with notable family planning programs; 2) the proposed data system would cover contraceptives in both the public and private sectors of the developed and developing countries; 3) program directors support the establishment of a system which would ensure continuous supply of acceptable contraceptives; and 4) the integrated planning and management system would best meet the contraceptive requirements of the public sector over the next 5 years. A lengthy discussion following the presentation of the additional information covered the following areas: a data system (buyer's information service, supply data system, demand forecasting system), purchasing service, local production of contraceptives, and the planning and management service. There was almost universal consensus that a buyer's information service was needed and should be implemented.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 7-9.The principal objective of the International Planned Parenthood Federation (IPPF) -- an international federation of 95 voluntary national family planning associations with operations in 110 countries -- is to enable people to practice responsible parenthood as a matter of human right, family welfare, and the well-being of the community. A second IPPF objective is to increase understanding on the part of people and governments of the demographic problems existing in their communities and the world. In the area of lactation the IPPF has had several activities in the past few years. 1 activity was a Biological Sciences Workshop on Lactation and Contraception in November 1976. A 2nd activity is a study on breastfeeding being conducted in collaboration with the World Health Organization (WHO). The Central Medical Committee of the IPPF passed a resolution early in 1976 which states that lactation is a good thing in itself, that breastfeeding is the best way of feeding an infant in the early months, if not the early years of its life, and that breastfeeding is a good contraceptive in its own right. A definite advantage of breastfeeding is that there is more avoidance of pregnancy and more protection of women from unwanted pregnancy by breastfeeding than by all combined scientific technology in family planning based programs. Some of the problems of breastfeeding and outside work relate to sheer expense, both in a positive and negative sense. There is also the question of inconvenience of breastfeeding. 1 approach to the disadvantages has been prolonged maternity leave with pay. Another approach is causing the child to invert its feeding rhythm.
In: Djerassi C. The politics of contraception. New York, Norton, 1979. 215-25.Future strategies in the development of contraceptives should depend upon the time frame of goals developed. In the next 5 years it will be possible only to improve upon the existing armamentum of contraceptives. In a 10 to 20 year period, it will be possible to develop many new contraceptive methods if the public will influence government to enact appropriate policies. Most importantly, these include the earmarking of expanded funds for contraceptive research, and providing a freer hand to the pharmaceutical companies to experiment and develop methods. At present an adversary relationship exists between the government in the FDA and industry. Unless industry is given wider incentives and fewer restrictions, new drugs will not likely to borthcoming. The reality of the situation is that no new medications or contraceptive methods will be developed without the paticipation of private industry, which now feels the restrictions and financial risks to be too great to go into such a venture. The World Health Organization can help the process by approving new drugs for use more widely, even when restrictions are kept within the United States. Misguided consumer advocates harm matters when they manipulate the press and public to look for black and white answers to the problems of contraception. There are no clear cut answers, and difficult choices must be made by all of us.
London, IPPF, . 46 p.Mexican social, economic, and population indicators are discussed and tabulated. In 1972, the government, realizing the magnitude of the nation's population problem, reversed its previous antinatalist policy. The President acknowledged the individual's right to have family planning services available and the government's duty to provide family planning information. The Ministry of Health instituted a program to provide family planning services for that part of the population needing public services. A National Population Council was established to coordinate various public and private services active in the population field. Market research is being undertaken into the feasibility of government sponsored commercial distribution of contraceptives. Sterilization will be an integral part of the governmental family planning services. Acceptor targets and accomplishments and the budget for these governmentally-provided services are presented. A detailed discussion of the history and activities of the IPPF affiliate in Mexico is also presented. Despite the initially unfavorable atmosphere in the mid-1960s, FEPAC (Foundation for the Study of Population) was able to establish a network of family planning clinics. In addition to clinic programs, FEPAC carries out research, training, and education/information activities.
