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  1. 1
    Peer Reviewed

    Dissemination and use of WHO family planning guidance and tools: a qualitative assessment.

    Kraft JM; Oduyebo T; Jatlaoui TC; Curtis KM; Whiteman MK; Zapata LB; Gaffield ME

    Health Research Policy and Systems. 2018 May 22; 16(1):42.

    BACKGROUND: As countries continue to improve their family planning (FP) programmes, they may draw on WHO's evidence-based FP guidance and tools (i.e. materials) that support the provision of quality FP services. METHODS: To better understand the use and perceived impact of the materials and ways to strengthen their use by countries, we conducted qualitative interviews with WHO regional advisors, and with stakeholders in Ethiopia and Senegal who use WHO materials. RESULTS: WHO uses a multi-faceted strategy to directly and indirectly disseminate materials to country-level decision-makers. The materials are used to develop national family planning guidelines, protocols and training curricula. Participants reported that they trust the WHO materials because they are evidence based, and that they adapt materials to the country context (e.g. remove content on methods not available in the country). The main barrier to the use of national materials is resource constraints. CONCLUSIONS: Although the system and processes for dissemination work, improvements might contribute to increased use of the materials. For example, providers may benefit from additional guidance on how to counsel women with characteristics or medical conditions where contraceptive method eligibility criteria do not clearly rule in or rule out a method.
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  2. 2
    Peer Reviewed

    Strategies to expand contraception coverage: another tool in the box.

    Godfrey EM

    Contraception. 2011 Oct; 84(4):339-41.

    This editorial focuses on a strategy to expand contraceptive coverage through the development of a numerical International Statistical Classifications of Diseases (ICD) code for "unwanted fertility." It explains how this strategy would work, how to make the strategy happen through a revision process, and defining unwanted fertility as a medical problem. Copyright © 2011 Elsevier Inc. All rights reserved.
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  3. 3

    Understanding the links: globalization, health sector reform, gender and reproductive health.

    Evers B; Juarez M

    New York, New York, Ford Foundation, 2003. [45] 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)
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  4. 4

    ICT, gender equality, and empowering women.

    Daly JA

    [Unpublished] 2003 Jul 9. 15 p.

    How can information and communication technologies (ICT) be used to promote gender equality in developing nations and to empower women? This essay seeks to deal with that issue, and with the gender effects of the “information revolution.” While obvious linkages will be mentioned, the essay seeks to go beyond the obvious to deal with some of the indirect causal paths of the information revolution on the power of women and equality between the sexes. This is the third1 in a series of essays dealing with the Millennium Development Goals (MDGs). As such, it deals specifically with Goal 3: to promote gender equality and to empower women. It is published to coincide with the International Conference on Gender and Science and Technology. The essay will also deal with the specific targets and indicators for Goal 3. (excerpt)
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  5. 5

    Cairo commitment must be honored.

    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)
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  6. 6

    The role of the traditional midwife in the family planning program. Report of National Workshop to Review Researches into Dukun Activities related to MCH Care and Family Planning.

    Indonesia. Department of Health; Indonesia. National Family Planning Coordinating Board [BKKBN]; Indonesian Planned Parenthood Association; Universitas Indonesia

    [Jakarta], Indonesia, Department of Health, 1972. 83 p.

    A number of studies conducted already have revealed that there are possibilities of using dukuns as potential helpers in the family planning programme. Bearing in mind that the number of dukuns at the present time is large, it is easy to imagine that they are capable of contributing a great deal towards progress in our family planning programme provided that the dukuns are assigned a role which is appropriate. In this respect, I am only referring to dukuns whose prime function is helping mothers during pregnancy and immediately afterwards, and who have close contact therefore, with the target of the family planning programme, i.e. the eligible couples. It would indeed be very helpful, if we could find out from the available data and from the results of applied research what exactly is the scope and usefulness of dukuns in the family planning programme. It seems to me that in this project we have to consider a twofold problem. The first aspect of the problem is that the dukuns are mostly of an advanced age and they are illiterate. The second aspect is that in spite of relationships with MCH centers extending over a period of years most of the dukuns still prefer their own way of doing things and they remain unaffected by modern ways of thinking. (excerpt)
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  7. 7

    Family planning saves women's lives.

