[Family planning in Hungary: past and present]. / A családtervezés Magyarországon: múlt és jelen.

Periconceptional Care Service begins 3 month before the planned pregnancy and continues until 12th week of pregnancy. Its goal is to prevent congenital abnormalities (CAs) and preterm birth. Nowadays, 20-25% of infant mortality is caused by CAs in industrialized countries and CAs are among the leading causes of death. An important feature of CAs is that they represent a defect condition; therefore it's difficult to achieve a complete recovery. Thus, prevention is considered the only optimal solution in the medical care of cases affected with CA. In the last 25 years, several studies confirmed the possible prevention of CAs mainly neural-tube defects (NTDs) by folic acid supplementation during periconceptional period. Family Planning Service exists in Hungary since 1984. This model is optimal for the introduction of periconceptional folic acid/multivitamin supplementation, thus provide an effective method for primary prevention of birth defects.

Family planning: today and in the future.

This review covers the state of contraceptive development noting new entries in the clinic (mainly steroidal and different delivery methods) and novel leads for nonsteroidal female- and male-methods in the pipeline. The time taken to market and the absence of partnerships with industry are stressed as major factors for the slow progress in their development.

Changes in British men's use of family planning services between 1991 and 2000: secondary analysis of a national survey.

BACKGROUND AND METHODOLOGY: Although men are identified as a priority group for sexual health initiatives, limitations in other data sources mean little is known about their use of general practitioners (GPs) or family planning clinics (FPCs) for family planning services. This paper provides a unique profile of which men have increased their use of GPs or FPCs for family planning services over the 1990s. Data were taken from the repeated cross-sectional British Omnibus Survey, 1991-2000. In total, 16 470 men aged 16-49 years were asked which health service they had used for family planning purposes within the last 5 years. RESULTS: Although around two-thirds of men cite general practice as their preferred source for professional advice on contraception, in 2000 only 12.5% (95% CI 11-14) had used this source for family planning purposes in the past 5 years. Between 1991 and 2000, the greatest growth was in use of FPCs, particularly among men aged 16-24 years, of single or cohabiting marital status, or of professional or unskilled social class. The greatest growth in use of GPs relative to use in 1991 was among men aged 35-44 years and those in the skilled non-manual and skilled manual social classes. DISCUSSION AND CONCLUSIONS: As the 1990s progressed, an increasing percentage of men attended GPs and FPCs for family planning purposes. Differential rates of growth by age group, marital status and social class have occurred, but levels of use are still much lower than for women.

(Re)defining reproductive health with and for the community: an example of participatory research from Mali.

Qualitative research was carried out in central Mali to inform the development of curricula for an intervention to improve young people's reproductive health. Both the young people and 'societal gatekeepers' (including religious leaders and traditional healers) perceived reproductive health to comprise the social dynamics in which reproductive health decision-making is embedded and not just the biological aspects of sexual relations and fertility. Their definitions of reproductive health reflected social taboos about pre-marital sex, infidelity and illegitimate children, and comprised holistic notions of bodily and spiritual cleanliness. It is argued that the 'Cairo' definition sees many of the social factors identified by respondents as comprising the context or background of reproductive health. The findings presented here indicate that local populations may see them as integral to the concept itself. It is discussed how the 'Cairo' definition of reproductive health needs to be made culturally specific in order to facilitate programme design and implementation.

Opinions of imams about family planning and their use of methods in Kayseri, Turkey.

OBJECTIVES: Imams are religious leaders who have significant influence on the social attitudes and behavior of a society. This study examined the views of imams on family planning and their personal preference of birth control methods. MATERIALS AND METHODS: Using a pre-prepared questionnaire, an on-site individual interview was conducted face-to-face with each of 164 imams at Kayseri, a city in Central Anatolia. RESULTS: All of the imams included in the study knew of at least one family planning method. Withdrawal was the most widely known method of family planning (84.2%). Among imams, 88.4% approved the use of birth control. While only 61.8% of the imams used at least one method of family planning, 20.1% used none at all. Of the family planning methods used, we considered 43.1% efficient (modem) and 18.7% inefficient (traditional). The most important factor affecting preference of traditional methods was religious suitability. CONCLUSION: Contrary to common belief, imams viewed family planning positively and used family planning methods at a rate similar to that of the general public. If provided with accurate information, we believe that imams may have a positive contribution to make in the development of family planning programs.

Changes in ante-natal care and family planning in Krakor, Pursat, Cambodia, 1996-1998.

