12.
DOCUMENT NUMBER: PIP/109668
AUTHOR: Bennett A ; Frisen C ; Kamnuansilpa P ; McWilliam J
TITLE: How Thailand's family planning program reached replacement level fertility: lessons learned.
NOTES: This publication was prepared for USAID/Thailand and Office of Population, Bureau for Science and Technology, Agency for International Development, Washington, D.C. under Contract No. DPE-3024-Z-00-8078-99

The factors responsible for Thailand's success in family planning (FP) are very closely interwoven and arise from its own unique blend of national, societal, and programmatic influences. Where Thailand differs is in the unusually high number of individual characteristics and influences that have predisposed it to, and abetted in, the rapid adoption of FP. Some of its program initiatives, too, have been distinctive. Thailand stands apart from other countries in 2 fundamental ways: the unusually high demand for contraceptives that greeted the National Family Planning Program (NFPP) at its start and that has continued unabated throughout its history; and the extraordinary strong commitment of the government to supporting the program throughout. Particularly strong characteristics of Thai society and its government are: the advanced status of women, which had made this pivotal segment of the population unusually receptive to family planning; the receptivity, particularly of the national leadership, to the economic arguments for controlling the national fertility rate; the ability of national leadership to utilize international donor assistance with maximum effectiveness and a minimum of bureaucratic ado; the pragmatism of those running the NFPP; the high regard for training within the civil services; and the emergence on the family planning field of 2 unique leaders, who captured both national and international attention with their commitment and imaginative approaches to the issues (Mechai Viravaidya, a charismatic family planning publicist who is director of the Population and Community Development Association in the private domain; and, in the public domain, the Dr. Somsak Varakamin, Manager of the NFPP who won an increasing share of the national budget for the NFPP, increased foreign assistance, and obtained the cooperation of the private sector). External factors involved in Thailand's success include the extraordinarily large amount of external donor support, which has allowed development of a solid program infrastructure; the existence of good demographic data; and the country's strong transportation system, contributing to the mobility of women and to the support of program activities. NFPP operational innovations include the early use of experimental pilot projects to pave the way for national program initiatives; the willingness of NFPP to enlist participation of all parties in the family planning effort; the use of paramedics to provide pills, IUDs and injectables; and NFPP's continuing efforts to increase prevalence, in particular among difficult groups. (author's modified)

18.
DOCUMENT NUMBER: PIP/118655
AUTHOR: Bruce J
TITLE: Fundamental elements of the quality of care: a simple framework.
NOTES: A slightly expanded version of this paper was published originally as a Population Council Programs Division Working Paper, No. 1 (May 1989).

A framework for analyzing quality of family planning services is offered. Quality is a property that all programs have. The framework is made up of 6 parts: 1) choice of methods; 2) information given to clients; 3) technical competence; 4) interpersonal relations; 5) follow- up and continuity mechanisms; and 6) the appropriate "constellation" of services. Switching contraceptive methods is common. The ability of people to switch satisfies them. First use with temporary contraception methods is usually under 2 years. Having different contraceptive methods helps the program respond to the individual's need. Choice is not possible without an adequately developed delivery system. A positive relationship exists between a wide range of methods being available and contraceptive prevalence rates. Of Indonesian client who had reported not receiving the contraceptive method that they wanted, 85% discontinued within the year. Of those who got the method that they wanted, the discontinuation rate was 25%. Clients who wanted to practice contraception will be discouraged if not given information that can be used, or if the method is not available. How much contraception information should be given to the client? Enough so that they know that these are choices and that methods can be changed. There appears to be poor knowledge among clients of use, risks, and benefits of contraceptives. Many different monitoring technics are needed to analyze technical competence. The disparity between standards of competence in the West and what is found in the field should be addressed. Interpersonal relations is the affective content of the provider/client transaction. The characteristics of programs and clients have changed since the idea of follow-up was first brought about. The appropriate constellation of services should respond to clients rather than some artificial demarcation. Ways in which the framework may be used as an analytical and practical tool are discussed. Quality can be seen from the structure of the program, the service- giving process, and the outcome of care. The outcome of care consists of knowledge, behavior, and service satisfaction. (author's modified)

21.
DOCUMENT NUMBER: PIP/081708 ; IND/8024514
AUTHOR: Bulatao RA ; Levin A ; Bos ER ; Green C
TITLE: Effective family planning programs.

