Family planning policy and administration; an overview

With 2.4% of the worlds area and 2% of the world income, India supports 14% of the total world population. The family planning program which stated in 1952 is organized at the centra, state, district, and block level. The central government family planning department handles communication, financing, and supplies for the national program. Innovative projects can be tried at the state level. Some of the program's weaknesses are: 1)population education at any level is not included; 2)professional consultation for the program is needed; 3)population services in rural areas are lacking; 4)family planning should be integrated with maternal and child health programs; 5)the IUD program failed because follow-up care was lacking; and 6)more family planning training is needed. More attention needs to be paid to the program at the local level. Voluntary organizations could be useful in the following ways: 1)mass communication and education; 2)research; and 3)creation of favorable public opinion on the local level. Incentives and disincentives to establish the small family norm are recommended. Any new population policy must include more attention to general socioeconomic development of the country.     

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.     

Theoretical Foundation of Family Health Promotion—the Orientation of Family Planning Development in Urban Area

Objective To make a theoretical exploration of the function of family-based health promotion in family planning development.Methods Given the notion of reproductive health and the function of family in society,the author bring forward a new mode of family planning service, that was "healthy,happy household promotion" based on the principle of health education and health promotion.Results The mode of "healthy, happy household promotion" reflected the new F.P.service mode, and was the direction of family planning service. It might benefit both service provider and clients to make the family as the entrance point of quality care of reproductive health in communities, to develop health education and health promotion,and promote family health and family happiness.Conclusion Family health and family happiness should be the final goal of family planning.     

Family planning -- a priority social and health action programme for Africa and the role of the physician

The issues of contraception and family planning have been particularly sensitive and complex in sub-Saharan Africa. Family planning programs which promote the use of safe and effective modern methods of contraception have generally not been well received on the continent. The reality, however, is that sub-Saharan Africa has a rapidly growing population in the context of the world's least developed region. 25 of the world's 35 least developed countries are in sub-Saharan Africa. It is difficult enough to maintain existing services for populations in the region let alone expand them to meet the needs of even more people. Family planning should be seen as one of several strategies or interventions in an overall and integrated socioeconomic development plan. Unless population growth slows sharply and rapidly, living standards will continue to fall, unemployment and poverty will increase, and famine and hunger will lead to accelerated rural-urban migration, threatening national security and peace. The provision of family planning and high-quality reproductive health care can also help reduce the currently high levels of maternal mortality and morbidity. Physicians need to become more actively involved in advocating and providing family planning services.     

Current Situations of the Integration of RTIs Prevention and Treatment into Routine FP Program

Objective To understand the current situation of the integration of reproductive tract infections （RTIs） prevention and treatment into routine Family planning （FP） program. Methods Literature review, in depth interview and focus group discussion were employed to collect the related information. Questionnaire survey was conducted in 59 county level FP facilities. Results Both central and local governments provide policy supports to RTIs prevention and treatment. Nearly 98.3% of local FP facilities had integrated this work into their routine FP program. A comprehensive network system of family planning has been established in China and there were plenty of FP human resources. The existing FP resource should be effectively used, which could produce great social benefit if RTIs prevention and treatment be integrated into routine FP program. However, some problems still need to be solved in the integrated program, such as insufficient finance support, low quality of service, lack of co-operations between different sectors, etc. Conclusion It is possible and feasible to develop RTIs controlling projects in the family planning system. However, intensive training and close cooperation need to be applied respectively into FP staffs and relative departments.     

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.     

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.     

社区卫生家庭服务的特点及其改进

家庭卫生服务是社区卫生服务的重要内容。从功能上看,家庭卫生服务不但是实施社区预防保健和健康教育的有效手段,而且是方便群众就医的重要形式,是社区卫生服务功能的延伸和深化。从实践上看,家庭卫生服务适应城市社区卫生实际需求。但家庭卫生服务存在的问题也不容忽视。必须在社会层面形成具有法律效力和权威认可的规范和程序,实现家庭卫生服务的规范化发展。     

A curriculum for the times: an experiment in teaching health policy to residents in family medicine

The Department of Family Medicine at Queen's University in Kingston, Ont., recently undertook a pilot project to familiarize residents in family medicine with physician-related health policy issues. The objective of the project was to ease the residents' transition into practice and to equip them to participate effectively in future policy debates. All first-year residents assigned to a 4-month clinical rotation in the Department of Family Medicine took part in the program, which consisted of 5 weekly 1-hour lecture and discussion sessions. The program was offered as one component of the 130-hour core curriculum for first-year residents. Participants evaluated the program as highly informative and extremely relevant to their career plans. The authors conclude that health policy is a subject that can be incorporated into the core curriculum of residency training programs.     

Zimbabwe: a family planning profile

This brief article focuses on the history of family planning in Zimbabwe, available services, community-based distribution, contraceptive use, and program problems. Family planning services were first available in Zimbabwe in 1953. The Rhodesian Family Planning Association (RFPA) was established formally in 1965. RFPA distributed contraceptives in 1966 and trained for the first time "field educators" in 1967. The first community-based distributors were trained in 1972. The Ministry of Health integrated the RFPA into its department in 1981. In 1985, the family planning association became a parastatal and was renamed the Zimbabwe National Family Planning Council (ZNFPC). Services today are provided through 37 family planning clinics. The distribution of contraceptives includes IUDs, condoms, pills, and injectables. Harare and Bulawayo centers receive referrals and perform tubal ligation, vasectomy, and infertility counseling. 700 community-based distributors (CBDs) received a 6-week training course in order to educate about oral contraceptives, encourage their use, and screen clients for high blood pressure and side effects for oral contraceptives. CBDs use bicycles to make home visits and also have access to motorcycles. Each CBD averages 135 clients/month. Most visits are revisits. CBDs provided 25.3% of family planning in 1988. Local clinics provided 19.1% of family planning. Ministry of Health facilities provided 14.8% of services. ZNFPC clinics provided 13.7% of services. Private doctors or pharmacies provided 2.3% of services. 38% of women currently in a union used family planning in 1984, and 43% used it in 1988. 36% in 1988 used modern methods. The pill was the most common method, followed by withdrawal. Logistics of supplies and equipment remain problematic.     

