Family Planning Organizations Research Articles

Publicly Funded Family Planning Organizations' Response to the Coronavirus Disease 2019 Pandemic in Texas.

After the onset of the coronavirus disease 2019 pandemic, the use of family planning services decreased, but there are limited data on how safety net providers were affected. Between November 2020 and March 2021, we conducted in-depth interviews with administrators at health departments, federally qualified health centers and specialized family planning organizations across Texas about pandemic-related changes in family planning services. We analyzed interview transcripts using an inductive thematic approach. Administrators at the 19 participating organizations described pervasive service disruptions. Some organizations closed for 6-8weeks at the pandemic's onset owing to safety uncertainties and difficulty interpreting Texas' March 2020 executive order prohibiting "nonessential" medical services; others later suspended services after staff exposures. Health departments and federally qualified health centers commonly decreased family planning services to focus on coronavirus disease 2019 response, leaving specialized family planning organizations to absorb displaced reproductive health care clients. Some of the advantages of service delivery modifications-including telehealth, curbside and drive-through prescription pickup, and medication by mail-were difficult to realize; barriers included low reimbursement, necessary patient examinations, and clients' confidentiality concerns and lack of technological resources. Texas' diverse network of family planning organizations illustrated a range of responses to the pandemic, and organizations often focused on their core missions-public health, primary care, or family planning.

Men's involvement in family planning programs and associated factors from the perspective of women in Afghanistan; a case study

ObjectivesFamily planning is a cornerstone to the achievement of Sustainable Development Goals. However, men's involvement in family planning has been a challenge in many countries. This study aimed to investigate the participation of men in the family planning programs and related factors from the perspective of women referring to family planning organizations in Herat, Afghanistan 2021. MethodsThe study had a cross-sectional design. The participants of the study consisted of 544 married women aged 15-49 years selected by simple random sampling. The data collection tool was a valid and reliable questionnaire to assess the participation of men in family planning programs. To analyze the data, descriptive statistics and analytical methods including Mann-Whitney and Pearson Chi-Square tests were applied in SPSS 21. The answers to the open-end questions were analyzed, coded and classified in two main categories. ResultsThe average age of study participants was 28(±10) years and a significant proportion of them were illiterate (48.5%). Most of the participants were housewives (83.6%) and their husbands were non-professional workers (39.9%). The husbands participated in family planning programs by choosing the type of contraception (29.2%), provision of contraceptives (29.6%) and supporting their wives using them (49.3%). There were statistically significant relationships between women's and their husband's education level, and husband's employment status with the type of participation in family planning. The main incentives for Afghan men to participate family planning were the increased attention of families to the education and needs of children and the health and welfare of the wives. However, cultural norms supporting larger families, the desire for having boy children, the fear of contraception's side effects and religious prohibitions discourage them in using family planning methods. ConclusionA large number of the respondents stated that their spouse participated in family planning programs. It shows the importance and success of family planning centers in promoting sexual and reproductive health and family planning. Study showed that various factors affected men's participation in family planning programs. Recognition of these factors can help policy makers in designing behavioral interventions based on social marketing, and enhancing the effectiveness of these programs.

Contraception Deserts: The Effects of Title X Rule Changes on Access to Reproductive Health Care Resources

AbstractHistorically, access to contraception has been supported in a bipartisan way, best exemplified by consistent congressional funding of Title X—the only federal program specifically focused on providing affordable reproductive health care to American residents. However, in an era of partisan polarization, Title X has become a political and symbolic pawn, in part because of its connection to family planning organizations like Planned Parenthood. The conflicts around Title X highlight the effects of intertwining abortion politics and contraception policy, particularly as they relate to reproductive justice and gendered policy making. Family planning organizations like Planned Parenthood have responded to these battles by bowing out of the Title X network. To what extent have contraception deserts—places characterized by inequitable access to Title X—developed or expanded in response to policy changes related to contraception and reproductive health? What is the demographic makeup of these spaces of inequality? We leverage data from the Office of Population Affairs and the U.S. Census Bureau and use the integrated two-step floating catchment area method to illustrate the effects of a major change in the Title X network in 10 states. Our results reveal the widespread human ramifications of increasing constraints on family planning organizations as a result of quiet but insidious federal bureaucratic rule changes.