The World Bank has conducted an assessment of the performance of family planning (FP) programs in developing countries. The first part examines their contributions and costs. It concludes that FP programs have played a key role in a reproductive revolution in these countries. Specifically, all developing regions have experienced a transition to lower fertility (e.g., in the last 20 years, fertility has fallen 33%), resulting in lower infant, child, and maternal mortality. One chapter looks at experiences in East Asia, South Asia, Latin America, and sub-Saharan Africa. World Bank staff use research to present a broad summary of what methods and characteristics achieve effective programs. The book addresses other social development interventions that contribute to a lasting reproductive revolution. Despite the positive results of FP programs, maternal mortality in developing countries is still much higher (10 times) than it is in developed countries and 25% of married women in developing countries report an unmet need for FP. Government commitment to FP programs needs to be strengthened and donor support should keep up with needs to expand successful FP programs. FP programs can satisfy these needs if they provide quality services, including a solid client focus, effective promotion, and strong encouragement of the private sector to increase their participation. Indeed, program quality must be the top priority. Strategic management of FP programs is also crucial. Programs need to integrate and coordinate effective promotion of FP, e.g., social marketing, with other activities.

32.
DOCUMENT NUMBER: PIP/065787
AUTHOR: Destler H ; Liberi D ; Smith J ; Stover J
TITLE: Preparing for the twenty-first century: principles for family planning service delivery in the nineties.

The Family Planning Services Division of the Office of Population of USAID has issued a policy paper addressing how to re-allocate and manage resources for the 1990s. Recent changes in family planning programs in developing countries have included striking growth in populations, implementation of national population policies, marked success of some programs, new contraceptive technologies, more efficient approaches to service delivery, and broader donor support. These have all contributed to accelerating demand for contraceptive services, from 192 million users in 1990 to estimated 286 million in 2000. To meet these needs a new framework or typology was conceived, where AIDS recipient countries are classified into 5 levels based on on prevalence of modern contraceptive methods. The scheme works because of the patterns of family planning knowledge, supply and method mix typically occurring at each level. Examples are rising prevalence of permanent methods and growing participation of the private sector as programs mature. Thus in the 1990s service delivery will entail 6 principles: 1) quality of care; 2) cost-effective expansion; 3) improved method mix to serve a more diverse, younger market; 4) cooperation of all sectors; 5) sustainable services; and 6) more attention to strategy and efficient management. Evolving from this typology are the following criteria: countries and sub-projects will be selected with preference for need, private sector involvement and return on investment; improved systems management will be emphasized; and better coordination of donor and country agency input will be required.

44.
DOCUMENT NUMBER: PIP/042921
AUTHOR: Freedman R
TITLE: The contribution of social science research to population policy and family planning program effectiveness.

Social science research has made important contributions to population policy and to the effectiveness of family planning programs. Social science concepts, theories, and methods potentially are relevant to all aspects of reproductive behavior, including actual fertility, proximate variables, and desired family size. Social science research also contributes to the understanding of the social, economic, and political institutions that potentially affect, either directly or indirectly, the whole biosocial reproductive system and family planning programs. At least as important as its specific theories and findings is the role of social science in testing how to adapt such knowledge to distinctive national and local cultural circumstances of family planning programs. A central point is that carefully monitored pilot projects are desirable before launching full-scale national programs, as well as being continuing resources for program development. The research on early programs in Asia has been important, because those programs encountered and overcame some of the presumed obstacles to new programs. (author's)

46.
DOCUMENT NUMBER: PIP/681352
AUTHOR: MCELROY WD ; BERELSON B ; COALE A ; DUFFY B JR ; FOLKERS K ; FREEDMAN R ; KETY S ; MARKERT CL ; SNYDER J ; TAYLOR H
TITLE: Family planning and other population controls. (Letter)

As a goal within the context of current policy, zero population growth has little support in either the developed or developing world, especially not among governments. Programs of social change must operate within the framework of existing values. If governments tried to adopt stringent policies, either social or economic, to reduce birth rates they may find themselves out of power. There is still a long way to go to see that governments in need of population policies establish them, and those with population policies have the programs and means to implement them. Any steps to reduce population growth should be taken as an intermediate contribution toward a zero growth rate.

