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Bethesda, Maryland, University Research Corporation, 1991 Apr. ix, 77,  p. (BAN-14; USAID Contract No. DPE-3030-C-00-5043-00; TvT No. BAN-SAS-04-10)Save the Children has a women's savings program (SAVE), which is an integral part of its comprehensive integrated rural development program. Women's savings groups were introduced in Bangladesh on an experimental basis in 1982. Over the years, these indigenous small groups have evolved from simple "savings" groups to dynamic forums to improve women's economic and social horizons and enable them to gain greater control over their lives and those of their children. An operations research study was undertaken, at a cost of US $35,874, to examine and document the impact of womens' savings groups on contraceptive use. The study was undertaken in 8 villages in Nasirnagar Upazila where SAVE programs were in operation: 5 villages where programs were initiated in 1982 (old villages) and 3 villages (new villages) where programs were begun in 1989. 2 comparison villages (without SAVE programs) were also selected at random from among the villages in the same geographic area. The experimental and comparison villages were similar in terms of household size, age, parity, and total fertility of the married women of reproductive age. The study employed a quasi-experimental design. Data were collected using a baseline survey and a mini-contraceptive prevalence survey conducted in both experimental and comparison villages as well as 2 rounds of individual and group interviews with selected savings group members and nonmembers in the experimental villages. Relevant cost data were obtained from SAVE/Dhaka. Selected variables from the SAVE project management information systems (PMIS) were also used for comparison with similar variables obtained in the baseline survey. Womens' savings groups, combined with family planning (FP) motivation, supplies, and services can be an effective strategy of raising contraceptive prevalence in rural Bangladesh. Contraceptive use, both ever and current, was higher in the experimental than in comparison villages and was higher in the old than in the new villages. Contraceptive use was higher among savings group members than among nonmembers, and contraceptive use was higher among the latter group than in the comparison villages, suggesting that the SAVE program helped raise contraceptive use among both members and nonmembers in the project villages. Current use at the baseline among members was 30.9 and 16.9% among members in old and new villages, respectively, and 7.3% in the comparison villages. Among nonmembers, current use was 17.9% in the old villages and 12.9% in the new villages. Current contraceptive use declined from 30.9 to 25.4% in the old villages over the life of the project. One of the main reasons reported for discontinuation was nonavailability of FP methods.
Switching back: an experimental intervention of family planning client remotivation and clinic staff retraining: impact upon reacceptance and continuity.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 73-82.In 1990, the Mauritius Family Planning Association presented educational sessions for former clients allowing them to meet f amily planning personnel and other women with similar experiences. It used audiovisual aids to discuss use of modern contraceptives and the advantage of scientific family planning, to dispel myths and rumors, and to explain how different methods could be used to meet their and partners' needs. At the same time, 10 service providers from the experimental clinic underwent a 6 week sensitization and retraining program emphasizing organization for efficiency, counseling skills, and skills to build client self esteem. Researchers observed both the control and experimental clinic for 9 months in 1991. 36 remotivated clients (73% return rate) and 29 mainly former clients who did not attend a session reaccepted a contraceptive method at the experimental clinic. As for the control clinic, 24 remotivated clinics (46% return rate) and 7 mainly former clients reaccepted a method. Both clinics' staff said that the extra clients returned because the 93 remotivated clients recommended or referred them directly to the clinics. The 2 interventions therefore had a spread effect. The experimental clinic did have a much better retention rate than the control clinic (46 client vs. 28 clients), however. Further it had higher continuity rates throughout the study period. At the end of the study, the continuity rate was 93.8 for the experimental clinic and 53.8 for the control clinic. The researchers concluded that the improved clinic services of the experimental clinic due to staff retraining in skills and attentiveness were responsible for the superior retention record and rates of return and continuity. Thus IEC programs that attend to former and potential clients' needs and develop skills and attentiveness of providers improve acceptor and continuity rates.
Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.
