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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.
[WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). A summary] WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Eine zusammenfassende Darstellung.
GEBURTSHILFE UND FRAUENHEILKUNDE. 1991 Jan; 51(1):9-14.The WHO's Special Program of Research, Development, and Research Training in Human Reproduction (HRP) has been involved in a global research and development program since 1972 in the are of human reproduction with special regard to the needs of developing countries. HRP set up a worldwide network of cooperating institutes and organized task forces for carrying out priority research objectives/assignments. The goals of HRP include reducing population growth in developing countries by improving health care and by increasing the availability of contraceptives. HRP training and research activities have encompassed workshops, seminars, and training courses. Research and development have been concerned with contraceptive prevalence and use; risks of contraceptives (carcinogenicity, cardiovascular effects, and subdermal implants' side effects); the development of new and safe methods (1-2 month depot preparations; and the levonorgestrel-releasing vaginal ring); and efficacy of contraceptive methods (lactation for birth spacing and natural family planning). A multicentric study in 25 countries has examined infertility caused by infections and sexually transmitted diseases. The extension of research capacity in developing countries was enabled by long-term institutional development grants, capital grants, labor cost financing, training of scientists, and improvement of management. The social and individual determinants of family planning aims at increasing contraceptive prevalence from 11% in Africa, 24% in Southeast Asia, and 43% in Latin America to the level of industrial countries 68%. The structure and management, goal setting and priorities, international cooperation, and finances of HRP are further detailed.
WASHINGTON POST. 1991 May 14; A1, A10.The Annual Report of the UN Population Fund (UNFPA) shows an increase in contraceptive usage among married couples to 51% in 1991 from 45% in the 1980s. This provides strong evidence that family planning does work. The current world population is 5.4 billion, and increases of 85 million/year and 850 million/10 years are expected. Desired family size has also declined as reported in numerous household surveys. In Latin America and Asia, birth rates have declined from an average of 6 to 3- 4/woman. Thailand, Indonesia, and South Korea have birth rates that have dropped precipitously. In Africa, which has the highest fertility rate and the lowest rate of contraceptive usage, there was only a modest decline from 6.6 in the 1960s to 6.2 currently. The declines in family size and birth rate are viewed by a demographer at UNFPA as the result of families seeing the advantages of smaller size. In spite of declines, the rate of growth is still higher than the replacement rate and is a root cause of environmental degradation and mass poverty. Rapid growth (even with fertility reduced from 6 to 4 children/women) in the presence of increased life expectancy and lower mortality means the population will not stabilize until it reaches 10.2 billion in 1085. Stabilization requires contraceptive usage of 75% worldwide. Over the next 100 years, demographers project that the ceiling will be 12.5 billion, with increases primarily in the developing world. Slow growth means widespread use of birth control (59%) in developing countries by the 2000. Contraceptive usage is unevenly distributed. China's usage is 72%, while west Africa's is 4%. The US figures are approximately 70%. There has been greater acceptance of family planning worldwide. Only Saudi Arabia, Iraq, Cambodia, and Laos actively restrict access to family planning services. UNFPA needs to increase spending on family planning to 9 billion US dollars by the year 2000 in order to increase birth control use. The US cut off support for UNFPA, but there is hope that the funding will be restored.
REVUE DE L INFIRMIERE. 1991 May 21; 41(10):33-5.The coordinator of a project fighting against AIDS in Tanzania in collaboration with the government is a Danish nurse, one of 4 mobilized teachers, working for the Tanzanian Red Cross to spread the message of prevention in primary and secondary classes in the North of the Kagera region using original pedagogical methods such as theater, song, and poems. The educational project consists of a group of 8 persons (social workers and nurses) travelling in 2 groups directed by a doctor. The Red Cross helps orphans, providing them with uniforms and school supplies by turning to the village administration, who indicates which families need help with their health. At present the problem of the cholera epidemic is the most pressing, and AIDS is dealt with in conjunction with the filtration of water and the plantation of trees in the Red Cross program that started in March 1989. The extreme poverty is attributable both to AIDS and to the war with Uganda, in addition to economic difficulties caused by the free fall of the price of coffee, the principal cash crop of the region, and the fact that banana trees contracted a disease. It is a higher priority for most men to obtain food than a box of condoms, especially since the disease is hard to comprehend until symptoms appear. However, they do not distribute condoms, but only inform young people where to get them, partly because of the opposition of religious organizations to this preventive measure. The other solution is to have only 1 sexual partner, but a good number in their audience are Muslim who have several wives. Many other nongovernmental organizations mobilize in Tanzania with actions against this epidemic. Some people change their behavior, other never do, and the hope lies in making young people aware of this disease.
