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PubMedDate not supplied

Low-income women's perceptions of family planning service alternatives.

A sample of 665 low-income women from a predominantly rural area of north central Florida rated the value of 25 features of family planning providers and reported their perceptions of how characteristic each feature was of different types of providers. A well-trained, trustworthy and friendly staff, the presence of a doctor if you need one and a staff that is gentle with the examination were the most desirable features of family planning services. The respondents' perceptions of public health clinics suggest that the strongest qualities of such facilities are that they treat people from different backgrounds, accept Medicaid, are easy to find and teach you how to avoid pregnancy and how to take care of yourself and stay healthy. Features thought most characteristic of private physician services were a well-trained staff, privacy and the presence of a doctor if you need one. Voluntary organizations were seen as providing services for people of different backgrounds, having a friendly staff, serving as a referral agency and teaching about staying healthy and avoiding pregnancy. However, voluntary organizations were rated lower than public health clinics or private physicians on nearly all features. The total scores for public health clinics and private physicians were not significantly different from each other, but both were noticeably higher than the score for voluntary organizations. Ethnicity affected ratings dramatically, with black respondents clearly more favorable toward public health clinics and private physicians than white respondents; conversely, whites were more positive toward voluntary organizations than were blacks. For many of these low-income respondents, the high ratings of private physicians may have represented their expectations rather than their actual experience.

Adolescent↗
PubMedDate not supplied

[Hormonal contraception in 46 public family clinics in Rome].

This study investigates the role of 46 public Consultori of Rome, as far as the hormonal contraception with "pill', the most common contraceptive method used by roman women, is concerned. With a series of phone calls, a hypothetic potential customer asked for an appointment directly with the gynaecologist for getting adviced to use "pill" for the first time. The results show that, although the wait for the first appointment directly the gynaecologist is not long (11,3 days as an average), it is very difficult to get it and this was possible only in 12 cases out of 46. We have noted that the first appointment for "pill" was offered with no-medical personnel, like social assistants, sanitary assistants or midwives, in most 16 of cases, and that in a significant number of Consultori was not possible to obtain an appointment whatever. In public Consultory of Rome we have found a different attitude in giving appointment to women for contraception with pill, even inside the same USL (Local Sanitary Unit, the basic structure of public health in Italy, in which Consultori have the role of prevention and promotion of maternity and tutelage of infancy). From this study the need emerges of uniformity in the attitude of Consultori staff in managing the customers, in order to avoid that women, finding so many difficulties, give up referring to these public structure for beginning contraception and choose private professionals or decide not to use the "pill".

Appointments and Schedules↗
PubMedDate not supplied

The politics of birth control.

By the time Senate subcommittee hearings on the "population crisis" ended in 1968, a sizeable consensus had begun to emerge favoring government support of voluntary family planning programs at home and abroad. The goal to develop a national family planning program was easier to set than to accomplish, however, and there have been no lack of difficult questions to haggle over in the past 20 years. Beginning with the Johnson administration, the executive branch of government has tended to favor block-grant funding of family planning services, while Congress has insisted on categorical funding. Conflict has also existed over financial eligibility for government-supported services, over whether teenagers and unmarried women should be served in publicly supported clinics and over which services should be included in the definition of family planning. The Reagan administration has exacerbated the conflicts with attempts to redefine family planning by placing primary emphasis on natural methods and abstinence for those who wish to prevent pregnancy and attempts to deny funding to both domestic and foreign programs that support access to abortion. While future government support for family planning programs does not seem seriously threatened, funding has not grown in 15 years, once the effects of inflation are taken into account, and most programs have had to limit eligibility to survive. The Bush administration is unlikely to be as confrontational as the Reagan administration on the subject of family planning, but the political reality is that conflict can be expected to continue.

Abortion, Legal↗
PubMedDate not supplied

Beyond supply: the importance of female family planning workers in rural Bangladesh.

Using participant observation data on worker-client exchanges from Bangladesh, this article examines the interface between a government family planning program and the rural women it serves. Case material focuses first on the program function typically identified in the literature: meeting unmet demand for contraception by providing convenient supply. Functions that have been less recognized are then illustrated: (1) the worker's role in reducing fear of contraceptive technology; (2) her effort to address religious barriers, child mortality risks, and high fertility preferences; and (3) her role in mobilizing male support. The range of functions performed by the female family planning worker in the cases discussed here demonstrates that her role transcends the boundaries of what is conventionally implied by the concept of supply. She acts as an agent of change whose presence helps to shift reproductive decision-making away from passivity, exposing women long secluded by the tradition of purdah to the modern notion of deliberate choice.