浅谈医患沟通交流与技巧在计划生育咨询和手术中的主导作用

根据计划生育优质服务的需要，医学模式的改变。各级计划生育技术服务机构要充分认识实施生殖健康保健服务的重要性，必要性、迫切性和可行性，改善计划生育服务行业形象，体现计划生育技术服务的人性化服务，确保人口计划完成和提高节育率。     

重庆市社区卫生服务现况调查——社区卫生服务机构医护人员工作开展情况

目的评价重庆市社区卫生服务机构医护人员提供公共卫生服务和基本医疗服务的情况和能力。方法采用自行设计的标准调查表对重庆主城10区共20个社区卫生服务机构的63名医务人员进行访谈式问卷调查。结果社区居民高血压建档率45.4%,糖尿病建档率47.4%,社区卫生服务机构人员开展计划免疫、心理咨询、儿童保健、妇女保健、老年人保健、计划生育技术服务分别为22.2%、42.7%、7.7%、13.5%、38.2%、30.0%;3年间巡诊、急诊与急救人次平均上涨141.2%、21.6%、62.2%;81.0%的社区卫生服务机构开展家庭服务;医护人员平均工作11h/d,人均工资894.15元/月,人均月奖金243.15元。结论社区卫生服务机构医护人员开展公共卫生服务不力;家庭医疗需要法律保障;双向转诊渠道不通;医护人员的服务能力与待遇亟待提高。     

India increases spending on health

The government of India announced that the fifth Five-Year Plan (1974-1979) will provide a total of $2,316,000 for health, family planning and nutrition programs. During the next five years emphasis will be placed on increasing the accessibility of health services to rural areas, correcting the uneven distribution of medical manpower, intensifying control of communicable diseases, and improving educational training of health personnel at all levels. The family planning program will continue to receive the highest priority. The main goal will be to achieve a reduction of the birth rate to approximately 30/1000 population. Methods of family planning in India include IUD insertion, sterilization, oral contraception and the presently very popular vasectomy.     

江泽民同志论计划生育工作

江泽民同志关于计划生育工作的论述 ,为全社会更加重视和加强计划生育工作奠定了思想理论基础。其主要内容有 :要从可持续发展的战略高度认识人口问题的重要性和紧迫性 ;要充分认识计划生育工作的长期性和艰巨性 ,深入细致地做好宣传工作 ;抓好计划生育工作要突出重点 ,坚持计划生育与扶贫开发相结合 ;对计划生育工作要实行党政一把手亲自抓、负总责 ,充分发挥基层党组织的领导核心作用和共产党员的先锋模范作用 ;要做好计划生育工作 ,必须努力提高妇女地位     

Help stamp out mandatory continuing education!

Mandatory continuing education programs for health professionals, as they are now administered, are predictable failures. Such programs may destroy the will to learn. Objective studies indicate that current continuing education programs do not influence the methods of practice of the health professional. Current programs are primarily pedagogical, reflecting the philosophies and techniques of child-youth education. Present methods of program evaluation are sorely inadequate. Adults may be coerced into attendance, but learning and subsequent application of knowledge may not be forced. Future continuing education programs should be problem-centered. The adult practitioner must become actively involved in the planning and execution of these programs.     

夏津县计划生育技术服务人员消毒、隔离与医疗废弃物管理知识水平调查

了解计划生育技术服务人员对消毒、隔离和医疗废物管理知识的知晓情况,探讨开展健康教育的方法。方法:2006年1月,采用整群抽样方法对夏津县108名计划生育技术服务人员进行问卷调查。结果:计划生育技术服务人员对消毒灭菌、隔离和医疗废弃物管理知识的总体知晓率分别为77.69%、77.96%和60.0%。只有14.81%的人知晓灭菌剂应每月进行一次生物监测,23.15%的人知晓紫外线不能杀灭HIV,对其它消毒、隔离和医疗废物管理知识知晓率为33.26~99.07%。78.7%的计划生育技术服务人员是通过继续教育和业务培训获得消毒、隔离和医疗废弃物管理知识。不同文化程度、不同技术职称、不同岗位计划生育技术服务人员对相关知识的知晓率无明显不同,差异无统计学意义(P>0.05)。结论:计划生育技术服务人员对消毒、隔离和医疗废弃物管理知识的掌握不够系统、全面,应加强对计划生育技术服务人员消毒、隔离和医疗废弃物管理相关知识的培训。     

儿童焦虑症与不同家庭特征的对照研究

目的：探讨不同家庭特征与儿童焦虑的关联性。方法：使用费立鹏等引进的家庭环境量表对144例焦虑症患儿的家庭特征进行调查，同时以无心理疾患的正常儿童家庭作对照。结果：除恐怖性焦虑症外，其余焦虑症儿童家庭在亲密度，独立性，成功和娱乐性等分量表中的得分明显低于儿童家庭（P＜0．01），社交性焦虑症患儿家庭在道德宗教分量表上得分最低（P＜0．01）。在4组焦虑症患儿家庭，亲密度均与知识性呈正相关（r=0.9219,0.8348,0.8935,0.9550,P均＜0．001）。结论：焦虑症患儿家庭成员间的心灵沟通欠缺，社交，文化活动不够。家庭特征明显影响儿童心身的正常发育。     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

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.