The Origins of Family Planning in Tunisia: Reform, Public Health, and International Aid.

This article explores the origins of the national family planning program in Tunisia during the 1960s. It moves beyond previous interpretations of the global population control movement that emphasized external intervention at the hands of international organizations. Instead it analyzes the mutually beneficial partnership between Tunisian president Habib Bourguiba and the Population Council, an American organization committed to reducing population growth. Using Tunisian sources and Population Council records, it argues that after independence in 1956, Bourguiba sought to address France's underdevelopment of public health during the colonial period with robust reforms and international aid. Implementing a family planning program enabled Bourguiba to acquire resources that contributed to training Tunisian medical personnel, funding clinics and health services, and increasing the distribution and circulation of contraception. This article demonstrates that actors in the Global South were not mere beneficiaries of international health initiatives following decolonization; they were active participants and negotiators of their implementation at home.

A lost family-planning regime in eighteenth-century Ceylon.

Based on Dutch colonial registers (thombos), this paper reconstructs fertility for two districts in Ceylon, 1756-68. It overcomes challenges in data quality by establishing the outer bounds of plausible estimates in a series of scenarios. Among these, total fertility rates (TFRs) averaged 5.5 in one district, but only 2.7 in the other. These figures exclude the victims of infanticide, a custom noted in European travelogues between about 1660 and 1820. Sex ratios among children differed depending on the number of older siblings, and overall, 27 per cent of girls are missing in one district and 57 per cent in the other. There was little significant variation either in the TFR or the sex ratio by socio-economic status, suggesting that poverty was not a key factor in motivating infanticides. Instead, we argue that at least parts of Ceylon had a forward-looking culture of family planning in the eighteenth century, which was lost in subsequent decades.

Family Planning for Low-Income African American Families: Contributions of Social Work Pioneer Ophelia Settle Egypt.

Historically, African Americans made huge contributions to the field of social welfare and the social work profession, yet little has been written about them in the professional literature. This article explores the contributions of pioneering social worker Ophelia Settle Egypt. A thorough assessment of her pioneering role would reveal her unique work as an educator, researcher, and grassroots social worker, but the focus here is on her innovative commitment to the Planned Parenthood movement. Egypt's work around population control in her Southeast Washington, DC, neighborhood with low-income African American families in the early 1950s became a labor of love in her community that can help inform current practice approaches in urban environments with African American populations.

"Civil unrest does not stop ovulation": women's prenatal and family planning services in a 1960s Detroit neighborhood clinic.

In 1965, Nancy Milio established a prenatal and family planning clinic in Detroit, Michigan, to address health disparities and limited access to care among low-income, African American, urban women. Women's health disparities persist today nationally and internationally. Using historical methods, this research analyzes how Milio provided women's health services in the context of the social and political environment. Milio empowered neighborhood women to direct, plan, and participate in the care they received. Successful methods to address disparities in access to family and planning and prenatal care should include empowered participation from the women these programs are intending to serve.

"Breaking the chain of poverty": family planning, community involvement, and the Population Council-Office of Economic Opportunity alliance.

The Office of Economic Opportunity-Population Council program is an example of a mid-twentieth-century federal government/private foundation cooperative effort to place family planning and maternal health at the center of a fight against entrenched poverty. These joint efforts were the trend in family planning and maternal health provision by the 1960s and had two overlapping but also contradictory goals. The first was to provide contraceptive services to poor women to reduce the numbers of poor children, thus relieving the poor of added mouths to feed. Popular fears of a population explosion, mounting welfare rolls, and an increase in the numbers of African Americans receiving welfare fueled this goal. The second aim, however, was to expand comprehensive maternal health services to help reduce poverty by increasing poor women's involvement in and control over the health institutions that could have significant impact on their lives. While the first goal pivoted on encouraging poor women to bear fewer children, the second sought to integrate poor women into community healthcare delivery systems.

