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Washington, D.C., Island Press, 1991. lxii, 272 p.In 1988, the World Meteorological Organization and the UN Environment Program established the Intergovernmental Panel on climate Change (IPCC) to consider scientific data on various factors of the climate change issue, e.g., emissions of major greenhouse gases, and to draw up realistic response strategies to manage this issue. Its members have agreed that emissions from human activities are indeed increasing sizably the levels of carbon dioxide, methane, chlorofluorocarbon (CFC), and nitrous oxide in the atmosphere. The major conclusions are that effective responses need a global effort and both developed and developing countries must take responsibility to implement these responses. Industrialized countries must modify their economies to limit emissions because most emissions into the atmosphere come from these countries. They should cooperate with and also provide financial and technical assistance to developing countries to raise their living standards while preventing and managing environmental problems. Concurrently, developing countries must adopt measures to also limit emissions as their economies expand. Environmental protection must be the base for continuing economic development. There must be an education campaign to inform the public about the issue and the needed changes. Strategies and measures to confront rapid population growth must be included in a flexible and progressive approach to sustainable development. Specific short-term actions include improved energy efficiency, cleaner energy sources and technologies, phasing out CFCs, improved forest management and expansion of forests, improved livestock waste management, modified use and formulation of fertilizers, and changes in agricultural land use. Longer term efforts are accelerated and coordinated research programs, development of new technologies, behavioral and structural changes (e.g., transportation), and expansion of global ocean observing and monitoring systems.
Colombo, Sri Lanka, Family Planning Association of Sri Lanka, 1991. , 54,  p.This report describes the accomplishment of the Family Planning Association of Sri Lanka (FPASL) during the 1990-91 year. The report opens with a section describing 1990 highlights, a year that witnessed great strides in clinical, contraceptive retail marketing, rural motivational, and AIDS education activities. In June, FPASL hosted the Regional Council Meeting of the South Asia Region, a meeting attended by IPPF Secretary Dr. Halfdan Mahler, who praised the efforts of the association. Designed to coincide with the regional meeting, FPASL organized a national seminar on "Family Planning Research and the Emerging Issues for the Nineties." IPPF invited FPASL to be one of the 6 countries do develop a new strategic plan for the 1990s. Other FPASL highlights included: increased AIDS education, Norplant promotion campaigns, and the establishment of a counselling center for young people. Following the highlight section, the report provides an overall program commentary. The report then examines the following components of FPASL: 1) the Community Managed Integrated Family Health Project (CMIRFH), which is the associations' major family planning information, education, and communication (IEC) program; 2) the Nucleus Training Unit, established in 1989, whose primary emphasis is to organize and conduct AIDS education programs; 3) the Youth Committee, whose activities include populations and AIDS education; 4) the Clinical Program, whose attendance increased by 15% (this section describes the types of services provided); and 5) the Contraceptive Retail Sales Program. While condom sales increased by 5%, the sales of oral contraceptives and foam tablets decreased -- a declined explained by the turbulent situation of the country.
New York, New York, UNFPA, . v, 36 p. (Report)The former government of Romania sought to maintain existing population and accelerate population growth by restricting migration, increasing fertility, and reducing mortality. The provision and use of family planning (FP) were subject to restrictions and penalties beginning in 1986, the legal marriage age for females was lowered to 15 years, and incentives were provided to bolster fertility. These and other government policies have contributed to existing environmental pollution, poor housing, insufficient food, and major health problems in the country. To progress against population-related problems, Romania most urgently needs to gather reliable population and socioeconomic data for planning purposes, establish the ability to formulate population policy and undertake related activities, rehabilitate the health system and introduce modern FP methods, education health personnel and the public about FP methods, promote awareness of the need for population education, and establish that women's interests are served in government policy and action. These topics, recommendations, and the role of foreign assistance are discussed in turn.
