Acceptance Of Family Planning Research Articles

Family Planning in Mali

From January 1972 to January 1974 a pilot family planning program for Mali reported 2000 acceptors among 10000 consultation visits to the central clinic in urban Bamako a figure representing 5% of the citys childbearing population. 71% of the acceptors chose the IUD 17% chose the pill and the remaining 6% preferred other contraceptive methods. A 1960-1961 survey of Bamakos 250000 residents estimated the proportion of monogamous women at 54% and wives of polygamous unions at 46%; proportions among clinic population were 62% and 38% respectively. Proportion of widows divorcees and single women (34%) and the literacy rate were higher among the clinic clientele. Fertility research indicates that a long tradition of birth spacing either by prolonged lactation or sexual abstinence greatly influenced acceptance of family planning in Mali. 68% of the women attending the clinic were motivated by a desire to space their children; only 22% wished to prevent all future births and 6% wanted to postpone the first birth. Family planning programing in Mali was provoked by the immediate needs of urban dwellers rather than by the demands of long range demographic goals. In 1973 the Ministry of Health decided to expand family planning services as part of an overall program for improved health and social welfare. Maternal and child health clinics will be reorganized as family health centers and 23 new clinics are expected to be operating within agricultural and industrial centers by December 1977.

The Containment of World Population Growth

The world has reached the present position of unprecedentedly rapid population growth not by achieving uniquely high fertility but by bringing about extraordinarily low mortality. The high growth rate and the built-in momentum of the age structure are obstacles to achievement of an acceptable standard of living for most of the world's population. Although government population programs have the potential to curb this growth rate, this potential has not been realized, and such programs are too often perceived both by their administrators and the population concerned as an end in themselves rather than a means toward a better standard of living. It is in this latter perspective, and in the context of the total development process, that population programs should be implemented.

China's experience on population control: The elusive model

After the Cultural Revolution China initiated a very intensive family planning programme. Although statistical data are not available, there is enough information to conclude that the custom of postponing marriage and planning births is gaining momentum. The new socio-economic environment is much more conducive to the acceptance of family planning by the young adults than was the case in previous campaigns. Contraceptives, abortions and sterilizations are free of charge and readily available through the extensive public health system. Most important to the success of the programme are the unique methods of motivation which involve virtually all segments of the society.

The social psychology of family planning in a part-aboriginal rural community, 1970 to 1973.

Social and psychological factors affecting family planning practice in a part-Aboriginal community in rural New South Wales are examined. The service must be geared to the understanding viewpoint and health needs of the client group not to middle class views. Aborigines place a high value on children: for this reason it is important that family planning be presented as a child spacing practice not just a means of child limitation. The Aboriginal male view of children as a mark of his virility prevalent fears of genocide and feelings of sexual jealousy are hindrances to a successful family planning campaign. Males must not be neglected in the presentation of family planning information. The Catholic Church in the area has not hindered acceptance of family planning. Films and field rather than clinic service are most effecti ve in presenting family planning. Personal relations between family planning doctors and the client group are important.

The Role of the Family in Postpartum Family Planning Acceptance

450 women divided equally between family planning acceptors and nonacceptors in the postpartum programs of three large maternity hospitals in Medellin Colombia were interviewed a short time after confinement. Results showed that a) higher parity was strongly associated with acceptance b) family planning acceptance was heavily influenced by the approval or disapproval of the womens husband first and mother second c) and that the climate of opinion has become more favorable toward family planning. The recommendation is that every postpartum program should be able to provide some information to the husband to assist him in making a joint decision with his wife regarding family planning.