Achievements of the Iranian family planning programmes 1956-2006.

Family planning programmes initiated in the Islamic Republic of Iran from 1966 met with limited success. Following the 1986 census family planning was considered a priority and was supported by the country's leaders. Appropriate strategies based on the principles of health promotion led to an increase in the contraceptive prevalence rate among married women from 49.0% in 1989 to 73.8% in 2006. This paper reviews the family planning programmes in the Islamic Republic of Iran and their achievements during the last 4 decades and discusses the principles of health promotion and theories of behaviour change which may explain these achievements. Successful strategies included: creation of a supportive environment, reorientation of family planning services, expanding of coverage of family planning services, training skilled personnel, providing free contraceptives as well as vasectomy and tubectomy services, involvement of volunteers and nongovernmental organizations and promotion of male participation.

Factors affecting sex ratio at birth in Croatia 1998-2008.

This investigation aims to contribute to the existing literature on demographic and ecological factors affecting the sex ratio at birth, by analysing the births in Croatia from 1998 to 2008. Data from birth certificates for all Croatian births for the investigated period (n=420,256) were used to establish the link between parental ages, birth order, region of birth, parental occupation and parental education level, and sex of the child. The χ² test and t-test were used to assess the significance of each of the factors, along with multiple logistic regression to control for possible confounding effects. The results suggest that a joint higher age of both parents significantly lowers the sex ratio at birth. There is also a regional variation in sex ratio at birth, the lowest value being in Central Croatia and the highest in the City of Zagreb. Changes in the reproductive physiology of older parents are most probably responsible for the lower sex ratio, although the limited sample size warns against widespread generalizations. The causes of the regional variation in sex ratio at birth are most likely the different regional levels of obesity and physical inactivity.

Planejamento Familiar no Brasil no contexto dos determinantes históricos e sociais / Family planning in Brazil in the context of the historical and social determinants

A Política de Planejamento Familiar envolve ações que lidam diretamente com as questões de concepção e contracepção. Questões estas que estão correlacionadas a assuntos como liberdade sexual, aborto, famílias muito numerosas de baixa renda, gravidez na adolescência, mortalidade materna, entre outros, assuntos que geram polêmica e discussão na sociedade e na mídia, muitas vezes por questões políticas e religiosas. O estudo tem como Objetivo Geral analisar as intervenções propostas pelo Governo Federal brasileiro que lidam com a questão do planejamento familiar, identificando sua orientação para enfrentamento dos problemas de saúde pública relacionados aos determinantes sociais (...). Foi possível identificar a necessidade de analisar a forma como a Política do Planejamento Familiar vem sendo implantada, baseado nos Problemas de Saúde Pública e nos Determinantes Sociais relacionados a linha de atuação desta Política.

Women, microcredit and family planning practices: a case study from rural Ghana.

This paper examines the influence of informal banking club participation on family planning practices in rural Ghana. Research from Asia suggests that family planning practices are improved by club participation. This study examines this thesis in an African context, using rural Ghana as a case study. A sample of 204 women (19 years and older) was drawn from Abokobi village, Ghana. Multivariate analyses of direct, mediating and moderating effects of women's demographic background characteristics, membership status and length, and women's empowerment status as predictors of family planning practices are assessed. Findings suggest that club membership and membership length is not associated with family planning practices; however, age, education level, number of children and empowerment status are.

Approaching 4 decades of legislation in the national family planning program: an analysis of Title X's history from 1970 to 2008.

Family planning is an important public health activity. Title X (Pub L No. 91-572), enacted in 1970, remains the only national family planning program in the United States dedicated to providing voluntary and confidential services to all individuals. We conducted a thematic analysis of Title X's legislative history. Of 293 federal bills included in the legislative history, only 20 (6.8%) were enacted into law. Regardless of the proposed challenges, limited changes have been adopted. Except for technical amendments, bills involving restrictions accounted for the highest percentage of enacted bills, demonstrating efforts to undermine reproductive health rights. Title X requires political will and bipartisan support if it is to continue to protect individuals' reproductive rights.