ASIA-PACIFIC POPIN BULLETIN. 1991 Dec; 3(4):10-2.The government of India set up a population program 25 years ago, yet the population is expected to surpass that of China in the near future. The current UN Population Fund (UNFPA) program for India covers the period 1991-95 with coordination, implementation, and evaluation. Improved services focus on states with high fertility and mortality, high infant mortality, self-reliance in contraceptive production, models for maternal health care and traditional health care, national communication strategy, public awareness enhancement, and raising women's status by female literacy expansion and employment generation. UNFPA trains, provides equipment and contraceptives, and nongovernmental organization participation. The bulk of the $90 million cost of the program will come from UNFPA: maternal-child health, family planning (FP), and information, education, and communication (IEC) will receive the most funding. Ethnic and tribal areas will get attention under a decentralized scheme in accordance with the concept of a multicultural society where early age at marriage and high economic value of children are realities. The Ministry is responsible for IEC and FP targets and allocation of funds. Government institutes and universities carry out population research. The creation of India POPIN patterned after the Asia-Pacific Population Information Network is under development under IEC activities. The status of women is varied throughout India, in the state of Kerala literacy reaches 100%, and the birth rate of 19.8%/1000 women is below the national average of 30.5. In contrast, the states of Bihar and Rajasthan with female literacy of 23% and 21%, respectively, have birth rates of 34.4% and 33.9%.
New York, New York, UNFPA, . vii, 71 p.The Government of Botswana followed good economic policies during the 1970s-80s and received considerable revenues from minerals which it invested in its social and economic infrastructure. this resulted in more employment and improved health, education, and skills of the population. Even though these actions were a good start in dealing with population issues, the population continues to grow rapidly (3.45%) and total fertility is high (6.39). Despite the country's small population size (1.3 million; population density=2/square km), it strains Botswana's limited resource base. In the future, the water supply will be Botswana's most serious problem. It is now facing increased teenage and unwanted pregnancies, malnutrition, overcrowding, and street children. Yet Botswana has no official population policy. Maternal and child health (MCH) programs provide family planning (FP) information, services, and supplies, but based on the growth rate, women tend to use contraceptives to space births. Contraceptive prevalence is around 32%. The government does not have a definite information, education, and communication (IEC) strategy that targets populations not served by MCH/FP programs. UNFPA recommends that the government of Botswana begin formulating a population policy and implementation strategy. It suggests that the strategy include an institutional framework; a policy document; the organization of a national population program as soon as possible; IEC; a component addressing women, population, and development; FP services; a framework for data collection and analyses; and mechanisms to improve date quality, analyses, and dissemination of findings.
POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
New York, New York, UNFPA, . , 16 p. (Programme Advisory Note)This report explains that a comprehensive strategy is needed to meet the reproductive health needs of young people and to facilitate their participation in development. Out of a world population of 5.3 billion people, 1.5 billion are between the ages of 10 and 24 years. 82% of these young people live in developing countries. And with the total fertility of developing countries at 4.0, the number of young people will continue to increase. Developing countries already face enormous problems in providing education and employment to these young people. The report identifies the issues that are involved in youth, population, and development, such as reproductive health information, family planning services, population distribution and urban migration, and sustainable development. The report also provides examples of UNFPA-funded youth projects. A program in Thailand, for example, aims to raise contraceptive awareness among adolescents in school. The outcome of these projects indicates the need fora comprehensive strategy that takes into account the following: 1) developing and implementing youth policies, plans, and programs; 2) carefully targeting IEC activities to specific audiences; 3) strengthening maternal and child health/family planning services for young people, including unmarried youth; 4) improving the status of young women; 5) increasing the involvement of men in family matters, especially family planning; 6) complementing other development activities that have wide-range impact; and 7) using nongovernmental organizations to help empower young people.
