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New issues, new options: a management perspective on population and family planning.

As population problems increasingly are seen in the context of socioeconomic development and as programs to reduce fertility become more diversified and multisectoral, issues facing program managers are changing. In addressing today's challenges in the areas of population policy and development planning, family planning program design, and problem-solving mechanisms, a variety of options can be considered. No blanket prescriptions can be made, but familiarity with some of the alternative and an understanding of their political and administrative implications may be helpful to managers, not only of population programs but in related development field as well.

Family Planning Services↗

Interest in natural family planning among female family practice patients.

OBJECTIVE: Although modern methods of natural family planning (NFP) are effective both to avoid and to achieve pregnancy, relatively few women use these methods. It is not known whether this is due primarily to lack of interest or to other factors. We therefore explored the level of interest in NFP among female family practice patients. METHODS: We mailed information about NFP to 400 female patients between ages 21 and 42 and conducted follow-up interviews by telephone. We excluded 162 women for whom we could not obtain accurate addresses or phone numbers, 68 women we could not reach by telephone, 67 women who were not currently at risk of pregnancy, and 15 women for other reasons. Twenty-eight women refused to participate in the study. Sixty women completed telephone interviews. RESULTS: Forty-three percent of respondents (n = 60) were interested in learning more about NFP, 24% said they were likely to use NFP to avoid pregnancy, and 32% were likely to use NFP to achieve pregnancy. Younger women and women who were Christian but not Catholic and not of a major Protestant denomination were more interested in NFP. CONCLUSION: Some female family practice patients are interested in learning and using NFP.

Adult↗

Attitude towards family planning in Dharan, east Nepal: implications for the family planning programme.

A survey of the knowledge, attitude and practice of family planning was conducted in Dharan, Nepal. The town offers a full range of family planning services free of charge. There was a strong desire to limit family size; 52.5% of couples were currently using some modern method of family planning. Of the current users, 62.3% had been sterilized, including 92.3% of those in the lowest socioeconomic group. Health risks and incompleteness of the family were the most common reasons for non-use of contraception, the latter reason reflecting ignorance of the temporary nature of some methods. There was a strong preference for male children and couples rarely used contraception until at least one so had been born. Even in this prosperous town where couples were highly motivated towards family planning and all methods were readily available, there was heavy reliance on sterilization. This is typical of Nepal and has largely been responsible for the failure of the family planning programme--as most couples choosing sterilization are in the older age group and have completed a relatively large family. If Nepal is to succeed in meeting its target of reducing the total fertility rate (i.e., births per woman) from the current 5.8 to 4 by the year 2000 it will need not only to expand services but actively to promote temporary methods of contraception, particularly the more reliable longer acting reversible methods such as Depo-Provera, Norplant and intrauterine contraceptive devices.

Adolescent↗

Breastfeeding promotion in family planning programs.

Family planning programs serve large numbers of women of childbearing, and thus breastfeeding, age. Although these programs appear to have a number of characteristics which would be useful for promoting and supporting breastfeeding, most family planning programs have done very little in this area. The Agency for International Development (A.I.D.) and the Institute for International Studies in Natural Family Planning are working to find ways to remove barriers to family planning breastfeeding promotion efforts. Such barriers include lack of or conflicting measures of program success and lack of information on the breastfeeding/fertility relationship. The Institute is developing guidelines to help family planning programs promote breastfeeding.

Breast Feeding↗

Results of establishing medical guidelines for selecting oral contraceptive types in family planning agencies.

Family planning agencies are attempting to increase their efficiency and cost-effectiveness in delivering services, as federal funding is diminishing. We have examined the effects of establishing guidelines in a family planning agency, outlining the types of OCs to be routinely prescribed. We found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.

Contraceptives, Oral↗

Prospective European multi-center study of natural family planning (1989-1992): interim results. The European Natural Family Planning Study Groups.

Since 1989 an international multicenter prospective study to evaluate the effectiveness and acceptability of natural family planning (NFP) methods in Europe has been conducted by the NFP Research Center at the University of Düsseldorf in collaboration with the European Zone of the International Federation for Family Life Promotion (IFFLP). Fourteen NFP-organizations from nine European countries participate in the study. Cycle data from women in the fertile age group are transferred to a special standard computer sheet by the respective organizations and forwarded at three-monthly intervals to the study center for analyses. To date, 10,045 cycles from 900 women aged between 19 and 54 years have been analyzed. This paper presents the pregnancy rate for the women aged between 19 and 45 years of age, who contributed 9284 cycles. In the analyses the cycles were subdivided into two categories consequent to sexual practices during the fertile phase: group I (NFP only--4277 cycles) use only NFP to avoid a pregnancy; group II (FA/mix--5007 cycles) where barrier methods or coitus interruptus during the fertile phase, at least in some cycles, were used to avoid a pregnancy. The women used different clinical indicators such as basal body temperature (BBT), cervical mucus, calculations, cyclical cervical changes or combinations of these to determine the beginning and the end of the fertile phase necessitating a further division into four subgroups, A, B, C, D, and different efficiency rates for each of these groups. In group A (symptothermal method, double check) 15 unintended pregnancies (UIP) occurred in 7404 cycles, giving a pregnancy rate of 2.4 Pearl Index (PI); in group B (muco-thermal method) there were 12 UIP in 1352 cycles with a pregnancy rate of 10.6 (PI); in group C (mucus to detect the beginning and mucus and BBT to determine the end of the fertile phase) there was one UIP in 434 cycles, and in group D (mucus method only) there was one IUP in 70 cycles. The numbers in group C and D are too small to calculate a pregnancy rate (PI). No pregnancy was observed in women over 40 years of age. Our conclusion from these preliminary results is that in the continent of Europe, the symptothermal method when used with periodic abstinence (NFP only = group I) and fertility awareness with the use of barriers during the fertile phase (FA/mix = group II) are effective methods of family planning.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Natural family planning.

Natural family planning includes the calendar (rhythm), basal body temperature, ovulation (mucus), and sympto-thermal methods. Reliability of such methods often is underestimated, but effectiveness of various methods has been reported. Correct understanding and use of proper techniques, primarily abstinence during fertile periods, is imperative for effectiveness. New methods being studied may heighten awareness of fertile times and shorten required periods of abstinence or use of back-up methods.

Adolescent↗