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At least 19 recordsLinked to original sources

Public funding of contraceptive, sterilization and abortion services, fiscal year 1990.

In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.

Abortion, Legal↗

Restructuring federalism: the impact of Reagan policies on the family planning program.

Through fiscal cutbacks and structural changes, Reagan's federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagan's federalism upon social programs and have manifold implications for public health.

Capital Financing↗

Family planning operations research in Africa: reviewing a decade of experience.

Between 1979 and 1990, Columbia University conducted 26 family planning operations research (OR) projects in 13 sub-Saharan African countries. Most of these projects were implemented in settings where family planning service delivery had not yet been initiated or was new and poorly developed. In keeping with program needs in the early stages of development, the majority of the OR projects were based on demonstration or diagnostic designs. Only four of the 23 projects were comparative or quasi-experimental in design. Projects demonstrated the growing demand for family planning, and the feasibility and acceptability of a range of service delivery models. Sixteen of the projects have been sustained or replicated by national or local governments and institutions following the initial OR phase, replication of two others is planned, and another four resulted in policy formulation or improvements in existing national programs. OR in Africa played an important role in generating political and medical support for contraceptive services, and served to improve project management. OR proved more useful in the implementation and strengthening of individual programs than in generating universal lessons regarding service delivery. In order to maximize OR's utility in Africa, simple research designs and methods should be adopted.

Africa↗

The effects of federal funding cuts on family planning services, 1980-1983.

According to data from surveys conducted in the past two years, some changes occurred in the provision of family planning services between 1980, the year before the 1981 federal budget cuts, and 1983. Six percent of the family planning agencies that were operating in 1980 had closed or had stopped offering medical family planning services by 1983. The annual income of the family planning agencies that continued to operate, adjusted for inflation, was lower in 1983 than in 1980. While Title X remains the principal source of family planning funding, the proportion of clinics receiving income from Title X declined substantially during the period under study; this drop occurred among all types of providers. There was a slight decline in the proportion receiving funding from the Social Services block grant (formerly Title XX) in 1983, but there was no change in the contribution made by the Maternal and Child Health (MCH) block grant (formerly Title V). The proportion of total clinic income represented by Title XIX (Medicaid) funds rose slightly during this period. Decreases in federal funding appear to have been partly offset by an increase in the proportion of total income contributed by state and local governments and by private sources, particularly patient fees. Indeed, the number of agencies that collected patient fees, the proportion of clinic income derived from such fees and the proportion of patients who paid at least part of the cost of their family planning services all increased between 1980 and 1983. A separate survey of providers shows that fees varied widely, depending on a woman's income and on the type of agency.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Planning Services↗

Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh.

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

Bangladesh↗

Changing commitments of American women to work and family roles.

This article, based on a study of Chicago-area women aged 25--54, concentrates on six major dimensions of women's involvement in employment and family roles. First, it breaks new ground in exploring women's attitudes about social security and retirement expectations. Second, it documents cohort changes in overall life patterns, employment, and family role involvements from age 19 to the period studied. The article also focuses on four aspects of those life patterns especially relevant to the social security program: changing levels and patterns of education and job training, factors related to employment rates, differences between full-time homemakers and employees, and a detailed examination of the womens occupations. The study shows that neither social security policies nor retirement plans are matters of everyday concern to the women. Those who believe that social security policies are unfair hold widely differing and partially conflicting views on why and for whom they are unfair. Low-income women often emphasize that their benefits are too small; those involved in jobs or careers emphasize unfairness to different groups.

Adult↗

Impact evaluation of the "not me, not now" abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, New York.

"Not Me, Not Now" is an abstinence oriented, adolescent pregnancy prevention integrated communications program developed by Monroe County, NY. The evaluation utilized a cross-sectional time series approach in the analysis of items from several waves of youth surveys administered to two different age groups: (1) a survey of 7th and 8th graders on awareness, attitudes and intended behavior, and (2) the Youth Risk Behavior Survey administered to 9th through 12th graders. The trends found in the surveys demonstrated high levels of awareness of the program, changing attitudes and intended behaviors consistent with the program's messages. Analysis of pregnancy rates for 15-17 year-olds in the county were compared to reductions found in similar geographic areas. Pregnancy rates in Monroe County declined faster than in comparison areas. The authors conclude that there is a strong likelihood that the program had independent effect on the outcome of pregnancies in the population exposed to the program.

Adolescent↗

The effect of operations research on program changes in Bangladesh.

This article is based on the ten-year experience of an operations research project in Bangladesh. It assesses how, and under what circumstances, research-based advice and results of pilot projects contribute to change in large-scale public programs. It discusses project research on issues facing the national family planning program: recruitment and training of field-workers; delivery of injectable contraceptives; management information; field-workers' use of service registers; field supervision; satellite clinics; and contraceptive user fees. These issues are used to illustrate the advantages and disadvantages of a long-term institutionalized project, and to describe the diversity of means for communication with policymakers. The analysis shows that research, policy decision, and implementation can occur in any sequence. Policy advice that disrupts long-standing power relationships and organizational culture takes a great deal of effort to implement. Operations research can produce useful changes in organizational behavior, even when large-scale problems remain.

Bangladesh↗