Ernakulam's Third Vasectomy Campaign Using the Camp Approach

In Ernakulam District Kerala State India as a continuation of the two previous successful family planning campaigns which achieved 78423 sterilizations through two month-long camps held in November-December 1970 and July 1971 the third intensive family planning campaign in the district was conducted from 25 July 1972 to 17 August 1972 (24 days). The purpose of this campaign was to cover the maximum number of target couples within the district under the program and to further the goal of acceptance of family planning by the entire population of the district. Unlike the first two campaigns which were concentrated in massive camps centralized at Cochin the present campaign consisted of 15 decentralized camps held in the seven taluk (subdistrict) headquarters of the district and in specially selected centers to serve specified areas of population concentration. Vasectomies were performed at the camps and tubectomies and IUD insertions were performed at the taluk hospitals and other health institutions with adequate facilities. The camps were organized under the overall leadership of the district collector and the individual leadership of committees set up in each area. Intensive publicity and motivational efforts were organized throughout the district by a large number of committees that included family planning workers and opinion leaders at the grass-roots level of the urban wards and rural villages. (excerpt)

Some political and ethical problems in the development of family planning.

This paper is concerned with the political and ethical aspects of the development of family planning for the underprivileged and with the use of the underprivileged as subjects in clinical trials of new contraceptive technology. In the past decade family planning has evolved from a component of corporate philanthropy to a major U.S. government policy. The diffusion of family planning has been aided by its apparent “depoliticization” and “internationalization.” Differences of sex, race, nationality and class between researchers and subjects suggest ethical shortcomings in the clinical investigation of new contraceptive technology. The further diffusion of family planning depends partly on developing more acceptable methods and partly on developing new methods of dissemination. Various public opinion campaigns and incentive schemes designed to increase the acceptance of family planning by the underprivileged represent a move from voluntarism toward coercion. It is unfortunate that the development of the potentially liberating practice of family planning has been accompanied by these exploitative phenomena.

An Analysis of Future Population Pressures

The population issue is 1 major international issue that has suffered and continues to suffer from misinterpretation misrepresentation and deliberate or ignorant distortion for ends which are mostly nonscientific. It does need to be stressed however that the population issue is itself not a simple one of biology or medicine. The mere size of the population is not the only major problem since the indications are 1) that there will be enough space to accommodate this sort of population and 2) that with the proper application of known technology the feeding of a population of the expected size is not likely to go beyond human ingenuity as long as certain political and social barriers are eliminated. However 1 has to be pessimistic about the removal of such political and social barriers. It cannot be expected at this time that the more industrializaed countries will suddenly accept a deliberate effort to slow down their economic growth and assist the less developed nations to progress toward their level. The main future pressures in terms of medicine have to be related not only to the mere size of the population but to its structure. The problem of the future is that infant mortality will probably continue to decrease in some countries or regions rather precipitously. The life expectancy in the developing countries will continue increasing. The population will therefore continue to increase and this will occur despite that fact that many more countries will come to accept family planning as a logical step for population control. However family planning as now practiced cannot posibly lead to population control or global fertility limitation of any consequence. There is a need for realistic planning which includes a drastic limitation of the population. Doctors need to recognize their leadership role be informed about what can be done and support and encourage social activities which will really deal with the problems. Methods of fertility control should be freely and readily available and research for safer and more effective methods must be continued.

Psychological aspects of family planning.

The psychological aspects important in family planning counseling are discussed with a particular emphasis on attitudes toward sexuality. Family planning involves very complex motivational attitudes and requires careful handling by family planning personnel. Family planning ideally enables every couple to determine exactly when they want a child and thus avoid unwanted pregnancies. Starting a family involves a wide range of psychological issues including religious economic and sexual considerations. Despite the changing role of women in modern society childbearing is still an important socially-recognized female function. Counseling must stress the tie of sexuality and pregnancy particularly when dealing with unmarrieds and te emotionally handicapped. Compounding the problem has been the slow acceptance of family planning by society the law religion and the medical profession. Professionals have had trouble dealing with family planning because of their own problems with sexuality. Often the family planning patient whether she is a single teenager or a married mother needs help in facing her sexuality and the need to avoid pregnancy. Contraceptive methods such as the diaphragm foam condom or the rhythm method often complicate psychosexual problems. The oral contraceptive pill and to some extent the intrauterine device have had a major impact on family planning by helping to disassociate contraception from sexuality. Since the success of family planning lies in healthy conscious and unconscious attitudes towards sexuality marriage and parenthood the family planning counselor must be prepared to help the patient in these critical areas.