    United States. Agency for International Development [USAID]. Center for Population, Health and Nutrition

    Washington, D.C., USAID, Center for Population, Health and Nutrition, 2001 Nov. [2] p. (POP Briefs)

    This document presents the benefits of family planning programs on women's health. It includes statistics on this topic and gives examples of the US Agency for International Development (USAID) programs in this area.
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  8. 8

    National report on population and development of Malaysia. International Conference on Population and Development, September, 1994, Cairo.

    Malaysia. National Population and Family Development Board. Technical Working Group for ICPD

    [Kuala Lumpur], Malaysia, National Population and Family Development Board, Technical Working Group for ICPD, 1993. [4], 64 p.

    Malaysia considers its population policy an integral part of its overall social and economic policy planning. In order to achieve its goal of becoming an industrialized nation by the year 2020, Malaysia considers it imperative to create a quality population based around a strong family unit and a caring society. This report on population and development in Malaysia begins with a description of the demographic context in terms of past and current trends in population size, growth, and structure; fertility, mortality, and migration as well as the outlook for the future. The implementation of the population policy, planning, and program is described in the context of the following issues: longterm population growth, fertility interventions, women's labor force participation, aging, the family, internal and international migration, urbanization, and the environment. The evolution of the population policy is included as is its relationship with such other population-related policies as health, education, human resource development, regional development, and the eradication of poverty. Information is provided on the current status of the population policy and on the role of population issues in development planning. A profile of the national population program includes a discussion of maternal-child health services; family planning services and family development; information, education, and communication; data collection and analysis, the relationship of women to population and development; mortality; migration; the environment; human resources development, poverty alleviation; aging; and HIV/AIDS. The national action plan for the future is presented through a discussion of the emerging and priority concerns of population and family development and an outline of the policy framework. The summary reiterates Malaysia's efforts to integrate population factors into development planning and its commitment to promoting environmentally-sound and sustainable development. Appendices present data in tabular form on population and development indicators, population policies, incentives, and programs; program results; and the phase and area of implementation of the national population and family development programs.
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  9. 9

    Fortieth report and accounts, 1971-1972.

    Family Planning Association [FPA]

    London, FPA, 1972. 48 p.

    Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
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  10. 10

    Micro-enterprise projects for women - linkages with family planning.

    United Nations Population Fund [UNFPA]

    Evaluation FINDINGS. 1993 Jul; (1):1-6.

    This thematic evaluation included in-depth studies of seven projects in six countries-Egypt, Ghana, India, Kenya, Paraguay, and the Philippines-and desk reviews of other micro-enterprise projects in China, Indonesia, Jordan, Mali, Mauritius, Morocco, Nepal, Nigeria, Senegal, and Uruguay. It found that a dual focus on women's productive and reproductive roles can lead to a viable strategy for improving the situation of women as well as reducing fertility rates. In addition, increases in women's income can have a catalytic effect on the demand for family planning and maternal and child health.
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  11. 11

    United Nations Population Fund (UNFPA) moves Day of Six Billion from mid-June to 12 October 1999.

    POPULI. 1999 Jan; 25(4):3-4.

    Revised population estimates released last month by the Population Division of the UN Department of Economic and Social Affairs indicate that fertility levels in developing countries are dropping, partly due to improved reproductive health and family planning services and education for women. HIV/AIDS-related morbidity and mortality are also helping to slow the rate of population growth in certain developing countries. The available data indicate a long-term decline to below replacement level fertility in most industrialized countries. These declines in fertility levels have caused the United Nations Population Fund (UNFPA) to push back the date when world population will reach 6 billion people from June 16, 1999, to October 12, 1999. World population, however, continues to grow by 78 million people every year. 97% of that increase is in developing countries, where access to family planning and reproductive health services is limited.
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  12. 12

    Choice and a better life in the dusty heart of India.