New York, New York, UNFPA, 1991. iv, 73 p.Nigeria has more people within its boundaries than any other nation in Africa. Since it total fertility rate is so high (6.6) and the modern contraceptive prevalence rate is so low (3.5%), its population is growing considerably (3.3%). April 1989, the Government of Nigeria officially launched its National Policy on Population which set several goals, e.g., family planning (FP) coverage to 80% of women of reproductive age and reducing the population growth rate to 2% by 2000. Part of the national overall strategy for implementing the population policy in 1992-1996 includes giving priority to activities in maternal and child health (MCH)/FP; information, education, and communication (IEC); and women's role in population and development. It also stresses collection of population data, demographic analysis, and research. For example, the last population census was in 1963 so the Government plans a census in late 1991. Nigeria has integrated FP into the MCH program within the context of primary health care. Specifically, it centers on training and using traditional birth attendants to deliver infants in a safe manner, to provide FP services (e.g., as distribution of nonprescription FP methods), and to educate women about women's health and FP using IEC techniques. Further the Government intends to institutionalize the IEC strategy at all levels. For example, the Nigerian Educational Research and Development Council and its corresponding State Committees have integrated population education into secondary school curricula. In addition, IEC population education activities have been extended to nonformal and adult education, such as the organized labor sector and counseling at clinics and other health facilities. The Government has set up the National Commission for Women to integrate women's issues into all sectors of national development. Donor agencies active in population activities in Nigeria include UNFPA, UNICEF, UNICEF, USAID, the World Bank, the European Economic Community, Japan, and the Netherlands.
Guidelines on improving delivery and evaluation of population and family planning programmes in African countries.
Addis Ababa, Ethiopia, United Nations Economic Commission for Africa, 1991 Dec. vi, 82 p. (ECA/POP/TP/91/2 [1.2(ii)])In December, 1991, the UN Economic Commission for Africa (UNECA) released guidelines geared toward professionals involved in population and family planning programs in Africa. By this time, many African countries had adopted such programs either for health and human rights reasons or to influence demographic trends. Yet several countries still had laws against family planning from the colonial days. UNECA stressed that programs should be central to socioeconomic development planning, since changes in population affect socioeconomic development and vice versa. It also emphasized the importance of planning and formulation of programs and policies. This included political commitment and leadership; involvement of women, men, youth, and communities; consideration of resource allocation, institutional arrangements, and infrastructure; and wide discussion of policies and programs at all levels including the grass roots levels. UNECA pointed out the need for policy makers and program managers to clearly state objectives and that the objectives be tied with socioeconomic development and improvement of the welfare of the people. It encouraged population and family planning professionals to give consideration to the delivery and evaluation of programs. For example, they should incorporated information, education, and communication efforts designed to improve attitudes and encourage quality services into these programs. Leaders should strive to reform legislation which acts against population and family planning programs. UNECA also stressed the need to integrate evaluation activities into these programs. The guidelines ended with experiences on implementation of programs from Botswana, Ghana, Kenya, Mauritius, Tunisia, Zimbabwe, China, and Thailand.
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.
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. 1-12.40 couples participated in separate focus group discussions each with 10 single sex individuals either in the city of Harare, Zimbabwe or at a rural center. Researchers also conducted indepth interviews with 25 couples. The wanted to examine husband-wife communication concerning fertility management. Only younger married women, especially those in Harare, included family planning issues as topics of occasional communication. Urban young married women tended to be more educated than older and rural women. Older rural women tended to avoid discussions concerning marital interpersonal relationships. Men believed that women had much opportunity to talk and to make decisions about family welfare such as household management and child care. Yet women did not feel that they had the opportunity to discuss issues. In fact, they believed that the men made fertility decisions while the men believed these decisions were mainly up to the women. Some men did mention, like urban young married women, that ideally these decisions should be made jointly, however. Men were uncomfortable talking to the researchers about fertility management decisions. Both men and women were reluctant to discuss who initiates discussions on family planning. Basically women do not because they are afraid and men only initiate discussion when things go wrong. Women did have a tendency to use inference or indirect inference to initiate family planning discussions. For example, the neighbors' children have new school uniforms actually means they have a small family and can afford them. Women also used repetitional offhand reminders and bargaining or negotiating position. Men's fear that the male command structure within the family (the status quo) will not be maintained and women's fear that making fertility management decisions would threaten their marriage were barriers to husband-wife communication concerning family planning.
