Integrated family planning services: a Nigerian experience

An integrated health and family planning program, operated by the University of Ife Teaching Hospital, was assessed to determine the impact of the integrated approach on family planning service utilization among the predominantly Yoruba residents of the city. In Nigeria, family planning services are generally delivered in clinics which have little or no connection with medical facilities, and service utilization is low. In 1979 the hospital decided to include family planning as part of the routine medical services provided at its 8 clinics located within a 25 kilometer radius of the hospital. Staff members at the clinics were trained in family planning. Trained female fieldworkers conducted motivational activities to encourage the women in the community to use the family planning services of the clinic. The program provided women with an opportunity to obtain contraceptives in a familiar setting and as part of their routine medical care. Neither parental nor spousal consent was required. Yoruba men tend to oppose family planning. Data for the study was obtained from the records of the program's 1495 new acceptors served by the program during its first 2 years of operation. 50.6% of the acceptors were 25-34 years of age, and another 31.7% were between 35-44 years of age. Very few teenagers utilized the services. 96% of the wome were married and they had an average of 4.4 living children. 56% were Catholic, 25% were Protestant, and 16% were Muslim. 37% were illiterate, and another 42.5% could barely read or write. Most were wives of government workers or service men. 88% had never used a modern contraceptive, and 94.5% were not using a method at the time of their first clinic visit. 68.4% of the acceptors were referred to the clinic by the fieldworkers or other health personnel. Only 11.2% sought the services on their own. 85% of the acceptors choose oral contraceptives (OCs), 13% had IUDs inserted, 0.3% were sterilized, and the remaining 2% chose other methods. The low sterilization rate probably reflected the fact that spousal consent was required for sterilization. Side effects reported by the OC users included asthma (9.6%), headaches (5.2%), phlebitis (3.5%), jaundice (1.7%), chest pain (1.5%), depression (1.5%), scanty menses (0.8%), and high blood pressure (0.4%). Among IUD users, 10.8% had intermenstrual bleeding, 18.4% reported pelvic pain, and another 6.8% reported a variety of other problems. 42.1% of the acceptors wanted no more children, and the remainder wanted to avoid the hardships associated with traditional methods of spacing. Correlation analysis revealed that the total number of living children was negatively related to maternal education and that women with sons wanted significantly fewer additional children than women with fewer or no sons. 51% of the acceptors were continuing contraceptive use at the time of the study. The study confirmed the feasibility of an integrated approach. The findings should be of use to government officials who want to improve service utilization in the national family planning program.     

我国中西部基层计生服务人员激励因素现状调查

目的 从员工评价的角度,了解目前我国中西部基层计生服务人员激励因素的现状.方法 对样本县乡计生机构进行员工问卷调查.结果 县乡计生服务人员收入水平均较低,县级计生机构保障略高于乡级（P＜0.05）,县乡计生服务人员均认为设备已得到改善,但是生活便利方面乡级比县级差（P＜0.01）,此外,在培训机会、晋升及职业发展机会等方面,乡级较县级差（P＜0.01）.结论 计生机构激励制度改革应从多个方面着手,要重视乡级激励因素改善,建立县乡一体化,以提高基层计生人力的工作动力.随着新一轮国务院机构改革启动,为提高计生服务质量和稳定基层计生队伍,有必要从薪酬、福利、晋升等方面着手,提高基层计生机构宫内节育器（IUD）放置人员工作的积极性.     

Impacts of Clinic-based Informed Choice Program on Quality of Individualized Counseling Service in China

Objective To evaluate the impacts of clinic-based informed choice program on quality of individualized service in family planning clinics in China。Methods During the program, family planning service staff in intervention clinics were trained on counseling skills and key points of individualized counseling service.Questionnaire surveys were conducted pre- and post-informed choice program to evaluate the impacts of the program.Results Informed choice program had significantly improved the quality of individualized counseling service. The multivariate regression analysis showed that clients of the clinic were more likely to give the better evaluation of the service, the OR of evaluation score of individualized service is 1. 712 (95% CI is 1. 146 to 2. 564) in Experiment Group of post-program in contrast with pre-program. The program also could satisfy individual needs of clients and increase the satisfaction degree of the service.Conclusions Informed choice program is helpful for the improvement of the quality of individualized counseling service. It is necessary and imperative to improve the skills of counseling service provided in family planning clinics.     

Colposcopy in a family planning clinic: a future model?

