Family planning in Britain

In Britain in 1968 there were 780 family planning clinics using all conventional methods except IUDs and 220 IUD clinics. In 1967 of 173,000 new patients, 77,000 chose oral contraceptives, 60,000 chose diaphragms, and 24,000 chose IUDs. A short training course is given to both nurses and doctors. The Family Planning Association is the private agency responsible for promoting birth control advice, information, and services. Since the Family Planning Act was passed in 1967, the National Health Service has the authority to provide family planning service to those who want it for free.     

Family planning in the United Arab Republic

Discussion of the family planning program in the United Arab Republic (UAR) is presented. The Supreme Council for Family Planning was set up in 1965 with the aim of organizing programs of family planning in the UAR as well as setting up time schedules for execution, supervision, follow-up, and evaluation. In 1966, The National Planning Program started to operate 1,991 centers in urban and rural areas for women requesting oral contraceptives. By July of 1969, the number of centers reached 2700. However only villages with government health units have family planning centers. Each center is fully equipped and has a doctor, nurse or midwife, 1 or 2 assistant midwives, a social worker a clerk, and a worker. Centers now also offer IUD services. Propaganda and motivation in connection with family planning is discussed, as is training of personnel involved in the program.     

云南省基层计划生育服务机构宫内节育器放置类型的差异及其成因探讨

目的:比较云南省县、乡计划生育服务机构宫内节育器(IUD)放置类型的差异及其成因。方法:根据计划生育优质服务县的标准将云南所有县分为"好"、"中等"、"差"3层,每层抽取1个县,进行3个县、区的横断面调查。收集与IUD放置类型相关数据及资料,并进行小组及个人访谈以确定县、乡差异原因。结果:云南省县、乡两级机构所放置的IUD类型存在差异、造成差异的原因较多;乡级服务机构采用政府采购IUD的比例高于县级服务机构。结论:应促进各级IUD放置服务机构科学地优选失败率低的IUD类型,进一步提高政府采购IUD的接受性和使用,减少IUD类型选择不当而导致的避孕失败。     

East Asia Review, 1973. 1. Hong Kong

Developments in the field of population and family planning during 1973 in Hong Kong are reviewed. The most significant event of the year was the start of the government family planning program. Hong Kong $2.4 million has been allocated to cover the cost of the government's participation in a phased program to integrate family planning services into its maternal and child health program. 4 part-time clinics run by the Family Planning Association of Hong Kong became the responsibility of the Medical and Health Department in October 1973. In January 1974, 4 full-time clinics will be taken over, and the remaining clinics in maternal and child health centers will be turned over beginning April 1974. This should 3e completed by the end of 1974. The crude annual birth rate for 1973 was 19.8 per thousand. In 1972 it was 19.7. The death rate remained at around 5. The population growth rate increased to around 3%, of which about half was due to immigration from China. There was a 5.8% increase in new acceptors from January 1973 to November 1973. The Association increased its use of the mass media, particularly radio and television. In 1972, the Association conducted a "Study of the Impact of Industrialization on Fertility in Hong Kong" in conjunction with the Social Research Center of the Chinese University. It was determined that industrialization has affected fertility in a number of interrelated ways. Higher education levels, better employment opportunities (particularly for women), urbanization, desire for improved living standards, and postponement of marriage, which are the primary effects of industrialization, have resulted in changing attitudes toward children and childbearing as reflected in the finding that the percentage of people using contraceptives rose from 44% in 1967 to 48% in 1972. In the future, the Association will establish new clinics in those parts of the colony not presently being reached, and it will develop services to reach such groups as working women, men, and "middle-class" clients. The Association will develop large-scale information, education, and publicity programs.     

The McCormick Family Planning Program in Chiang Mai, Thailand.

