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Ottawa, Canada, International Development Research Centre, 1973. 30 p. (IDRC-009e)This paper evaluates the progress of a Latin American population through stages in family planning adoption. The focus is on changes in knowledge of contraception, attitudes, and practices which occurred over 5 years (1964-69) of widespread public discussion concerning family planning and of program activity in Bogota, Colombia. Data from 2 surveys, 1 in 1964 and the other in 1969, permit the 1st temporal analysis of family planning adoption for a major metropolitan city in Latin America. Additional data on rural and small urban areas of Colombia from the 2nd survey permit a limited assessment of diffusion of family planning from the city to the nation as a whole. The 1st survey in Bogota revealed moderate to high levels of knowledge of contraceptive methods and generally favorable attitudes to birth limitation. However, at this time many women had never spoken to their husbands about the number of children they wanted, nor tried a contraceptive method at any time. The 2nd survey showed substantial changes in this picture. The proportion of currently mated women who had spoken to their husbands about family size preference changed from 43 to 62% for an increase of 71%. Fertility fell appreciably over this period, especially among younger women. Family planning program services had a significant direct contribution to the adoption process, since 36% of mated women had been to a clinic by 1969. The most modern methods of birth control -- the anovulatory pill and the intrauterine device -- which were scarcely known in 1964 were widely known in 1969, and contributed most to the observed increase in current contraceptive practice. However, among the previously known methods, the simplest method of all, withdrawal (coitus interruptus), showed the greatest increase in current practice and remained the most commonly used method. These findings suggest that favorable attitudes and knowledge tend to become rather widespread before levels of husband-wife discussion of family size preferences and levels of contraceptive trial increase appreciably. The results also indicate that contraceptive knowledge and favorable family planning attitudes are spreading rapidly outward from the cities into the rural areas, but that contraceptive practice is still predominantly restricted to urban populations. (author's)
Journal of Social History. 1985 Spring; 18(3):399-411.The transition from resistance to acceptance of birth control in the US can be characterized as a 3 stage process, with each period facing its own issues and choices. The 1st stage -- the fight over birth control in the early 20th century -- has been documented by historians like James Reed, Linda Gordon, and David Kennedy. A 2nd stage, approximately the years from 1936-60, has not been fully explored although the period was crucial in shaping the current system of contraceptive health care. This discussion focuses on this transitional period, particularly its 1st decade, 1936-47. Physicians' attitudes, as revealed through American Medical Association (AMA) policy and a national survey conducted in 1947, are considered in relation to reported data on clinic and private practice. This evidence reveals that despite the liberalization of laws and public opinion in the mid-1930s, contraception did not become widely available until after 1960 -- the beginning of the 3rd stage in the history of American contraception -- and that the restriction of birth control information during the period was traceble in large part to the medical profession. Analysis of the 1936-47 decade, particularly with regard to the concerns of doctors, provides a framework for understanding the forces that affected contraceptive health care in the mid 20th century and suggests conditions that continue to shape the politics of birth control. In 1936, when the AMA's committee on contraception submitted its 1st report, it was clear that legal and public opinion had moved decisively toward more liberal attitudes concerning birth control. In 1937 the AMA passed a qualified endorsement of birth control, indicating that the organized medical profession as represented by the AMA held views on birth control at the beginning of the 2nd stage that were more conservative than those of most middle-class Americans. Its conservatism was challenged by lay groups who threatened to circumvent standard office practice if physicians failed to modify their views. Public opinion and behavior thus had a demonstrable effect on medical attitudes. 10 years after the AMA resolution a suvey found that more than 2/3 of physicians approved of contraception for any married women who requested it. The 1937-47 period witnessed 2 important changes in medical attitudes toward contraception: the profession's public, though cautious, endorsement of birth control; and the apparent adoption of liberalized standards for the prescription of contraceptive materials. The period also was a time of tremendous growth for the new birth control clinics that offered services to women who could not afford private care. Available evidence suggests that physicians' attitudes toward contraception, and particularly toward birth control clinics, were more important than either laws or public opinion in limiting the availability of those contraceptives considered most efficient (and most compatible with sexual pleasure) between 1936-60.