Women’s Rights, Family Planning, and Population Control: The Emergence of Reproductive Rights in the United Nations (1960s–70s)

The article traces the emergence of reproductive rights principles in the UN during the 1960s–70s. Family planning programmes were the key discursive terrain on which conflicts over fertility, global population, and women's roles in ‘third world development’ were interlinked. The UN’s Commission on the Status of Women was a key actor: in the late 1960s it defined family planning in relation to a broadened definition of human rights, and repositioned it as a women’s rights issue. This shift resulted from competing but in some respects converging concepts of women’s rights among Western-based, communist-aligned and Global South-based women’s organisations at the Commission. While subsequent UN conferences, specifically Bucharest 1974 and Mexico City 1975, revealed enduring global conflicts over ‘population management’ and ‘third world development’, the UN reframed family planning in relation to human rights principles. It hereby responsibilised women in their social roles, potentially enhancing their reproductive autonomy – but failing to fully abandon the population control agenda, against the calls of feminist movements in the Global South. The article contributes to histories of the UN and of the emergence of globally connected feminist movements, and is based on archives and publications of women’s rights NGOs, UN agencies, and family planning organisations.

Changes to medication abortion clinical practices in response to the COVID-19 pandemic

ObjectivesTo document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. Study designLongitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. ResultsSeventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. ConclusionsSites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. Implications statementMedication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.

USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy

The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates. We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743 691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy. We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10 000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted. Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy. The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.

“Estará nas pílulas anticoncepcionais a solução?” Debate na mídia entre 1960-1970

Resumo: O artigo apresenta o debate social sobre pílulas anticoncepcionais, veiculado em O Globo, nos anos 1960 e 1970. Realizamos uma pesquisa sócio-histórica, utilizando o método de estudo de controvérsias. A segurança e a oportunidade dessas tecnologias no Brasil foram as principais questões dos conflitos que envolveram médicos, Igreja, autoridades públicas e entidades de planejamento familiar. Após anos de ambiguidade, o Estado entra efetivamente no debate e, recuperando a ideia de “paternidade responsável”, difundida pela Igreja Católica, contribui para a estabilização das controvérsias. O centro dos debates se desloca de questões malthusianas para uma perspectiva neomalthusiana liberal-conservadora que relaciona o direito de decidir sobre a prole e à responsabilidade moral e cívica de limitar o número de filhos àquele que se possa criar.

