International Planned Parenthood Federation Research Articles

Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region

Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence.

Policy climate, scholarship, and provision of emergency contraception at affiliates of the International Planned Parenthood Federation in Latin America and the Caribbean

Emergency contraception (EC) has great potential to decrease the incidence and resulting consequences of unwanted pregnancy, including unsafe abortion. We conducted this study to understand EC practices in Latin America and the Caribbean (LAC). We contacted 43 International Planned Parenthood Federation affiliates in LAC to interview them about EC availability. We collected family planning norms and researched registered EC products in LAC. We searched English- and Spanish-language sources to compile EC literature reviews. Thirty-seven affiliates (86%) responded to the survey, and 62% offer EC. Central and South American affiliates are more likely to offer EC than are Caribbean affiliates. Of those offering EC, 96% offer cut-up packets of oral contraceptives, whereas six affiliates offer dedicated products. Of those not offering EC, 79% believe it constitutes abortion. EC availability and support for the method appear to be increasing in LAC, and clearer distinctions between EC and abortion in medical and policy guidelines should increase acceptance further.

Measuring Family Planning Service Quality through Client Satisfaction Exit Interviews

A model client exit interview developed by the International Planned Parenthood Federation Western Hemisphere Region was used to measure levels of client dissatisfaction with various components of quality. During 1993-96 89 surveys of more than 15000 clients were conducted in eight Latin American and Caribbean countries. The areas of quality that most often received more than 5% negative response from clients (termed negative response cases) were waiting time (mentioned in 70% of surveys) with a mean dissatisfaction level of 20%) ease of reaching the clinic (in 54% with an average dissatisfaction level of 12%) and price of services (47% and 10% respectively). Using the survey results participating family planning associations made changes to improve quality in these areas ranging from improving appointment systems to relocating to implementing sliding fee scales. Results from 16 subsequent follow-up surveys showed a decline in each country in the number of negative response cases as well as in the mean level of dissatisfaction. For example in Brazil the mean number of negative response cases per survey declined from 2.7 to 2.2 and the mean level of dissatisfaction among them fell from 19% to 11%. Well-known problems of measuring client satisfaction may be addressed by focusing on a low threshold of dissatisfaction as a way to uncover shortcomings in service quality. Although declines in dissatisfaction cannot be attributed entirely to the changes made as a result of the use of the questionnaires client surveys can provide a quick and inexpensive way of determining areas of service where quality could be improved. These kinds of improvements will be necessary if service providers hope to become more sustainable and if they are to help clients meet their reproductive health needs. (authors)

Organizing for social change and policy reform: Lessons from the international planned parenthood federation

The International Planned Parenthood Federation (IPPF) was formed by a network of volunteers from around the world concerned about maternal and infant mortality and the lack of family planning information and services available. The IPPF network is credited with having a global influence on population policies and the development of public support for the provision of family planning services. The success of the movement is due in large part to their organizing strategies. They initially organized around what we would now identify as a network as opposed to a bureaucratic approach. Over time the IPPF became a large international bureaucracy but the lessons of the early years hold important implications for grassroots organizations promoting policy and social change.

Non-governmental organizations and world population issues

This article profiles nongovernmental organizations (NGOs) and describes their legal foundation definition and importance in addressing world population issues. In the 71st article of the Charter of the UN it is stated that the UN Economic and Social Council (ECOSOC) may negotiate with international and national organizations concerning issues in the Councils field of activity. The NGOs can be granted consultative status with ECOSOC if they can fulfill certain conditions. A substantial precondition is that they have special expertise and they represent a special group in several countries not based on an intergovernmental agreement. In the context of definition an ECOSOC report states that NGOs are nonprofit independent associations. Members are citizens or civic organizations from one or several countries and activities are determined by its membership to satisfy the needs of the members or those of one or more fields of activity. There are two nongovernmental organizations being recognized internationally. These are the International Union for the Scientific Study of Population (IUSSP) and the International Planned Parenthood Federation (IPPF). The significance of NGOs particularly IUSSP and IPPF on population issues it is noted that NGOs have had an important role in every continent of the world and special emphasis is placed on the leading role of IPPF and womens NGOs in the activities of the civil society.

