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The blurred line between aiding progress and sanctioning abuse: United States appropriations, the UNFPA and family planning in the P.R.C.
New York Law School Journal of Human Rights. 2000; 17(3):1063-1104.This note discusses the trend in People's Republic of China programs, international standards of human rights, legislative trends, and the United States budget for fiscal years 2000 and 2001 as they apply to family planning programs. Specifically, this discussion shows why Congress should condition funding of these programs based on assurances of compliance with human rights standards. Part I presents an overview of the P.R.C. programs. Part II reviews internationally accepted standards of human rights concerning reproduction and population control, as well as China's violations of these rights. Part III describes UNFPA funding of the P.R.C.'s programs, emphasizing their latest 4-year program. Part IV discusses the legislative trend since 1985 of limiting or halting funding to the programs, and the current state of the federal budget regarding these appropriations. Part V discusses the global gag rule and the necessity of its removal. Part VI considers recently proposed legislation regarding funding family planning. Finally, the conclusion proposes a possible solution to the family planning dilemma in the face of both the continuing need for assistance and the continued existence of human rights abuses. (excerpt)
[Contraceptive fact sheets. A tool for advisors in logistics] Fiches factuelles sur les contraceptifs. Un outil pour les conseillers en logistique.
Arlington, Virginia, JSI, Family Planning Logistics Management Project, 1998.  p. (USAID Contract No. CCP-C-00-95-00028-04)This guide lists the visual indicators of eventual quality problems, special considerations, donors, manufacturers, brands, shelf life, primary and secondary conditioning, units per shipping crate, and the dimensions and weights of boxes of the following contraceptive methods: condoms, oral contraceptive pills, IUDs, injectables, contraceptive implants, spermicides, and other vaginal barrier methods. These methods are presented in different categories according to donor: USAID, IPPF, or FNUAP. These data are provided as a tool to consultants in logistics. References are given for additional information on each method discussed.
Washington, D.C., DKT International, 1992 Jun.  p.1991 statistics form various contraceptive social marketing programs are presented in a 5-page leaflet complete with a table and 2 bar graphs. The table consists of program sales and couple years of protection (CYP) data for 32 social marketing programs in developing countries ranging from Bangladesh to Zimbabwe. 1 CYP is defined as 100 condoms or foaming tablets, 13 cycles of oral contraceptives (OCs), 0.53 IUDs, and 4 injectables. All but 2 programs distribute condoms. Peru's social marketing program markets only OCs and vaginal foam tablets. The program in Thailand just sells OCs. 12 programs distribute only condoms, including programs in Burkina Faso, Cameroon, Costa Rica, Ivory Coast, Ethiopia, Mexico, Nigeria, Pakistan, Philippines, Turkey, and the Nirodh program in India. Other contraceptives distributed by various programs are IUDs and injectables. Only the program in Sri Lanka markets Norplant. It also provides condoms, OCs, vaginal foam tablets, IUDs, and injectables. In 1991, India had by far the highest CYPs at around 3.28 million followed by Bangladesh at 1.44 million. Bolivia had the lowest CYPs (10,608), CYPs (10,608). CYPs as percentage of target market (80% of 15-44 year old women in a union) statistics do not exhibit the same pattern, however. Jamaica had the highest share (15.9%) followed relatively closely by Egypt (14.8%). 2 other outstanding countries in terms of CYPs as percentage of target market were Colombia (11.7%) and Bangladesh (9.2%). India had only 2.8% and the 3 lowest were Turkey (0.3%), Philippines (0.1%), and Nigeria (0.1%). Leading funding supporters of social marketing programs include USAID, country governments, and IPPF.
ECONOMIC AND POLITICAL WEEKLY. 1987 Jul 11; 22(28):1099.India's family planning program has been restructured from a massive effort, using multimedia promotion and 2 million volunteers and designed to convey the "small family message" directly to the families concerned, to a smaller scale program emphasizing child survival, delayed marriage, village infrastructure, and birth spacing. The change is due to 2 factors: 1) The terminal approach failed to achieve lower birth rates because people will not accept the small family unless they can rely on the survival of the children; and 2) The terminal approach contained an element of coercion which caused the US to reduce support to the US Agency for International Development (USAID) and the UN Fund for Population Activities (UNFPA). The new scaled-down approach should be more effective, since more couples are now practicing family planning and birth spacing, oral contraceptives, IUDs, and longterm hormonal contraceptives are more appropriate than terminal methods to the present demographic picture.