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
Fertility trends and prospects in East and South-East Asian countries and implications for policies and programmes.
POPULATION RESEARCH LEADS. 1991; (39):1-17.Fertility trends and prospects for east and southeast Asian countries including cities in China, Taiwan, the Republic of Korea, Thailand, Indonesia, Malaysia, the Philippines, Myanmar, and Viet Nam are described. Additional discussion focuses on family planning methods, marriage patterns, fertility prospects, theories of fertility change, and policy implications for the labor supply, labor migrants, increased female participation in the labor force (LFP), human resource development, and social policy measures. Figures provide graphic descriptions of total fertility rates (TFRS) for 12 countries/areas for selected years between 1960-90, TFR for selected Chinese cities between 1955-90, the % of currently married women 15-44 years using contraception by main method for selected years and for 10 countries, actual and projected TFR and annual growth rates between 1990-2020 for Korea and Indonesia. It is noted that the 1st southeast Asian country to experience a revolution in reproductive behavior was Japan with below replacement level fertility by 1960. This was accomplished by massive postponement in age at marriage and rapid reduction in marital fertility. Fertility was controlled primarily through abortion. Thereafter every southeast Asian country experienced fertility declines. Hong Kong, Penang, Shanghai, Singapore, and Taipei and declining fertility before the major thrust of family planning (FP). Chinese fertility declines were reflected in the 1970s to the early 1980s and paralleled the longer, later, fewer campaign and policy which set ambitious targets which were strictly enforced at all levels of administration. Korea and Taiwan's declines were a result of individual decision making to restrict fertility which was encouraged by private and government programs to provide FP information and subsidized services. The context was social and economic change. Indonesia's almost replacement level fertility was achieved dramatically through the 1970s and 1980s by institutional change in ideas about families and schooling and material welfare, changes in the structure of governance, and changes in state ideology. Thailand's decline began in the 1960s and is attributed to social change, change in cultural setting, demand, and FP efforts. Modest declines characterize Malaysia and the Philippines, which have been surpassed by Myanmar and Viet Nam. The policy implications are that there are shortages in labor supply which can be remedied with labor migration, pronatalist policy, more capital intensive industries, and preparation for a changing economy.
Contraceptive source and the for-profit private sector in Third World family planning. Evidence and implications from trends in private sector use in the 1980s.
[Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991.  p.Estimates by Family Health International and UNFPA predict that the annual cost of modern family planning in meeting the target overall contraceptive prevalence level of 52% will be between $5-9 billion by the year 2000. The number of couples using modern methods of contraception will increase dramatically in future years, incurring great cost to donors, governments, and users. Urbanization, rising incomes, and higher education levels are generally seen as positive factors in permitting an expanded private sector role in the provision of modern contraceptives, providing an alternative source to donor and government programs. The for-profit concerns within the private sector of developing countries, were studied using available 1978-89 data from 26 countries to examine private family planning sources of contraceptives. Also, hypothetical determinants of private family planning use are established and their interrelationship with the use of for-profit family planning services, is investigated. Contrary to result expectations, it was found that use of the major provider for-profit private sector is declining in the face of rising incomes, urbanization, and better education. Government services are crowding out the private sector. Additionally, results indicate a strong user desire for longer-term methods. Full comprehension of the private sector and the factors governing choice of contraceptive source should lead to more effective use of donor and government funding in efforts to achieve set population objectives. Policy and program development will more accurately reflect social needs. Policy implications of the results are discussed.
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. 83-100.Researchers studied 62 pregnant women intending to not terminate their pregnancy and to continue their studies and 27 nonpregnant women to learn about female student fertility related behavior. They were all enrolled at the University of Zambia either during the 1987-1988 or 1989-1990 academic years. Methodology consisted of interviews, questionnaires, and focus group discussions. 68% of all women were single with 40% of them having at least 1 child. 75% of the women were sexually active. 42.7% knew traditional family planning methods with friends, grandmothers, and social aunts telling 25.9% of all the women about such methods. Yet mass media provided most women (49.4%) with knowledge about modern methods. 50.6% thought the pill to be the most effective method. >65% considered the 24-26 as the ideal age at marriage. The mean ideal family size was 3.5, somewhat less than family size for urban women in Zambia. 71.9% considered children to be assets since children are a means to social security (33%), self fulfillment (8%), and companionship (7%). 94.4% approved of family planning mainly for purposes of child spacing (29.2%), limiting (23.6), and spacing and limiting (32.6%). Even though they knew about and approved of family planning and claimed modern attitudes concerning ideal age at marriage and ideal family size, 62% of single pregnant students and 59% of married pregnant students did not use or regularly use contraception. This suggested that they considered early childbearing to be an asset. The leading reasons for contraception nonuse included perception of low pregnancy risk (40%) and desire for a child (28%). Only 3.2% claimed method failure. 64% of all women said partners did not approve of contraceptive use. Access to family planning and cost were not a problem. Only 22% of pregnant students said pregnancy would reduce their chances of marriage. In conclusion, many women became pregnant surreptitiously.