52.
DOCUMENT NUMBER: PIP/052342
AUTHOR: Gallen ME ; Rinehart W
TITLE: Operations research: lessons for policy and programs.
NOTES: RH Training Materials

Operations research has become a major tool that family planning and related health programs use to improve service delivery. To date, operations research has focused on community-based distribution of family planning and other selected primary health services and the cost-effectiveness of different approaches. Some important findings from operations research are: 1) a variety of people, selected from the community and trained briefly but intensively, can distribute contraceptives in effective, efficient, and acceptable ways to increase use, especially in rural areas; 2) community-based distribution of oral contraceptives is safe and creates no additional hazards to women's health; 3) specially trained nurse-midwives and auxiliary nurse-midwives can insert IUDs as safely as physcians can; 4) adding new contraceptive methods to a family planning program can increase contraceptive use; 5) satisfied users can work with program personnel to stimulate increased use of family planning; 6) training is an important determinant of community workers' knowledge; 7) it is not always necessary to offer basic health services along with family planning to increase contraceptive use; 8) charging a small fee for services or supplies does not necessarily decrease their use; 9) phasing in a small number of new services over time is a feasible way to implement an integrated community-based program; and 10) adding health measures to a family planning program makes the family planning services less cost-effective but may add to health benefits.

78.
DOCUMENT NUMBER: PIP/054710 ; IND/8010791
AUTHOR: Jain AK
TITLE: Fertility reduction and the quality of family planning services.

Because most family planning programs in developing countries focus on producing a quantitative effect on fertility, the qualitative aspect of fertility control may be overlooked. To achieve population stabilization and affect societal attitudes and acceptance, a fertility program must consider the individual's fertility needs. A program must also consider and incorporate the elements of quality such as offering a choice of contraceptive methods, presenting information to acceptors, providing competence and good client/provider relations, pursuing former clients with recontact and follow-up and by offering an appropriate constellation of services. If the quality of a program is increased, it is hypothesized that the fertility rate will decrease because attitudes toward contraception and a continuation of family planning will be positively affected. Conscientiously handling a smaller, more manageable number of acceptors into a planning program is also considered a beneficial measure as opposed to attempting to meet the needs of an overwhelming number of program acceptors neglecting the aspect of quality. Although the theory of increased acceptance and continuation has been proven in simulated models, it needs to be implemented and tested in larger programs and field projects where the impact of varying levels of quality in fertility programs can be directly assessed. It is also important to observe that the success of a family planning program is dependent on a couple's desire to regulate their fertility and this is often affected by the quality of a family planning program.

84.
DOCUMENT NUMBER: PIP/060242 ; IND/8014213
AUTHOR: Keller A ; Severyns P ; Khan A ; Dodd N
TITLE: Toward family planning in the 1990s: a review and assessment.
NOTES: Article is based on a report completed in June 1989 entitled UNFPA Review and Assessment of Population Programme Experience

Between 1987-89 UNFPA consulted with experts throughout the world on the constraints and challenges of expanding family planning services during the decade of the 90's including: 1)strategic issues; 2) administrative issues; 3) special challenges; and 4) country-specific strategies. UNFPA concluded that effective family planning programs (FPP) share similar characteristics which are directly related to contraceptive prevalence rates. Some of the most important strategic issues are: political commitment, generation of demand, accessibility to services, acceptability of services, community participation, user incentives and disincentives, an adequate personnel base, and an adequate financial base. If maternal and child health services and FPP are to succeed the following supportive functions must be in place: logistics, supervision, management information systems, research and evaluation, and training. Special challenges facing managers and administrators of FPP during the next decade include changing the focus of FPP on just married women to include other vulnerable groups such as adolescents and expansion of services to prevent the high incidence of morbidity and mortality due to illegal abortions, sexually transmitted diseases and AIDS. Country-specific strategies will need to target countries with similar patterns of contraceptive prevalence rates (CPR); these can be divided into 4 groups: 1) countries with CPR of less than 20%; 2) countries with CPR between 20-35%; 3) countries with CPR between 36-50% and 4) countries with CPR of over 50%. Improvements in MCH and FPP in the future will depend on the coverage and quality of services provided. However, resources will need to increase substantially if CPR is to increase and strategies such as community-based distribution, social marketing programs, and privatization schemes will need to be introduced. Women's roles will need to change from passive acceptors to designers and managers of FPP worldwide. (author's modified) (Summaries in ENG, FRE and SPA)

89.
DOCUMENT NUMBER: IND/8006560 ; PIP/048788
AUTHOR: Knodel J ; Chamratrithirong A ; Debavalya N
TITLE: Thailand's reproductive revolution: rapid fertility decline in a Third-World setting.