In: Zatuchni GI, Labbok MH, Sciarra JJ, eds. Research frontiers in fertility regulation. Hagerstown, Maryland, Harper and Row, 1980. 58-63. (PARFR Series on Fertility Regulation)The important characteristics of a contraceptive are as follows: 1) sex of the user; 2) duration of effectiveness; 3) probability and ease of reversibility; 4) timing of use; 5) ability to be used after the suspicion or recognition of conception; 6) mode of applciation; 7) frequency of use; 8) safety and side-effects; 9) contraceptive effectiveness; 10) need for continuing volition or motivation to use the method; and, 11) peer approval. Scientists often underestimate the potential for misuse of even the simplest means of fertility control. One-time methods such as the IUD or sterilization have been found effective in developing countries unable to provide a continuous supply of contraceptives to their population. For the IUD, adequate follow-up care msut be available. Many methods require a sophisticated health care system. To expect physician-dependent delivery of anything but a 1-time only method as a practical approach to family planning is unrealistic. Community workers, auxiliary, and paramedical personnel have been able to reach many couples with Western style methods, e.g. pill distribution. Contraceptives like the condom can be distributed through commercial systems. By procuring contraceptive commodities competitively and in bulk, USAID has negotiated extremely low costs. From 1968-79, over $233 million was spent for these commodities.
UNICEF-meeting to determine and coordinate medical/technical aspects of family planning supplies-April 29, 1974. [Memorandum]
Washington, D.C., U.S. Government, 1974 May 1. 5 p.A meeting was held among personnel from UNICEF, WHO, IPPF (International Planned Parenthood Federation), and UNFPA (United Nations Fund for Population Activities. The meeting was held to determine and coordinate funding aspects of family planning supply programs. UNFPA agreed to fund OCs (oral contraceptives), condoms, Depo-Provera, spermicides, IUDs, and abortion equipment for UNICEF programs. It was mentioned that AID (the U.S. Agency for International Development) supplies most of the contraceptives needed for IPPF activities. WHO sets standards and prepares lists of acceptable contraceptive supplies. The UNFPA funding called for $2 million for OCs, $1 million for condoms, and much lesser amounts for the other types of contraceptives.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Egypt, USAID. 1978 March; 82.A review of Egypt's population/family planning policy and assessment of the current population problem is included in a multi-year population strategy for USAID in Egypt, which also comprises: 1) consideration of the major contraints to expanded practice of family size limitation; 2) assessment of the Egyptian government's commitment to fertility control; 3) suggestions for strengthening the Egyptian program and comment on possible donor roles; and 4) a recommended U.S. strategy and comment on the implications of the recommendations. The text of the review includes: 1) demographic goals and factors; 2) assessment of current population efforts; 2) proposed approaches and action for fertility reduction in Egypt; and 4) implication for U.S. population assistance. Based on analysis of Egyptian population program efforts, the following approaches are considered essential to a successful program of fertility reduction: 1) effective management and delivery of family planning services; 4) an Egyptian population educated, motivated and participating in reducing family size; 5) close donor coordination; and 6) emphasis on the role of women.
CBFPS (Community-based Family Planning Services) in Thailand: a community-based approach to family planning.
Essex, Connecticut, International Council for Educational Development, 1978. (A project to help practitioners help the rural poor, case study no. 6) 91 pThis report and case study of the Community-Based Family Planning Service (CBFPS) in Thailand describes and evaluates the program in order to provide useful operational lessons for concerned national and international agencies. CBFPS has demonstrated the special role a private organization can play not only in providing family planning services, but in helping to pioneer a more integrated approach to rural development. The significant achievement of CBFPS is that it has overcome the familiar barriers of geographical access to family planning information and contraceptive supplies by making these available in the village community itself. The report gives detailed information on the history and development of the CBFPS, its current operation and organization, financial resources, and overall impact. Several important lessons were learned from the project: 1) the successful development of a project depends on a strong and dynamic leader; 2) cooperation between the public and private sectors is essential; 3) the success of a project depends primarily on the effectiveness of community-based activities; 4) planning and monitoring activities represent significant ingredients of project effectiveness; 5) a successful project needs a sense of commitment among its staff; 6) it is imperative that a project maintain good public relations; 7) the use of family planning strategy in introducing self-supporting development programs can be very effective; 8) manning of volunteer workers is crucial to project success; and 9) aside from acceptor recruitment in the short run, the primary purpose of education in more profound matterns such as childbearing, womens'roles in the family, and family life should also be kept in mind. The key to success lies in continuity of communication and education.
