Family allowance and family planning in Chile.

Family allowances designed to promote maternal and child health and welfare could be self-defeating if they stimulated otherwise unwanted births, as often assumed. That assumption, with its public health and demographic implications, needs testing. An attempt to test it was made in Chile in 1969--1970 through interviews with 945 wives receiving an allowance and 690 non-recipients. Recipients practiced contraception significantly more than did non-recipients. This was not explained by wives' educational attainment or employment, the couples' earnings, or number of living children, but was associated with a 50 per cent greater utilization of professional prenatal care by recipients during the most recent pregnancy; women with such care (regardless of allowance status) were 75 per cent more likely than others to control their fertility. Prenatal care was probably sought more by recipients in part because an additional stipend was provided as soon as pregnancy was confirmed, usually at clinics with integrated family planning. Greater family income, attributable to the allowance, probably also contributed to the recipients' better prenatal attention and to contraceptive practice. Noteworthy, too, was the finding that with the number of living children controlled, contraceptive practice was significantly greater amoung couples who had never lost a child.     

Family planning in the balance

Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents. National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights. In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy.     

Family planning in India

The overall impact of the family planning movement on the Indian birth rate has been negligible so far, with only token areas of success. In 1961 there were 75 million couples of reproductive age; the present estimate is 84 million. Of these couples, 1.1 million have been sterilized and 400,000 fitted with IUDs, while 500,000 use other forms of contraception. Thus only 2.4% of reproductive age couples are contraceptive users, instead of the 65% who would have to use completely efficient contraceptive means in order to reduce the present birth rate of 40 per 1000 to 25 per 1000 by 1975: this indicates the vast size of the problem. Education and propaganda are needed, but the results of research into the best way of approaching the people about planning would come too late. An all-out communication and education programme would be launched in the field, together with an effective service programme. Communication experts, doctors, and demographers are all needed to formulate and carry out family planning policies. All the main methods of contraception should be offered. Sterilization, generally regarded as irreversible, is not attractive to younger couples; the IUD is becoming more and more popular and condoms are used quite extensively. No mention is made of oral contraception.     

Family planning in Italy

In the past 5 years, four knowledge, attitude and practice (KAP) surveys on family planning have been organized by the Unit of Population Survey Methodology of the Istituto Superiore di Sanita' (National Institute of Health). These surveys show that during the past 20 years, use of reliable contraceptives in Italy has increased, particularly in the North, encouraged by the more open attitude toward sexual behavior, following legalization of the provision of information on contraception and abortion upon request, and other social and cultural changes.In 1989 and 1991, 25% of women in Central and Southern Italy were using the pill or an IUD. However, the percentage of women not using contraceptives was still high (26% in 1989, and 19% in 1991) and withdrawal was the most widley used method (31% and 33%). The data show large regional differences.The main reasons for not using contraception, in the 1989 study, were fear of side-effects and ignorance, especially in the youngest and oldest women. Those least likely to use modern contraception were the young, the ill-educated and the nulliparous women.Lack of information seems to be the main problem in Italy. In fact, the 5044 women interviewed showed a medium level of knowledge of contraception, with only 63% who could identify correctly the fecund period in the menstrual cycle. However, their attitude toward the use of modern contraception was positive; 65% of the women interviewed said they would recommend the Pill or an IUD to a friend, and 10% of them would recommend condoms.Induced abortion is still common in Italy (13 reported abortions per 1000 women aged 15–44), although the incidence has steadily decreased since 1982. In the vast majority of cases, abortion was an emergency measure after the failure of contraceptive methods. It has been calculated that from 10% to 50% of induced abortions might be prevented in a short period through appropriate programs of health education and family planning involving the 2474 governmental maternal and child healt clinics in Italy.