The McCormick Family Planning Program is a private, single-purpose program that has been offering contraceptive services to women in largely rural Chiang Mai province in Northern Thailand since 1963. In addition to two clinics in Chiang Mai city, the program operates a mobile unit, which visits service points throughout the province. An injectable contraceptive, DMPA, has been selected by about two-thirds of program acceptors since 1965, despite its prevalent side effect of amenorrhea. The service generates sufficient revenues, from relatively low fees for sterilization and contraception, to cover most operating costs. The program is seen as successful in providing rural women with contraceptives services. Aspects of the program--particularly the use of DMPA and the mobile service unit--are considered replicable in other settings.     

加强部门协调 发挥两个积极性 做好计划生育和妇幼保健工作

云南省党委、省政府十分重视妇幼保健和计划生育工作，在统一思想、提高认识的基础上，正确地认识两项事业的关系，把两项事业都摆在优先发展的位置上。省委、省政府加强了对计生和卫生两个部门的领导，使两个部门相互尊重、相互支持、相互配合，在行政管理中加强部门的协调和法规衔接，在业务上互相支持，互相配合，有效地促进了计划生育与妇幼卫生两项事业的共同发展。     

城镇已婚育龄妇女避孕方法选择现状及影响因素调查

目的:了解城镇妇女避孕方法选择现状及影响因素。方法:调查辽宁省皇姑区、山东省临淄区和陕西省灞桥区部分社区20～50岁育龄群众避孕方法选择情况。结果:共调查已婚育龄妇女1807人,平均年龄39.7岁,高中及以上文化71.9%;现避孕率为82.4%;避孕方法构成以宫内节育器(IUD)为主(75.6%),避孕套使用率为18.6%,其它避孕方法使用比例少;高龄、低文化程度、职业人群、有一次活产史及无人工流产史者使用IUD的比例较高;育龄妇女选择避孕方法主要关心有效性、安全性和便捷性,卫生机构、计划生育机构及超市等商业机构为避孕方法的重要获取渠道。结论:参与调查城镇育龄妇女的避孕率较高且以IUD为主,不同特征对象的避孕率及避孕方法构成不同。今后应加强对重点人群的避孕宣教与指导,根据不同对象的特点提供个性化计划生育服务,提高群众对计划生育服务的信任度与利用度。     

A broadly based project

The family planning work in and around the North Thai town of Chieng Mai, under the leadership of Thai doctors and their colleague Dr. Edwin B. McDaniel, is well known in family planning circles. It is estimated that in 1969 about 13,000 women-years of protection against pregnancy were provided. The services are interesting for the variety of methods used and the range of clinical activities undertaken. Family planning is integrated with the local McCormick Hospital. Injectable methods accounted for 1700 new patients last year at this hospital, and in some cases the method was used postpartum. Oral contraceptives and IUDs are also distributed, and 270 women had sterilization operations. Family planning is available too at municipal clinics; here a patient load of 30,000 was served during 1969. There are also mobile clinics, some of which serve villages many miles from the rural capital of Chieng Mai. The mobile clinics work in each area for four days, and served 1350 new patients in 1969, of whom 60% accepted oral contraceptives. Finally, the clinical and administrative experience of the teams working in Chieng Mai has inspired a series of cooperative clinics outside the province. Nearly 4000 new patients attended at these clinics in 1969, and most of them received oral contraceptives. It appears that in order to serve a large community, family planning needs to be offered at a number of different sites and that a variety of methods appears to be necessary in order to get widespread acceptance. It is possible that as schemes develop in a community the fixed and mobile clinics, and clinics which are conducted in buses which are also used for other aspects of community care, may be mutually supportive. It is interesting that injectable contraceptives have proved most popular, but in addition to solving the family planning needs of many women they appear to carry in their wake interest in other forms of family planning, so that when they are used there is an increase in the acceptance of alternative methods, such as oral contraceptives, within the same community.     