Costing of Reproductive Health Services

Context: The principles endorsed by delegates to the 1994 International Conference on Population and Development expanded on the areas typically included in reproductive health. Yet implementation of more comprehensive reproductive health programs has been slow, and the impediments to program expansion need to be identified. Methods:The elements of a reproductive health care program were identified, and in 1995, the disaggregated costs of providing some of these services were gathered from a program of the Zimbabwe National Family Planning Council (ZNFPC) and from MEXFAM, a nongovernmental organization in Mexico affiliated with the International Planned Parenthood Federation. These data were used to estimate and compare the costs (in U.S. dollars) of various components of reproductive health care per visit (or per diagnosis and treatment) in the two countries. Results: The costs of providing contraceptive methods, particularly surgical ones, as well as gynecologic and general health services, varied between ZNFPC and MEXFAM. Whereas tubal ligation cost $70 and oral contraceptives $3 at ZNFPC, a tubal ligation cost $269 and oral contraceptives $4 at MEXFAM. During a gynecologic visit, the cost of treatment for a sexually transmitted disease was $19 at ZNFPC and $29 at MEXFAM. The cost of providing an adolescent with a routine examination and iron supplement was $5 at ZNFPC and $4 at MEXFAM. At ZNFPC, providing a Pap smear, screening for a reproductive tract infection and checking an IUD during a single visit cost $4, compared with $6 when the procedures were performed separately. Conclusions: Costing reproducitive health programs requires breaking service components into individual cost elements. This process can help managers understand both the financial and programmatic implications of alternative implementation strategies.

IUDs Safe for HIV-Infected Women

The World Health Organization and the International Planned Parenthood Federation have recommended against IUD use in HIV infected women, but no

Complications of use of intrauterine devices among HIV-1-infected women

A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infected women based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infected women than in non-infected women. 649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians. Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infected women, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out. Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.

Family planning in the 21st century: perspective of the International Planned Parenthood Federation

Many women still die as a result of pregnancy or childbirth and yet there are an increasing number of women who wish to regulate their fertility and space or limit their child-bearing. This paper, outlining some success stories, elucidates the family planning challenges and identifies key messages to indicate the role that IPPF can play in the 21st century. Issues such as advocacy for sexual and reproductive health and rights, increased male participation, serving the interests of marginalized groups, appropriate technology, quality of care and cooperation between various partners, all need to be addressed to improve sexual and reproductive health including family planning in the 21st century.

Emergency Contraception: The International Planned Parenthood Federation's Experience

T he first contraceptive revolution took place in the early 1960s with the introduction of the pill. During the ensuing three decades, oral contraceptives, IUDs, injectables, barrier methods and improved forms of surgical contraception became widely available and acceptable. As a result, contraceptive prevalence worldwide rose from 10% in the 1960s to around 50% in the mid-1980s. Despite this dramatic escalation in contraceptive use, an estimated 500 million women throughout the world have an unmet need for contraception.' These include not only women who do not have access to effective methods, but also those who are not satisfied with the method they are using and those who discontinue use even though they want no more children. According to data from the Demographic and Health Surveys in a variety of countries, among the reasons women give for discontinuing contraceptive use are their dissatisfaction with the methods available or worries about side effects, their partners' disapproval of the methods, inconvenience of use, difficulties in obtaining the methods and cost. Furthermore, since even an effective, available and acceptable method can fail or be used incorrectly, a different kind of contraceptive might also provide backup for these situations. The International Planned Parenthood Federation (IPPF) has been promoting and offering guidance on such a method-emergency contraception-for more than 10 years.

