An evaluation of the cost-effectiveness of mobile family planning services in Tunisia

This report presents the results of a study conducted in Tunisia in 1986 to evaluate the cost-effectiveness of the 63 mobile units managed by the Tunisian Office National de la Famille et de la Population (ONFP). In 1985 the units produced one-third of the ONFP's national program output, serving 868 service sites dispersed throughout the rural governorates of Tunisia. In some governorates the mobile units contributed as much as 74 percent of program output. Overall, in 1985, the units provided over 250,000 service visits, saw almost 25,000 new acceptors, and provided approximately 34,500 couple-years of contraceptive protection (CYPs). The median cost per visit was US$4.93 and the median cost per CYP (including tubal ligations) was US$18.66. Multivariate analysis is used to identify significant variables that explain variation in unit output; among these, literacy of the population, number of centers served by a unit, and frequency with which centers were served in a month were positively correlated with unit output. Specific recommendations are made on how to improve cost-effectiveness.     

Program planning for family planning services

This exchange of opinions was occasioned by an article which appeared in the October 1969 Perspectives under the title Family Planning Services in the U.S.: a National Overview, 1968. Mr. Sieverts criticizes the article as follows. The ratio of unmet need claimed to available facilities is considered not properly stated in that all indigent girls and women from their midteens through their midforties do not need such services every year and that clinic services do not represent the total of such services available. Many have no such need. The private physician and hospital clinic provide much service. Development of new services should also consider demands, resources, and alternative solutions. Other health services must also be coordinated. Mr. Jaffe's defense follows. The stated need is an approximation by applying the Dryfoos-Pulgar-Varky (DPV) formula to the 1966 census figures. The need figure which results is about 5 million out of a total of over 8 million poor and near-poor women in the age group 15-44. This estimate is considered reasonably accurate. The number included but not in need is partially offset by some below the age of 18 who are also in need. Poor families have relatively less access to private physicians than others. This is shown by the number of women who deliver their babies on the ward service of hospitals without the presence of a private physician. Also, private physicians tend to give less attention to contraception for low income patients than do clinics. Many women depend on nonmedical and unreliable birth control measures. Family planning is not a one-time educational process. Revisits, continuing supervision, and check-up examinations are advocated particularly for IUD users and those taking pills. With current contraceptive technology adequate family planning services contemplates care extending for most of the patient's reproductive years. Resources require allocation. The study rests on the findings that the poor have a higher incidence of unwanted fertility than the nonpoor with significant adverse health and social consequences for both the individual and society. The study was a systematic attempt to achieve a national goal of providing modern family planning services to all who need and want them but cannot afford private care.     

Adolescent demand for contraception and family planning services in low- and middle-income countries: A systematic review

ABSTRACT

An estimated 23 million adolescent girls age 15–19 in low- and middle-income countries (LMICs) have an unmet need for contraception. Despite the recognised importance of expanding access to appropriate methods of contraceptives for adolescents in LMICs, the evidence base on their total demand for contraception is limited, and there is no consensus on how to measure this important phenomenon. The aim of this study was to review the published literature in order to better understand the level of adolescent demand for contraception in LMICs and to explore what demand-related indicators are being measured. A total of 1375 articles were identified and 18 met the inclusion criteria. Included studies reported findings from 29 LMICs, revealing high adolescent demand for contraception. The demand for contraception among adolescents and young women ranged from 22% among married adolescents in Azerbaijan to 98% in Peru. However, measures of this phenomenon were limited, with most studies only reporting current contraceptive use or unmet need. Most studies relied on cross-sectional data, and young, unmarried, and male adolescents were largely excluded. We make several recommendations for alternative approaches for a more comprehensive understanding of adolescent demand for contraception in LMICs.     

Telemedicine for contraceptive counseling: An exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic

ObjectiveDuring the COVID-19 pandemic, many clinicians started offering telemedicine services. The objective of this study is to describe the experience of US family planning providers with the rapid adoption of telemedicine for contraceptive counseling during this period.Study designThis is a cross-sectional web-based survey of family planning providers practicing in the United States.ResultsA total of 172 providers completed the survey (34% response rate). Of these, 156 (91%) provided telemedicine services in the 2 months preceding the survey. Most (78%) were new to telemedicine. About half (54%) referred less than a quarter of contraception patients for in-person visits, and 53% stated that the most common referral reason was long-acting reversible contraceptive (LARC) insertion. A majority of providers strongly agree that telemedicine visits are an effective way to provide contraceptive counseling (80%), and that this service should be expanded after the pandemic (84%). If asked to provide telemedicine visits after the pandemic, 64% of providers would be very happy about it. Many providers used personal phones or smartphones to conduct telemedicine visits but stated that ideal devices would be work-issued computers, tablets, or phones. More than half (59%) of providers prefer video over phone visits.ConclusionsFamily planning clinicians in the United States reported a positive experience with telemedicine for contraceptive counseling during the early stage of the COVID-19 pandemic and believe that this service should be expanded. Clinicians seem to prefer using work-issued devices and conducting video rather than phone visits.ImplicationsTelemedicine is a promising option for providing contraceptive counseling even beyond the COVID-19 pandemic. An investment in hospital or clinic-issued devices that allow for video conferencing may optimize clinicians’ telemedicine experience.     

