The quality of family planning services in rural China.

This article provides a preliminary analysis of three aspects of service quality in four rural counties in China--the availability of contraceptive methods, information given to users, and provider knowledge about methods. Contraceptive choice and characteristics of contraceptive use by women in the study areas are also examined. The data are derived from a survey carried out by the authors during 1987, under the auspices of China's State Family Planning Commission. The survey was conducted in four rural counties located in Fujian and Heilongjiang provinces. A total of 318 married women of reproductive age were randomly selected and interviewed. All family planning service sites serving the women were visited and a sample of service providers was interviewed. No shortage of contraceptives existed in any of the counties, but variations in community wealth and local procurement practices have resulted in the acquisition of an IUD with high failure rates. Although providers believe they inform women about method choices and side effects, women were poorly informed about the methods they selected. Not all providers who insert IUDs and distribute pills were knowledgeable about contraindications and side effects of the methods. Ever-use of contraception was nearly 100 percent, but most women, especially in Heilongjiang, have only used one method: the IUD or sterilization. Improvements in quality, especially in method mix, providers' level of knowledge, and the quality and quantity of information provided to users will likely improve contraceptive continuation, client satisfaction, and women's health.     

Fertility and family planning in the Arab region

This article describes fertility trends and family planning practices in the 8 Arab countries participating in World Fertility Surveys in 1976-81: Egypt, Jordan, Mauritania, Morocco, the Sudan, Syria, Tunisia, and the Yemen Arab Republic. The region's population growth rate currently stands at about 3%/year, and the population of the Arab World is expected to reach 400 million by the year 2010. Mean age at 1st marriage now ranges from 17 years in Yemen to 24 years in Tunisia, and has been slowly rising in all 8 countries. Current fertility levels in the Arab region are 2-3 times those required for generational replacement. Completed fertility of ever-married women 45-49 years of age ranges from over 6 children in Mauritania and the Sudan; about 7 children in Egypt, Morocco, Tunisia, and Yemen; about 8 children in Syria; to almost 9 children in Jordan. Examination of age-specific and total fertility rate trends reveals little change in Mauritania, the Sudan, and Syria; a decline in total fertility of about 1 child/woman in Jordan; declines of 1.5-1.8 children/woman in Egypt, Morocco, and Tunisia; and increases in total fertility in Yemen. 93-99% of infants in the region are breastfed, with a mean duration of 12-20 months. Breastfeeding appears to prolong the period of anovulation by an average of 4 months in Syria; 6 months in Egypt, Tunisia, and Yemen; and 9 months in Mauritania and the Sudan. The mean number of children desired by currently married women is about 4 in Egypt and Tunisia; 5 in Morocco and Yemen; 6 in Jordan, Syria, and the Sudan; and 9 in Mauritania. The percentage of ever-married women who have ever used contraception ranges from 2-3% in Mauritania and Yemen to 40-46% in Egypt, Jordan, and Tunisia. Current contraceptive use is highest (36%) in Tunisia. The following factors seem to be associated with greater use of contraception: urban residence, higher educational levels, 3 or more children already in the family, and more sons than daughters. Only 32-38% of women in Egypt, Jordan, and Tunisia indicated they would never use contraception compared to 92-97% in Yemen and Mauritania. Rising age at 1st marriage and reductions in child mortality have ushered in the transition from high to moderate fertility levels in the Arab world. However, unless population growth rates are further reduced, socioeconomic development will be impeded and efforts to improve women's status, maternal child health, and the quality of life will be frustrated.     

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.     

Fertility and family planning in Vietnam.

This report provides the first reliable statistical data on fertility patterns and the family planning program in the Socialist Republic of Vietnam. Findings are from the 1988 Demographic and Health Survey of Vietnam and the 1989 census survey. The data show that the total fertility rate has declined from over 6 children per woman in the early 1970s to under 4 in the later 1980s. Contraceptive prevalence for modern methods is estimated at 37 percent among married women of reproductive age in 1988. The average duration of breastfeeding is over 14 months; marriage is relatively late. The IUD is the most common contraceptive method and abortion is widespread. The major factors likely to influence fertility and family planning in the future are the government's population policy, improved access to modern methods of contraception, and the institution of new economic policies that are currently under way in Vietnam.     

Indigenous perceptions and quality of care of family planning services in Haiti

This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.     

Fertility policy and family planning in the Arab countries

An increasing number of Arab countries are instituting family planning programs to lower their populations' high fertility rates. This article examines Arab governments' perceptions of their countries' fertility situation, their desire to intervene in order to reduce or increase the rate of population growth, and the measures they have taken to influence the level of fertility. Special attention is given to family planning programs and access to methods of fertility regulation. A combination of stronger program effort and improved socioeconomic conditions account for much of the variation in contraceptive prevalence rates in 11 countries. Socioeconomic setting and political factors are found to be of primary importance in determining Arab fertility policies.     