The fertility decline in Thailand is the 3rd largest fertility decline, behind only South Korea and China. Thailand's total fertility rate of 6.4 during the 1st half of the 1960s was quite typical of large Third World countries; by the early 1980s, total fertility in Thailand had fallen to 3.6. Thailand is an especially intriguing case because of the rapidity and pervasiveness that have characterized the fertility decline there and because reproductive change has occurred during a period when the country is still predominantly rural and agrarian. The significance of Thailand as a case study of reproductive change in the Third World is further enhanced by the fact that at an early stage of the fertility decline, an official policy and program were instituted to encourage and facilitate the practice of contraception with the explicit goal of reducing the population growth rate through lowering fertility. Although Thailand is not among the least developed of the Third World countries, neither does it rank particularly high with regard to many conventional indices of socioeconomic development. Chapter 2 discusses sources and methods and provides socioeconomic and related background information for Thailand. Chapters 3 and 4 review recent trends in fertility and family size preferences. The quantitative evidence concerning the proximate determinants of reproductive change is examined in chapter 5, which includes an assessment of the relative contribution of several key proximate determinants to the recent levels and changes in Thai fertility. The results clearly show that increased contraceptive use is the main proximate determinant accounting for Thailand's fertility decline. Chapter 6 also focuses on the proximate determinants but is based on qualitative evidence and includes a discussion of evidence pointing to a substantial latent demand for lower fertility even before fertility went down. The relations between societal change and reduced family size are the topic of chapter 7. Chapter 8 focuses on aspects of the Thai culture that are particularly relevant to understanding reproductive behavior and attitudes. Chapter 9 explores the channels through which the means of fertility reduction spread through Thai society. The final chapter summarizes basic arguments regarding the causes and conditions behind Thailand's rapid fertility decline.

93.
DOCUMENT NUMBER: PIP/069644 ; IND/8019843
AUTHOR: Lande RE ; Geller JS
TITLE: Paying for family planning.
NOTES: RH Training Materials

This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.

110.
DOCUMENT NUMBER: PIP/084421 ; IND/8025568
AUTHOR: Mauldin WP ; Sinding SW
TITLE: Review of existing family planning policies and programs: lessons learned.

The lessons learned from decades of experience with family planning programs in Asia, Africa, Latin America, and the Middle East have centered on the following key factors: political commitment, leadership, administrative structure, civil bureaucracy, contraceptive availability, modes of service delivery, community-based distribution and social marketing, experimental and demonstration studies, nongovernmental organizations, incentives, IEC, and costs. Although academic arguments have focused on the relative impact of family planning versus socioeconomic development on fertility decline, research has unequivocally confirmed that both contributed to fertility decline. Socioeconomic development sets the parameters within which programs function. In the last ten years fertility decline has been hastened by well-organized family planning programs. Political support has been very helpful to family planning program implementation in Bangladesh, China, Indonesia, and Kenya, but strong programs without policy support have still developed in countries such as Korea, Taiwan, Thailand, Costa Rica, and Colombia. Political commitment became important in countries with low socioeconomic development and a setting less conducive to family planning. Examples from Indonesia, Taiwan, and Colombia have proven the merits of strong leadership and supervision. Many administrative structures have been effective as long as the agency was placed high enough in the political hierarchy and had high quality leadership. Civil bureaucracies could be important additions to family planning programs as long as the policy was not overzealous or coercive. Contraceptive services with a wide range of methods should be available and accessible, which does not always occur in rural areas. Continuation rates were found to increase when a number of methods were available at affordable prices. Jain found that adding just one more method to the mix available increased contraceptive prevalence by 12% and led to a reduction of 0.8 in the total fertility rate. Alternative modes of distribution will increase use. Community-based distribution and social marketing could have a direct impact on people. Incentives have been found to be effective, but ethics must also be considered. IEC messages have been found to be more effective if continuously generated.