Editorial Note: Women and the Global 1970s

Editorial NoteWomen and the Global 1970s Elisa Camiscioli and Jean H. Quataert What does the 1970s look like through the lens of women's history? The articles in this issue explore key markers of this decade—the expansion of the rights revolution that began in the 1960s, a loosening of previous restrictions on contraception and abortion, the broadening of women's healthcare and family planning organizations, and the growth of the environmentalist movement—to show how these developments touched the lives of women in Egypt, Australia, the United States, and Spain. Whether centered on national and regional studies or such global moments in 1970s women's history as the 1975 International Women's Year Conference in Mexico City, the articles highlight women's empowerment through bodily sovereignty, sexual exploration, state resistance, and traditional forms of high politics. We open with two articles that examine the long 1970s with regard to family planning initiatives. The first, by Alissa Walter, focuses on Egypt under President Jamal 'Abd al-Nasir's modernization project while the second, by Teresa Ortiz-Gómez and Agata Ignaciuk, is located in Spain during late Francoism and the transition to democracy. Family planning centered on contraception became an important postwar social experiment, dovetailing with UN debates about population and resources. By the 1960s, the widespread availability of contraceptive technologies like the Pill and the IUD invigorated these programs, and often their primary objective was women's empowerment through the avoidance of unwanted pregnancies. But this was not necessarily the focus in the developing world where, as Walter shows, family planning reflected postcolonial anxieties about the strain that high birth rates placed on state resources, thereby hindering national development. In Nasir's Egypt, contraception was part of an effort to modernize the lower classes. Walter illustrates rural women's spirited "non-participation" in this program, which was a key reason it failed in the 1960s and 1970s. In her account, ignoring the state constitutes resistance, and ignore the state they did: women declined to use any modern contraceptives at all, they rejected government-issued contraceptives, they used traditional herbal or barrier methods instead, or they adopted contraceptives provided by the government to space births, in the hope of increasing the number of surviving children in their families. This was not about religious objections, or women's refusal to act "rationally" by eschewing small families. As Walter concludes, rural Egyptian women "were not averse to regulating their fertility, they simply wanted to do so on their own terms." [End Page 7] The Spanish family planning movement developed in a different context: the public debates on contraception and abortion that occurred in many Western states from the mid-1960s through the 1970s. By the end of the decade, Britain, France, Italy, West Germany, Canada, and the United States all had witnessed a loosening of legislation on birth control and abortion. As Ortiz-Gómez and Ignaciuk show, such liberalization also occurred in Spain where, under the dictatorship of Francisco Franco, contraception was illegal. Birth control activism nonetheless emerged among progressive members of the medical profession in the late 1960s, in the outpatient clinics of public hospitals where doctors and nurses circumvented "hospital directives and contemporary legal norms" to advise in favor of contraception. They were joined by members of the burgeoning feminist movement that had sprung up after Franco's death in 1975. While for Spanish feminists, family planning was part of the "new sexual ethics" promoted by the international women's health movement, for doctors, it was generally a reflection of their support for the ideals of the World Health Organization and the International Planned Parenthood Federation. Ideological differences between feminists and physicians did not deter cooperation, however. This successful grassroots coalition of doctors and feminists helped to bring about the decriminalization of contraception in 1978, during Spain's transition to democracy. Women's healthcare is also central to Flannery Burke and Jennifer Seltz's analysis of "natural birth" in the United States. Their article reminds us that the rise of modern environmentalism—and the emergence of environmental anxieties about pollution—occurred in the decade of the 1970s as well. Burke and Seltz compare the perspectives of feminists and...

Iodine nutritional status of the vulnerable population in Henan province in 2011

To investigate the iodine nutritional status of the vulnerable population in Henan in 2011. From March to December 2011, 44 049 urinary samples of newly married women of childbearing age (363), pregnant women (31 874), lactating women (4893) and children under 2 years (6919) collected from hospitals, maternal and child care hospitals and outpatient department of family planning organizations from 8 cities of Henan province (only including the areas where water iodine was less than 100 µg/L) were tested for urine iodine concentration. The iodine nutritional status of different groups was analyzed. The median of urinary iodine for newly married women, pregnant women, lactating women and children under 2 years was 204.5, 190.9, 145.5 and 185.4 µg/L, respectively (χ(2) = 874.16, P < 0.01). The proportion of urinary iodine below 150 µg/L of pregnant women and below 100 µg/L of lactating women and children under 2 years was 33.0% (10 519/31 874), 24.9% (1218/4893) and 12.4% (855/6919), respectively. The proportion of urinary iodine above 300 µg/L of newly married women was 33.6% (122/363). The median of urinary iodine for pregnant women in the first, second and third trimester was 186.7, 193.8 and 182.5 µg/L, respectively (χ(2) = 55.19, P < 0.01). The median of urinary iodine for the breast-feeding, formula-feeding and mixed-feeding infant under the age of 1 year was 194.8, 85.6 and 176.0 µg/L, respectively (χ(2) = 179.25, P < 0.01). The overall iodine nutrient levels of the vulnerable population in Henan in 2011 were appropriate, but there were still some proportions of pregnant and lactating women with low iodine level. The iodine intake of the formula-feeding infants was not sufficient.