    Datta B


    Since its inception in 1995, the Family Planning Association (FPA) of India's Small family By Choice project has developed three broad strategies to increase reproductive choice for 4.35 million people living in three of the poorest districts of the country: providing quality clinical services, improving access to health care, and stimulating community participation. The FPA provides scholarships so that girls can attend school where they will acquire a deeper understanding of the need for small families along with employable skills. Another FPA project offers impoverished young women in urban areas the chance to acquire income-generating skills. Trainees also attend health camps where they are provided with gynecological check-ups, pre/postnatal care, and counseling. Other FPA-sponsored programs include community-based adult literacy classes; child care centers in the project's main health clinic; establishment of community-based delivery rooms and training of midwives; community-based distribution of contraception; and management of a full clinic in Bhopal. The project reaches out to marginalized prostitutes by subsidizing a hostel close to a school for their children. Such flexible, needs-based innovations are having an enormous impact. The programs provide a range of choices of high quality contraceptives and have even been successful in promoting the condom. The clinic has served 554 patients from July to early September 1997 and provides counseling to help women improve their decision-making skills.
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  13. 13

    Challenges in India and Bhutan.

    Zaman W

    JOICFP NEWS. 1997 Dec; (282):4.

    While India is making overall progress in maternal and child health and reproductive health (MCH/RH), all states are not moving ahead. In fact, it is the states with the larger populations which are lagging behind. Primary education, women's status, and literacy remain problematic. UNFPA has worked in India for a long time, helping to realize the decline in total fertility rate from 6 to 3.5 over the past 20-30 years. India's population, however, is still growing at the annual rate of 1.8%. UNFPA's program in India for the period 1997-2001 will stress women's health as a matter of overall reproductive health, a new approach in India which has long relied upon sterilization. Attention must be given to meeting the needs of the poor in India as the country continues to grow in size and wealth. While Bhutan's estimated population is just over 1 million, the annual population growth rate of 3.1% threatens development over the long term. With a mountainous terrain and a low resource base, Bhutan cannot sustain a high population growth rate. Significant improvements have been made and women's status is good, the infant mortality rate has been reduced, and the health infrastructure is not bad. UNFPA's 5-year program beginning in 1998 will mainly address RH, especially adolescent RH.
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  14. 14

    Achieving reproductive health for all. Annual report 1996.

    International Planned Parenthood Federation [IPPF]. Arab World Region

    Tunis, Tunisia, IPPF, Arab World Region, 1996. [2], 16, [2] p.

    This annual report of the Arab Region of the International Planned Parenthood Federation (IPPF) opens with a message from the Chair of the Regional Council, who notes that the IPPF is adopting new strategies to meet the challenges in its "Vision 2000" plan. The Arab Region has aided this effort by engaging in strategic planning, amending its constitution to empower women, and boosting youth participation. Next the regional director summarizes the following areas of interest in this report: 1) training family planning associations to engage in strategic planning and project development; 2) strengthening the Euro-Arab partnership; 3) generating interest in youth-related concerns; 4) empowering women; 5) evaluating progress in implementing the recommendations of the International Conference on Population and Development; and 6) establishing firm links with other organizations. The report also deals with efforts to incorporate the concept of male responsibility, collaboration, and understanding as the notion of responsible parenthood is promoted. Specific programs described include a ground-breaking youth peer-group program in Algeria; a method of information diffusion that incorporates the oral poetic tradition; and use of operations research to upgrade service provision in Syria, Lebanon, and Egypt. Efforts to insure that the development of evaluation indicators occurs during project planning and implementation are also discussed. The report closes by presenting the financial report for 1995.
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  15. 15

    Funding family planning [letter]

    Senanayake P

    BMJ. British Medical Journal. 1994 Mar 12; 308(6930):718.

