Family planning and fertility decline in Korea: retrospect and prospect.
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In a 24-month period 145 New Zealand women sought abortion in a Melbourne practice, comprising 10 percent of such patients seen. Some 4000 New Zealanders are estimated to fly into Australia annually because of less restrictive abortion laws in some Australian states. The age range in this sample of 145 was from 14-43 years with the mean average age at 21.4 years. Only 24 (16.5 percent) had ever been married and 111 (76.5 percent) were pregnant for the first time. Almost half, 63 (43.5 percent), had never used any contraception in the past. Of the 142 patients aborted, 71 (50 percent) were at least 11 weeks pregnant, four being 14 weeks. Obstacles along the route to abortion, personal, medical and those due to international airline schedules contributed to delaying the date of the operation. The operative procedure was evacuation curettage performed in a private hospital under general anaesthesia. Patients received contraceptive education and returned to their local New Zealand doctor for follow-up.
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Women attending for family planning advice at area health authority and general practitioner clinics were offered a test of rubella antibody status. The acceptance rate was approximately 50 per cent. Of the 100 women tested, 15 were not immune and 8 of these were subsequently vaccinated. In this study, the cost of the service was estimated to be 1-50 pounds per woman, or approximately 5000 pounds to prevent one case of congenital rubella. On this basis the assessment of rubella immunity in women using reliable contraception is considered to be feasible and could prove even more worthwhile on a cost-benefit basis if applied to an entirely nulliparous group.
Family planning clinics throughout the United States are facing a variety of obstacles that threaten their ability to provide necessary contraceptive services to low-income women and teenagers, according to interviews with clinic administrators. In the last few years, the proportion of patients coming to family planning agencies in need of screening or treatment for sexually transmitted diseases (STDs) has increased dramatically. Many providers report that 10-15 percent of their clients are infected with chlamydia, the most prevalent STD. The increasing costs of Pap tests and contraceptives are also major problems: As a result of recent federal legislation, the price of Pap tests has risen substantially, and that of contraceptives is beginning to increase steeply. Finally, Title X funding for family planning services has decreased 66 percent over the last decade if both cuts and inflation are taken into account. As a result of the squeeze between increased costs and decreased public funding, clinics have been forced to charge higher fees, maintain long waiting lists for appointments and curtail community outreach. In addition, growth of the family planning patient population has slowed dramatically, and even declined, in some places.
In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.
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The abortion policies of these Western, industrialized countries reflect different attitudes toward women's health, children, and families.
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This paper presents data on contraceptive use and fertility in Honduras obtained from a household survey conducted in 1984, and compares these data with similar information obtained from surveys carried out in 1981 and 1983. About half of the increase that has taken place in contraceptive use in Honduras is accounted for by sterilization. In 1981, 27 percent of women in union aged 15-49 years were practicing contraception; in 1984, the percentage of those 15-44 was 35 percent. The increase in urban areas was smaller (from 47 percent to 51 percent) than in rural areas (from 16 percent to 24 percent). Also, fertility remained almost unchanged in urban areas while declining in rural areas. Information from questions on place of purchase, price, and brand of contraceptive (for orals) was used to determine source of supply. The use of multiple questions to determine source results in a higher percentage of contraceptive use attributed to the Honduran Family Planning Association as compared with answers to a single question. The duration of breastfeeding in Honduras has increased, with the greatest changes occurring among women in urban areas and women with the highest levels of education. Efforts have been made to promote breastfeeding in urban areas and these results suggest that the efforts have been successful.
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