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PubMed2002

The future of family planning programs.

National family planning programs have been an important instrument in accelerating global fertility decline and in restricting ultimate world population to a level probably below ten billion. They began to come into being after 1950 and will probably go out of existence in most of the world's regions by 2050. The archetypal programs were instituted in Asia and North Africa. The end of the twentieth century is an appropriate half-way mark at which to evaluate the twentieth-century programs and to assess what changes in them will be needed for the twenty-first century. Some changes are necessary because dramatic events have occurred: (1) long-term replacement-level fertility has been attained in most of East Asia and some of Southeast Asia, and accordingly, some programs there are being phased out; (2) mainland South Asian fertility has been slower to decline; (3) international donor funding is diminishing and may not be significant during much of the twenty-first century; (4) the 1994 International Conference on Population and Development held in Cairo called for a radical change in programs away from demographic aims and toward reproductive health and the improvement of the situation of women; and (5) the future family planning frontier will be sub-Saharan Africa, for which radically new types of programs may have to be developed. These issues were discussed in January 2000 at a conference held in Dhaka, Bangladesh. A selection of contributions to the conference is published here. This article provides an overview of the issues based partly on this selection and partly on the discussions that took place at the conference.

Developing Countries↗
PubMed1984

Volumetric vaginal aspirator may aid in natural family planning.

All natural family planning (NFP) methods are based on the determitnation of a woman's fertile period so that a couple may abstain from sexual relations or use a mechanical means of birth control during that time. Researchers are seeking more accurate methods of predicting the onset of ovulation in order to increase the effectiveness of NFP. A new device developed by Dr. Gebhard F.B. Schumacher, a fertility specialist at the University of Chicago who serves on FHI's Technical Advisory Committee, and Dr. Stepen J. Usala, a former medical student at the University's Pritzker School of Medicine, holds the promise of providing a new, cheap, and relatively simple way of predicting ovulation. Called a volumetric vaginal aspirator, the instrument allows women to measure their own vaginal fluid on a daily basis. In early studies of 7 women carefully studied over 18 menstrual cycles, a striking 3 fold to 30-fold increase in the volume of vaginal fluid occurred a few days before ovulation. Results from 12 more women for a total of 26 cycles confirmed the earlier studies. Blood samples were taken in order to measure the levels of estrogen, known to increase prior to ovulation, and luteinizing hormone, which peaks sharply on the day of ovulation, in the women studied. These confirmed that ovulation typically had occurred after the fluid volume increase. In addition, participants recorded their basal body temperature (BBT) upon awakening. Although the BBT does not predict ovulation, it frequently increases by 1/2-1 degree Fahrenheit after ovulation thus serving as an indicator of the end of the fertile period. The prototype of the vaginal aspirator is a disposable plastic syring marked at .05 milliliter intervals so that fluid levels can be easily measured. After the manufacturing process for the aspirator is perfected so that the instrument can be mass produced, Dr. Schumacher hopes that largescale clinical trials will be initiated in the US and abroad. The larger studies and an endocrine study are needed in order for effective rules to be developed for applying the method in either birth control or fertility enhancement. The vaginal aspirator could be useful not only for preventing unplanned pregnancy but also for aiding couples experiencing infertility to pinpoint the time that conception is most likely to occur. As an aid in birth control, the aspirator should have a success rate similar to or better than that of a diaphragm, Dr. Schumacher believes. Although the women testing the vaginal aspirator were ablet to use it without assistance, Dr. Schumacer emphasizes that some patient education will be necessary if it becomes commercially available. Fertility awareness teachers could incorporate it into their courses. Research on the volumetric vaginal aspirator has been supported by FHI and by Mothers' Aid Research Fund of Chicago Lying-In Hospital.

Clinical Laboratory Techniques↗
PubMed1996

The cost-effectiveness of family planning service provision.

BACKGROUND: Family planning services are amongst the most highly utilized services in the National Health Service. There have, however, been few empirical studies of the cost-effectiveness of these services. METHODS: Two measures of output were used to calculate the cost-effectiveness of family planning services. The first measure is based on the number of pregnancies averted. The second measure uses the couple year of protection as the measure of output. Accordingly, two cost-effectiveness ratios are calculated: cost per pregnancy averted and cost per couple year of protection. RESULTS: The direct cost per pregnancy averted is between 48 pounds and 167 pounds for reversible and 18 pounds and 21 pounds for non-reversible methods. The cost per couple year of protection is between 49 pounds and 184 pounds for reversible and 17 pounds and 21 pounds for non-reversible methods. For both approaches, if averted NHS costs associated with family planning services are included these translate into resource savings to the NHS resulting from the provision of these services. CONCLUSION: From the perspective adopted in this study, family planning services are highly cost-effective. According to calculations made in this paper, these services provide a high rate of return to the NHS and, when the resource consequences of unplanned pregnancies in the health sector as a whole are considered, result in resource savings.

Cost Savings↗
PubMedDate not supplied

Management issues in the organization and delivery of family planning services.

Statewide family planning programs have been developed primarily in the Southeast and in a few other States of the nation. They are managed by State public health agencies with a few exceptions. This paper presents issues which are of importance to persons and agencies interested in developing a statewide family planning program; namely State support, allocation of funds, setting goals based on impact rather than efficiency of services, secondary sources of funding, and patient data systems. Arguments for a statewide program include the maximum use of available resources (for example, title V maternal and child health funds), the opportunity to distribute resources equitably throughout the State, the development of a statewide third-party reimbursement system, the opportunity to develop evaluation mechanisms, support for starting a system of fee collection, and the use of a statewide patient data system. Arguments against a State program include some loss of local control of a project, possible organizational battles within State agencies, State political domination of program policy, and a possible shift of funding away from existing strong projects. In the early 1970s, development of statewide systems was coupled with a rapid increase of funding when broad coverage of services and accessibility were key factors. At the present, categorical funding is no longer increasing, and efficiency and maximization of resources are becoming more important.

Adolescent↗
PubMed2006

Family planning services: an essential component of preconception care.

Family planning services are necessary for the widespread adoption of preconception care for two reasons. First, preconception care is more likely if pregnancies are planned, and family planning services encourage pregnancy planning. Second, family planning services usually include counseling, and counseling provides an opportunity to discuss the advantages of preconception care. However, the potential of family planning services to promote preconception care is limited by underutilization of these services and inadequate attention to preconception care during family planning visits. This article suggests ways to reduce these problems.

Adolescent↗