Journal of the Royal College of General Practitioners. 1984 Nov; 34(268):600-2.The immediate responses of physicians and patients to adverse publicity about the possibility of cancer among women using combined oral contraceptives (OCs) were studied in 2 separate locations: the main family planning clinic in the city of Aberdeen, and a provincial general practice of 10 doctors based in the Peterhead Health Centre. A press release was issued 1 day prior to publication of 2 articles in the Lancet of 22 October 1983, reporting possible risks of breast and cervical cancer in some patients on combined OCs. For the 20 workdays immediately after publication, the 16 participating doctors at both locations collected survey data on the ages of patients and outcomes of consultations for all patients who expressed concern about the OCs. In the family planning clinic, 207 consultations with clinic doctors were prompted by anxiety over the pill and accounted for 24.8% of the workload over the 20 days. In the practice, 73 women (7.8% of all the pill users) who attended over the 20 days expressed concern about OCs. The general practitioners reported lower than expected levels of patient response, whereas the family planning clinic required extra sessions to accomodate the temporary upsurge in demand. At each consultation, the doctor either changed the type of pill, changed the method of contraception, or offered reassurance only. At the family planning clinic and practice respectively, the 1st outcome choices were a change of pills for 58.5% and 39.7% of patients, a change of method for 14.0% and 2.7%, and reassurance only for 27.5% and 57.5%. The mean age of patients was 25.1 years at the family planning clinic and 25.6 years at the health center. This limited study suggests that the predicted "pill scare" did not occur at the Peterhead Health Centre, while in contrast the family planning clinic reported a marked increase in workload including inquiries from the press and local radio stations. Factors accounting for the general practitioners' more conservative responses to patients with pill-related anxiety may have included differences in the type of patient seen; the greater time constraints on the general practitioners, whose patients were booked at 6-minute intervals compared to 12-minute intervals in the clinic; or the continuity of care provided by the general practitioners.
American Journal of Obstetrics and Gynecology. April 15, 1971; 109(8):1118-1127.The 1970 Nelson Committee hearings were held to determine whether Pill users were properly told about the side effects and suspected complications. The author charges the Committee hearings of sensationalizing adverse results of the Pill, causing 18% of all U.S. users to stop this treatment and another 23% to seriously consider quitting. A survey following the Nelson hearings showed 97% of the 13,000 U.S. obstetricians and gynecologists questioned believed oral contraceptives to be medically acceptable. The Scowen report of England (1970) said the Pill is the best contraceptive available, and the low-estrogen pill (50 mcg) is the safest. Because of the relationship of the pill to thromboembolism brought out by Nelson hearings oral contraceptives now must carry a health warning, and the result of the Scowen Committee will most likely encourage doctors to prescribe low dosage estrogen pills.
In: McDaniel EB, ed. Second Asian Regional Workshop on Injectable Contraceptives. Oklahoma City, Oklahoma, World Neighbors, 1982. 74-83.To prevent anti Depo-Provera publicity family planning associations have used a number of techniques. They have helped to create positive attitudes to family planning by identifying, contacting, and informing decision makers and community opinion leaders. They have also pinpointed the opposition and tried to find areas of agreement. The author suggests that in reassuring the public serious concerns about Depo-Provera should be investigated and corrected and that a possible complication should not be covered up. The anti Depo-Provera publicity is mostly concentrated in the international women's movement and it is suggested to try to establish communication with women's groups which are not completely opposed to Depo-Provera. Planning family planning with a broader social context has depended on adjusting family planning programs to local development needs. If family planning organizations are seen as helping with community health and better living conditions there might be more positive attitudes toward the use of Depo-Provera as a family planning product. Successful Depo-Provera users also need to be encouraged to speak openly, especially if they are in influential positions. In addition journalists can be invited to hear the positive arguments for Depo-Provera and about family planning organizations in general, and if the confidence of the journalism community is gained then the family planning organization will be asked for its viewpoint more often. Some suggestions for creating good relations with media are: 1) hold press lunches, 2) hold informal briefings, 3) mail background information, 4) have third party medical support with the media, and 5) always be prepared to answer questions.