Determinants of contraceptive method choice after first delivery, before first abortion, and after first abortion in East China

A 10% sample of the data from East China from the two-per-thousand fertility and contraception survey of the Chinese State Family Planning Committee was analysed to study determinants of contraceptive choice in three situations: after first surviving delivery; before first abortion after first surviving delivery; and after first abortion. A total of 2880 women were included.

For first method choice after first delivery, the most popular method is the IUD, although there are urban/rural differences. Better educated women in urban areas prefer the condom and IUD to the pill, whereas better educated women in rural areas prefer the pill. Younger women prefer the IUD and the pill. For last method choice before first abortion, women who had no sons had apparently high failure rates on the pill.     

Urban-rural differences in attitudes and practices toward long-acting reversible contraceptives among family planning providers in Texas

BackgroundDespite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers’ attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban–rural differences exist in providers’ attitudes toward LARCs and in clients’ use of LARCs.MethodsData were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008).ResultsFindings indicated that, although providers were aware of the advantages of LARCs, clients’ LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers’ misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas.ConclusionsIn light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients.     

Cervical dilatation in interval insertion of an IUD. Who requires it and does it lead to a high expulsion rate?

Cervical dilatation is occasionally performed to facilitate IUD insertions in difficult-to-insert cases. Patient characteristics associated with the need for dilation and whether dilation is associated with an increased risk of early expulsion of the IUD have rarely been studied. This analysis, using the extensive international IUD data base developed and maintained by Family Health International, is intended to answer these questions. This case-control analysis revealed that nulliparous women as well as women who had used oral contraceptives or an IUD in the previous month were more likely to require cervical dilatation at IUD insertion. Breastfeeding women, on the other hand, were less likely to require cervical dilatation to facilitate IUD insertion. Hypotheses are generated from this analysis that need to be tested in future studies. The six- and 12-month gross cumulative life-table expulsion rates and other pertinent termination event rates (e.g., accidental pregnancies and removals due to bleeding and pain) were not found to be higher for women with cervical dilatation than for women without.     

Studies in family planning. 6. Singapore

Family planning progress in Singapore during 1972 is reviewed. The Singapore Family Planning and Population Board launched its most intensive family planning campaign in July 1972. A primary objective of the campaign was to promote both male and female sterilizations. Stronger social disincentives to discourage large family size (higher delivery fees, reduction of income tax deductions, reduction of allowable maternity leaves, and housing priority for small families) have been read in Parliament and will take effect August 1, 1973. The 1972 crude birth rate was estimated at 22.6 per 1000, compared with 22.3 in 1971. The crude death rate remains constant at an estimated 5.4 per 1000. The rate of natural increase has risen to an estimated 17.2 per 1000, compared with 16.9 in 1971. The Second Five-Year Plan (1971-1975) sets a target of 80,000 new acceptors to be recruited evenly throughout the period. In 1972, the Board recruited 17,666 new acceptors. The main method used continued to be the pill, but the number of new pill users dropped from 19,000 in 1968 to 10,000 in 1971 and 1972. The number of condom acceptors dropped from 10,076 in 1968 to 7343 in 1972. IUD insertions were 3703 in 1968, and in 1972 there were only 177 IUDs inserted. Female sterilizations rose from 477 in 1966 to 3848 in 1971 to over 5700 in 1972. Abortions rose from 2929 in 1969 to 5943 in 1972. The Board approved the establishment of a Research and Evaluation Committee at the close of 1972. An Information, Education, and Communication Unit and a Training Center financed by the United Nations Fund for Population Activities (UNFPA) were established in 1972. The Family Planning Campaign is being evaluated by pre- and postcampaign KAP-type surveys. During 1972, clinical trials were initiated on the Dalkon Shield and the Copper 7 with encouraging preliminary results. The average desired family size among Singapore families is 3.6, and there are problems in trying to reduce this figure. The informational aspects of the communications program have reached a "saturation" stage. Future emphasis must be on persuasion and motivation.     