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Resumen En los 5 últimos años, la Sección de Metodología de Encuestas Demográficas del Istituto Superiore di Sanità realizó cuatro estudios de conocimiento, actitud y práctica (KAP) respecto a la planificación familiar. Estos estudios indican que, en los 20 últimos años, el uso de anticonceptivos fiables en Italia ha aumentado, especialmente en el norte, fomentado por una actitud más abierta en cuanto a la conducta sexual, tras la legalización y otros cambios sociales y culturales.En 1989 y 1991, el 25% de las mujeres de la región central y meridional de Italia utilizaban la pídora o el DIU. Sin embargo, el porcentaje de mujeres que no utilizaban anticonceptivos continuaba siedo alto (26% en 1989 y 19% en 1991) y elcoitus interruptus era el método más utilizado (31% y 33%). Los datos indican grandes differencias regionales.Los motivos principales de la no utilización de anticonceptivos, en el estudio de 1989, eran el temor a los efectos secundarios y la ignorancia, especialmente entre las mujeres de menor y de mayor edad. Las que probablemente menos utilizaran anticonceptivos modernos eran las mujeres jóvenes, las de bajo nivel de educación y las nulíparas.La falta de información parece ser el problema principal en Italia. En realidad, las 5044 mujeres entrevistadas tenían un nivel medio de conocimiento y sólo el 63% pudo identificar correctamente el período de fecundidad del ciclo menstrual. Sin embargo, su actitud respecto al uso de anticonceptivos modernos era positiva; el 65% de las mujeres entrevistadas manifestaron que recomendarían la píldora o el DIU a una amiga y el 10% de ellas recomendarían preservativos.El aborto provocado continúa siendo común en Italia (13 abortos notificados por cada 1000 mujeres de 15–44 años de edad) si bien su incidencia ha disminuido constantemente desde 1982. En la gran mayoría de los casos, el aborto era una medida de emergencia después del fracaso de un método anticonceptivo. Se ha calculado que del 10 al 50% de los abortos provocados podría impedirse en un plazo breve mediante programas apropiados de educación sanitaria y planificación familiar con la participación de las 2474 clínicas maternoinfantiles estatales de Italia.

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Resumé Au cours de cinq dernières années, le service chargé de la méthodologie pour les enquêtes sur la population à l'Istituto Superiore di Sanità a organisé quatre enquêtes sur les connaissances, les attitudes et les pratiques en matière de planning familial. Ces enquêtes ont révélé qu'au cours de vingt dernières années en Italie, l'utilisation de contraceptifs fiables s'est répandue, notamment dans le nord du pays, encouragée par une attitude plus ouverte à l'égard du comportement sexuel à la suite de changements législatifs et autres dans le domaine social et culturel.En 1989 et 1991, 25% des femmes en Italie centrale et méridionale utilisaient la pilule ou un DIU. Le pourcentage de femmes ne faisant appel à aucune méthode de contraception était cependant encore élvé (26% en 1989 et 19% en 1991) et le retrait était la méthode la plus fréquemment adoptée (31% et 33%). Les données font apparaître d'importantes différences régionales. D'après l'étude de 1989, les raisons essentielles du non emploi des contraceptifs provenaient de la crainte d'éventuels effects secondaires et de l'ignorance, surtout chez les juenes et les femmes plus âgées. Les femmes les moins susceptibles de faire appel à la contraception moderne étaient les jeunes, les femmes peu éduquées et les nullipares.Le manque d'information semble être le problème principal en Italie. En fait, les 5044 femmes interrogées ont fait preuve de connaissances moyennes sur la contraception, 63% à peine étant capables d'identifier correctement la période de fécondité du cycle menstruel. Leur attitude à l'égard de la contraception moderne était cependant positive; 65% des femmes interrogées ont répondu qu'elles recommanderaient la pilule on un DIU à une amine, et 10% qu'elles recommanderaient le préservatif.Les avortements provoqués sont encore fréquents en Italie (13 avortements signalés pour 1000 femmes de 15 à 44 ans), mais leur incidence a progressivement diminué dequis 1982. Dans la grande majorité des cas, l'avortement est une mesure d'urgence après l'échec des méthodes de contraception. On a calculé que 10 à 50% des avortements provoqués pourraient être évités en peu de temps si l'on prévoyait des programmes appropriés d'éducation sanitaire et de planning familial dans les 2474 cliniques maternelles et infantiles qui existent en Italie.

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This paper is a revised version of one presented at the Workshop Acceptance and Effectiveness of Modern Contraception, organized by the International Health Foundation at the SAC Meeting, Barcelona, Spain, October 1992.     

Family planning in Uganda

Characteristics of child welfare clinics with family planning services, postnatal clinics with family planning services, and separate family planning clinics, all in Uganda, are discussed. During the years 1964-1967, growth was most rapid in and attendance was larger at separate family planning clinics. It is thought that this is the only way women in small villages will ever be reached. Whether a family planning clinic is a separate unit or is integrated with other clinics depends on the local situation. When women begin to learn that there are safe ways of controlling fertility, the government will probably begin offering these services along with other maternal and child health services. Until that time, the Family Planning Association has an important role to fill in offering these services in whatever manner the situation permits.     