2 Post-partum contraception

The choice of a post-partum contraceptive method depends on many factors, including the need for a temporary versus a permanent method, the infant feeding choice and the extent to which informed consent is made prior to delivery. For maximum protection, the non-breast-feeding woman should be protected from the fourth week post-partum, even if that means using a temporary method, such as condoms or spermicides, until her method of choice is procured. Combined oestrogen/progestin methods should be avoided by all women for 2-3 weeks to avoid elevating the risk of thromboembolism. Preparations containing oestrogen should be avoided altogether during lactation because they have been associated with a reduction in milk production. POPs, implants and injectables are appropriate regardless of infant feeding choice. They can be administered immediately post-partum in bottle-feeding women, but should ideally be postponed for 6 weeks in breast-feeding women. It is best to insert IUDs within 10 minutes of delivery of the placenta, in order to minimize the risk of IUD expulsion. Insertion immediately after expulsion of the placenta requires special training, and expulsion rates are reduced with the insertion experience of the practitioner. Breast-feeding is not associated with an increase in IUD expulsion or uterine perforation, and it is associated with fewer removals for bleeding or pain. Tubal sterilization is safe, convenient and cost-effective when performed immediately after delivery, but it requires extensive counselling and fully informed consent prior to the onset of labour to avoid potential regret over post-partum tubal ligation. If the procedure is performed immediately, any effect on the establishment of lactation may be minimized. LAM is a method that can only be used by breast-feeding women. It may prove to be a useful way to time the commencement of a second, less temporary contraceptive method. Natural family planning methods require a period of abstinence for the establishment and identification of the new symptoms of fertility. When LAM is used during this interval, the need for abstinence may be reduced significantly for breast-feeding women. Breast-feeding provides health benefits for the woman and her infant, as well as the best possible nutrition for the baby. The International Planned Parenthood Federation (1990) (among others) recommends that, 'As far as is practicable, all women should be advised and encouraged to breastfeed fully'. The infant feeding decision affects the choice of a contraceptive method, and this is an important reason for the woman's physician to be interested in her infant feeding choice.

Legal and political barriers affecting sexual and reproductive health services International Planned Parenthood Federation Africa Region, 1995

Legal and political barriers affecting sexual and reproductive health services International Planned Parenthood Federation Africa Region, 1995

Gender awareness for population and development: An IPPF bibliography International planned parenthood federation, 1995

Gender awareness for population and development: An IPPF bibliography International planned parenthood federation, 1995

Consensus statement on emergency contraception

Twenty-four experts from around the world, representing the fields of research, policy, communications, women's advocacy and medicine, gathered at the Rockefeller Foundation Conference Center in Bellagio, Italy, in April 1995 to discuss emergency contraception. The conference was hosted by South-to-South Cooperation in Reproductive Health and co-sponsored by the International Planned Parenthood Federation, Family Health International, the Population Council and the World Health Organization. The conference was supported by the Rockefeller Foundation.

Halfdan Mahler on Women's Control of Their Reproductive Lives

The UN Population Award established in 1981 and presented annually for contribution to awareness of population questions or to their solutions was given in 1995 to an individual Halfdan Mahler of Denmark and an institution Inter-African Committee on Traditional Practices Affecting Health of Women and Children. In his acceptance remarks at award ceremony at UN Headquarters in New York on 5 June 1995 Dr. Mahler who between 1973 and 1988 served as director-general of WHO (World Health Organization) and since 1989 has been secretary general of International Planned Parenthood Federation discussed goal for women to control their own reproductive lives and conditions that would assure its realization. Stating that tens of millions of unwanted children [are] born in just one year and that several hundred million couples and individuals on Earth would like to regulate their fertility but cannot because they lack proper access to family planning information and modern contraceptive methods Mahler identified opposition to family planning as the politicized creations of men supported by anti-women ideology parading in robes of `religion and `morality. (authors)

Adolescent knowledge and use of injectable contraceptives in developing countries