The postpartum approach to family planning: Experiences in Thailand, from 1966 to 1971

Thailand has had a postpartum program since 1966 in 4 large Bangkok hospitals and since 1969 in an additional 11 rural hospitals. The results have been dramatically successful, and a total of 99,434 women have accepted family planning services within 3 months of delivery or abortion, the majority accepting an intrauterine contraceptive device (IUD) or female sterilization prior to discharge from the hospital, usually on Days 2 to 4 post partum. There were more than 48,000 immediately postpartum acceptors of an IUD, which is thought to be the largest series of such cases reported in the literature. One hospital had over 66,000 IUD acceptors (direct and indirect) between 1965 and 1971 and continues to average more than 700 total new acceptors per month. Two rural Maternal and Child Health Centers have had over 70 per cent of obstetric patients to accept family planning services, the vast majority choosing either an IUD inserted prior to the discharge from the hospital or a female tubal ligation. The successes are primarily due to major efforts placed on motivation during the antenatal and postpartum periods. Based on the success of this program, it is recommended that the term “postpartum program” be abandoned in favor of the postpartum “concept,” in which family planning becomes a routine part of postpartum care, offered in all institutions providing maternity services. The fact that the majority of rural women in many parts of the world are delivered at home, supervised only by traditional personnel or relatives, means that the activities must be modified to meet this situation, which will have different requirements and needs from a hospital-based program.

A Beleaguered Welfare Program: A Case Study in Organizational Response

The effect of a change in a state welfare department's family-planning policy for mothers receiving public assistance following an intense public controversy is examined for its impact on the effectiveness of the program and the differential responses among counties of varying populations and community acceptance of family planning. By analysis of the service records it was found that the most negative impact occurred in those counties which, prior to the policy change, were most effective in enrolling the potential users of service and which represented the most positive attitudes toward family planning. It is hypothesized that the debasement of the organization's commitment to a value has a negative impact on the staff's propensity to action in support of that value to the degree of the staff's previous commitment to the value. The consequences for organizational effectiveness are discussed. Appropriate administrative response to value-laden controversy is suggested.

A Comparison of Family Planning Programs in Iran and Turkey

If family planning is to progress Iran and Turkey will have to embark upon total societal modernization including changes in economic demographic and attitudinal characteristics. Backward ideology regarding women has created a low output of female nurses and physicians. Both countries are economically very underdeveloped with per capita income of $353 and $283 for Turkey and Iran respectively. Both countries lack adequate systems of national vital statistics registration to show fertility changes. An annual growth rate of 3.0% for Iran and 2.7% for Turkey has been indicated. Both countries are aware of the socioeconomic problems of rapid population growth. In 1964 the National Family Program was established in Turkey and in 1967 for Iran. In Iran the goal is to have 500000 acceptors of family planning by 1972; in Turkey family planning was to be available to 2 million women by 1972. The program is located within the Ministry of Health for both countries. Although fixed family planning clinics have been established in 67 provinces of Turkey mobile units are heavily relied upon. Iran has established 397 family planning clinics. The Family Planning Association of Iran was registered with the International Planned Parenthood Federation in 1969 1963 for Turkey. In Turkey family planning was based upon IUDs but the pill was used in Iran. Both Iran and Turkey have a postpartum program limited to the main hospital in their capitals (40000 patients for Iran 12000 for Turkey). In Iran 81% postpartum used pills 20% for Turkey. 75% selected the IUD in Turkey. Both countries have developed short courses in family planning.

A family planning project in Rhodesia.

Discussions with 552 man and 254 women in Rhodesia explored their reasons for nonacceptance of family planning. Reasons given include: a desire for many children for personal, economic and tribal security reasons; fear of high mortality; need for children as a labor resource; will of God; and personal pride in many sons. A change in attitudes toward acceptance of family planning may be attained by effective communication (not merely transmission of information), by involvement of community innovators; and by personalized persuasion thru material and child welfare services. The use of trained midwives concentrating on ante and postnatal care would be an asset to the program.