A.I.D.'s research program to develop new and improved means of fertility control. (Statement, May 2, 1978)
In: United States. Congress. House of Representatives. Select Committee on Population. Population and development: research in population and development: needs and capacities. Vol. 3. Hearings, May 2-4, 1978. Washington, D.C., U.S. Government Printing Office, 1978. p. 287-319USAID, in attempts to develop and improve means of fertility control, spent $4.8 million on new ways to control corpus luteum function and block progestational activity, $4.4 million to develop gonadotropin releasing factors, and $6 million on prostaglandins as a means of inducing the menses or terminating pregnancy in the second trimester. Studies at Johns Hopkins University developed thyrotropin releasing hormones to ensure postpartum infertility without interfering with lactation. Research to improve current forms of birth control amounts to $16.5 million. Side effects of oral contraceptives, single aperture laparoscopic sterilization, reversible male sterilization, and tissue glues for non-surgical female sterilization are some of the new techniques being funded by USAID. $19 million has been allocated to evaluate contraceptive programs in developing countries. Funds have come from DHEW, the Ford foundation, the Population Council, pharmaceutical companies, and WHO. Although improved birth control is desireable, money is best spent supplying available methods to developing countries.
In: Watson, W.B., ed. Family planning in the developing world: a review of programs. New York, Population Council, 1977. p. 54-55The government of Honduras included a population policy in its National Development Plan for the period 1974-1979. This policy will be implemented by providing information regarding responsible parenthood, by using natural and technical resources to produce a well-nourished and creative population, and by applying the principles of voluntary participation in family planning programs. The 2 family planning programs in Honduras are the government maternal and child health program and the Family Planning Association of Honduras program. The government program, initiated in 1968, operates 34 clinics which offer family planning along with prenatal and postnatal care, child care, and nutrition education services. The Family Planning Association, established in 1961, operates 2 clinics and served 42,000 people during 1975. 9000 of this group were 1st acceptors. Oral contraceptives were chosen by 80% of the new acceptors; 13% chose IUDs and 5% chose injectables. The Association's information and education activities included conferences, talks, courses, seminars, and home visits. Additionally, the Association is operating a demonstration community-based distribution program with financial assistance from the International Planned Parenthood Federation. 40 workers in each of 2 cities provide contraceptives in their own neighborhoods.
In: Organization for Economic Cooperation and Development (OECD). Development Center. International assistance for population programmes: recipient and donor views. Paris, OECD, 1970. p. 107-133Pakistan has been experiencing an increasing rate of population growth since the beginning of the 20th century. During the period from 1960 to 1965, about 40% of the economic growth was absorbed by population increase. In order to deal with this problem, the Family Planning Association of Pakistan was founded in 1953. It soon became recognized that the government would need to assume primary responsibility if family planning efforts were to be successful. The 3rd plan of Pakistan includes a revised and more comprehensive family planning scheme. The minimum goal set for the program is to reduce the birthrate from an estimated 50-40/1000 by reaching all the estimated 20,000,000 fertile couples by the year 1970. The current scheme in Pakistan is postulated on the following 6 basic assumptions: 1) family planning efforts need to be public relations oriented and not merely clinical; 2) operations should be conducted through autonomous bodies with decentralized authority; 3) monetary incentives play an important role; 4) interpersonal motivation in terms of life experiences of the clientele through familiar contacts along with mass media publicity should be used; 5) supplies and services should be easily available to all people; and 6) training, evaluation, and research should be multidimensional and continual as an integral part of the program. During the 4th Plan, 1970-1975, family planning efforts will be greatly expanded. Some of the main features of the 4th Plan will be an expansion of the field structure, more emphasis on training research and evaluation, inclusion of hormonal contraceptives, and increased relaince on sterilization.
IPPF Situation Report, June 1973. 10 p.The Indonesian Planned Parenthood Association (IPPA) was founded in 1957 and pioneered family planning services. It made little headway duri ng the pronatalist Sukarno regime, but in 1967 the present government announced an intensive family planning program and the IPPA was named as an implementing unit in 1971. 2 primary roles now are the training activities for fieldworkers and the development of community education and motivation programs. This complements the national mass media program. In 1970 the government took over all clinics except those in the Outer Islands (the islands outside Java, Bali, and Madura). The IPPA runs 150 clinics in the Outer Islands, is responsible for all supplies and maintenance, and has a number of model clinics in Java and Bali. The Community Education program has 8 components: speakers bureau, family planning clubs, mobile audiovisual units, exhibitions, tr aditional media, special events, local mass media support, and evaluatio n. In 1971 the 'ippa trained 2951 people; in 1972 this was increased by 25%. In 1973 the target is training 3000 fieldworkers with 16 centers for training and 16 field demonstration areas. An agreement with the U.N. Fund for Population Activities/International Development Association (UNFPA/IDA) will provide for building, equipping, and staffing. The research and evaluation function is also expanding to complement government activities. The government program aims to train 20,250 medical and paramedical personnel over 5 years and medical schools have incorporated the teaching of population and family planning. Government allowances are being curtailed for all children over 3 for government workers. An active clinic program aims to set up 1200 fully equipped and 1250 moderately equipped facilities by 1973. An active media campaign has been launched and for the 1st time in the population field the UNFPA and the IDA are helping to finance a project to expand a family planning program and broaden its activities. This su pport will provide for physical facilities, technical assistance, training, motivation, evaluation, research, and population education.
