Integrated Family Planning Activities in Maternal and Child Health Centres in Cap Bon, Tunisia: 1. Methodology and Results

Abstract

This paper describes an integrated approach to family planning and maternal and child health services in Cap Bon Tunisia an area where in 1971 birth rate was as high as 43/1000. The permanent immunization program covers about 80% of children between 1-4 and it is a good opportunity to check mothers at regular intervals. As they come to the clinic all information on mother and child is recorded on a single chart; the same personnel are in charge of child care and family planning activities; prescription of a contraceptive method is done by a midwife and all surgical procedures by a doctor. The target population of the center represents 27% of all married women in fertile age and the acceptability of the clinic by the target population went from 52.6% in 1973 to 74.3% in 1976. The percentage of contraception users has had a decline in 1976 probably because of the already high number of old users. The first 230 new IUD acceptors and the other 132 pill or condom and jelly acceptors were followed for 5 years and compared to new acceptors studied in a national investigation. In the Cap Bon series 52.5% were less than 30 years old as compared to 42.5% in the national study; 56.9% started contraception before the 6 month after delivery as opposed to 36.7% in the national study and IUD continuation rate was 93.4% as opposed to 87.5% in the national study; continuation rate for pill condom and jelly was only 51.2%. For any method the most frequent reasons for interrruption of contraception were personal reasons; discontinuation rates for IUD were 11.8% at 12 months and for the pill condom and jelly were 62.7%. Pregnancy protection rates after 24 months were 93% for the IUD and 70% for the pill condom and jelly. 53.3% of acceptors had 4 children or more and mean duration of breast feeding was 14.5 months; no difference was found in the acceptance of contraception between lactating and nonlactating mothers or according to the childs nutritional status. 95% of women consulting the clinic came from within 2-3 Km. of distance. Cost of the program at the clinic is $6 per new acceptor as opposed to $21 with mobile units.