129.
DOCUMENT NUMBER: PIP/094339
AUTHOR: Piotrow PT ; Treiman KA ; Rimon JG 2d ; Yun SH ; Lozare BV
TITLE: Strategies for family planning promotion.

Family planning (FP) programs must influence entire populations, but the success of these programs depends upon private individual actions. The information, education, and communication (IEC) component of FP programs is critical, therefore, in creating awareness, increasing knowledge, building approval, and influencing behavior. This paper reviews the most important lessons learned about IEC campaigns during the past 2 decades. The quality of interpersonal communication between client and provider greatly influences a client's willingness to use the services offered as does the provision through counseling of enough information to make informed choices. Training can improve the quality of communication and counseling in a program, and IEC campaigns can encourage open discussion about FP among families and in the community to the point where trained peer motivators can be used effectively. The mass media can create FP awareness and increase acceptance. Well-designed mass media campaigns can also stimulate behavioral changes in the audience. Despite governmental reluctance, most people want more FP information from the mass media. Mass media campaigns can complement interpersonal communication efforts to great advantage and can use entertainment ("enter-educate") techniques to reach large audiences. IEC programs can be designed with built-in cost saving and cost recovery strategies to minimize costs while maximizing impact. These strategies include the sale of commercial-quality project materials, the use of corporate sponsors for "enter-educate" products, negotiating entertainment fees with professionals, and negotiating for free air time. Using IEC managers rather than technicians and purchasing materials from the private sector can also save costs as can using the initially more expensive mass media which can result in cost savings in the longterm. Cost-effectiveness measurements are being devised, but since they depend upon many variables, they may not be easily transferred from one project to another. IEC programs should be designed through a process which moves from analysis to design to development, pretesting, and revision to implementation, monitoring, and assessment and, finally, to review and replanning. Objectives established at the beginning of the program should form the basis for later evaluation. Most FP programs benefit from technical assistance in setting up an IEC component. Program issues which donor agencies should consider include 1) achieving immediate positive results and building longterm institutional capability, 2) training and technical assistance, 3) integrating FP services and IEC, 4) using the private sector, 5) dealing with opposition and controversy, and 6) appropriate donor support. Specific recommendations are included for each of the issues presented in this paper.

155.
DOCUMENT NUMBER: PIP/064249 ; IND/8016428
AUTHOR: Potts M ; Rosenfield A
TITLE: The fifth freedom revisited: 1, background and existing programmes.

Family planning in 1965 was a minor specialty outside mainstream medicine and contraception was still illegal in several states in the US. Scandinavia and Eastern Europe were the only regions with legal abortion, while sterilization usually required strict application of arbitrary rules of age and parity. Poor women were discriminated against in terms of contraceptive choices because middle and upper income women often found ways to obtain assistance from private physicians. The UN still refused to respond to requests from member nations for family planning assistance even though world population was 3.5 billion and growing at 2%/annum (70 million/year). Today world population is 5.3 billion and growing at 1.8%/annum (or 90 million/year). Regulating fertility can have a great effect on maternal and child health. Pregnancy is most hazardous for women under 17, or over 35, or at a parity of 4 or more children. Infants born less than 2 years apart are at the greatest risk. Every year 14 million children under the age of 5 die, with expanded contraceptive usage birth spacing and family size would be reduced, thus saving lives. Pregnancy related causes kill 500,000 women every year. Access to family planning since 1965 included its incorporation into British National Health Service and voluntary surgical sterilization is made freely available. Contraception became legal in the US in 1973 with the striking down of the Comstock Laws. In 1970 the Family Planning Services and Population Research Act Title X) was passed and focused on poor women. Worldwide family planning is seen as a basic human right, although there are some countries where it is forbidden. The funding structure of family planning has been changing since 1965 with IPPF receiving its 1st government support in 1967, USAID rapidly started its work in 1968, UNFPA was established in 1969, and by 1990 most industrialized countries contributed some money to international family planning organizations. By 1988 US$7.2 billion has been provided.