    Brian Harradine calls for an end to "population control programmes" funded by, among others, the International Planned Parenthood Federation "because of their coercive nature and the negative effect they have on women's health." The aim of the International Planned Parenthood Federation is to provide women and their families with information and services that will allow them to live healthier and longer lives. Through its worldwide network of autonomous national family planning associations the federation responds to family planning needs and reproductive health needs expressed by local people, particularly women. Currently more than 120 million women in the developing world are not using contraception although they say that they want to avoid pregnancy. As many as 500,000 women die every year from causes related to pregnancy. An African woman has a 1/22 likelihood of dying from a cause related to pregnancy. These figures are well known to those working with reproductive health issues. On paper, however, they do not necessarily reflect the suffering and ill health that each of those women may encounter in her desire to practice the right to regulate her own fertility. The International Planned Parenthood Federation agrees with Harradine's hope that family planning programmes will continue to concentrate on the individual needs of users. It enjoys a close relationship with the Australian International Development Assistance Bureau and hopes for the bureau's continuing support in its work. (full text)
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  16. 16

    Time for a new agenda. Looking to Cairo.

    Germain A

    POPULI. 1994 Jul-Aug; 21(7):4-6.

    An agenda for significant change is proposed for the International Conference on Population and Development (ICPD). Current progress toward the agenda is viewed as insufficient unless there are resource reallocations, political will, vision, and the adoption of the agenda at the ICPD. The ICPD goals also should be accepted by the World Summit for Social Development and by the Fourth World Conference on Women in 1995 in order to achieve human security and development. Population agencies must 1) increase investments in health, education, water, sanitation, housing, and social services; 2) enact and enforce legislation empowering women in sexual, social, and political ways; 3) provide credit, training, and income development so women can have decent lives; 4) involve women's advocates at all levels of decision making; and 5) eliminate the gender gap in education, prevent violence against girls, and eliminate sex role stereotypes. The literature in the population field has neglected sexuality, gender roles, and relations and has concentrated on unwanted pregnancy, sexually transmitted diseases, and contraceptive efficacy. Many family planning (FP) programs reinforce gender roles. Improvement in the quality of services must be a top priority for FP programs. Quality of care is conceptualized differently by FP providers and women's health advocates. Basic program management and logistics systems could be changed with modest investments in staff motivation and revised allocations of human and financial resources. Clients must be treated with dignity and respect. Programs should not concentrate on married, fertile women to the neglect of adolescents and other sexually active women. Preventive health should include those sexually active beyond the reproductive age. Men's responsibility in FP is viewed as fashionable but problematic in terms of actual program change.
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  17. 17

    IMF / World Bank boards of governors discuss population, migration.

    ICPD 94. 1994 May; (15):3.

    A brief presentation was given of the statements Dr. Nafis Sadik, Executive Director of the UN Fund for Population Activities (UNFPA) and Secretary General of the 1994 International Conference on Population and Development (ICPD), made before a meeting of the International Monetary Fund (IMF) and the World Bank on resource flows to developing countries, population, international trade, and migration. The meeting was attended by finance ministers from 24 countries. The IMF Managing Director gave an overview at the meeting of the world economic situation and the need for international assistance for effective population and family planning programs. Dr. Sadik emphasized this need as a requirement for implementation of the 20-year ICPD Programme of Action. The increased investment was considered beneficial because it would increase life expectancy, lower demand for health and education services, reduce pressure in the job market, reduce economic hardship, and increase social stability. The growth of prosperity was considered by Dr. Sadik to be tied to increased demand for housing, energy, and utilities. A slower and more balanced population growth would allow for government services to meet demands and for the world to adjust to increasing numbers of people. Several ministers supported the call for increased funding of population programs and poverty reduction programs. A special communique by ministers recognized that the connections between economic growth, population, poverty reduction, health, investment in human resources, and environmental degradation must be integrated into population policy. Ministers urged the ICPD to emphasize improvements in primary school enrollment in low income countries, in access to family planning and health services, and in maternal and child mortality rates. Ministers wanted to see increases in the proportion of aid directed to population programs above the current 1.25%. Requests were made for more research into the social, political, and economic impact of international migration among both host and origin countries.
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  18. 18

    Creating common ground in Asia: women's perspectives on the selection and introduction of fertility regulation technologies.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction

    Geneva, Switzerland, World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction, 1994. 45 p.