A DIGEST OF THREE PAPERS BY JOSEPH D. BEASLEY*

2 family planning programs operating in New Orleans and Lincoln Parish Louisiana between 1965 and 1967 are reviewed to refute the concept that indigent women and those who have experienced out-of-wedlock pregnancies are uninterested in fertility control. Studies conducted prior to the inception of both programs determined a lack of reproductive and contraceptive knowledge among lower socioeconomic couples rather than a lack of motivation. The population of rural Lincoln Parish is 41.8% black and the median annual family income ranges between $2000 and $3000. 50% had delivered out-of-wedlock the median age was 23.6 years and the majority displayed low parity. In the New Orleans program annual family incomes were below $4500 and 95.7% of the patients were black (primarily because poor whites were unwilling to attend integrated clinics). Birth records from public and charity hospitals were used to identify patients and priority contact was given to current postpartum patients followed by high-risk mothers who had delivered in the past 2 years. Low-risk women were contacted last. Contact with postpartum mothers was made 1 or 2 days after birth by a program nurse and included an individual education session literature and the offer of an appointment 4 to 6 weeks later. High and low-risk women were contacted by family planning auxiliary workers selected from the indigent population and trained in reproductive physiology contraceptive techniques and program orientation. Auxiliary workers were responsible for the program follow-up system which increased the total number of first admissions by 22% in New Orleans. Patients received a call or letter after missing their first appointment and a home visit after a second cancellation. Data from the Lincoln Parish programs second year of operation showed a significant decrease (47%) among indigent illegitimate births and other pertinent indices. In New Orleans 96% of the first admissions accepted some form of birth control. Oral contraceptives were chosen by 62% of the women and the IUD was chosen by 20% compared to previous usage levels of 24% and .2% respectively. 88% of the first admissions remained with the program over an 18-month period. Both Louisiana programs demonstrate that successful acceptance of family planning by indigents depends upon the design and provision of adequate maternal health services which stress privacy freedom of choice and sustained personal contact.

OBG: Nurse's Role in Family Planning at a Municipal Hospital.

Expansion of the family planning service in a municipal hospital resulted from a reassignment of personnel; the nurses role in this expansion is described. The nurses 4 functions include preparing the patient for the acceptance of family planning; this was usually done by a doctor. Another function was educating the patient a natural extension of the first function. The nurse discussed described and demonstrated the different family planning methods. By assigning these 2 roles to the nurse the doctor could make more efficient use of his time with the patient and concentrate on the emphasis of special family planning factors. The fourth function has proven to be one of the most important: the giving of reassurance and being available throughout the week for questions. This patient-nurse contact has yielded a singular source of satisfaction from the operation of the program.

The administration of the famlly planning programme in Pakistan with special reference to the employment of paramedical personnel.

Pakistans government-sponsored family planning program began in 1965 with the objective of making contraceptive services available to the entire eligible population. The central government is responsible for the implementation coordination assessment and evaluation of the family planning activities in the provinces and for research and procurement and distribution of foreign aid. All forms of contraceptives are available to both men and women at little or no cost. Contraceptives can be obtained in all family planning clinics and in most of the shops throughout the country. Clinical services emphasize vasectomies and IUD insertions which are restricted by a culture allows only women doctors to insert IUDs. In order to overcome this restriction clinical paramedical personnel and health visitors are being trained to insert IUDs. They are placed in rural areas as family planning clinic staff. The dais the village midwives are also being recruited to provide family planning service. This group has the most access to women before and following their deliveries are accepted as competent by the women and are in a good position to advise them. With training and supervision the level of their performance will increase and they can provide an invaluable service by promoting the acceptance of family planning. Also younger more educated women are becoming midwives. They are paid incentives for contraceptive acceptors.

Relative fecundability of users and nonusers of contraception.

