Contraceptive use and pregnancy before and after introducing lactational amenorrhea (LAM) in a postpartum program

There is good evidence that lactational amenorrhea (LAM) is an effective method of fertility regulation during the first 6 months postpartum, provided no other food is given to the baby and the mother remains amenorrheic. However, although breast-feeding is strongly promoted in many maternity hospitals that also run postpartum family planning progams, LAM is rarely included among the contraceptive options being offered.This paper presents the results of an operational study which compared the prevalence of contraceptive use and the cumulative pregnancy rate at 12-months postpartum among 350 women observed before and 348 women studied after introducing LAM as an alternative contraceptive option offered to women following delivery at the Instituto Materno–Infantil de Pernambuco (IMIP), in Recife, Brazil.The percentage of women not using any contraceptive method was significantly lower (p<0.0001) after the intervention (7.4%) than before (17.7%). This difference remained statistically significant after controlling for age, number of living children, marital status and years of schooling. The proportion pregnant one year postpartum was also significantly lower (p<0.0001) after the introduction of LAM (7.4%) than before (14.3%), but the difference was no longer significant after controlling for the same variables. It is concluded that LAM is a useful addition to family planning postpartum programs.     

The contribution of social science research to population policy and family planning program effectiveness

Social science research has made important contributions to population policy and to the effectiveness of family planning programs. Social science concepts, theories, and methods potentially are relevant to all aspects of reproductive behavior, including actual fertility, proximate variables, and desired family size. Social science research also contributes to the understanding of the social, economic, and political institutions that potentially affect, either directly or indirectly, the whole biosocial reproductive system and family planning programs. At least as important as its specific theories and findings is the role of social science in testing how to adapt such knowledge to distinctive national and local cultural circumstances of family planning programs. A central point is that carefully monitored pilot projects are desirable before launching full-scale national programs, as well as being continuing resources for program development. The research on early programs in Asia has been important, because those programs encountered and overcame some of the presumed obstacles to new programs.     

A decade of Nepal's family planning program: achievements and prospects

Knowledge and practice of family planning in Nepal increased considerably from mid-1976 through mid-1986, with significant improvements in the availability of and accessibility to contraceptives. However, a proportionately larger share of the achievements were made during 1976-81 than in 1981-86. The impact on fertility of contraceptive use during the decade was minimal. Knowledge and use of reversible contraceptive methods remained very low, primarily because of the continued strong emphasis on sterilization in Nepal's family planning program. Consequently, the welfare of many couples who may be in need of contraception for spacing births, but not necessarily for terminating childbearing, does not appear to be adequately addressed by the program. A more balanced emphasis on reversible methods of contraception does not necessarily imply that a substantially higher level of contraceptive prevalence would be required to reach the fertility target. Several steps to improve program performance and contraceptive method mix are suggested.     

Psychoanalytic perspectives on substance abuse: implications for treatment, program planning and social policy.

Current clinical and socio-political interventions with substance abusers are based on two suppositions regarding the addict: a cognitive ability to discern harm to oneself, and a corresponding capacity to discipline oneself in recognition of the punitive consequences of behavior. A psychoanalytic understanding of the addict's intrapsychic needs provides clarification of these assumptions: offering a psychodynamic explication of why the addict can not "just say no." A comparative analysis of early psychoanalytic thought and contemporary ego psychology elucidates the relationship between hysteria and the addictions, demonstrated in clinical studies with addicted patients. The clinician's use of self is delineated as a treatment tool, mirroring the need for self-exploration on societal and political levels, with implications for treatment, program planning and social policy.     

Responsive feeding: implications for policy and program implementation

In this article, we examine responsive feeding as a nutrition intervention, with an emphasis on the development and incorporation of responsive feeding into policies and programs over the last 2 decades and recommendations for increasing the effectiveness of responsive feeding interventions. A review of policy documents from international agencies and high-income countries reveals that responsive feeding has been incorporated into nutrition policies. Official guidelines from international agencies, nongovernmental organizations, and professional organizations often include best practice recommendations for responsive feeding. Four potential explanations are offered for the rapid development of policies related to responsive feeding that have occurred despite the relatively recent recognition that responsive feeding plays a critical role in child nutrition and growth and the paucity of effectiveness trials to determine strategies to promote responsive feeding. Looking to the future, 3 issues related to program implementation are highlighted: 1) improving intervention specificity relative to responsive feeding; 2) developing protocols that facilitate efficient adaptation of generic guidelines to national contexts and local conditions; and 3) development of program support materials, including training, monitoring, and operational evaluation.     

The efficacy of the lactational amenorrhea method (LAM) among working women

The purpose of this study was to assess the efficacy of the lactational amenorrhea method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.     