The quality of family planning services: a challenge for the 1990s

This paper reviews the quality of family planning services offered by the International Plan Parenthood Federation (IPPF) and examines the challenges faced by IPPF in the 1990s. The goal of IPPF is to maintain a good quality of family planning services for the following important reasons: to secure the safety and effectiveness of the methods provided; to secure the satisfaction of the clients with the services; to secure the acceptability and sustained practice of family planning; and to secure confidence among the public and the supporters of family planning programs. Moreover, IPPF utilizes three principles when planning strategies and activities for the quality care and these principles are stated in the paper. Furthermore, the Central Council of the IPPF at its November 1990 meeting passed a resolution emphasizing quality of care as the top priority. The paper also presents the highlights of the IPPF meeting that was held in London on August 30-31, 1994.     

农村地区生殖健康/计划生育服务质量评估

目的 了解农村地区育龄男女对生殖健康／计划生育服务的利用情况和相关知识、态度、行为及保健需求。方法 采用定性研究的方法，于2001年对安徽、广东、青海、重庆4省(市)8个村的105名育龄男女分成16个小组进行专题小组讨论。结果 农村育龄妇女孕产期保健情况较好；村级孕产妇大多在乡镇卫生院分娩；妇女产后多采用宫内节育器避孕。育龄妇女中分别有72．5％，35．3％和70．6％的人了解有关生殖道感染／性传播疾病的传播途径、危害和预防措施。获取生殖健康知识的最佳形式是与医生和保健人员面对面地交流与咨询。结论 应加强孕产期保健工作，提高农村孕产妇的住院分娩率；为农村育龄男女提供完善的计划生育指导；并通过多种形式的健康教育，促进农村群众生殖健康水平的提高。     

Health care reform and family planning services

With the reforms expected for US health care, the question remains as to the impact on family planning services. Although the focus is on health care finance reform, the mix of patients seen, the incentives for decision making, and the interactions between health care providers will change. Definition of key concepts is provided for universal access, managed competition, and managed care. The position of the obstetrician/gynecologist (Ob/Gyn) does not fit well within the scheme for managed health care, because Ob/Gyns are both primary care providers and specialists in women's health care. Most managed health care systems presently consider Ob/Gyn to be a specialty. Public family planning clinics, which have a client constituency of primarily uninsured women, may have to compete with traditional private sector providers. "Ambulatory health care providers" have developed a reputation for high quality, cost effective preventive health care services; this record should place providers with a range of services in a successful position. Family planning providers in a managed competition system will be at a disadvantage. 3 scenarios possible under managed competition are identified as the best case, out of the mainstream, and most likely. The best case is when primary reproductive health care services, contraception, sexually transmitted disease screening and management, and preventive services are all obtained directly from reproductive health care providers. Under managed care, this means allowing for an additional entry gatekeeper to specialized services. The benefits are to clients who prefer seeing reproductive health care providers first; reproductive services would be separated from medical services. The out of the mainstream scenario would place contraceptive services and other preventive services as outside the mandated benefits. The government would still provide Title X type programs for the indigent. The most likely scenario is one where primary care providers offer contraceptive services, and some family planning providers would expand their services to include nonreproductive health care. Abortion services are presently out of the health care mainstream, and efforts will need to be made to identify impact on reproductive and family planning practices and to advocate for specific provisions in health care reform.     

Computer mapping of family planning need and services

Computers are being used to plot the spatial distribution of the population in need of services and those currently receiving services from Georgia's family planning programs. A Fortran computer program costing about $400 uses 5 graduations of shading to show proportions of active contraceptors. Each user supplies a data deck with map coordinates which can be digitized for about $250 for a state with 100 counties. By calculating contraceptors monthly, the program activity in each county can be determined to show areas of stable high performance and those areas which need to improve their family planning services. The spatial distribution according to services rendered can be mapped at intervals depending on frequency of data collection.     

State administration and financing of family planning services

A 1971 survey by the Center for Family Planning Program Development consisted of a questionnaire mailed to health and welfare directors in 50 states and 5 federal jurisdictions concerning their family planning policies and administrative practices. 52 agencies responded; Guam, Mississippi, and Louisiana did not. The major funding for state health agencies was allocated by HEW and by maternal and child health (MCH) formula grants under Title 5 of the Social Security Act. 11 states made additional expenditures of $1.7 million for a variety of purposes. 21 states required local welfare departments to purchase services under the Medicaid program established by Title 19 of the Social Security Act. Administration was assigned to specific organizations within the state health agencies. 31 states reported a total of 128 full-time professional personnel, with 90 assigned at state headquarters level. In general, on a state-by-state basis, the full-time staff does not correspond to the size of the appropriations. Survey findings were useful measures of resource commitments to family planning services by state health and welfare agencies and provided data on future levels of resource requirements.