    Participants from Bangladesh, India, Indonesia, the Philippines, and other countries with which WHO's Special Programme of Research, Development, and Research Training in Human Reproduction collaborates and in which women's groups are active attended the Asian regional meeting on Women's Perspectives on the Research and Introduction of Fertility Regulation Technologies in February 1991. The meeting aimed to establish a dialogue between women's groups and researchers, policymakers, and family planning service providers. Other objectives included defining women's needs and viewpoints on reproductive health and fertility regulating technologies and identifying appropriate follow-up activities which would form a basis for regional networking. WHO's Special Programme of Research, Development, and Research Training in Human Reproduction published a report of the meeting. The meeting consisted of plenary sessions, group work, and keynote presentations. Presentations addressed women's realities, policy considerations, research, and service provision. Topics concerning women's realities were community attitudes towards fertility and its control, women's autonomy, health status, and family planning services. Presentations on policy considerations covered: taking users into account, objectives of family planning programs, participation in decision making, and men's responsibility. Redefining safety and acceptability as well as research on female barrier methods were addressed during presentations on research. The report presents proposals for action for Bangladesh, India, Indonesia, and the Philippines. Meeting participants reached a consensus on recommendations addressing policy, research, services, and WHO. The report concludes with a list of participants and a list of papers presented.
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  19. 19

    Cairo conference galvanizes world opinion on reproductive health. Setting priorities for the future.

    ALTERNATIVES. 1994 Oct; (2):1, 3.

    The International Conference on Population and Development (ICPD) held in Cairo, Egypt, in September 1994 capitalized on a growing recognition of the integral relationship between family planning and the larger issues of reproductive health, education, status of women, and development, and made several recommendations to that effect. Many countries in Asia and the Near East region have begun to incorporate the concept of reproductive health into their existing family planning and government health care services, but are experiencing difficulties in implementing the concept in an integrated way. These countries also have problems providing couples with information on reproductive health and providing information on safe, affordable contraception. Operations research (OR) can help broaden the relationship between family planning, reproductive health, and development, and help governments identify the current and future needs of their client populations and make informed decisions on ways to improve the quality of services. OR can also help identify ways to provide the information on reproductive health and family planning that can be a basis for better communication between partners. For example, in Indonesia and Bangladesh, OR is helping to find ways to improve access to family planning information and services, village education for girls, and employment opportunities for young women through cooperatives, credit unions, and NGOs.
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  20. 20

    Working for and pro women.

    FORUM. 1994 Jun; 10(1):12-3.

    APROFAM, the International Planned Parenthood Federation affiliate in Guatemala, is working to reduce the high rate of maternal mortality in the country (24/100,000 live births) not only by expanding reproductive health services but also through improvements in women's social conditions. At present, only 34% of Guatemalans have easy access to health care services. Since just 22% of labor, hypertensive disorders of pregnancy, and abortion complications confer significant mortality. Key to improving the health services available to poor women is greater incorporation of women into the development process, which will in turn produce a societal view of women as a resource rather than a liability. Examples of APROFAM programs aimed at improving the health of women and children through an educational, community-based approach are: Woman, for the Defense of Women's Human Rights, a network of women's organizations that serves as an organizing force for improvements in women's status; Teacher to Teacher, a program that trains teachers to educate women in remote rural areas; Support System and Legal Advice, which offers consultations for women; Groups of Family Development, which involve local women in a range of health and development activities; and Dressmaking School, which trains women to earn an income as well as provides education on maternal-child health care promotion.
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  21. 21

    Country report: Bangladesh. International Conference on Population and Development, Cairo, 5-13 September 1994.


    [Unpublished] 1994. iv, 45 p.