To review recent survey data on knowledge and use of injectable contraceptives among adolescents and young women in developing countries. The proportion of adolescents who are aware of this method, who have ever used it, and who are currently using the method, are described. Use of the injection is compared to overall use of any method, as well as to use of two other specific methods, the contraceptive pill and the condom. The data reported here come from a series of nationally representative surveys carried out in 25 developing countries, in the mid to late 1980s, as part of the Demographic and Health Surveys (DHS) project. These are surveys of 5,000-10,000 women aged 15-49 years that obtain information on whether women have heard about each specific method, as well as on ever-use and current use of contraception. The data presented here are compiled from published sources, and focus on currently married young women (15-24 year olds), and adolescents (15-19 year olds). Although the injection is recognized by a moderately high proportion of young women and adolescents (40-70% in most countries), use of this method is extremely low in almost all countries. The exceptions, based on DHS data, are 3 Asian countries (Indonesia, Sri Lanka and Thailand) and to a lesser extent, two Latin American countries (Colombia and Mexico). Other countries with moderately high levels of use of Depo-Provera, based on other sources, are China, Jamaica and New Zealand. However, apart from these few countries, when adolescents and young women do choose to use contraception, it is the pill that they are much more likely to choose. Problems of availability of supplies of the injection may explain some of the observed variation in levels of use of this method. Supplies are mostly provided by international donor agencies such as United Nations Fund for Population Activities and International Planned Parenthood Federation. The lack of approval of the method by the United States until recently also probably had a negative effect on the likelihood of some other governments approving this method or promoting it. Now, with the approval of the United States, supplies may become more available and there may be a greater willingness to use Depo-Provera and other injectables in the developing countries.

Women, Politics, and Global Management

The United Nations (UN) sponsored three decennial world population conferences over the period 1974-94. The first such conference was held in 1974 in Bucharest, Romania, at which the North and the South became polarized over the importance of demographics relative to other development concerns. Northern countries proposed vigorous family planning programs to control rapid population growth, while many Southern governments, led by China and India, argued instead that higher priority should be given to socioeconomic development and the more equitable distribution of resources between the North and South. After a decade of extremely rapid population growth, however, most Southern countries had adopted antinatalist policies by the second world population conference held in 1984 in Mexico City. While Southern countries had adopted the 1974 Northern view of world population growth, widespread political and religious conservatism in the US at the time of the second conference had the US delegation opposing abortion and being neutral on demographic factors. The US argued that private markets would solve many population problems and the US government even withdrew financial support to several international organizations, such as the International Planned Parenthood Federation and the UN Population Fund. The third decennial UN-sponsored world population conference, the 1994 International Conference on Population and Development (ICPD) held in Cairo, Egypt, however, succeeded in shifting concern about world demographics into a gender-sensitive, people-centered approach of sustainable human development and bringing sensitive and ideologically charged population issues into the public domain. It was also a landmark in the management of complex global problems such as population. The international consensus achieved in Cairo and summarized in a World Program of Action was truly a monumental achievement. The authors note the shift in rhetoric to concerns about women's status and reproductive health, the involvement of nongovernmental organizations, and the unfinished agenda of the World Program of Action.

Calls for legal abortion come from Northern Ireland

Abortion law in Northern Ireland needs urgent change, said delegates at a meeting organised by the International Planned Parenthood Federation in County Down last week. Over 80 doctors, civil servants, and family planning experts met to discuss options for change at a symposium that aroused angry responses from politicians in Northern Ireland and from antiabortion groups. Britain's Abortion Act of 1967, allowing women access to legal abortions, does not extend to the province. Most women seeking abortion still have to travel to mainland …

Unsafe abortion and post abortion family planning in Africa: The Mauritius conference International Planned Parenthood Federation Africa Region, 1994

Unsafe abortion and post abortion family planning in Africa: The Mauritius conference International Planned Parenthood Federation Africa Region, 1994

The ideology of population control in the UN draft plan for Cairo

This paper examines the influence of population control ideology on the draft plan for the UN Cairo Conference on Population and Development. It is argued that this draft plan can only be fully understood in the context of the recent history of the population control movement and of the empirical reality of population control in particular countries. The paper focuses on the origins of the ideology of population control in the eugenics movement initially, and more recently in organisations such as International Planned Parenthood Federation. The role of the United Nations Population Fund (UNFPA), in promoting an incremental approach towards the wider acceptance of population control since the first intergovernmental conference on population in Bucharest in 1974, is outlined. Despite the serious loss of credibility for the UN, through the association of the UNFPA with the Chinese population control programme — the most coercive programme of its type in history — the UN in the draft plan for Cairo continues to promote the ideology of population control. This paper argues for the need to develop a more positive model of development, which acknowledges the complementarity between the lack of development of poorer countries and their potential for significant progress, and the overdevelopment of industrialised regions, whose future growth is increasingly based on intense competition for shrinking markets.