ASIA-PACIFIC POPIN BULLETIN. 1991 Jun; 3(2):7-11.George Walmsley, UNFPA country director for the Philippines, discusses demographic and economic conditions in the Philippines, and present plans to revitalize the national population program after 20 years of only modest achievements. The Philippines is a rapidly growing country with much poverty, unemployment and underemployment, uneven population distribution, and a large, highly dependent segment of children and youths under age 15. Initial thrusts of the population program were in favor of fertility reduction, ultimately changing to adopt a perspective more attuned to promoting overall family welfare. Concurrent with this change also came a shift from a clinic-based to community-based approach. Fertility declines have nonetheless grown weaker over the past 8-10 years. A large gap exists between family planning knowledge and practice, with contraceptive prevalence rates declining from 45% in 1986 to 36% in 1988. Behind this lackluster performance are a lack of consistent political support, discontinuities in program implementation, a lack of coordination among participating agencies, and obstacles to program implementation at the field level. The present government considers the revitalization of this program a priority concern. Mr. Walmsley discusses UNFPA's definition of a priority country, and what that means for the Philippines in terms of resources nd future activities. He further responds to questions about the expected effect of the Catholic church upon program implementation and success, non-governmental organization involvement, the role of information and information systems in the program, the relationship between population, environment and sustainable development, and the status of women and its effect on population.
[Unpublished] . 10,  p.Based upon United Nations medium population projections, the population of developing countries will grow from 4,086 million in 1990, to 5,000 million by the year 2000. To meet this medium-level projection, 186 million contraceptive users must be added for a total 567 million in addition to increased contraceptive prevalence of 59% from 51%. This study estimates the number of contraceptive users, acceptors, and cost of contraceptive commodities needed to limit growth to this medium projection. Needs are estimated by country and method for 1990, 1995 and 2000, for medium, high, and low population projections. The number of contraceptive users required to reach replacement fertility is also calculated. Results are based upon the number of women aged 15-49, percent married, number married ages 15-49, and the proportion of couples using contraception. Estimation methodology is discussed in detail. Estimated users of respective methods in millions are 150 sterilizations, 333 IUD insertions, 663 injections, 7,589 cycles of pills, and 30,000 condoms. Estimated commodity costs will grow from $399 million in 1990 to $627 million in 2000, for a total $5.1 billion over the period. Pills will be the most expensive at $1.9 billion, followed by sterilizations at $1.4 billion, condoms $888 million, injectables $594 million, and IUDs $278 million. Estimated costs for commodities purchased in the U.S. show IUDs and condoms to be significantly more expensive, but pills as cheaper. With donors paying for approximately 25% of public sector commodity costs, developing country governments will need to pay $4.2 billion of total costs in the absence of increased commercial/private sector and donor support.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
New York, New York, United Nations Population Fund [UNFPA], 1991. , 48 p.Developing countries increased their commitment to implement population policies in the late 1980s and early 1990s with the support and guidance of UNFPA. These policies focused on improving, expanding, and integrating voluntary family planning services into social development. 1985-1990 data revealed that fertility began to fall in all major regions of the world. For example, fertility fell most in East Asia from 6.1-2.7 (1960-1965 to 1985-1990). This could not have occurred without strong, well managed family planning programs. Yet population continued to grow. This rapid growth hampered health and education, worsened environmental pollution and urban growth, and promoted political and economic instability. Therefore it is critical for developing countries to reduce fertility from 3.8-3.3 and increase in family planning use from 51-59% by 2000. These targets cannot be achieved, however, without government commitments to improving the status of women and maternal and child health and providing basic needs. They must also include promoting child survival and education. Further people must be able to make personal choices in their lives, especially in contraceptive use. Women are encouraged to participate in development and primary health care in Kerala State, India and Sri Lanka. The governments also provide effective family planning services. These approaches contributed significantly to improvements in fertility, literacy, and infant mortality. To achieve the targets, UNFPA estimated a doubling of funding to $9 billion/year by 2000. Lower costs can be achieved by involving the commercial sector and nongovernmental organizations, building in cost recovery in the distribution system of contraceptives, operating family planning services efficiently, and mixing contraceptive methods.