Emergency Contraception

ObjectiveTo review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. OptionsThe combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. OutcomesEfficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. EvidenceStudies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. ValuesThe studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). Benefits, Harms, and CostsThese guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. SponsorThe Society of Obstetricians and Gynaecologists of Canada. Summary Statements1.Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2)2.The earlier hormonal emergency contraception is used, the more effective it is. (II-2)3.A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2)4.Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I)5.Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I)6.Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I)7.A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations1.Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A)2.Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B)3.Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A)4.During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C)

Islamic logics, reproductive rationalities: family planning in northern Pakistan

This paper explores the use of Islamic doctrine and jurisprudence by family planning organizations in the Gilgit-Baltistan region of northern Pakistan. It examines how particular interpretations of Islam are promoted in order to encourage fertility reductions, and the ways Muslim clerics, women and their families react to this process. The paper first discusses how Pakistan's demographic crisis, as the world's sixth most populous nation, has been widely blamed on under-funding for reproductive health services and wavering political commitment to family planning. Critics have called for innovative policy and programming to counter ‘excessive reproduction’ by also addressing socio-cultural and religious barriers to contraceptive uptake. Drawing on two years of ethnographic research, the paper examines how family planning organizations in Gilgit-Baltistan respond to this shift by employing moderate interpretations of Islam that qualify contraceptive use as a ‘rational’ reproductive strategy and larger families as ‘irrational’. However, the use of Islamic rhetoric to enhance women's health-seeking agency and enable fertility reductions is challenged by conservative Sunni ulema (clergy), who seek to reassert collective control over women's bodies and fertility by deploying Islamic doctrine that honors frequent childbearing. Sunnis’ minority status and the losses incurred by regional Shia-Sunni conflicts have further strengthened clerics’ pronatalist campaigns. The paper then analyses how Sunni women navigate the multiple reproductive rationalities espoused by ‘Islamized’ family planning and conservative ulema. Although Islamized family planning legitimizes contraceptive use and facilitates many women's stated desire for smaller families, it frequently positions women against the interests of family, community and conservative Islam.

Guidelines of the Italian Society for Virology on HPV testing and vaccination for cervical cancer prevention.

ObjectiveTo provide guidelines for health-care providers on strategies for cervical cancer prevention based on HPV testing and anti-HPV vaccination.OutcomesOverall efficacy of different preventive strategies, assessing reduction in the incidence of invasive cervical cancer and precancerous lesions.EvidenceMedline and the Cochrane Database were searched for articles in English on subjects related to HPVs, HPV diagnosis, HPV anogenital lesions, cervical cancer, HPV testing, and HPV vaccines, in order to elaborate an up-dated document. Relevant Italian Government publications and position papers from appropriate health and family planning organizations were also reviewed.ValuesThe quality of the evidence and ranking of recommendations for practice were rated using criteria defined by SIV, which were adapted from the Canadian Task Force on Preventive Health Care.