An evaluation of an adolescent family planning program

The family planning program of an adolescent care clinic (ACC) was evaluated to determine its effect on the teenage birth rate. The ACC was attempting to provide more accessible family planning services to a low-income, minority teenage population. The first evaluation compared the teenage birth rate for the target area served by the ACC with a matched area for 4 years before the ACC began offering services ("pre-intervention") and four years after ("post-intervention"). The two groups did not differ for the pre-intervention period, but the ACC target area had a lower birth rate for the post-intervention period (p = 0.015). The second evaluation was designed to compare the teenage birth rate within the target area for adolescents using the ACC and those not using the service for one year. Adjusting for age and race, the rate for the ACC was 58.0 births per 1,000 and for the non-ACC group, 112.4 births per 1,000 (p less than 0.001). The results suggest the importance of providing accessible family planning services for adolescents.     

Estimating the balance of general practice versus family planning clinic coverage of contraception services in London

OBJECTIVE: To compare levels of provision of contraception from general practice and family planning clinics for the populations of the 32 London Boroughs. METHOD: Retrospective analysis of routine activity data, including the estimated numbers of first attendance, for 295 family planning clinics (managed by 28 NHS Trusts) and more than 1800 GP partnerships in Greater London, supplemented by data from a survey of family planning clinics. The results were expressed as the estimated percentage of women aged 16-49 obtaining advice on contraception from GPs and family planning clinics. These results were compared to those expected based on results in the General Household Survey. RESULTS: Across London in 1995/96, 12% of women aged 16-49 obtained contraception services from family planning clinics, and 24% obtained contraception services from a GP. At a borough level there was variation from 11% to 25% in coverage by family planning clinics, and from 11% to 41% in coverage by GPs. Estimates of the proportion of women in this age group not using NHS-provided medical or surgical contraception ranged from 0 to 30%. Across all boroughs, there was no consistent relationship between levels of GP activity and family planning clinic activity. CONCLUSION: The results indicate substantial variations between boroughs in the proportion of women using NHS-provided medical or surgical methods of contraception. The absence of any clear inverse relationship between activity in family planning clinics and activity in general practice suggests that changes to one will not be compensated by changes in the other. More specifically, health authorities that opt to purchase lower levels of family planning clinic activity cannot assume that women may opt to use GPs as an alternative. Such a strategy may increase the likelihood that women who would have used family planning clinic services will either not use contraception at all, or will use less effective 'over the counter' methods.     

Use of contraception and use of family planning services in the United States: 1982-2002

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. METHODS: Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. RESULTS: The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.     

Nursing and family planning: the interfaces of contraception

This work analyses some aspects of family planning policy in Brazil related to contraceptive methods as published in Revista Brasileira de Enfermagem between 1960 and 1997. The subject analysis considers three categories: Catholic church, feminist and official state discourse. According to the records, in the decade of 1960 the Catholic church discourse was predominant. This situation continued in the decade of 1970, accompanied with emerging voice of the official state discourse. In the decade of 1980, the feminist discourse joined. Finally, in the decade of 1990 the feminist discourse continued, the official state discourse was consolidated and that of the Catholic church was not found any more. In conclusion, the journal established family planning on the agenda of Brazilian nursing by the means of scientific production. The methodology used enabled us to identify what are the obligations of nursing with respect to family planning in the context of its relationship with state policies and with the society.     

The role of private providers in maternal and child health and family planning services in developing countries

This paper uses data from the Demographic and Health Surveys program (DHS) in 11 countries in Asia, Africa, and Latin America to explore the contribution of private health care providers to population coverage with a variety of maternal and child health and family planning services. The choice of countries and services assessed was mainly determined by the availability of data in the different surveys. Private providers contribute significantly to family planning services and treatment of children's infectious diseases in a number of the countries studied. This is as expected from the predictions of economic theory, since these goods are less subject to market failures. For the more 'public goods' type services, such as immunization and ante-natal care, their role is much more circumscribed. Two groups of countries were identified: those with a higher private provision role across many different types of services and those where private provision was limited to only one or two types of the services studied. The analysis identified the lack of consistent or systematic definitions of private providers across countries as well as the absence of data on many key services in most of the DHS surveys. Given the significance of private provision of public health goods in many countries, the authors propose much more systematic efforts to measure these variables in the future. This could be included in future DHS surveys without too much difficulty.