[Kuching, Malaysia, SFPA, 1991]. ii, 35 p.The Sarawak Family Planning Association's (SFPA's) main focus in 1990 was the strengthening of the Family Planning Clinic Service Program. Although the number of clinics has remained at 8, the number of resupply points increased from 50 in 1989 to 112 in 1990. These resupply points are set up in areas where transportation, financial, or social factors impede the ability of established acceptors to attend the static clinics. In part because of the increased availability of contraceptive services, the number of acceptors increased by 3352 over 1989, to reach 28,996 in 1990. The remaining 31, 847 acceptors in the country are serviced by the Ministry of Health. The SFPA utilizes a "cafeteria approach" to contraceptive choice; methods available are oral contraceptives, IUD, condom, injectable, spermicides, vasectomy, and natural family planning. At SFPA's clinic sites, the pill accounts for 57-93% of total contraceptive acceptance. The physicians at the 8 clinics also provide clients with cervical and breast cancer screening, pregnancy testing, infertility counseling, gynecological examinations and referral, and premarital advice. An extension of the Clinic Service Program, the Community Clinic Extension Family Planning Program, operates in the main towns. Involved in this program are 41 physicians, who distributed largely hormonal forms of contraception to 3587 acceptors, and 76 non-medical workers, who distributed condoms to 289 acceptors. As the major source of family planning information in Sarawak, the SFPA has an extensive IEC program that uses talks, home parties, fieldwork motivation, mass media campaigns, and community meetings to recruit new acceptors. Finally, the Family Life Education Project sought, in 1990, to increase the involvement of young people in determining their own programs and activities.
New York, New York, UNFPA, . vii, 96 p.Working to balance population growth with socioeconomic development, the Government of India has had a population policy in place since 1951. Net reproduction rate of 1 is targeted to be met by the year 2000. This paper present India's population policy, and analyzes overall strategy for achieving population goals. While strategy is basically sound, there are, however, serious problems with program implementation. Information, education, and communication activities, as well as population education are reviewed. Non-governmental organizations and organized labor are then examined in the context of their roles in overall population strategy. Programmatic review continues and concludes with discussion of integrated maternal and child health/family planning components, improving the status and roles of women, and consideration of institutional framework, coordination, and management. Specific observations and recommendations are presented for each of these issues and topics, as well as for data collection and policy analysis, and the coordination of population assistance. Future UNFPA country programs should expand already initiated projects, and develop new ones aimed at providing a wider array of locally available contraceptives. While past assistance has focused upon health and family planning, future programs may encourage other areas of population activities. Examples of such activities include demographic research and training, research and action programs in women and development, and experimental approaches to population education.
New York, New York, UNFPA, . ix, 66 p.This paper discusses Sri Lanka's population policy with special focus upon UNFPA's role in establishing and implementing a successful multi-sectoral family planning program for the country. Progress made in the past years must continue, while ongoing efforts are made to attain the goal of 2.1 TFR by year 2000. A suitable program must be better coordinated with a view to cutting waste and duplication, guarantee an adequate supply of appropriate contraceptive supplies, streamline research operation, more fully implement its educational programs, and recognize women's centrality in population programs, and recognize women's centrality in population programs. UNFPA assistance should be offered to effect such programmatic change and development, with service delivery needs addressed 1st. The Government of Sri Lanka lacks adequate resources to supply calls for an integrated approach focused upon creating a National Coordinating Council; developing a more sophisticated and targeted approach to information, education, and communication; providing contraceptive supplies, software for service delivery, and client counseling; training providers; and improving coordination with other multilateral programs for child care and human resource development. The present population and development situation, the national population program, proposed sectoral strategies for implementation, the role of technical assistance, and general recommendations for external assistance are discussed in detail.
Population education in the nineties: a quest for a regional programme strategy in Asia and the Pacific.