156.
DOCUMENT NUMBER: PIP/064383
AUTHOR: Potts M ; Rosenfield A
TITLE: The fifth freedom revisited: II, the way forward.

The goal of doubling the number of contraceptive acceptors in the world during the 1990s is achievable if family planning services are made universally accessible and a continuous supply of contraceptives is maintained. With serious attention to the elimination of unwanted pregnancies, the world's population could stabilize at under 8 billion; without it, the global population will approach 15 billion before stabilization. To counteract the impact of a 30% increase in the numbers of women of fertile age in developing countries during the 1990s, 130 million new contraceptive acceptors must be recruited during the decade. A doubling of contraceptive use by 2000 also implies an infusion of investment in international family planning if the quality of services is to be adequate and abortion rates reduced. Specific methods of contraception that should be given special attention in the 1990s include voluntary surgical sterilization and socially marketed condoms (also effective in reducing the transmission of human immuno- deficiency virus). Surveys consistently indicate that 50-80% of women in Third World countries want to space or limit future childbearing. The guarantee of universally accessible family planning services makes this possible and will also contribute to an ecologically global economy.

160.
DOCUMENT NUMBER: PIP/742974
AUTHOR: RAVENHOLT RT ; CHAO J
TITLE: Availability of family planning services: the key to rapid fertility reduction.

The fertility changes during the decade of the 1960s in 12 developing countries with very active family planning programs are compared with those in 12 countries without such active programs during that time. The countries with vigorous family planning programs in the 1960s are Chile, Costa Rica, Egypt, Fiji, Hong Kong, Republic of Korea, Mauritius, Puerto Rico, Reunion, Singapore, Trinidad and Tobago, and Taiwan. There were significant declines in fertility in these countries. They had active privately sponsored family planning programs before the government became involved, and in most cases, it was determined that at least 5 years had elapsed between the initiation of a national family planning program and evidence of its impact upon fertility. In the 12 countries without active family planning programs (Algeria, Brazil, Ecuador, Ghana, Ivory Coast, Kuwait, Mexico, Nicaragua, Paraguay, Peru, Syria, and Venezuela), fertility did not decline even in those countries with social and economic improvement. It is concluded that the most important single factor in attaining sharp fertility declines is the availability of effective contraception through active nationwide family planning programs.

164.
DOCUMENT NUMBER: IND/8023962 ; PIP/118778
AUTHOR: Robey B ; Rutstein SO ; Morris L ; Blackburn R
TITLE: The reproductive revolution: new survey findings.

Data from the Demographic and Health Surveys and the Family Planning Surveys are used to review fertility trends in developing countries since the 1960s. Consideration is given to fertility patterns and preference; contraceptive use, knowledge, and availability; estimates of unmet needs for family planning services; trends in marriage age; infant and child mortality; and antenatal and child health care. Future fertility patterns are also projected. An appendix provides information on the status of the surveys in each participating country as of December 1992.

173.
DOCUMENT NUMBER: PIP/092617
AUTHOR: Ross JA ; Frankenberg E
TITLE: Findings from two decades of family planning research.

The empirical results of family planning (FP) research conducted over the past 20 years are presented. The topics cover the prevalence of contraceptive use and fertility patterns, large scale FP programs, community-based distribution, contraceptive social marketing, postpartum programs, changes and payments for services, contraceptive continuation and effectiveness, sterilization, induced abortion, and the links between health and contraception. This document updates an earlier publication. Methodology is not a factor in the discussion of findings. Each finding is identified by the authors and has a summary statement with supporting evidence. Unsupported or ambiguous findings are not included. When evidence is well founded, only summary references are given. Caution is urged in generalizing about these findings. The aim is to help the newcomer absorb the vast quantity of information on FP and to dispel mixed opinions, prejudices, and information common to oral discussion. For example, in the presentation of the postpartum program findings, studies reveal the advantages and disadvantages of postpartum programs, coverage and potential, unmet need, current method recommendations, interest in postpartum services, effects on abortions, breast feeding as a contraceptive method, and the overlap of contraceptive use with amenorrhea. Postpartum programs serve as low cost means of extending FP over the reproductive period; the logistics are simple because units are added to maternity services. This is convenient for women and efficient for administration. The health consequences are tremendous and include, for instance, increased infant immunizations and reduced frequency of short birth intervals. Unwanted pregnancy can be averted. The disadvantages are that some hormonal methods are inappropriate while the mother is breast feeding, and programs tend to be urban-based. Coordination of the program among several hospital departments strains services.

176.
DOCUMENT NUMBER: PIP/066993
AUTHOR: Sadik N
TITLE: Population policies and programmes: lessons learned from two decades of experience.

This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.