A historical perspective of the women's health nurse practitioner.

There are more than 12,000 women's health nurse practitioners (WHNPs) currently certified by the National Certification Corporation (NCC) and practicing in a wide range of roles. The purpose of this article is to describe the historical development of the WHNP specialty, and to review the evolution of the specialty from an initially very focused practice in the area of family planning into obstetric and gynecologic care to today's more diffuse role inclusive of primary care. Women's health nurse practitioners must broaden their educational background to include the lifespan of women, not just the reproductive years. With the inclusion of chronic disease management of the middle-aged and elderly woman, WHNPs will provide more comprehensive and integrative health care to women in all areas of the United States.

'New bottle, but old wine': from family planning to HIV/AIDS in post-Doi Moi Vietnam.

This paper begins with an observation that during the past two decades HIV/AIDS has emerged as a new public health priority in Vietnam and has commanded increasing attention and resources from both the government and the donor community. By juxtaposing HIV/AIDS with family planning, another social and health priority that preceded, and overlapped with, HIV/AIDS for a large part of the 1990s, we show two major gaps that have undermined both programmes. One is the lack of a strong civil society, that could have served as advocates for change, especially outside the government and the donor community. The other is the desire for control of women's bodies and sexuality that has been driven by the ever shifting project of nation building. We argue that these two major gaps represent more continuity than discontinuity in the way sexual and reproductive health issues are approached in Vietnam despite the seeming shift in priority that the emergence of HIV/AIDS suggests.

From low to high fertility in Sulawesi (Indonesia) during the colonial period: explaining the 'first fertility transition'.

This paper examines the past transition from low to high fertility which, in Indonesia as elsewhere, preceded the return to lower birth rates. Data from two parts of the island of Sulawesi where fertility rose during the colonial period are used to explain both why it rose, and why it was originally low. Economic conditions, it is argued, were the most important factors, affecting fertility via the supply of income and the demand for labour. Two schematic models of the 'first fertility transition' are proposed. In areas with low population densities and area-extensive forms of agriculture responsive to commercial stimuli, birth rates rose as the growth of commerce raised levels of prosperity, facilitated marriage, and undermined institutions such as debt-slavery which had previously acted to restrict marital fertility. In densely populated areas with labour-intensive agriculture and heavy state taxation in labour, fertility rose in response to demands for women's (and possibly child) labour that did not necessarily lead to gains in income.

Taiwan's population and family planning efforts: an historical perspective.

The unprecedented decline of Taiwan's natural population increase rate from 3% in 1963 to 1.9% in 1973, attributed primarily to an increasing use of contraception, brought universal attention to one of the first and most successful national family planning programs, at a time when successes were few. Taiwan met its goal of decreasing its natural increase rate despite its young population, increasing numbers of women of childbearing ages, a strong preference for sons and a per capita income at the outset in 1963 of less than U.S.$200. Recognition of this achievement brought thousands of professionals, particularly from developing countries, to study the program firsthand: more than 3,000 during 1970--73 alone. This was matched by an avalanche of publications about the program that appeared around the world, written by practitioners, academics and others. This article tells the story of this success.

Deliberate control in a natural fertility population: southern Sweden, 1766-1864.

In this article, we analyze fertility control in a rural population characterized by natural fertility, using survival analysis on a longitudinal data set at the individual level combined with food prices. Landless and semilandless families responded strongly to short-term economic stress stemming from changes in prices. The fertility response, both to moderate and large changes in food prices, was the strongest within six months after prices changed in the fall, which means that the response was deliberate. People foresaw bad times and planned their fertility accordingly. The result highlights the importance of deliberate control of the timing of childbirth before the fertility transition, not in order to achieve a certain family size but, as in this case, to reduce the negative impacts of short-term economic stress.