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Differentials in fertility, family planning practice, and family size values in South Korea, 1965-1971.

Data from five Korean national KAP surveys of currently married women, conducted between 1965 and 1971, are analyzed to determine whether differentials have emerged or are emerging between urban and rural women in three factors of crucial importance for population growth: fertility, family planning practice, and family size values. Graphics are used throughout to analyze urban-rural differentials and trends in these factors over time. In addition, two statistical tests, the sign and binomial, are applied to the differentials to provide a tabular summary of results. Part I provides background information on population growth, urbanization, the achievements of the national family planning program, and economic development in Korea since the 1950's. Part II describes both urban-rural differentials in fertility, as measured by mean parity, for married women aged 30-39 between 1966 and 1971; and urban-rural differentials in the proportions of women aged 25-39 currently practicing family planning between 1965 and 1971. Part III analyzes urban-rural differences in ideal family size and ideal number of sons, controlling for number of living children and number of living sons. Part IV attempts to evaluate the impact of the national family planning program on the fertility, family planning practice, and family size values of the rural population by examining the findings on urban-rural differentials in the context of social and economic development, viewing the program as one of a multitude of variables that can affect these factors.

Adult↗

Old challenges and new areas for international co-operation in population.

Taking stock of accomplishments in the field of population reveals that significant progress has been made since the late 1960s but that much remains to be done. Important challenges in population for 1990 and beyond include the implementation of more effective family planning programs, greater accessibility to better family planning services at the local level, a wider range of choices in contraceptive methods, and better training and supervision of family planning delivery personnel. Another major challenge is to give attention to the various aspects of the role of women--beyond mere acknowledgement and to the actual implementation of programs. Further, policies need to be formulated and implemented across several sectors to deal with the complex interaction between population, resources, and the environment. To devise such policies, knowledge of the interrelationships needs to be clarified and refined. Finally, still greater emphasis will have to be placed on improving the integration of population and development. Accomplishing that will require wider awareness, enhanced coordination and adequate resources--an increase of at least $100 million per year from now to the end of the century over the annual current level of some $550 million for all external assistance for population.

Conservation of Natural Resources↗

Decreased prevalence of Chlamydia trachomatis infection associated with a selective screening program in family planning clinics in Wisconsin.

The effectiveness of selective screening for control of Chlamydia trachomatis is unknown. In 1986, a statewide screening program began in family planning clinics in Wisconsin after the prevalence of infection among women was found to be 10.7% in four nonurban clinics and 13.7% in an urban Milwaukee clinic. In 1990, endocervical specimens were obtained from 1,757 women attending these same clinics; 5.2% of women in the non-urban clinics and 6.9% in the Milwaukee clinic tested positive for C. trachomatis. Prevalence of infection had decreased similarly (by 53% overall) in both high- and low-risk groups in all five clinics. Although reported condom use increased from 16% to 31%, most other demographic and behavioral risk factors for infection did not significantly change; in contrast, the prevalence of clinical signs of infection decreased. The percentage of infections identified by selective screening criteria decreased from 77% to 55%. Selective screening and attendant activities, as well as an increase in condom use, were associated with a decrease in prevalence of C. trachomatis infection in this population.

Adult↗

The dilemma of family planning in a North Indian State.

An empirical study of the family planning program and its clients in the rural areas of Allahabad Division of Uttar Pradesh in India was undertaken in 1971-1972. While family planning acceptance in this region is low, interviews with villagers and family planning staff suggest that organizational shortcomings of the program may help to explain the low level of acceptance. The reported level of contact between the program field staff and the village population was unexpectedly low. The paper discusses a number of administrative problems within the family planning organization, especially at the level of the primary health center. It is concluded that in designing family planning programs, efforts should be made to minimize organizational requirements.

Family Characteristics↗

International family planning funds will be expedited.

With a 53-46 vote on February 25, the Senate approved a resolution to speed up the release of funding to the US Agency for International Development (USAID) for its overseas family planning programs. The resolution, which had been passed by the House on February 13 (see RFN VI/2), will make money budgeted for fiscal year 1997 available on March 1, 4 months earlier than originally scheduled. Under the omnibus budget bill approved at the end of September 1996, funding was to have been withheld until July 1--a full 9 months into the fiscal year--unless President Clinton made a finding that the delay was harming the functioning of the US family planning program. Based on a report from USAID, which found that the delay would cause at least 17 programs around the world to suspend their services and result in significant and permanent damage to US population-control efforts, President Clinton issued the finding in support of moving up the release of funds. The Senate did not consider a House-passed provision that would have barred family planning programs that receive US money from providing abortions, even if they paid for the procedures through other sources of funding.