Family planning in Pakistan

The Pakistan Family Planning Program functions as an autonomous body through the Ministry of Health. The Minister of Health is chairman of the Family Planning Council which is the main policy and planning unit. Each province has a Provincial Family Planning Board responsible for implementation. The District Family Planning Board functioning within the province is in charge of publicity and education, distribution and sale of supplies, and provision of clinical services and facilities. The District Board has about 1000 workers--medical and paramedical in the clinics, family planning officers for education and motivation, lady organizers (local motivator and agent of sale of conventional contraceptives), and agents (outlets for conventional contraceptives). There are full-time clinics for IUD insertions, follow-up, and medical and paramedical training; part-time clinics; and mobile clinics for IUD service in remote areas. In 1967-1968 there were 938 clinics: 361 urban and 577 rural. There were 46 full-time and 315 part-time urban clinics and 158 full-time and 419 part-time rural clinics. 65,000 IUD insertions are done a month.     

Family planning in Africa

More than 100 delegates from many African countries attended a seminar on the role of family planning in African development, which was held at the University College in Nairobi, Kenya from December 12-16, 1967. This article outlines some courses of action suggested at the session dealing with the training of family planning personnel. Medical schools should ideally include family planning in their curricula and should be encouraged to set up family planning clinics as part of the teaching facilities. African students studying overseas should adapt their learning to their own countries. General practitioners need at least a 3-day intensive course in family planning. The training of paramedical personnel is also discussed.     

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 Benin--knowledge,attitudes and practice

"This article will deal with the family planning situation in Benin, more precisely [with] the level of knowledge, attitudes and practice (KAP) concerning modern contraceptive methods, and the hope for a successful family planning programme in Benin. We will look at studies which have already been done and we will also present some promising results of an experimental study which we carried out [in 1990]...." The period studied is from 1979 to 1991.     

Family planning clinic services in the United States, 1983

Almost five million women were enrolled in family planning clinics in the United States in 1983, eight percent more than in 1981. The number of family planning provider agencies declined slightly, from 2,504 to 2,462, but the number of clinic sites that could be identified increased slightly, from 5,124 to 5,174. Family planning clinics operate in three-quarters of U.S. counties; in 1975, the last time county coverage was checked, four-fifths of the counties had clinics. About one in 20 women who are exposed to the risk of unintended pregnancy and live in unserved counties are teenagers or low-income women. Nonmetropolitan counties are more likely to be without clinics than are metropolitan counties. Overall, there are 417,000 low-income women and 249,000 teenagers at risk of unintended pregnancy living in counties where there are no family planning clinics. In 1983, health departments constituted six in 10 of all family planning agencies and served two-fifths of all family planning clinic patients; Planned Parenthood affiliates accounted for fewer than one in 10 agencies and served more than one-quarter of all patients. Hospitals and all other agencies served about one-third of the total 1983 caseload. These patterns were similar to those reported for 1981. Family planning clinics continue to serve primarily low-income women: Four-fifths of the nearly five million clinic patients in 1983 had family incomes below 150 percent of the federally defined poverty level. About 1.6 million women aged 19 and younger were served, representing one-third of all clinic patients in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)     

中国生殖健康方案的推进和已婚育龄人口避孕模式转变——ICPD+10: 避孕方法的医控模式和自控模式有变化吗

  目的  利用既往数据了解避孕方法的夫妻内部决策与妇女对现采用避孕方法满意度的关系,发掘过去计生工作的问题,为优化“全面二孩”时期避孕节育服务提供思路。  方法  选取2001年全国计划生育和生殖健康调查中15 654名15～49岁育龄妇女,对避孕方法决策者以及避孕方法的满意度进行描述性分析,通过二分类logistic回归分析避孕方法决策者与满意度之间的关联。  结果  所调查的育龄妇女中,对目前采用的避孕方法满意率为79.87 %。不同决策者选择的避孕方法间的满意度存在明显差异。妇女对自己选择和丈夫选择的避孕方法满意的可能性分别是夫妻共同选择的1.13（95 % CI = 1.02～1.24）倍和0.71（95 % CI = 0.54～0.93）倍。避孕方法决策与满意度的关系存在城乡差异。  结论  育龄妇女对自己选择及夫妻共同选择的避孕方法满意度更高。中国开放二孩后,应避免以往计生工作中存在的问题,加强知识普及,维护妇女家庭和社会地位,提倡男性参与并保障女性的生育自主权,进一步推进优质生殖健康服务。