    The country report prepared by Bangladesh for the 1994 International Conference on Population and Development begins by highlighting the achievements of the family planning (FP)/maternal-child health (MCH) program. Political commitment, international support, the involvement of women, and integrated efforts have led to a decline in the population growth rate from 3 to 2.07% (1971-91), a decline in total fertility rate from 7.5 to 4.0% (1974-91), a reduction in desired family size from 4.1 to 2.9 (1975-89), a decline in infant mortality from 150 to 88/1000 (1975-92), and a decline in the under age 5 years mortality from 24 to 19/1000 (1982-90). In addition, the contraceptive prevalence rate has increased from 7 to 40% (1974-91). The government is now addressing the following concerns: 1) the dependence of the FP and health programs on external resources; 2) improving access to and quality of FP and health services; 3) promoting a demand for FP and involving men in FP and MCH; and 4) achieving social and economic development through economic overhaul and by improving education and the status of women and children. The country report presents the demographic context by giving a profile of the population and by discussing mortality, migration, and future growth and population size. The population policy, planning, and program framework is described through information on national perceptions of population issues, the evolution and current status of the population policy (which is presented), the role of population in development planning, and a profile of the national population program (reproductive health issues; MCH and FP services; information, education, and communication; research methodology; the environment, aging, adolescents and youth, multi-sectoral activities, women's status; the health of women and girls; women's education and role in industry and agriculture, and public interventions for women). The description of the operational aspects of population and family planning (FP) program implementation includes political and national support, the national implementation strategy, evaluation, finances and resources, and the role of the World Population Plan of Action. The discussion of the national plan for the future involves emerging and priority concerns, the policy framework, programmatic activities, resource mobilization, and regional and global cooperation.
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  22. 22

    Health policies and programmes: accomplishments and future directions of the Safe Motherhood Initiative.

    World Health Organization [WHO]

    In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 236-9. (ST/ESA/SER.R/128)

    99% of the 500,000 annual maternal deaths worldwide occur in developing countries; women in developing countries are 100 times more likely to die from pregnancy than women in more developed countries. Inadequate health services as well as the social, cultural, and economic environment in which these women live are contributing factors to their excess mortality. A global effort to reduce maternal mortality and morbidity by 50% by the year 2000, the Safe Motherhood Initiative was initiated in 1987 in response to this ongoing trend. It will attempt to realize its objective by improving the socioeconomic and political status of women, providing family planning services, ensuring the availability and accessibility of high-quality, community-based prenatal and delivery care for all women, and ensuring the provision of skilled obstetric care for high-risk and emergency cases. This paper discusses the Initiative's accomplishments in the areas of advocacy, research, human resources development, and program development and considers future directions.
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  23. 23
    Peer Reviewed

    Medical barriers to contraceptive use.

    Cottingham J; Mehta S

    REPRODUCTIVE HEALTH MATTERS. 1993 May; (1):97-100.

    Various practices keep women from receiving and using contraception. These medical barriers include those pertaining to eligibility, process, and regulatory and provider bias. Eligibility barriers place too strict criteria on what women may use a particular contraceptive. For example, severe migraine headaches are a relative contraindication for oral contraceptives (OCs), but some community-based distribution programs include headaches without being specific on their checklist, resulting in denying OCs to women who have had a recent headache. Blood tests to rule out liver and cardiovascular diseases as a prerequisite for a prescription of combined OCs in some West African countries represent a process hurdle. Yet, just a brief medical history can identify women at risk of these diseases. Restricting IUD insertion to physicians in some countries is another example of a medical barrier. Family planning providers or program managers sometimes determine themselves what methods are best suited for various women. This provider bias essentially eliminates women's choice of methods. Until 1992, the US Food and Drug Administration (FDA) had not approved the 3-month injectable contraceptive method, Depo-Provera, despite many studies confirming its safety. The lack of FDA approval prevented other countries from approving it. Despite 30 years of OC use worldwide, Japan still does not allow OC use. According to a WHO survey of 50 collaborating centers, the most common medical barrier to contraceptive use is requiring women who use OCs and IUDs to return for follow-up examinations more often than is necessary. This recent survey concludes that no overall standardized information about contraceptives, their side effects, and who can and cannot use them safely exists. WHO and other groups are developing internationally accepted guidelines to counteract conflicting information and outdated criteria for contraceptive delivery.
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  24. 24

    Population issues: briefing kit 1992.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 1992 Jul. [2], 21 p.