Americas↗

Fertility decline in Barbados: some spatial considerations.

Despite its small size, Barbados exhibits some striking regional differences in fertility levels, which persisted during a period of major fertility decline in the 1960s. Regression analyses are performed for 28 subregions, using sex ratio, male occupational structure, female education, and female employment for 1960 and 1970 as the independent variables. The spatial influence of the Barbados family planning program is also considered. The author argues that a concentration of family planning programs in areas of greatest accessibility and modernization contributes to spatial variations in fertility.

Adolescent↗

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.

Age Factors↗

Improving the quality of service delivery in Nigeria.

This study evaluates the effect of a nurse training program in family planning counseling skills on the quality of service delivery at the clinic level, as well as its impact on client compliance with prearranged appointments. The study used a quasi-experimental design to compare certified nurses who received six weeks of family planning technical training with certified nurses who, in addition to the technical training course, received a three-day course in counseling skills. Data were collected through client exit interviews, expert observation, and inspection of medical record abstracts. Trained nurses performed better than their untrained counterparts in the quality-of-care areas investigated--interpersonal relations, information giving, counseling, and mechanisms for encouraging continuity. The likelihood that clients will attend follow-up visits was also found to improve when they were attended by trained professionals. Short-term counseling training can significantly improve the quality of care provided by family planning workers, as well as client compliance with follow-up appointments.

Adolescent↗

A benefit-cost analysis of family planning services in Iowa.

An analysis of publicly funded family planning services in Iowa was undertaken to provide tangible estimates based on local data of the value of these services in averting unplanned and unwanted births to women who voluntarily use them. The study reports methods that can be applied by other states in evaluating their own family planning programs. Benefits were measured as the cost savings in public expenditures avoided by providing family planning services to low- and marginal-income women. Iowa data for AFDC, food stamps, and Medicaid payments were used to calculate benefits. The total benefit savings were adjusted to reflect the impact of family planning services on preventing births. The adjusted savings were accrued over one-year and five-year time frames and for four age groups (14-19, 20-29, 30-34, and 35-44). In the base year, the cost of providing family planning services in Iowa to the more than 56,000 women who used them was $3.1 million, or $59 per user. Results showed that the benefits of family planning services were highest for teenagers who would become eligible for public assistance programs upon the birth of a child.

Adolescent↗

Determinants of contraceptive method choice in rural Tanzania between 1991 and 1999.

Four pooled Demographic and Health Survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania for the period from 1991 to 1999. The individual data are linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The focus of the study is an examination of the effect on method choice of the three major components of Tanzania's family planning program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of family planning message recall. Simulations are used to quantify the impact of the important policy variables. All three components of the program are shown to have had an impact on modern method choice.

Adolescent↗

Past and current contraceptive use in Pakistan.

Despite a vigorous national family planning program and such innovations as the Continuous Motivation System, there has been little change in contraceptive use in Pakistan in recent years. Data from the 1968-69 National Impact Survey and the 1975 World Fertility Survey for Pakistan show that, while use rates increased by a small amount in urban areas, the rates in rural areas seem to have declined. Even in urban areas contraceptive use is low in comparison with other developing countries that began family planning programs around the same time. Although this is probably due to differences in economic development, further investigation of program structure and inputs is recommended.

Adolescent↗

Cost-effectiveness of USAID's regional program for family planning in West Africa.

Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

Adolescent↗

The first generation to control family size: a microstudy of the causes of fertility decline in a rural area of Bangladesh.

In Bangladesh, the total fertility rate declined from more than six children per woman of reproductive age in 1980 to 3.3 children per woman in 1996. Much discussion has ensued about the circumstances responsible for this decline and, in particular, about the contribution made by the national family planning program. For this study, qualitative interviews were conducted with 67 women concerning the factors influencing their reproductive behavior. The participants, residents of a rural area in southwestern Bangladesh, consisted of two groups: women who were currently practicing family planning and women who had never practiced or had not done so for at least four years. The findings suggest that the family planning program has played an important role in reducing family size, but also indicate that economic and social changes, and especially growing aspirations (particularly for a life outside agriculture) have combined with changes in the nature of family decision making to make couples more receptive to the idea of family planning.

Adult↗