This study examines variations in ante-natal care (ANC) and family planning in Krakor, Pursat, Cambodia between 1996 and 1998. Population-based survey interviews were conducted with a total of 291 women in 1996 and 211 women in 1998. An intervention strategy designed to enhance the skills and roles of Health Centre staff, Village Health Volunteers (VHVs) and Traditional Birth Attendants (TBAs) was conducted. Over this timeframe, reported ANC access increased from 37% to 47%. Most women delivered their last child at home, usually assisted by a TBA. Few women practiced family planning, despite the fact that most reported that they did not want any further children. A range of reasons for not practicing family planning were found to be highly significant, including the lack of available services (p<0.01). The fear of side-effects decreased significantly (p<0.01), with the community education provided by the VHVs and TBAs, potentially being one contributing factor. The results of this study suggest that continual support of VHVs and TBAs will further improve the health of women in Cambodia.

Abortion law and practice in China: an overview with comparisons to the United States.

This article utilizes legal documents, policy statements and ethnographic data to compare abortion law and practice in China and the United States. It outlines Chinese abortion law from ancient to modern times, identifies categories of reasons for aborting, and describes both folk remedies and the most common methods of modern medicine for inducing abortion. The contemporary incidence of abortion is discussed in the context of official family planning policy; evidence is presented to suggest that while modern methods are far safer than traditional remedies, the use of abortion as a major form of birth control has had an impact on women's health. The interference of the state in women's reproductive life is put in historical/cultural context and compared to U.S. views of women's reproductive rights. Differences in conception of abortion rights are attributed to contrasting historical relationships between the state and the individual and religiously and legally based theories of human rights, including fetal personhood and right to life.

[Future prospects in contraception]. / Zukunftsperspektiven der Empfängnisverhütung.

PIP: Only 40% of the 1.2 billion couples in reproductive age have access to effective contraceptive methods, although only $3.0 per couple per year would suffice for contraception worldwide. Abortions are performed for 40-60 million women annually. More than 200,000 women die as a result of abortions, and another 500,000 die due to labor complications. Contraception for women comprises the following: 1) agents that prevent ovulation; prolonged breast feeding (98% safe contraception within the first 6 months); oral contraceptives containing estrogens and gestagens (60-80 million women use them worldwide; in 1968 the 50 g estrogen containing pill, in 1972 the micropill with 30 g of ethinyl estradiol [EE], and in 1992 the ultra-low-dose pill with 20 g of EE were introduced); and future developments (third generation progestagens, antigestagens, nonsteroidal natural substances, melatonin, the combination of gonadotropin-releasing hormone analogs and natural estrogens); 2) prevention of fertilization: mechanical methods (diaphragm, sterilization methods by laparoscopy or chemical means); chemical methods (spermicides such as nonoxynol); behavioral methods (temperature methods using refined measurement of the body temperature, cervical mucus resistance); hormonal methods (implants such as Norplant containing levonorgestrel [LNG], Implanon containing 3-ketodesogestrel, the vaginal ring [the WHO-ring and the Organon ring], the minipill with pure gestagen, one-month injection with Cyclofem), IUDs (copper-containing IUDs, LNG-containing IUDs with a Pearl Index of 0.2-0.5 and reduction of dysmenorrhea); and immunological contraception (ovum and spermatozoon antigens); 3) the prevention of implantation: hormonal methods (the morning-after pill with high-dose EE or the combination of estrogen and gestagen); insertion of an IUD up to the 6th day after coitus; immunological methods (human chorionic gonadotropin antibodies, antibodies against the zona pellucida glycoproteins, implantation inhibition through interaction with interleukin IL-1 receptor, and antibodies against specific proteins of the endometrium influencing implantation). Contraception for men consist of the condom, vasectomy, coitus interruptus, and medical inhibition of spermiogenesis (testosterone ester and gossypol).^ieng

Fertility and family planning in Vietnam.

This report provides the first reliable statistical data on fertility patterns and the family planning program in the Socialist Republic of Vietnam. Findings are from the 1988 Demographic and Health Survey of Vietnam and the 1989 census survey. The data show that the total fertility rate has declined from over 6 children per woman in the early 1970s to under 4 in the later 1980s. Contraceptive prevalence for modern methods is estimated at 37 percent among married women of reproductive age in 1988. The average duration of breastfeeding is over 14 months; marriage is relatively late. The IUD is the most common contraceptive method and abortion is widespread. The major factors likely to influence fertility and family planning in the future are the government's population policy, improved access to modern methods of contraception, and the institution of new economic policies that are currently under way in Vietnam.