The first year's experience of a satellite colposcopy clinic in the Glasgow Family Planning Centre was analysed. Establishment of the clinic was supervised by an experienced member of the colposcopy team at the department of gynaecology, Western Infirmary, Glasgow, who trained one of the family planning centre's staff. Close links were thus maintained with the hospital clinic to which patients were referred for treatment. The policy at the new colposcopy clinic was to study prospectively all women in the hospital catchment area whose cervical smears were reported as abnormal. In 58 of 162 such patients there was at least moderate dyskaryosis and the cytologist's recommendation had been referral for colposcopy. In 104 cases the changes were either atypia alone or mild dyskaryosis and a repeat smear was recommended within three to 12 months; 18 of these patients had grade II or III cervical intraepithelial neoplasia on biopsy, and relying on repeat smears would have resulted in an 11.7% false negative rate. If an atypical cytological picture is to be an indication for colposcopy clinics attached to family planning centres may have an important role, given satisfactory training and close links with central specialist colposcopy clinics.     

Expanded services for intrauterine contraception in Sudan

Twenty nurse-midwives in government service in the Sudan (health visitors) were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by obstetrician-gynecologists who found that only six (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors with respect to perforations, infections, expulsions, and pregnancies compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertions which would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.     

刍议在基层计划生育服务机构开展生殖道感染防治的意义

随着我国的计划生育工作发生战略性的转变,国家人口计生委组织实施的包括生殖道感染（RTI）干预工程在内的＂三大工程＂在全国计划生育服务机构逐步推开。基层计划生育技术服务工作也有了新的内容,特别是包括RTI防治工作面临新的、巨大的机遇。经过多年各级政府的努力,基层计划生育服务网络逐步健全,技术人员、技术设备逐步配齐,开展生殖道感染防治的条件成熟。     

The provision of family planning services by family doctors in a Health Board region

A survey was carried out to ascertain the extent of family planning services provided by family doctors. Of the 134 doctors surveyed, 119 (88.8%) replied. Of these 97 (81.5%) were male, 30 (25.2%) were aged less than 40 and 22 (18.5%) were greater than 60. Sixty-four (53.8%) worked in single-handed practices, 52(43.7%) were vocationally trained, 101 (84.9%) had the MICGP or equivalent and 42 (35.3%) had a family planning certificate. Of the 119 respondents, 99 (83.2%) give instruction in natural family planning methods, 114 (95.8%) prescribe oral contraceptives, 102 (85.7%) prescribe the “morning after pill”, 40 (33.6%) fit diaphragms and 17 (14.3%) fit intrauterine devices. Only 3 (2.5%) perform male sterilisations. Doctors aged less than 60 years were 1.3 times more likely to prescribe oral contraceptives (p <0.0001), and were four times more likely to fit diaphragms (p<0.01). Doctors who hold a family planning certificate were 2.4 times more likely to fit diaphragms (p<0.001) and were 2.5 times more likely to fit intrauterine devices. As to who should provide these services, the family doctor was the preferred option for 95 (79.8%) with regard to natural family planning, 107 (89.9%) for the contraceptive pill, 76 (63.9%) for the diaphragm, 58 (48.7%) for the intrauterine device, 45 (37.8%) for male sterilisations and 4 (3.4%) for female sterilisations. Younger doctors and those with a family planning certificate were more likely to say that family doctors should provide these services. Whilst family doctors provide some aspects of a family planning service, there are clearly identified service and training needs emerging from this study which need to be addressed if family doctors are to provide a comprehensive family planning service.     

Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Since the International Conference on Population and Development held in Cairo in 1994, and the Fourth World Conference on Women held in Beijing in 1995, the international organizations and public health communities have paid more attention to reproductiv…     

Some factors affecting acceptance of family planning in Manus.

This paper examines selected factors affecting the acceptance and delivery of modern family planning from health centres in Manus. A survey was carried out of mothers attending Maternal and Child Health clinics and a written questionnaire was given to health workers. The survey of mothers demonstrated the importance of the husband's approval for contraceptive practice and showed that knowledge about traditional methods of family planning is widespread. The health workers' questionnaire demonstrated a high level of dissatisfaction with the current family planning program delivered by health clinics: 45% found the program ineffective; 68% wrote that health workers' attitudes discouraged mothers from attending for family planning. The perceived and actual benefits and costs of children and the role of men should be assessed locally before planning future family planning programs. Widespread retraining and motivating of health workers is essential if improved coverage is to be achieved through health services. The efficacy of alternative methods of delivery of family planning such as local community-based and social marketing programs should also be investigated.     