In: Zatuchni GI, Sobrero AJ, Speidel JJ, Sciarra JJ, ed. Vaginal contraception: new developments. Hagerstown, Md., Harper and Row, 1979. 66-81.Although condoms are still produced from a variety of materials, the popularity of the condom increased mainly after the dipped latex process was developed in the 1930s. Condoms went with US troops all over the world during World War Two. It is only in recent years that strict quality standards were established. Many countries, including the US, measure quality in the number of pinholes acceptable per unit, the number of acceptable holes varying considerably between countries. Japan has made a standard based on leakage as measured by sodium ion concentration. Various types, colors, names, and sizes of condoms are popular in different countries. Large scale distribution in recent years has raised the question of shelf life. It is generally thought that a condom kept in a sealed tinfoil package will stay good indefinitely. Nonetheless, for management as well as safety purposes smaller shipments are preferred over large shipments in mass distribution programs. Condom popularity is partly associated with the number and accessibility of distribution points; therefore, it has become more prevalent to use both government units and regular commercial distribution points for popularizing the condom, and there is reason to believe that this type of program will grow. In light of the current interest in integration of contraceptive programs with health care and development efforts, population specialists should look closely at the condom and the commercial resources available for its distribution. A series of tables gives gross numbers of condoms supplied by international donor agencies in the developing countries, 1975-78.
UNFPA Newsletter. 1979 Dec; 5(12):1.The major responsibility for determining the specific type of contraceptive distributed in UNFPA family planning programs is delegated to the government of the country concerned; however, UNFPA does refuse to process orders for contraceptives which have been designated as unsafe or ineffective by WHO. Most of the contraceptives requested by specific governments have been approved for use in developed countries. In approving orders for condoms, the UNFPA applies standards set by various international organizations. UNFPA does not directly purchase supplies. Purchases are made by either UNICEF or WHO, but UNFPA does have an officer who provides purchasing advice.
Proceedings of the Royal Society of London, B. 1976 Dec 10; 195(1118):187-198.In the past 15-20 years there have been advances in fertility regulation. These advances are modest gains that frequently involve a bioengineering input, include collaboration between public agencies and industry, and are closely related to the needs of developing nations. They are the result of the existence of specialized programs whose major goal is the development of new technology. However, a similar specialized public mechanism to undertake the wide range of activities related to product development and introduction of the new technology into family planning does not exist. The 3 major phases of the contraceptive development process are biomedical development, product development, and product introduction-market development. There are 4 areas that require more attention. The 1st of these is a product development laboratory that would accept responsibility for dosage form development, stability testing, quality control procedures, product and packaging modifications, and the production of supplies for biomedical research. Such a laboratory would increase the acceptability of existing methods and promote new developments. Also needed is a contraceptive information service, offering ''full disclosure'' product-related information to managers of family planning programs. A 3rd need is for a patent and licensing administration for the public sector; this would assure that new contraceptives developed with public funds would be made widely available to family planning programs at a reasonable cost. Finally, there is a need to establish a contraceptive introduction planning unit that would consider the program implications of new methods of fertility control and aid countries in planning for their introduction. The availabiltiy of a specialized capacity to take responsibility for public leadership in these 4 areas would contribute greatly to the development of new contraceptive methods that are appropriate to the needs of developing countries and to the success of present international contraceptive research and development efforts.(Authors', modified)
In: Diczfalusy E, Diczfalusy A, ed. Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2. Background documents. Copenhagen, Denmark, Scriptor, 1983. 901-10.The role of governments in research on fertility regulation is to support, finance, coordinate, legislate and take regulatory action necessary to assure the development of new and improved contraceptive technologies. The major advances in contraceptive technology in the 1940s and 1950s were made possible by funding support from industry and private foundations. In the late 1960s government funding, particularly in the US, assumed an increasingly important role. During this same time, 2 UN organizations were formed in addition to several nonprofit institutions whose purpose was to promote research on fertility regulation for developing countries. Worldwide funding for research and training in human reproduction peaked in 1972-1973 at around US 100 million with 20-25% allocated for research on fertility regulation. The level of funding has since declined, most markedly the contribution from private industry. The funding needs for research on human reproduction, including fertility regulation, are in excess of present levels. Funding requirements may be 3-7 times higher than current levels. The prospects for future funding are not optimistic. However, it is hoped that the increased informational focus on parliamentarians and the 1984 World Population Conference will contribute to a reversal of this current trend in decreasing funding levels. The increased emphasis on safety and efficacy of new drugs and devices has lengthened the time between the development of a product and the approval for marketing. The 6 to 8 years between the granting of a patent to the marketing of a product has decreased active patent life. This, together with problems of product liability, has contributed to the declined in industrial investment in research and development on fertility regulating agents. The need for a global institution to establish standards for new contraceptive products is advocated, and WHO should be responsible. Patent laws should be eased. (author's modified)