Infant mortality and family welfare: policy implications for Indonesia

STUDY OBJECTIVE: To examine the effect of family welfare index (FWI) and maternal education on the probability of infant death. DESIGN: A population based multistage stratified clustered survey. SETTING: Women of reproductive age in Indonesia between 1983-1997. DATA SOURCES: The 1997 Indonesian Demographic and Health Survey. Main results: Infant mortality was associated with FWI and maternal education. Relative to families of high FWI, the risk of infant death was almost twice among families of low FWI (aOR=1.7, 95%CI=0.9 to 3.3), and three times for families of medium FWI (aOR=3.3,95%CI=1.7 to 6.5). Also, the risk of infant death was threefold higher (aOR=3.4, 95% CI=1.6 to 7.1) among mothers who had fewer than seven years of formal education compared with mothers with more than seven years of education. Fertility related indicators such as young maternal age, absence from contraception, birth intervals, and prenatal care, seem to exert significant effect on the increased probability of infant death. CONCLUSIONS: The increased probability of infant mortality attributable to family income inequality and low maternal education seems to work through pathways of material deprivation and chronic psychological stress that affect a person's health damaging behaviours. The policies that are likely to significantly reduce the family's socioeconomic inequality in infant mortality are implicated.     

Veterans use of non-VHA services: implications for policy and planning

Most Veterans elect not to use the Veterans Health Administration (VHA), even if eligible, or access the VHA system but rely on non-VHA providers as well. Given considerable cross-system use, failure to account for non-VHA care can bias conclusions about prevalence and incidence in utilization, diagnoses, and other characteristics. Furthermore, though dual VHA and non-VHA use provides Veterans with additional service options, it makes it difficult for VHA to ensure continuity of care. To better coordinate services, the VHA needs to construct the necessary health information bridges while widening the purview of case management programs. These changes are especially important in light of increased demand for care among younger Veterans returning from Iraq and Afghanstain and older Veterans who served in previous wars.     

A formula for the 1970s: estimating need for subsidized family planning services. Commentary: Family planning need and the future of the family planning program

Joy Dryfoos has made the most careful estimates of need for family planning services ever attempted in the U.S. Her estimates indicate a need to subsidize family planning services for low- and marginal-income families and sexually active teenagers without disposable income. The amount of subsidy provided will determine the number of unwanted pregnancies and/or abortions necessitated in the future for millions of U.S. couples. In pursuit of an announced goal to prevent unwanted births, federal government spending for family planning has increased from $0 to $150 million a year since the early 1960s. More than 3 million women now receive subsidies. New policies disclosed by the Department of Health, Education, and Welfare threaten the family planning program by 1) freezing project grants, 2) substituting state-administered and funded programs for a national program, and 3) requiring that family planning funds come under Medicaid and Title IV-A (aid to families of dependent children) programs. The Dryfoos estimates should be used to plan adequate family planning services for all who want and need them.     

Efficacy of a new method of family planning: the Standard Days Method

The Standard Days Method is a fertility awareness-based method of family planning in which users avoid unprotected intercourse during cycle Days 8 through 19. A prospective multi-center efficacy trial was conducted to test, in a heterogeneous population, the contraceptive efficacy of the Standard Days Method. A total of 478 women, age 18-39 years, in Bolivia, Peru, and the Philippines, with self-reported cycles of 26-32 days, desiring to delay pregnancy at least one year were admitted to the study. A single decrement multi-censoring life table analysis of the data indicate a cumulative probability of pregnancy of 4.75% over 13 cycles of correct use of the method, and a 11.96% probability of pregnancy under typical use. This article describes the study and the results. Results suggest that despite its requirement that couples modify their sexual behavior when the woman is fertile, the Standard Days Method provides significant protection from unplanned pregnancy and is acceptable to couples in a wide range of settings.     

The voiceless and the new population policy. Misguided family planning priorities

Over three decades and a half, the family planning program in India has caused depredations on its state of health services, particularly in the rural health services. The preoccupation with the implementation of birth control has corroded the vitals of the health service system, leaving the entire organization and management in shambles. It is noted that the family program has inflicted three major blows to the country. It repeatedly failed to yield the expected results; a huge quantity of resources was wasted in its implementation; and it dealt a devastating blow on the health service system of the country. Ultimate accountability for these failures and the consequent neglect of health services are put on the hands of those in the political arena. These include the minister in-charge, the cabinet, the National Council for Health and Family Planning, the National Development Council, the Planning Commission and finally, the Parliament.     

The correlation between family planning program inputs and contraceptive use in Indonesia

Using 1980 Census and 1986 service statistics program inputs, this paper evaluates the net correlation of socioeconomic, region, and program variables with 1987 contraceptive prevalence and method-specific use rates for Indonesian regencies and municipalities. The region variables--primarily, though not exclusively, reflecting program design and maturity--correlate most strongly with the contraceptive prevalence rates. Field-worker activities, field-worker supervisor activities, and community-based distributors also have a correlation with these rates. Pill use is highest in the areas that are predominantly Islamic and least developed, whereas the pattern is reversed for use of the IUD, condom, and other modern methods (mainly female sterilization). The findings are assessed in terms of their implications for policymaking.     

Declines in the age and family size of family planning program acceptors: international trends

Social changes are encouraging couples to inititate contraception at younger ages, practice spacing, and in general reduce fertility. The personal characteristics of acceptors in the family planning programs of 23 developing countries were accumulated with concentration on the age and number of children by contraceptive method. The findings indicate that the ages and family sizes of acceptors decline with little relation to available family planning programs or contraceptive method. Contraceptive methods must fit the needs of younger couples; therefore, services for sterilization must still be maintained while new services are added which take into account age distributions of married women and age-specific acceptance rates.