Implenting family planning in a Ministry of Health: organizational barriers at the state and district levels

1. Family planning occupied a subordinate position in the medical and health bureaucracy almost two decades after its introduction. Senior Ministry officials accorded low priority to formal program objectives, while the State Family Planning Officer, the highest state official concerned solely with the family planning program, suffered from a relatively subordinate position in the Directorate and a lack of authority and support. Within the medical profession, family planning was held in low esteem, and the medical and health bureaucracies did not have a mechanism for selecting personnel on the basis of interest and commitment. 2. Organizational adjustment to family planning in the Ministry of Health was a slow and painful process, absorbing the energy and attention of Ministry officials for almost a decade. The repeated reorganizations of the district setup revolving around the division of labor between medical, health, and family planning acitvities and between the rural and urban program, led to months of almost total inertia and detracted substantially from the supervisory capacity of the officials involved. 3. Decision making and guidance suffered from the quick turnover of the Secretary, the most powerful administrator in the Ministry. In Uttar Pradesh Secretaries stayed barely long enough to begin to understand the complex organizational setup of the program. 4. Multiple and often conflicting lines of authority characterized the relationships between the higher and lower echelons within the Ministry. This was accentuated when the District Family Planning Officer was placed under the administrative control of the District Magistrate. While intended to "energize" family planning through the association of the most prestigious and powerful district official with the program, this organizational arrangement resulted in conflicting instructions to the staffs of the primary health centers. 5. The organizational behavior of the Ministry of Health was shaped by the interplay of the various "professional cultures" of its key actors. The generalist administrators' short time horizon and eagerness to produce quantitative results clashed with the specialists' emphasis upon long-term goals and technical constraints; the politician's defense of the interest of his constituents clashed with the administrator's desire to defend his autonomy. The calculus of political survival made support for family planning goals a costly burden that few politicians have been willing to shoulder. As the party system does not reward the advocacy of family planning, ministers emphasize those programs within their ministry or those decisions within their discretion that correspond to the demands of their constituents.     

Failed IUD insertions in community practice: an under-recognized problem?

BackgroundThe data analysis was conducted to describe the rate of unsuccessful copper T380A intrauterine device (IUD) insertions among women using the IUD for emergency contraception (EC) at community family planning clinics in Utah.MethodsThese data were obtained from a prospective observational trial of women choosing the copper T380A IUD for EC. Insertions were performed by nurse practitioners at two family planning clinics in order to generalize findings to the type of service setting most likely to employ this intervention. Adjuvant measures to facilitate difficult IUD insertions (cervical anesthesia, dilation, pain medication, and use of ultrasound guidance) were not utilized. The effect of parity on IUD insertion success was determined using exact logistic regression models adjusted for individual practitioner failure rates.ResultsSix providers performed 197 IUD insertion attempts. These providers had a mean of 14.1 years of experience (range 1–27, S.D. ± 12.5). Among nulliparous women, 27 of 138 (19.6%) IUD insertions were unsuccessful. In parous women, 8 of 59 IUD insertions were unsuccessful (13.6%). The adjusted odds ratio (aOR) showed that IUD insertion failure was more likely in nulliparous women compared to parous women (aOR=2.31, 95% CI 0.90–6.52, p=.09).ConclusionThe high rate of unsuccessful IUD insertions reported here, particularly for nulliparous women, suggests that the true insertion failure rate of providers who are not employing additional tools for difficult insertions may be much higher than reported in clinical trials. Further investigation is necessary to determine if this is a common problem and, if so, to assess if the use of adjuvant measures will reduce the number of unsuccessful IUD insertions.     