Bangladesh↗
PubMed1987

[Research in psychiatric care: a contribution to the evaluation of the extramural care of schizophrenic patients].

The conceptual approach and the structures of psychiatric service have changed, and hence the question of efficacy of measures and institutions for mental patients is of special significance. In the U.S.A. this realization has led to a regulation that compulsorily prescribes the evaluation of Government-sponsored programs (Dowell and Ciarlo, 1983). Whereas the investigation into the efficacy of individual therapeutic measures is part of standard psychiatric research (Garfield and Bergin, 1978, Clark and del Guidice, 1970), the evaluation of institutions or part systems of service has only just begun, to a major part due to the methodical difficulties arising from investigating such a claim. It is often impossible, for both ethical and practical reasons, to initiate an experimental study approach that definitely provides for random allocation of patients to various service care and monitoring parameters. Hence, we must look for alternative research strategies enabling analysis of cause and effect relationships on the basis of observation studies. In this study we attempted to improve the significance of statistical analyses by means of adequate data analysis technique, the object of analysis being a community psychiatric service; such a procedure would restrict the number of possible alternative possibilities of interpretation. We could prove for a group of schizophrenic patients that continual aftercare by aftercare clinics had a really significant effect on the rehospitalization of patients, which was considerably reduced without entailing any adverse effect on the patients in consideration of the pattern of signs and symptoms involved.

Ambulatory Care↗
PubMedDate not supplied

Strengthening government health and family planning programs: findings from an action research project in rural Bangladesh.

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.

Bangladesh↗
PubMed1980

Assessment of family planning service delivery in Egypt.

The Arab Republic of Egypt has used family planning service delivery as the main vehicle for implementing its national family planning policy since 1965. This paper reports results of a study undertaken during 1975-77 using a systematic sample of 100 health units offering family planning services in two governorates of Egypt. The findings suggest that there is considerable potential for improving the service delivery system through better management. Broadening the choice of technology offered, increasing the quantity and quality of outreach and communication activities for new and continuing contraceptors, and improving staff availability could lead to improvements in national program participation and continuation.

Contraceptive Agents↗
PubMedDate not supplied

Public health departments providing sexually transmitted disease services.

Results of a 1995 survey reveal that 1,437 local health departments-half of those in the country-provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health care typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.

Adolescent↗
PubMed1987

Ethical issues in government sponsored public health campaigns.

Health communications campaigns are a major strategy used by governments to promote health. This article discusses key issues in the ethics of health communications campaigns, including the compatibility of health campaigns with the principle of respect for autonomy and how conflicts with this principle can be justified. Five potential justifications for state-sponsored health communications campaigns are reviewed: the public's health as an independent value; collective efficiency and majoritarian preferences; third party or state's interests; harm to the health of others; and countering the short-term contingencies of a market.

Behavior Control↗
PubMed1986

Black adolescent pregnancy: prevention and management.

In New York State, today and every day, 180 teenagers become pregnant. However, pregnancy in adolescents is not just a technical or demographic issue. It has cultural and practical dimensions. Nationally, unmarried black teenagers are five times more likely to give birth than white teenagers. In other words, one in every five nonwhite babies has a teenager for a mother! This has long-term societal consequences incalculable dimensions; and black leaders are increasingly concerned. It is recognized that sex-role socialization is an important component of personality development. Yet, few researchers have examined the unique situation of black girls in a society which denigrates both the female and the black role. As pluralistic as our society may be, and no matter how relevant cultural and subcultural values may be, it is an incontrovertible fact that, by exceedingly early childbearing, poor teenagers who are black immeasurably increase their inherent disadvantages to pursue education and acquire marketable skills, not to mention attractive jobs. On the other hand, more women in upper socio-economic categories are characteristically delaying, childbearing, and even marriage, into their thirties. The immediate and long-range consequences of unplanned teenage pregnancies are many. These include poverty, stress, suboptimal environment, nutritional inadequacy, and frequently, late or no prenatal care. Negative outcomes include low birthweight, prematurity, child abuse and development disability. There are, in addition, many delayed effects. Therefore, physicians and other health professionals must ensure that wanted pregnancies yield a healthy child. Young women and young men must be convinced that early childbearing will foreclose chances of a better socio-economic future for themselves and their progeny.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