Family planning in Melbourne: a medical-social project

The 1st 12 months of operation of a family planning clinic, established by the Brotherhood of St. Laurence in a low income district of Melbourne, Australia, was assessed. The Brotherhood decided to establish the clinic despite the attitude on the part of the medical and social work personnel that the demand for family planning services among low income groups was insignificant. The Brotherhood believed that it was not possible to assess the demand since the services had never been made widely available to the city's poor. During the initial 12 months of operation, 185 patients utilized the services of the clinic and they made a total of 208 return visits. The majority of the patients were referred to the clinic by public hospitals or by the Brotherhood. 72% of the patients had incomes below $50 a week, which is the standard used to denote limited means in Australia. 79 of the 185 patients had only 2 or 3 children. Many of the patients came to the clinic from outside the district. 126 of the patients chose oral contraceptives, 46 chose IUDs, 6 chose the diaphragm, and 2 chose the ovulation method. Patients paid according to their income, and no one was turned away because of inability to pay. Husbands and wives were urged to attend, and the clinic was open in the evening to accommodate clients who worked during the day. The Brotherhood is a welfare organization and normally does not provide family planning services. It is too early to determine whether the services will be used sufficiently to justify the government or some other organization setting up a permanent clinic in the district. At the present time the Brotherhood is planning to continue operating the clinic and is also planning to conduct an attitudal survey among the residents of the district.     

Quality of care in family planning clinics in Jamaica. Do clients and providers agree?

This paper uses data from 199 providers and 20 simulated clients collected at 50 public sector and Non Governmental Organization (NGO) health facilities islandwide in 1995 to compare the two groups' views on quality of care of family planning services. Each of the five components of quality of care studied can be improved in Jamaica. Nearly two-thirds of the simulated clients felt able to freely choose a contraceptive method; however, more adequate and appropriate information needs to be imparted to clients through improved counselling, including promotion of dual method use (against STD/HIV/AIDS and conception). The requirement that a woman must be menstruating to receive services has inadvertently resulted in many clients going away empty-handed (without counselling or condoms) when they visit family planning clinics. While providers generally treat clients well, training and service delivery practices need to be revised to improve the technical competence of providers. All of the providers would recommend these clinics to others, compared to a little over half of the simulated clients. Both the providers and simulated clients said that privacy should be strengthened, particularly in small facilities in rural areas. Many of these aspects of quality of care are being improved in Jamaica's public sector health facilities. Managers can learn more about quality of care by seeking the knowledge, opinions and experiences of both providers and clients.     

Fournier's gangrene complicating vasectomy

Quality of care of services provided to family planning clients is a source of major concern in reproductive health care, especially in resource-poor settings. It may be measured in terms of safety of the method or service provided and may be influenced by the knowledge, skills and experience of the service providers, the environment in which the services are provided and the care thereafter. As a result of various efforts by the government and other stake-holders there have been tremendous developments in the family planning programme in Malawi in the past ten or so years. The contraceptive prevalence rate (CPR) more than doubled between 1992 and 2000. Secondly there has been expansion of facilities providing contraceptive services and the method mix such as introduction of voluntary surgical contraception (VSC) for both females and males. The increased demand for contraceptive services has outstripped the available services and as a result led to lapses in the quality of care. These have resulted in some apparently healthy individuals either dying in the course of or following service provision or suffering serious morbidities. This paper presents two cases of Fournier's gangrene following vasectomy in previously healthy male adults in Malawi. It discusses their diverse management and results thereof, and explores the potential impact on the programme in Malawi, in the context of adverse publicity on contraceptives. The possible operational factors for the complications are explored and preventive strategies proposed to ensure sustenance of the already registered gains in fertility control in Malawi.     

Role of planned parenthood for enrichment of the quality of life in Sri Lanka

The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was 5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.     

社区全科医生儿科临床适任能力培训效果评价及其对社区儿科门诊运行的影响研究

背景　目前我国儿科医疗的“供需矛盾”正逐渐凸显,全科儿科的发展是最有可能缓解儿科医疗资源紧张的突破口。在嘉定区,社区儿科服务能力明显不足。在此背景下,为了合理配置儿童医疗资源,解决常见病、多发病占用儿童专科医院资源的难题,2017年上海市嘉定区原卫生计生委开展了“全科医师儿科临床适任能力培训”项目。目的　调查第一批“上海市嘉定区全科医师儿科临床适任能力培训”项目对该区13家社区卫生服务中心开展全科儿科门诊的影响。方法　2018年1-3月,采用自主设计问卷对14名参培“上海市嘉定区全科医师儿科临床适任能力培训”项目的全科医生和社区其余未参培的部分全科医生进行调查。问卷内容包括接受调查全科医生的基本情况、社区开展儿科门诊后的现状及全科医生对儿科培训的建议。结果　共发放问卷207份,问卷全部有效回收,其中参培全科医生14名,未参培全科医生193名。50.0%（7/14）的参培全科医生认为自己能够胜任儿科门诊接诊,78.6%（11/14）能够掌握一些儿科常见危重症的急救处理,71.4%（10/14）认为已掌握了儿科用药规律。参培全科医生和未参培全科医生拟开展儿科诊疗的方式意愿、拟开展儿科门诊的时间意愿比较,差异有统计学意义（P<0.05）。社区儿科开展后,多数社区接诊量均小于5人次/半天。64.3%（9/14）的参培全科医生愿意参加更多儿科培训。结论　参培全科医生认为参加培训后开展社区儿科门诊的能力有所提高,但当前实践中仍存在儿科接诊经验不足、儿科药物及检验缺乏、儿科门诊就诊量少等问题,需要进一步改进。     