规范化培训乡(镇)节育技术人员提高IUD避孕效果

中国农村放置宫内节育器(IUD)的主要技术力量是乡(镇)节育技术人员。在安徽省全省范围内,选择房屋设备、人员情况等基本相同的34个乡(镇)计划生育服务所,随机分配成规范化培训组和对照组;每组随机放置TCu220C和带铜宫型IUD共3073例。填写统一表格,按期随访。生命表法分析随访一年的结果。两种IUD的妊娠率、脱落率、因出血或疼痛取出率等,规范化培训组明显低于对照组,揭示加强乡(镇)节育技术人员的规范化培训,有助于提高IUD的避孕效果。     

Characteristics of contraceptive acceptors in Lusaka, Zambia

This paper reports on a study conducted in Lusaka, Zambia in which 2,912 client records were examined in 22 randomly selected clinics throughout Lusaka Province. The purpose of the study was to assist the government and the local family planning association in targeting future efforts to extend services to underserved populations. Among newly enrolled acceptors in 1984, the study revealed a surprisingly low median age of 24 and a median parity of 3. The majority were married, had some secondary education, were unemployed housewives, and were breastfeeding at the time of the first visit. Nearly half had used contraceptives before. Over three-fourths of the clients received contraceptive pills when they enrolled. They returned to the clinic an average of 2.4 times during the first year, but only 24 percent were still active after 12 months. The availability of recently released census data allowed a comparison of contraceptive acceptors with women in the general Lusaka population. Data from urban clinics and smaller clinics in rural parts of the province revealed few significant rural-urban differences. Finally, the study examined trends in age, parity, and education of contraceptive users over a ten-year period.     

Clinic administration--Malayan experience

Criteria for starting a new family planning clinic in Malaya is described. In villages where there are 7-15 new mothers each month, there will probably be 5-7 acceptors, justifying a monthly visit from a National Family Planning Board nurse. The health subcenter is the best place to hold the clinic and it should be held on the same days as the postnatal clinic. The nurse explains the program and trains the staff to distribute oral contraceptives and keep records. Factors to be considered in the establishment of the clinic include finances, supply systems, staff development, and an evaluation system.     

Non-availability of the IUD and contraceptive choice

The Copper 7 and Lippes Loop IUD are no longer distributed in the United States, and the cost of the Progestasert precludes usage in many family planning clinics. The impact of the loss of this widely used contraceptive method was assessed in a pilot study at the UCLA Family Planning Clinic. The clients who would have selected an IUD at the time of their clinic visit between March and December of 1986 instead chose oral contraceptive pills (55%) or barrier methods (45%) but their level of dissatisfaction with the methods they received was significantly greater than that of all other contraceptors, and this led to their subsequent selection of another method which, in the majority (66%), was of lower efficacy than the IUD. There were two unplanned conceptions amongst twenty women who would have chosen an IUD, both due to non-compliance with oral contraceptive pills; and at the time of survey in March 1987, no clients had opted for sterilization. Women who no longer have their choice of the IUD represent a high risk for contraceptive dissatisfaction and failure, but have not made precipitous decisions to undergo permanent sterilization.     

Family planning--the role of the nurse/midwife in Britain in 1984

This article details the role of family planning nurses and midwives in the British health services today. They receive their training from Family Planning Association nurses in English National Board Course 900, Family Planning Nursing. This course, extending over a 3-month period, is now conducted in 37 centers. 7363 family planning nurses and midwives have received the Statement of Competence since 1976, when the former Joint Board of Clinical Nursing Studies 1st approved the course. The course provides personnel with a thorough background in birth control methods, counseling skills, and recognition of medical conditions. Ongoing education is provided through 1-day courses organized by the employing authority. Extended training also enables nurses and midwives to check and remove IUDs, fit occlusive caps, conduct routine pelvic examinations, and refer abnormal findings to physicians. At present, it is not within the scope of the role of nurses and midwives to prescribe hormonal contraception. Family planning is an area of medicine where well trained nurses and midwives can play an especially important role, freeing up physicians to concentrate on the more complicated cases. International exchange visits could provide family planning nurses and midwives with a better understanding of population planning issues in other areas of the world.