Population et Societes. 1991 Dec; (263):1-3.This work contrasts 2 world population atlases published in 1991, 1 the work of a demographer and the other of a geographer. Both works synthesize the concepts of demography as it is currently practiced. The work by the geography, Daniel Noin, (Atlas of World Population) has a more detailed bibliography and glossary and concentrates on the contemporary population situation. The other work (The Population of the World. From Antiquity to 2050), by Jean-Claude Chesnais, takes a historic approach. The 2 works are complementary and neither raises ecological alarms. They stress different issues in their conclusions, Chesnais asking whether the nations of Europe can compensate for their loss of demographic and economic power by regrouping into an entity large enough to maintain influence, Noin identifying fertility decline in the poor countries as the major current demographic challenge. Both authors use the same analytical instrument and rely on UN statistics. The UN, since its origin, has been the site of a confrontation between 2 schools of demographic thought, the American which is preoccupied with rapid population growth in the poor countries, and the French, which stresses fertility decline and demographic aging in the developed countries. The analytical instrument in both cases is the theory of demographic transition, on which both authors have already written. The 2 authors classify the countries differently, 1 identifying 5 stages of transition and the other 3 stages and 8 types of countries. Agreement on the basic phenomenon of the transition is accompanied by some difference of interpretation.
PACIFIC BASIN MATERNAL AND CHILD HEALTH RESOURCE CENTER WHAT'S NEW IN.... 1991 Dec; 3(58):1-2.The WHO has published partial results of an epidemiological study of the safety with respect to breast cancer of the injectable contraceptive depomedroxyprogesterone acetate, known as DMPA or Depo-Provera. The WHO Special Program of Research, Development and Research Training in Human Reproduction has been conducting a collaborative retrospective study of cancer and DMPA in 3 developed and 8 developing countries. Results from Kenya, Mexico and Thailand are published in Lancet on October 5, 1991. Comparing 869 women with breast cancer <64 years old and 11,890 matched hospital-based controls, the relative risk was 1.21, not statistically significant. 12.5% of the cases and 12.2% of the controls had used DMPA. Fine analysis pointed to a possibility of increased risk over the 1st 4 years of use. The data were not compatible with the hypothesis that DMPA. Fine analysis pointed to a possibility of increased risk over the 1st 4 years of use. The data were not compatible with the hypothesis that DMPA causes cancer, but only that it may speed the growth of early pre-existing cancer. When contemplating the choice of DMPA, people should evaluate their risks relative to the excellence of DMPA as a highly effective, convenient, long-acting, but reversible method.
Socio-economic development and fertility decline: an application of the Easterlin synthesis approach to data from the World Fertility Survey: Colombia, Costa Rica, Sri Lanka and Tunisia.
New York, New York, United Nations, 1991. ix, 115 p. (ST/ESA/SER.R/101)The relationship between fertility decline and development is explored for Colombia, Costa Rica, Sri Lanka, and Tunisia. The study applies Richard Easterlin and Eileen Crimmins; theoretical and empirical approach to analyzing World Fertility Survey (WFS) data in a comparative context. The paper specifically questions the strengths and weaknesses of the Easterlin-Crimmins framework when applied to developing country data, and what the framework implies about comparative fertility in these countries. 3 stages in all, an analyst 1st decomposes a couple's final number of children ever born through an intermediate variables framework. Stage 2 emphasized understanding the determinants of contraceptive use, while stage 3 explains the remaining stage-1 and stage-2 variables. A model linking the supply of children, the demand for children, and the cost of contraceptive regulation results. Stage 1 results were promising, stage 2 results were less encouraging, while stage 3 revealed a theoretically incomplete approach employing empirically weak WFS data. While the Easterlin-Crimmins approach may be promising, econometric, theoretical, and data quality and collection improvements are necessary. Among stage-3 variables open to manipulation, higher socioeconomic status was associated with delayed age at 1st marriage, lower infant and child death rates, lower numbers of children desired, increased knowledge of contraception, and reduced levels of breastfeeding. Apart from regional differences, the educational and occupational roles of women in the countries studied were of primary importance in understanding differential fertility.