Data from a fertility survey taken at the end of 1962 in Taichung Taiwan on 2443 married women (aged 20-39) were used to calculate the relative fecundability between birth control users and nonusers. The same women were interviewed at the end of 1963 and further follow-up was possible through a survey in 1965. 17% of the total accepted contraception; 78% of these selected the IUD and the rest used traditional methods. Using a Type I geometric model it was shown that acceptors who had used contraception had an initial fecundability about 25% higher than nonacceptors who had not used contraception prior to the interview which indicated that acceptors had had higher fecundability at marriage as well as at the time of the interview. These results suggest that family planning programs have a greater impact on fertility than would be expected if fecundability were the same for acceptors and nonacceptors. Approaching older women with higher parity who accept family planning methods more readily is important because of their greater potential in contributing to birth rates than other women in the same age groups.

Acceptance of family planning among a cohort of recently delivered mothers.

Acceptance of family planning among a cohort of recently delivered mothers. L Emerson, R Gordon, S Roman, Jr, M Koike, and J J SpeidelCopyRight https://doi.org/10.2105/AJPH.58.9.1738 Published Online: August 29, 2011

Thailand: Stability and Escalation

Throughout 1967 three major factors contributed to the continuation of political stability in Thailand. The ruling regime maintained a high level of unity and agreement within its own ranks in spite of considerable differences in personal background and outlook. The two top-ranking military leaders, Premier Thanom Kittikachorn and Deputy-Premier Prapart Charusathien, continued to work remarkably well together during the fourth year since the end of the highly centralized rule of the late Field Marshal Sarit Thanarat. In spite of rumors of personal rivalry and predictions of an inevitable split, Thanom and Prapart proceeded with an amicable and effective ruling style of their own. Their influence was balanced by civilian members in the Cabinet, most prominent of whom were the Minister of Foreign Affairs, Thanat Khoman, and the Minister of National Develop. ment, Pote Sarasin. The regime continued to enjoy the general support and legitimizing aura of the King. A second factor promoting political stability was the economic progress of the kingdom. The national currency remained sound. Employment opportunities expanded. Favorable balances of foreign trade pushed the total financial reserves in the treasury to almost $1,000,000,000. An industrial development program started in 1965 attracted more private foreign capital. By the end of 1967 approximately 400 Chinese, Japanese, American and other foreign corporations had invested more than $300,000,000 in the economy. A second five-year plan (1967-1971) was launched which aimed to raise the gross national product by 7% each year. The new plan envisioned a total investment of $2,700,000,000 with one-third of these funds coming from foreign sources. The prospects for further economic progress were enhanced by a gradual but growing acceptance of family planning. Thirdly, American aid did much to bolster the peace and progress of the country. The United States continued to provide the military equipment and weapons for the Thai armed forces, with the Bangkok government confining its financial obligations to military pay and allowances. Total American military spending went from $42,000,000 in 1966 to $80,000,000 in 1967. Construction projects at air bases in the Northeastern provinces raised per capita income in this depressed region to $80 per year, with some workers receiving the unprecedented income of $45 a month.With the military and economic aid programs having begun in 1950, total American assistance to Thailand passed the one billion dollar mark in 1967. Military aid has con-

International Postpartum Family Planning Program: Report on the First Year

Since conception occurs at a high rate after the first postpartum menstrual period and since women who have recently been pregnant are highly motivated to contraceptive use the Population Council began the International Postpartum Family Planning Program in 1966 in 25 hospitals in 14 countries. The total target population was 2720434 of which about 10% received family planning education and information. In the first 12 months of the program 101725 patients accepted family planning. 51% accepted IUDs 26% oral contraceptives 10% sterilization and 13% other methods. The expulsion rate for the first 3 months of use was 23.4 per 100 insertions for the obstetrical group and 13.1 for the postabortion group but there was a high rate of reinsertion of 60% to 95%. The median age of direct acceptors was 24.9 years and 27.1 for indirect acceptors. The median number of living children was 2.1 and 2.7 respectively. There was a substantial increase in postpartum return rates due to the family planning program. A sample survey of 1930 women showed that after 6 months only 7% were not using any form of contraception. The total cost per prevented virth is estimated at $24.00 assuming 40399 births were prevented by the program.