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Fertility and family planning in Haiti.

This paper presents data on current levels and trends in fertility in Haiti and discusses some of the factors that determine the current situation. Particular attention is given to knowledge and use of contraception and the impact of the recently established national family planning program. The major source of data is the 1977 Haiti Fertility Survey, but more recent information on family planning program activities is also presented. Factors likely to influence future trends in fertility and family planning are presented in concluding.

Adolescent↗

Factors related to autonomy and discontinuation of use of natural family planning for women in Liberia and Zambia.

From 1983 to 1988, natural family planning programs were conducted in Liberia and Zambia. In Liberia 1055 and in Zambia 2709 women used natural family planning to avoid pregnancy. These users could become pregnant, discontinue use of the method, or become autonomous users. Women who changed intention did not stop use of natural family planning and were not treated as discontinuations. In a multivariate analysis, client's age, breastfeeding status, employment, urban/rural residence, time of registration in the program, and visit intensity were significantly associated with the outcomes. The most consistent association was that women who entered the programs in the later time periods were more likely to become autonomous users and less likely to discontinue use of the method or to experience an accidental pregnancy.

Adolescent↗

Estimating the effects of contraceptive use on fertility: techniques and findings from the 1974 Philippine National Acceptor Survey.

Survey data on contraceptive use-effectiveness and on the fertility of family planning acceptors can provide a useful basis for estimating the fertility effects of a family planning program. The 1974 Philippine National Acceptor Survey (NAS), a sample survey of nearly 3,000 family planning acceptors reported by clinics in 1970--72 and interviewed in 1974, provided data for such an evaluation of the Philippine family planning program. The program's effects on the fertility of acceptors were estimated utilizing a series of analytical techniques, which are described in this article. Data from the NAS on continuation, pregnancy, and fertility following acceptance, as well as estimates of fertility decline associated with acceptance and continuing use of contraception, are analyzed. Findings are presented for acceptors of the four major program methods--pills, and the IUD, rhythm, and condoms. An appendix presents special procedures employed in estimating fertility effects.

Adolescent↗

Analysis of factors contributing to fertility decline in Korea.

With the successful Korean national family planning program and rapid socioeconomic advancement since 1962, the contraceptive prevalence rate has risen from 9% in 1964 to 79% in 1991, with the corresponding total fertility rate (TFR) going from 6.0 in 1960 to 1.6 in 1988, which is considerably below the replacement fertility rate. The main purpose of this study is, therefore, to identify the structural and causal factors that contributed to the fall in fertility over the last 3 decades, in an effort to formulate future population policy directions and strategies. The 2 methods used for the study were: the standardization approach to examine the structural factors on fertility decline, and the bongaarts model to measure the effects of the proximate variables in the fertility decline. The study indicated that the fall in the crude birth rate and the general fertility rate for the periods of 1960-70 and 1980-90 were largely influenced by the decline in marital fertility which was triggered by the national family planning program initiated in 1962. The analysis based on the bongaarts model revealed that the 3 principal factors which exercised a strong influence on the fertility decline were the rise in age at marriage, the increase in induced abortion, and the increase in contraceptive use, but the influence of induced abortion has been decreasing in recent years. In general, the study results suggest that the main concerns of the national family planning program should be shifted from the past quantitative approach with emphasis on fertility reduction to a qualitative approach which stresses maternal and child health and other public health programs.

Abortion, Induced↗

Reproductive change in Sri Lanka: analysis of intermediate variables, 1982 and 1987.

This study examines the intermediate determinants of fertility in Sri Lanka by making use of the data collected in the 1982 Sri Lanka Contraceptive Prevalence Survey and the 1987 Sri Lanka Demographic and Health Survey. The analysis shows that the most important inhibitor of potential fertility is deliberate control. The marital structure of the population is also an important fertility-inhibitor, but lactational infecundability is increasingly becoming an unimportant contributor. The findings show the success of the family planning program in Sri Lanka, which propelled fertility to a substantial lower level. Achievement of the replacement level fertility by the turn of the century, set by the Sri Lankan government, would largely depend on the efforts to increase the quality and quantity of contraceptive use and the duration of breastfeeding.

Adolescent↗

Contraceptive practice in the Philippines: a synthesis.

This article puts together all available data on contraceptive prevalence and effectiveness from 1968-83 in an attempt to assess the Philippine family planning program's performance in reducing fertility. 3 indicators of contraceptive effectiveness are discussed -- Pearl pregnancy rates, 12-month continuation rates, and effective protection level. Findings on factors associated with contraceptive prevalence are presented and discussed, with special emphasis on the effects of the Outreach project variables. The argument is that popualtion programs can influence demographic behavior, but the extent of this influence largely depends on the quality of program design and implementation.

Asia↗

A comparison of program and contraceptive use continuation rates in a family planning clinic.