POPULATION EDUCATION IN ASIA AND THE PACIFIC NEWSLETTER AND FORUM. 1991; (34):12-7.In 1990, Asia and the Pacific constituted 59% of the world's population and this percentage has been estimated to climb to 61.76% by 1995. In addition to rapid population growth, some of the other problems plaguing the region in the early 1990s included illiteracy, absolute poverty, environmental pollution, and low status of women. Population education can play a key role in an intervention strategy for fertility decline. Schools should include population education because, if girls attend school, it can improve girls' chances for employment and affect future family sizes, and both male and female students are most apt to occupy important private sector and government positions and be leaders. UNESCO has proposed a 1992-1995 regional population education and communication program and hoped to gain UNFPA support for the program. UNESCO has heeded UNFPA's plea for more formidable and intensive backstopping to country programs. It proposed to create regional advisory teams that will provide technical assistance, organize study tours and workshops, facilitate intercountry sharing, and identify new areas of development. This team would also be population education advocates. It has also proposed a workshop in population communication for staff of rural oriented nongovernmental organizations and religious groups to close the UNFPA identified gap in information, education, and communication (IEC). Other similar proposed activities to close the IEC gap included workshops on audiovisual (AV) aids development and use and maintenance of AV equipment and on communication strategies to reach male family planning acceptors and intercountry research studies. UNESCO has also planned to place more emphasis on management, development of prototype population education materials, and other needed population education activities.
New York, New York, UNFPA, . 31 p.The UN Population Fund (UNFPA) knows the linkages between women's status and execution of sustainable development initiatives. This booklet has taken the next step and explains how to include women in development, especially population initiatives. Women specific projects are 1 primary approach to realize women's participation. They include projects designed to improve their situation (education, skill development, training, or economic activities) or those designed to increase awareness of women's issues among policy makers, the media, and the public. These projects are often successful in motivating women to use family planning services. The 2nd approach involves mainstreaming women into development projects in all work plan categories. This approach provides women opportunities to work with men, to draft policy, and to take part in national development and is pivotal to the long term success of population efforts. One must 1st recognize obstacles to designing projects and programs that include women, however. 1 such obstacle is few discussions with women to learn their perceptions of national priorities and needs. The booklet features how one can be an advocate for maternal-child health/family planning (MCH/FP) and information, education, and communication (IEC) programs, research, policy, planning, special programs (e.g., those that train women in environmental management), and basic data collection and analysis. For example, statistics that prove that demand for family planning services exceed supply of those services allows an advocate to promote MCH/FP programs. UNFPA also recommends a gender impact statement be prepared for all development projects. For IEC programs, it may include questions about specific cultural, legal, financial and time constraints for females in having full access to education and how a project may change these traditional obstacles.
[Unpublished] 1991.  p.Jose G. Rimon, II, Project Director for the Johns Hopkins University Population Communication Services (JHU/PCS) Center for Communication Programs, visited Finland to attend a NORPLANT planning meeting. Meeting discussion focused upon issues involved in expanding NORPLANT programs from pre-introductory trials to broader national programs. Financing and maintaining quality of care were issues of central importance for the meeting. Participants included representative from NORPLANT development organizations, the U.S. Agency for International Development, the World Bank, and other donor agencies. Mr. Rimon was specifically invited to make a presentation on the role of information, education, and communication (IEC) on NORPLANT with a focus upon future IEC activities. The presentation included discussion of the need to develop a strategic position for NORPLANT among potential customers and within the service provide community, the feasibility of global strategies positioning in the context of country-specific variations, the need to identify market niches, the need for managing the image of NORPLANT, and the need to study IEC implications in terms of supply-side IEC, content/style harmonization, materials volume, and language and quality control. Participants collectively agreed to develop an informal group to address these issues, concentrating upon universal issues potentially addressed on a global scale. A meeting on strategic positioning is scheduled for August 19-20, 1991.
New York, New York, New York University Press, 1991. xxiv, 464 p.This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.
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.