农村已婚育龄妇女避孕方法满意度分析

目的　了解目前农村已婚育龄妇女对可逆性避孕措施的满意度 ,并分析其影响因素。方法　采用整群抽样的方法对我国 4个地区 8个乡镇 30个行政村的 2 0～ 4 9岁已婚未绝育妇女进行结构式问卷调查。结果　已婚育龄妇女对所用避孕方法的总体满意度高 (98.8% )。育龄妇女的年龄、当前采用的避孕方法、该避孕方法的获得途径、该避孕方法的决定主体、生殖道感染状况、计划生育综合知识得分 ,以及人流次数会影响育龄妇女对现用避孕方法的满意度。结论　避孕方法知情选择是提高育龄妇女对现用避孕方法满意度的重要途径。普查普治生殖道感染 ,推广RTI干预工程 ,提高女性生殖健康状况 ,有利于提高女性对避孕方法的满意度。继续完善和发展计划生育网络 ,为育龄妇女提供方便、快捷和高质量的计划生育 /生殖健康服务是计划生育优质服务推广的平台保证     

上海县妇女保健服务

上海县妇女保健服务在1981～1990年间,依靠三级保健网络对妇女进行了以孕产期为中心的系统保健,即在早孕建卡、定期产前检查、住院分娩、科学接生和产后访视等方面做到系列服务,重视高危孕产妇的管理和推行孕期家庭自我监护。每3～5年还为已婚育龄妇女进行一次妇女病普查普治。1988年开始实行的婚前健康检查制度和开展的婚育疾病指导,促使妇幼保健工作朝优生优育方向发展。     

Family planning and public health in Georgia: an enlarged commitment

County clinics reached an estimated 4% of eligible women in 1964 in Georgia. Continuing high crude birth rate showed a large gap between those eligible and interested and those, particularly nonwhites, being served. Although family planning was offered in 133 of 157 counties, the statewide postpartum return rate was only 24% in 1963-4. The maternal mortality rate in Georgia in 1964 was 5.7/10000. Of the 57 maternal deaths, 14 were associated with abortion and 15 with parities of 5 or more. Infant mortality rates were also higher than national figures, 29.2/1000. In November, 1974 State Health Department officials and prominent doctors reorganized the program to offer newer, more modern methods, e.g. oral contraceptives and IUDs, summarized the terms of state subsidization, and enabled clinics to consider systematically all the medical requirements for use of modern methods. Because of cost efficiency and ease of use, the IUD was the mainstay of the program. County acceptance increased steadily since June 1965. By 1966, 96 counties had plans for expanding services. By the end of 1965, 2434 devices were inserted, 832 women accepted oral contraceptives, and 4649 women were using traditional methods.     

兰州新区家庭医生签约居民续签意愿及影响因素研究

背景　家庭医生签约服务是以全科医生和被签约居民为主体建立起来的一种契约式服务,家庭医生是签约服务的第一责任人,为签约居民提供安全、有效、方便、价廉的基本医疗卫生服务,引导居民合理利用卫生资源,保障居民健康状况,实现人人享有初级卫生保健的目标。目的　了解兰州新区已签约居民续签意愿及其影响因素。方法　2018年3—6月,采用分层随机抽样法,选择兰州新区3个乡镇54个行政村的650例签约居民,采用自行设计的《已签约居民家庭医生式服务需求评估问卷》进行问卷调查。问卷内容包括：居民基本情况及家庭医生签约服务知晓情况、利用情况、需求情况及续签意愿。采用Logistic回归分析签约居民续签意愿的影响因素。结果　共发放调查问卷650份,回收有效问卷622份,有效回收率为95.7%。签约居民有续签意愿者占82.0%（510/622）。Logistic回归分析显示,是否清楚建有健康档案、是否愿意在社区继续康复治疗、是否需要家庭医生提供上门服务对签约居民的续签意愿有影响（P<0.05）。结论　是否清楚建有健康档案影响居民的续签意愿,愿意在社区继续康复护理者续签意愿较高,需要家庭医生提供上门服务者续签意愿较高。建议促进医疗卫生资源合理下沉,根据居民健康需求提供个性化服务,完善差别化医保政策,畅通转诊渠道。