IPPF Situation Report, February 1974. 6 p.Laos has been so torn by war and continuing waves of refugees that i t has been difficult to provide basic medical services to the population . In 1969 Laos had 53 medical doctors, 40 of whom were foreign instructors at the School of Medicine, 676 practical nurses, and 400 trained midwives. Before 1971 the government was opposed to family planning. A study commission in that year, however, examined population growth problems and recommended support for family planning. The voluntary association had been formed in 1966 and had sent representatives to international workshops. After the change in government attitude, the association has actively acted to distribute family planning supplies to villages, train midwives as motivators, and give additional training to public health center heads, home economists, medical assistants, and refugee village heads. The governmental emphasis is on better spacing of births rather than limitation. It took over operation of 7 association clinics in 1973 and now helps provide contraceptive services. The association still has 5 fixed and 6 mobile clinics. A refugee pilot program which opened in 1971 now has a permanent building and a full-time rural midwife. The association also stresses influencing opinion leaders through lecture forums, pamphlets, radio commercials, and film shows. Information and Education teams were formed to conduct 2-3 day seminar-lectures in other provinces to diverse groups like village headmen, town influentials, teachers, and other leaders. Many foreign groups have provided assistance, supplies, training, and other aid. WHO is helping with the integration of family planning into the nursing and midwifery curricula in the schools of Laos.
Country Profiles. 1972 Oct; 19.The estimated population of Iran in 1972 was 31,000,000, with an estimated rate of natural increase of 3.2% per year. In 1966 61% of the population lived in rural areas, male literacy was 41% and female literacy 18%. Coitus interruptus is the most common form of contraception used in Iran, followed by condoms. Because of the rapid rate of population growth, the government has taken a strong stand in support of family planning. The Ministry of Health coordinates family planning activities through the Family Planning Division. Contraceptive supplies are delivered free of charge through clinics. The national family planning program also is involved in postpartum programs, training of auxiliary personnel, communication and motivation for family planning population education, evaluation and research. The overall goal of the program is to reduce the growth rate of 2.4% by 1978, and to 1% by 1990.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.
IPPF Situation Report, June 1972. 5 pAll the demographic statistics and the cultural, economic, and geogr aphical sttuation of Sierra Leone are presented. The Planned Parenthood Association of Sierra Leone (PPASL) was founded in 1960. There is no anticontraceptive legislation in the country but the attitude of the government toward family planning is still tentative. Current educational, fieldwork, clinic operations, and fund raising projects are summarized. Current personneof PPASL are given. New acceptors choose t he IUD generally, with more educated acceptors favoring the pill or spermicides. Other services provided by PPASL are mentioned. Sources of funding, including international organizations, are listed.
IPPF Situation Report, June 1972. 4 pAll the demographic statistics and the cultural, economic, and geogr aphical situation of Sarawak, part of the Malaysia Federation, are presented. The history of interest in family planning and the current personnel of the Sarawak Family Planning Association (FPA) are presented. The FPA is assisted with clinics, grants, and land from the government. Family planning services are provided by the FPA at 8 urban and 57 rural clinics. Orals are the overwhelming favorite of acceptors. Current educational and training activities are summarized. International organizations providing assistance for the family planning program are mentioned.
IPPF Situation Report, September 1972. 7 pHong Kong, with 3858 people/sq km, is 1 of the world's most densely populated areas. Family planning was introduced in 1936 by the Hong Kong Eugenics League and 5 clinics were operating by 1940. The Family Planning Association (FPA) was formed in 1950 and was a founder member of IPPF in 1952. Interest in family planning increased as massive immigration from China added to overcrowding. The government supports FPA (in 1972 the grant was U.S.$254,545) and houses 80% of the FPA clinics in government properties. At present there are 46 female clinics providing 189 sessions per week and 2 male clinics operating eac h week. The decline from 54 to 48 clinics is due to the new emphasis on full-time rather than part-time clinics. In 1971 there were 347,894 attenders, an increase of 18% over 1970, and 31,898 new acceptors, an increase of 4%. There has been continued increase in the number of patients requesting oral contraceptives (70.6% in 1971). The IUD began to decline after bad publicity surrounded a large number of loops which had broken in the uterus; in 1971 only 6% of acceptors asked for IUDs. Condoms account for 11.5% and injectables, 3.6%. FPA offers subfertility and marriage guidance services and is extending its Papanicolaou smear service. An active media campaign, exhibitions, and seminars are conducted. Until 1967 fieldwork consisted of random home visits. An efficiency study led to concentration on maternal and child health clinics, postnatal clinics, and follow-up home visits. Home visi ts are still made on request. A number of international trials for various contraceptives have been run in Hong Kong. Many church and international organizations are helping to finance family planning activities, both through FPA and through their own organizations.