Programs and contraceptive use continuation rates were obtained for a rural Georgia family planning clinic. Program continuation is a measurement of maintenance of clinic attendance, while use continuation is related to actual use of effective contraceptives regardless of clinic activity status. Program continuation rates ranged from 0.77 at 12 months to 0.48 at 36 months. Contraceptive use continuation rates were 0.78 at 12 months and 0.58 at 36 months. Women who moved or were otherwise lost to follow-up formed the largest category of discontinuation. The highest rate of discontinuation from clinic attendance occurred after the first visit with secondary peaks around the time of scheduled annual checkups. Women who were younger and had fewer living children had a greater likelihood of discontinuing clinic attendance and contraceptive use. The reasons for and timing of discontinuation from clinic attendance suggest that clinic personnel should place special emphasis on the first visits, arrange referral for women who might have plans to leave the service area before the scheduled return visit, send reminders before first revisits, and follow up patients soon after missed visits. Priority might be assigned to the younger women of low parity who have been shown to be at higher risk of discontinuation. Other factors which might influence continuation include method of contraception, marital status, and race. Program continuation can be determined by analysis of clinic records alone while contraceptive use continuation often requires follow-up of patients. Although the two continuation rates were not equivalent, program and use continuation were roughly parallel through much of the study period. This suggests that a simple review of records in the clinic or on computer tape, when available, to determine program continuation may give an estimate of actual contraceptive use in the population.

Community Health Services↗

India: population: shocking results; monetary incentives.

Addressing a conference of Parliament members on population and development in New Delhi, Prime Minister Indira Gandhi was reported to have informed the gathering that results of India's latest census "shocked us." The census counted a total national population of 683 million. It was 11 million more than officially anticipated. In her speech, Mrs. Gandhi was also reported to have reiterated that her government is totally committed to "voluntary family planning" and "firmly against compulsion." J.R.D. Tata, chairman of the Family Planning Foundation of India, proposed that the government raise monetary incentives for citizens voluntarily opting for vasectomy and tubectomy. He suggested that the present Rs. 200 for vasectomy and tubectomy be upped to Rs. 5000. He made the proposal in a call to the government to increase its outlay for the family planning program.

Asia↗

Promotion of vasectomy in Thailand.

Though vasectomy plays an important great role in the national family planning program, its popularity has been very low in the past requiring a lot of promotion. During the promotion phase of 1972 to 1984, various methods were used with the stress on mobile vasectomy campaign. However, after 1984, there was evidence of deceleration of vasectomy rate. In this phase, non-scalpel vasectomy has been promoted including the training courses for physicians in provincial hospitals and local health centers. It is expected that vasectomy will gain better acceptance in the future.

Family Planning Services↗

Comparative costs of family planning services and hospital-based maternity care in Turkey.

The costs of running a recently established family planning program in the Turkish social security system were measured and compared with the costs of providing the medical services and nonmedical benefits for pregnant women. The undiscounted cost savings from averting pregnancy were estimated to exceed the program's recurrent costs by 17.6 to 1. Cost savings represent only 1 percent of all of the system's medical expenditures, but the family planning program is in an early stage, and potential savings could influence management decisionmaking regarding investments in specialized maternity hospitals.

Cost Savings↗

Fertility and contraceptive practice: Bogota, 1964-74.

The results of a 1974 survey of 6,692 Bogota women aged 15-49 conducted by the Colombian Association for Population Studies show that, in the last decade, approval of family planning practice increased 34 percent, contraceptive practice nearly doubled, and fertility declined by over 45 percent. Life-table analysis shows unusually high continuation rates for Bogota women. Data concerning crossovers between Bogota's three family planning programs and the commercial sector indicate that the manufacturers of contraceptives benefit from program activities. The study demonstrates, for the first time in Latin America, the feasibility of using a probability sample of the general female population to evaluate family planning programs.

Adolescent↗

Marketing of birth control in LDCs: with special references to India.

The authors outline a marketing approach for family planning programs in developing countries, with references to experiences in India. Following an overview of types of population programs, suggestions for strengthening program efforts are offered, and a framework for marketing birth control is described. "This approach was based on the recognition that acceptance of a small family norm is interwoven with the freedom to make that choice.... This framework suggests that marketing plans should be aimed at the three-dimensional goal of increasing the population's desire, ability, and capability toward acceptance of the small family norm and the practice of birth control [and] that in consideration of the wide geographical variations in population growth, per capita income, and the level of development in general, programs should be designed in a segmented manner to suit the socio-economic nature of each group."

Asia↗

[[Fertility in Bangladesh villages]].

The authors analyze the high fertility in two Bangladesh villages based on survey and genealogical data. "Compared with nation-wide data, [the] two villages showed comparatively high fertility. There was a difference in fertility between the two villages, which appeared to result from a difference in mean age at first marriage. No other factors were identified.... As for the government's family planning program, neither village showed much effect." (SUMMARY IN ENG)

Asia↗