Family Planning Delivery Systems Research Articles

Facilitating State-Wide Collaboration around Family Planning Care in the Context of Zika

IntroductionFamily planning providers have an important role to play in the response to the public health challenge posed by Zika. In the United States, there are high rates of unintended pregnancy, especially in states most at risk for mosquito-borne transmission of the Zika virus. This paper describes efforts by eight of these states (Arizona, California, Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas) to build capacity for quality family planning care in the context of Zika. MethodsDrawing on resources developed by the Office of Population Affairs, including a toolkit for family planning care in the context of Zika, agencies and stakeholders involved in the family planning delivery system in Southern states at risk for mosquito-borne transmission met over several months in the summer of 2016 to coordinate efforts to respond to the risk of Zika in their jurisdictions. ResultsThrough proactive communication and collaboration, states took steps to integrate Zika-related family planning care, including screening for Zika risk and providing appropriate, client-centered counseling. Challenges faced by the states included not having family planning included as a component of their state's Zika response effort, limited funding for family planning activities, and the need for robust communication networks between multiple state and federal agencies. ConclusionsThe efforts described in this paper can help other states to integrate family planning into their Zika response. This is relevant to all states; even when mosquito-borne transmission is not occurring or expected, all states experience travel-related and sexually transmitted Zika infections.

Unfolding Contraceptive Technology: Where Indian Population Stands Today?

The spurt in contraceptive technology particularly in spacing methods has opened up a wide variety of contraceptive choice for the potential user all over the world. India inspite of having national programs for family planning for long could not make proper use of the same. Sterilization still today remains the mainstay of the program. The current use of spacing methods in India is 7%. People still today are unaware of the importance of use and effectiveness of the spacing methods. Add to this the family planning delivery system is also not completely successful in reaching the methods to the target population and failed to achieve its goal to provide planned family to the nation. Under this situation the Indian population is far away and could not make use of the spurt in the contraceptive technology. Rigorous IEC on family planning, promoting spacing methods (introducing the use effectiveness of the new methods) and consolidating the national programme on family welfare and strengthening the outreach services can bring better results.

Family Planning in Rwanda: Status and Prospects

This article analyzes the status and future prospects of family planning in Rwanda. The use of traditional contraceptive methods is examined and major constraints to modern contraceptive use are discussed, both for potential users (low demand) and family planning delivery systems (poor supply). Current contraceptive prevalence, as well as evidence of potentially higher demand, are analyzed. Contraceptive prevalence for modern methods is estimated at 3-4 percent, for 1988, of women of reproductive age who are at risk of exposure to conception. An attempt is also made to target future contraceptive prevalence rates needed to attain specific levels of fertility. Finally, the prospects for family planning as well as recommendations to increase contraceptive use are reviewed.

Meeting the Need for Female Sterilisation

The single most common form of fertility control world wide is voluntary sterilization. 130 million women and 50 million men are sterilized each year. In the US and the UK sterilization is used by most 30% of couples of reproductive age. Also, the mean age at which someone chooses sterilization is declining. The main point of this article is that because such a large volume of people are having this type of surgery, any improvements in technique or reduction in complication, even if it is an incremental change, is an improvement. In the US the case-fatality rate for tubal sterilization is 4/1,000,00, while in Bangladesh the rate if 19.3/100,000. However, it is estimated that 100,000 female sterilizations prevent 1000 maternal deaths in the years between surgery and menopause. Post sterilization pregnancies is another issue addressed by this article. Among 20,749 sterilizations reported by Family Health International, there were 209 pregnancies. 1/3 of these were luteal phase pregnancies that were undetected at the time of surgery. Preliminary studies suggest that failures are more common with mechanical clips than rings, bipolar cautery, or the Pomeroy technique. (Although the differences are small). In the US 75% of female sterilizations are done by bipolar electrocautery because of a perception that it has the lowest failure rate. Ectopic pregnancies occurred at a rate of 0.64/100,000 operations. There are two primary ways of entering the abdomen to occlude the fallopian tubes. Minilaparotomy is very common, requires minimal surgical skills and is safe and cheap for the patient because a local anesthetic can be used. Laparoscopic sterilization while being convenient is more complicated, requires a higher degree of surgical skill, and more expensive equipment. In well equipped, high volume areas, this method is preferred because of its convenience. However, with very few exceptions, it is not practical for field or rural areas. Family planning delivery systems must walk a fine line between having too few controls on access to sterilization, and thus subverting informed consent; and having too many controls, and thus denying access to the people who will benefit the most.