PIP: An analysis of data gathered in the 1988 Vietnam Demographic and health Survey (VNDHS) and the 1989 Census Population Five Percent Sample suggests that the country has been undergoing a process of demographic transition since the reunification of North and South Vietnam in 1975. The total fertility rate has declined from 6.1 in 1969-1974 to slightly under 4.0 in 1988-89. Factors apparently promoting this decline include changes in nuptiality patterns (in 1988, the mean age at marriage was 23.5 years and only 60% of women of reproductive age were married), a low infant mortality rate (50/1000 live births in 1988-89), growing acceptance of the government's 2-child family size norm (desired family size stands at 2.7 children among rural women and 2.3 children among urban women), and a well-organized national family planning program (54% of currently married Vietnamese women 15-44 years of age were contraceptive users in 1988). 63% of contraceptive acceptors use the IUD--the method promoted by the government's family planning effort--but there appear to be problems with the quality of IUDs provided. 45% of ever-users of clinic methods and 19% of users of supply methods utilize the commune health center and another 37% and 24%, respectively, are supplied through district hospitals. The ability of the national family planning program to offer a range of contraceptive choices has been hindered by a severe fiscal crisis in the health sector, and privatization and decentralization are receiving consideration as possible solutions. Local demographers are currently assessing whether further economic renovation is likely to support further demographic transitions or undermine policy enforcement by weakening the influence of rural cadres.

[Changes in midwifery practice. 26. Postwar legislative guideline concerning family planning].

PIP: Yoshio Furuya, who authored the 1951 legislative guidelines for family planning in Japan, designated 3 villages to model family planning upon his return from the United States in 1950. The instructors were public health nurses, midwives and regular nurses who had been trained and certified by the National Public Health Institute. They showed film strips and slides, and distributed contraceptives and medication. Population Research Group also embarked on the New Life Style Movement among Japanese industries in 1951. The new life style was said to have 3 pillars: family planning, career planning, and family morals. The idea of family planning was welcomed at the beginning by industries because it would mean less dependents of employees to provide financial aid for. The movement lasted only several years. In 1955, the International Family Planning Federation and the Japan Family Planning Federation co-sponsored the Fifth International Family Planning Conference in Tokyo. 572 participants including Margaret Sanger delivered 91 papers on techniques and practices of family planning. Soon after the conference, the Family Planning Study Committee was organized, and they met once a month to discuss socio-cultural implications of family planning, theory and practice of contraception, maternal and child health. Many of the committee members were idealistic/feminist public health officials but there were no women among them. A post-war family planning movement approved by the Japanese government resulted in the dramatic reduction in the birth rate from 34.3% in 1947 to 17.2% in 1957. Midwives played an important role in enforcing the policy but they were excluded from policy making.^ieng

[Transition in the midwifery profession. 25. The prewar birth control movement and the concept of eugenics].

PIP: The concept of eugenics played a significant role in the pre-war birth control movement. Some favored birth control from the standpoint of an individual's right to happiness, while others were against it from the standpoint of preservation of good stock for the nation. Yamamoto, Nobuharu (1889-1929), who translated Margaret Sanger's speech and her book in 1922, advocated birth control purely from a biologist's point of view. Birth control is necessary for the survival of strong healthy human beings capable of overcoming all the difficulties in their lives. Birth control is a form of natural selection consciously done to avoid overburdening and wasting individual lives. Nagai, Sen (1876-1957) was opposed to birth control from eugenicc' point of view. He became the 1st president of Japan Racial Hygiene Society in 1930 and founded Eugenics/Marriage Counseling Clinic in 1933. In his book on eugenics published in 1936 he stressed the importance of continuation of race by protecting good stock and eliminating poor stock by sterilization. Birth control was opposed because it will shorten the life of an ethnic group or a race. Furuya, Yoshio (1890-1974), also a racial hygiene major, supported population policies based on eugenics. He studied a trend in childbirth among women of different professions and geographical areas. Educated and cultured urban upper-middle class women showed a sudden decline in childbirth in their later years of marriage, suggesting the prevalence of birth control among them, while less educated low-income women continued to reproduce. He opposed to birth control but was in favor of sterilization for eliminating poor stock.^ieng

[Changes in the midwifery profession. 23. A process leading to legislation of family planning].