    The UN Family Planning (FP) Association briefing kit examines 10 key issues in the field of population and development: changes in population growth; balancing population growth in developing countries; population program needs for 2000; the right to FP; growing support for population policy; valuing women equally; balancing people with environmental resources; migration and urbanization; information, education, and communication (IEC); and overcoming the barriers to reliable statistics. These issues demand prompt and urgent action. World population is expected to reach 6 billion by 1998, or 250,000 births/day. 95% of population growth is in developing countries. There have been decreases in family size from 6.1 to 3.9 today, and population growth has declined, but the absolute numbers continue to increase. Over 50% of the world's population in 2000 will be under 25 years. Population growth is not expected to stop until 2200 at 11.6 billion. By 2020-25, the developed world's population will be under 20% and will account for 3% of the annual population increase. Africa's population growth is the fastest at 3.0%/year, including 3.2% in eastern and western Africa, while Europe's is .24%/year. The demographic trends are indicated by region. FP program funding needs to be doubled by 2000 to US $9 billion in order to achieve the medium or most likely projection. $4.5 billion would have to be contributed by developing countries to achieve coverage for 59% of women of reproductive age. Of the US $971 million contributed in 1990, the US contributed $281 million, followed by $64 million from Japan. Other large contributors were Norway, Germany, Canada, Sweden, the UK, and the Netherlands, including the World Bank. In 1990, 141 countries received international population assistance of US $602 million, of which Asia and the Pacific received 35%, sub-Saharan Africa 25%, Latin America 15%, the Middle East and North Africa 9%, Europe 1%, and interregional 15%. FP must be an attitude toward life. Having a national population policy and implementation of an integrated program with development is the objective for all countries. The best investment is in women through increasing educational levels and status and reducing maternal mortality. Policies must also balance resource use between urban and rural areas; urban strategies must include improvement in rural conditions.
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  25. 25

    African women. A review of UNFPA-supported women, population and development projects in Gabon, Guinea-Bissau, Zaire, and Zambia.

    de Cruz AM; Ngumbu L; Siedlecky S; Fapohunda ER

    New York, New York, United Nations Population Fund [UNFPA], 1991 Jan. 45 p.

    In the late 1980s, UNFPA-supported women, population, and development projects in 4 African countries were reviewed during their early stages of implementation. The Gabon project aimed to identify pressing needs of rural women who worked in agroindustries or participated in agricultural cooperatives so the government could know how to integrate rural women into national development and in developing programs benefiting women. It realized that providing women with information about family health and sanitation did not meet their needs unless they first had a minimum income with which to implement what they learned. The Guinea-Bissau project chose and trained 22 female rural extension workers to inform women about sanitation and maternal and child health, nutrition, and birth spacing to improve the standard of living. It also hoped to strengthen the administrative, planning, and operational capacity of the women's group of a national political party to improve maternal and child health. Yet the women's group did not have the needed knowledge and experience in project development to operate a successful extension-based program. Further, it was unrealistic to expect women to train to become extension works when the government would not hire them permanently. In Zaire, women at local multiservice women's centers in 3 rural regions imparted information and education to modify traditional beliefs and behavior norms to increase women's role in development. In Zambia, Family Health Programme workers provided integrated maternal and child health care and family planning services through local health centers countrywide. The projects used scientific field surveys and/or interviews with villagers, local leaders, and organizations to conduct needs assessments. They did not assess the institution's strengths and weaknesses to determine its ability to be a development agency. The scope of all the projects as too limited. The duties of the consultant in 2 projects were not delineated, causing some confusion.
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