Missed Hormonal Contraceptives: New Recommendations

ObjectiveTo provide evidence-based guidance for women and their health care providers on the management of missed or delayed hormonal contraceptive doses in order to prevent unintended pregnancy. EvidenceMedline, PubMed, and the Cochrane Database were searched for articles published in English, from 1974 to 2007, about hormonal contraceptive methods that are available in Canada and that may be missed or delayed. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. The quality of evidence is rated using the criteria developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and CostsThis committee opinion will help health care providers offer clear information to women who have not been adherent in using hormonal contraception with the purpose of preventing unintended pregnancy. Sponsors: The Society of Obstetricians and Gynaecologists of Canada. Summary Statements1.Instructions for what women should do when they miss hormonal contraception have been complex and women do not understand them correctly. (I)2.The highest risk of ovulation occurs when the hormone-free interval is prolonged for more than seven days, either by delaying the start of combined hormonal contraceptives or by missing active hormone doses during the first or third weeks of combined oral contraceptives. (II) Ovulation rarely occurs after seven consecutive days of combined oral contraceptive use. (II) Recommendations1.Health care providers should give clear, simple instructions, both written and oral, on missed hormonal contraceptive pills as part of contraceptive counselling. (III-A)2.Health care providers should provide women with telephone/electronic resources for reference in the event of missed or delayed hormonal contraceptives. (III-A)3.In order to avoid an increased risk of unintended pregnancy, the hormone-free interval should not exceed seven days in combined hormonal contraceptive users. (II-A)4.Back-up contraception should be used after one missed dose in the first week of hormones until seven consecutive days of correct hormone use are established. In the case of missed combined hormonal contraceptives in the second or third week of hormones, the hormone-free interval should be eliminated for that cycle. (III-A)5.Emergency contraception and back-up contraception may be required in some instances of missed hormonal contraceptives, in particular when the hormone-free interval has been extended for more than seven days. (III-A)6.Back-up contraception should be used when three or more consecutive doses/days of combined hormonal contraceptives are missed in the second and third week until seven consecutive days of correct hormone use are established. For practical reasons, the scheduled hormone-free interval should be eliminated in these cases. (II-A)7.Emergency contraception is rarely indicated for missed combined hormonal contraceptives in the second or third week of the cycle unless there are repeated omissions or failure to institute back-up contraception after the missed doses. In cases of repeated omissions of combined hormonal contraceptives, emergency contraception may be required, and back-up contraception should be used. Health care professionals should counsel women in these situations on alternative methods of contraception that do not demand such stringent compliance. (III-A)

RETIRED: Canadian Consensus Guidelines on Human Papillomavirus

To serve as a guideline for health care providers on the use of continuous and extended combined hormonal contraception regimens, to prevent pregnancy, and to delay menses that affect health-related quality of life.All combined hormonal contraceptive methods available in Canada that may be used in a continuous or extended regimen are reviewed, and the implications are discussed.Efficacy of cited regimens and assessment of their side effects, patient safety, medical usage and non-contraceptive benefits, cost-effectiveness, and availability in Canada. Indications for patient counselling are also provided.Medline, PubMed, and Cochrane Database were searched for articles published in English between 1977 and May 2007. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed.The quality of evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1).The guideline is intended to help reduce unintended pregnancies and improve health-related quality of life in women who find their menses problematic. Increased awareness and empowerment of women, their partners, and health care professionals will improve their ability to make appropriate choices between continuous or extended and cyclic usage of these regimens.The development of this guideline has been supported by unrestricted grants from Bayer HealthCare Pharmaceuticals, Janssen Ortho, Organon Canada Ltd., Paladin Labs Inc., Pfizer Canada Inc., and Wyeth Pharmaceuticals.

Thinking Beyond ICPD+10: Where Should Our Movement Be Going?

In this roundtable discussion, three long-time international activists in the field of reproductive and sexual rights discuss the challenges facing the feminist women's health movement ten years after the 1994 International Conference on Population and Development in Cairo, and the 1995 Fourth World Conference on Women in Beijing. Their conversation reflects on the nature of the global context in 1994–95 and how that context has changed a decade later, especially in light of growing conservatism and the growing HIV/AIDS epidemic. They consider the successes and limitations of the Cairo agenda and the strategic importance of taking a long-term view. In particular, they emphasise the need for strengthening health systems worldwide, advocating for better and more woman-friendly use of existing resources and building broader coalitions. Much of the conversation explores points of commonality and difference between feminist groups on the one hand, and medical and family planning organisations on the other, as well as ways of utilising such venues as the World Social Forum. Points of greatest promise internationally include the growing youth movement for sexual and reproductive health and rights and the potential for opening up larger alliances around sexual and bodily rights with HIV/AIDS activists, sex workers, people living with HIV and AIDS and human rights organisations.

Family planning and sexual health organizations: management lessons for health system reform.