Causes and consequences of unwanted pregnancy from Asian women's perspectives

Shortcomings of contraceptives and of family planning delivery systems are major reasons for unwanted pregnancy and unsafe abortion in Third World countries. Family planning and health programs should provide empathetic counseling for contraceptive choices and pregnancy termination, adjust management systems and procedures to facilitate women's access to services and information, and offer comprehensive services to meet their multiple reproductive health needs.

A Report on a Contraceptive Social Marketing Experiment in Rural Kenya

There is a recognized need for the development of nonmedical, grassroots family planning delivery systems. This report describes the results of a two-year experiment in rural Kenya in which local marketing resources were utilized to promote and distribute condoms through village stores. The impact of the extensive advertising campaign on the test market area was measured by comparison with a control area and by before, during, and after sample surveys. In addition to achieving a condom sales level of 0.21 pieces per capita after 12 months, the program had a marked impact on family planning knowledge and practice, although not on attitudes. The authors assess the program's performance in relation to its goals and suggest how such social marketing programs could have far-reaching significance in most developing countries.

The United States National Family Planning Program, 1968-74

In the United States, there are currently an estimated 30 million women at risk of unwanted pregnancy; of these, more than 12 million low-and marginal-income women aged 20-44 and adolescents of all incomes appear to be in need of subsidized family planning services. A family planning delivery system capable of serving approximately one-half of these women has been rapidly organized: the clinic program has grown from 900,000 clients in 1968 to 3.4 million in 1974, and the private sector is assumed to be providing care for 3 million more. The allocation of federal funds, the enactment of supportive policies and laws, and the organization of a specialized and centralized agency in the federal government have been factors in the initiation and expansion of family planning services.

Organized Family Planning Programs in the United States: 1968-1972

The data analyzed in this article show that, notwithstanding differences among agencies, funding sources, and regions, the organized family planning delivery system, as presently constituted, with a varied mix of provider agencies, is serving almost exclusively women of low or marginal incomes. About 9 in 10 of these women came from families at or below 200% of poverty; about three-quarters of them were from families at or below 150% of poverty level, and about 7 in 10 were from families at or below 125% of poverty. However, about 20% of women at or below 150% of poverty received family planning service from private physicians. As might be expected, as the number of patients served by organized programs grew, more than tripling between 1968 and 1972 to an estimated 2,612,000 women, so did the number of counties in which services were provides and the number of agencies providing the services. In the course of this rapid growth, the organized family planning programs became one of the major sources not only of medical contraception, but of other preventive health services. Most of the patients were young (media age was 23), of low parity (media was 1.8, including about 30% childless), with a high school education. Less than 1/6 (16%) were receiving public assistance.

Evaluation of national health programs. IV. Louisiana family planning.

In 1966 the Orleans Parish Family Planning Program was developed with the objectives of developing a family planning delivery system that identified, contacted, educated, and provided all indigent families of the metropolitan area with family planning information and services; creating this program between July 1, 1967 and June 30, 1970; and evaluating the program by measuring its impact on fertility among the target population along with its effect on the various obstacles to family health associated with no family planning. The Orleans Parish component of Family Planning, Inc., a private non-profit corporation, is the largest single component of the statewide program that began in June 1967. The Orleans Parish Family Planning Clinic System consists of 1 central clinic and 3 satellite clinics. It offers prenatal care, postpartum care, prescription and medical supervision of contraceptive methods, screening for chronic diseases, and social and medical counseling. Evaluation of this program during the 1st 2 years of its operation revealed the following: 1) 17,459 families had become active users of the program; 2) about 74% of all patients who began contraceptive use during the 1st 6 months were still using contraception after 18 months; 3) over 95% of the families are black; 4) black women between the ages of 20 and 24 have been the biggest users of the services; and 5) the probability of a black patient using the program has been 6 times greater than for a white patient of the lower socioeconomic group. The people want and are motivated to receive these services when offered in an acceptable way. Such programs can be accepted throughout the country. A system that provides information about family planning along with the means to deliver health care and family planning services is what is needed.