PIP: Family planning legislation was officially discussed at the Japanese Cabinet meeting for the 1st time in October 26, 1951. Negative effects of abortion on women's health had prompted this move, which reflects changes in the Japanese government's attitude towards birth control. For many years birth control was suggested only to save mothers' lives and not to regulate the nation's population size. During the 5 years after WWII, when Japan lost all of her colonies and her industry was virtually non-existent, Japanese population increased by 15%. 47% of that increase was due to returnees from overseas. The Committee on Population Policy, established in November 1946, proposed the following to the government: By rebuilding the economy, the nation's capacity to accomodate its excessive population will be strengthened. A civilized nation should have an economic power matched with its population size, and within this context birth control can have a positive effect. A Eugenic protection law passed in 1948 resulted in too many cases of abortion. Various individuals and groups such as Socialist party members and medical doctors held meetings where family planning was discussed and advocated. McArthur's GHQ chose not to cooperate because of a great opposition from American Catholics. In 1954, the Population Problem Probe Committee decided that the government should deal with family planning as part of its overall population policy not just as a means of protecting maternal health.^ieng

The role of traditional fertility regulation in Sri Lanka.

Among the countries of South Asia, Sri Lanka, with a birth rate of 26 per 1,000, has achieved by far the lowest fertility level. The research reported here shows that at least half of all fertility control there is still practiced by means other than those offered by the national family planning program. This paper reports on an investigation carried out by the Sri Lankan Department of Census and Statistics, employing a micro-approach to demographic research, on the levels of "traditional" methods of family planning and attitudes toward the practice of both modern and traditional contraception. It is shown that knowledge of rhythm was diffused throughout society as the cost of raising children increased during a period when other methods of family planning were not easily accessible. These traditional methods were employed efficiently and their high level of continued use arises from strong cultural resistance to the pill and IUD, based upon local interpretations of how these methods function. Thus, any programmatic effort to reduce dependence on traditional family planning might well result in higher fertility levels. In addition, low fertility among Indian Tamil workers on the Tea Estates, as early as the 1950s, probably resulted from a desire (manifested by lower levels of sexual activity and some abortion) to avoid frequent pregnancies, since pregnancy interrupts work that the female Estate workers cannot afford to miss.

PIP: Among the countries of South Asia, Sri Lanka, with a birth rate of 26/1000, has achieved by far the lowest fertility level. The research reported here shows that at least 1/2 of all fertility control there is still practiced by means other than those offered by the national family planning program. The Sri Lankan Department of Census and Statistics, employing a micro-approach to demographic research, studied levels of traditional methods of family planning and attitudes toward the practice of both modern and traditional contraception. Knowledge of rhythm was diffused throughout society as the cost of raising children increased during a period when other methods of family planning were not easily accessible. Of those who practice it regularly, 2/3 report that it is a satisfactory method of fertility control, a much higher proportion than is the case with regard to any modern form of contraception. These traditional methods were employed efficiently and their high level of continued use arises from strong cultural resistance to the pill and IUD, based upon local interpretations of how these methods function. Most Sri Lankans believe that the pill has a heating effect. It is believed that the heat not only destroys the sperm but can dry or wither the womb and is likely to have a broader impact on a woman's health. Thus, any programmatic effort to reduce dependence on traditional family planning might well result in higher fertility levels. In addition, low fertility among Indian Tamil workers on the Tea Estates, as early as the 1950s, probably resulted from a desire (manifested by lower levels of sexual activity and some abortion) to avoid frequent pregnancies, since pregnancy interrupts work that the female Estate workers connort afford to miss.

Medicine in western Samoa.

This article describes the geographical, historical, economic and cultural background of Western Samoa. It explores the present medical problems and those likely to occur in the future, and draws attention to the medical manpower needs of a developing Pacific nation.

The transition in Korean family planning behavior, 1935-1976: a retrospective cohort analysis.

This study traces the diffusion of family planning behavior-the use of abortion, contraception, and/or sterilization-in Korea between 1935 and 1976. Within- and cross-cohort examinations were made of the levels of ever-use of family planning, method of initiation of family planning, and patterns of family planning behavior. Ever-use of any of the three modes was very low for all cohorts prior to the introduction of the National Family Planning Program in 1962; afterwards, family planning diffused at a rapid rate. A major determinant of ever-use levels attained by cohorts married before 1962 was the length of time between the introduction of the program and menopause.