Advocates of health system reform are calling for, among other things, decentralized, autonomous managerial and financial control, use of contracting and incentives, and a greater reliance on market mechanisms in the delivery of health services. The family planning and sexual health (FP&SH) sector already has experience of these. In this paper, we set forth three typical means of service provision within the FP&SH sector since the mid-1900s: independent not-for-profit providers, vertical government programmes and social marketing programmes. In each case, we present the context within which the service delivery mechanism evolved, the management techniques that characterize it and the lessons learned in FP&SH that are applicable to the wider debate about improving health sector management. We conclude that the FP&SH sector can provide both positive and negative lessons in the areas of autonomous management, use of incentives to providers and acceptors, balancing of centralization against decentralization, and employing private sector marketing and distribution techniques for delivering health services. This experience has not been adequately acknowledged in the debates about how to improve the quality and quantity of health services for the poor in developing countries. Health sector reform advocates and FP&SH advocates should collaborate within countries and regions to apply these management lessons.

The use of family planning services by non-English speaking background (NESB) women.

This study was undertaken to determine the proportion of family planning organization clients who are from a non-English speaking background (NESB), to analyse the services they used, and to compare it to the services used by other clients. Analysis of clinic data sheets from the 8 State/Territory family planning organizations (FPO) was conducted. From a total of 185,879 client visits in FPO clinics between July, 1996 and June, 1997, 27,349 (14.7%) were from NESB. The proportion of clients with NESB was quite similar to that in the community. This means that in general, FPOs are reaching their share of clients with NESB. The patterns of reproductive health services used varied between NESB women compared to English speaking women.

The use of reproductive health services by young women in Australia.

Retrospective analysis of clinical data from 8 State/Territory Family Planning Organizations (FPO) was conducted to determine the reproductive health services used by young women. Between July, 1996 and June, 1997, a total of 185, 879 client visits were recorded at FPO clinics, of which 72,303 (39%) were by young clients. The results showed that young women tended to use a combined oral pill, postcoital pill and spermicides more than those older than 25 years (p<0.05). Young women were also more likely to use services for management of sexually transmitted disease (STD), counselling for HIV, STD and sexual assault (p<0.05). However, there were considerable differences among the 3 groups of women: Aboriginal clients, those who did not speak English at home, and those who were born outside Australia. This study confirms that young women are using FPO services especially for emergency/postcoital contraception, STD screening and counselling. FPOs need to continue their existing role of providing reproductive and sexual health services catering to the need of this special segment of the population.

Men's Participation in Family Planning Decisions in Kenya

It is generally acknowledged that family planning organizations must focus upon couples not just women. The author presents a model using 1988/89 Kenya Demographic and Health Survey data on 1129 married couples to measure the effects of mens participation upon family planning decisions in Kenya. The model is designed to inform planners policymakers and service providers about the family planning needs and concerns of Kenyan men and the conditions which can motivate them to participate in family planning decisions. Cause-effect linkages which affect the decision to adopt contraception are identified. It is concluded that Kenyan men participate in family planning decisions are interested in planning their families support family planning and use contraception to achieve these goals. The recent transition to lower fertility is probably due at least partly to changes in mens attitudes. Men are playing an essential part in the currently changing perceptions of family planning. The husbands cooperation is essential for consistent and continued use of a family planning method.

Case Studies in Emergency Contraception From Six Countries

emergency contraceptive methods are marketed legally, but family planning organizations shy away from offering them. In China, postcoital methods have long been offered by the government family planning service. However, these methods have not been separated into those advocated for emergency use only and those recommended for ongoing use. Finally, in Mexico and Nigeria, awareness of emergency contraception continues to be low among both health care providers and the public. Research, both on a way to create knowledge of emergency contraception and on a way to publicize the methods, has been largely concentrated in European countries; many developing countries, and even many developed ones, have yet to conduct any research on this topic. For example, Mexico’s first clinical trial of an emergency contraceptive method (a combination of levonorgestrel and ethinyl estradiol, administered orally or vaginally) is under way, fully 30 years after the original research on the method was conducted. In the case studies that follow, we summarize information on experiences with emergency contraception in each of these countries. We then draw on these experiences to suggest lessons for other countries seeking to introduce or expand the use of this method. United Kingdom History of Emergency Contraception