This issue of Population Reports can help managers of family planning and reproductive health programs to: advocate inclusion of BCC in family planning programs, a crucial element that has had a low cost for each new contraceptive user; learn how to apply theories of behavior to help choose the most appropriate BCC strategies and messages; learn the key factors contributing to effective BCC programs; oversee the steps in planning, carrying out, and monitoring and evaluating a BCC program; make sure that monitoring and evaluation collect information that helps guide the program; compar

This Population Reports issue is the flagship publication of the "Elements of Family Planning Success" initiative that identified the top 10 elements most important to the success of family planning programs in coordination with health care professionals from around the world. The report synthesizes online discussions about these elements and highlights program experiences, best practices, and evidence-based guidance derived from nearly six decades in international family planning.

Family planning programs conventionally have paid primary attention to attracting new clients. Yet, each new family planning user is also a potential continuing client. As more and more people use family planning, continuing clients outnumber new clients by a widening margin. A family planning program that focuses on clients not only when they first choose a contraceptive method but also throughout their reproductive lives can offer better care than one that focuses on new clients alone.

Monthly bleeding changes are common with hormonal family planning methods and IUDs. They are rarely harmful, and they do not signify underlying or impending illness. These family planning methods also are the most effective reversible methods, and many women choose them for their effectiveness. Nonetheless, many women are concerned when a contraceptive method changes monthly bleeding. In fact, bleeding changes make up women’s most commonly reported method-related reason -- and sometimes the most common reason overall -- for discontinuing hormonal methods and IUDs.

 Know what to do. The materials that guide international humanitarian relief providers-- particularly the Inter-Agency Field Manual and its Minimum Initial Service Package (MISP)-- can inform local providers of the reproductive health care needs of refugees. Kits of supplies that are part of the MISP can be ordered. Disaster preparedness training courses can help providers and government officials respond effectively when crises occur. Plan ahead.

 For family planning (FP) programs, a consistent supply of contraceptives are needed.  Consistent supply results from a well- managed logistics system and from adequate and reliable funding.

 Performance Improvement (PI), a process pioneered in industry, is now helping to strengthen reproductive health organizations.  PI focuses on meeting the needs of service providers and other staff members.  When programs enable and inspire staff to do their best, the quality of care improves.  This document discusses features and benefits of the performance improvement approach in strengthening and expanding the choices of RH organizations that seek improvement of services.

 The best decisions about family planning are those that people make for themselves, based on accurate information and a range of contraceptive options. People who make informed choices are better able to use family planning safely and effectively. Providers and programs have a responsibility to help people make informed family planning choices.

 This Population Reports issue focuses on family planning and the importance of advocacy in family  planning programs.  Key evidences supporting family planning programs are summarized.  This  article presents the importance of advocacy for the improvement of the family planning programs  in developing countries.  Advocacy for family planning is becoming crucial as demand for  reproductive health care grows.  As many as 600 million people have

 Counseling about family planning (FP) and other reproductive health issues requires a set of specific skills designed to facilitate informed decision-making.  The GATHER approach to counseling--Greet, Ask, Tell, Help, Explain, and Return--has documented effectiveness in FP programs.  The more of the GATHER elements a counselor uses, the more satisfied clients are with their care and the more likely they are to use contraception.  This guide provides detailed information on each of the 6 elements of the GATHER model, including key p

 This Population Reports issue offers new perspectives that can help achieve the important goal of increasing the commitment of men to reproductive health (RH) and family planning (FP).  These perspectives recognize the facts that 1) men often make decisions that are crucial to women's RH; 2) men are interested in FP but need targeted communication and services; 3) it is important to understand and influence the balance of power between the sexes to improve RH behavior; and 4) couples who communicate about FP/RH make better, healthier decisions.  The

 Presented in this report are the recommendations of two expert groups, the Technical Guidance/Competence Working Group of the US Agency for International Development's Maximizing Access and Quality Initiative and the World Health Organization's Family Planning and Population Unit, regarding currently available family planning methods.  The former group addressed key biomedical questions and formulated recommendations about 11 groups of family planning methods: combined oral contraceptives, progestin-only pills during breast feeding, progesti

 This issue of "Population Reports" explores the concept of "unmet need" for family planning (FP) and presents new strategies FP programs can use to meet this need.  To focus on unmet need, FP programs solicit the statements of women through surveys, identify the groups most likely to be interested in accepting contraception, and attempt to reach these groups with services.  Unmet need affects over 100 million women in developing countries (a third of them in India) and an average of 20% of all married women of reproductive age in

 People move for many different reasons, and their circumstances vary widely. Still, they are alike in three important ways: 1) Disruption: Most have left behind the support of traditional values, extended families, friends, and familiar ways of life. With limited means, they face new and uncertain situations. 2) Differences: Culture and language often set them apart from their new neighbors. Reproductive attitudes and behavior often differ as well.

 The practice of female genital mutilation (FGM) is thought to be 2000 years old and continues today in many areas of Africa, the Mid-East, and Asia.  An estimated 100-132 million women have undergone the procedure, and 2 million more are subjected to it each year during infancy, childhood, or adolescence.  The World Health Organization has defined four categories of FGM.  Type 1 entails removal of the prepuce and, sometimes, all or part of the clitoris.

 To make informed choices about family planning (FP), women and men need accurate information in the media as well as in the clinic.  In turn, the media are looking for news important to the millions of people they reach each day. This issue of Population Reports includes several articles that instruct and encourage FP programs to help the news media cover FP fully and accurately.

 Many young people learn about love, romance, and sex through popular mass media entertainment, but the behavior that is promoted through most mass media leads to serious health risks.  Efforts are underway throughout the world to use this means of reaching a youthful audience to provide examples which young people can follow to adopt healthful behavior.  The "enter-educate" approach used for health messages is popular, persuasive, practical, and profitable and has been proven effective.

 Information gathered from a new survey and from a review of family planning (FP) research and program findings has revealed ten keys to FP program success.

 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 co

 The use of television, videotape, and film entertainment to promote family planning messages or services has proven to be an effective, efficient approach in developing countries.  For example, a televised vasectomy promotion spot in Brazil increased the number of vasectomies performed at the featured clinics by 80%.  240,000 women in Turkey are estimated to have adopted or switched to modern methods of contraception as a result of humorous spots, dramas, motivational, and documentary programs on t

 The use of television, videotape, and film entertainment to promote family planning messages or services has proven to be an effective, efficient approach in developing countries.  For example, a televised vasectomy promotion spot in Brazil increased the number of vasectomies performed at the featured clinics by 80%.  240,000 women in Turkey are estimated to have adopted or switched to modern methods of contraception as a result of humorous spots, dramas, motivational, and documentary programs on t

Family planning programs are beginning to recognize that men, too, are vital and interested participants in family planning. With mass media promotion tailored to this new audience, these programs are reaching men with messages and methods that encourage them to support family planning actively. It is often assumed that men have little interest in responsible parenthood. The few surveys available report otherwise. They suggest that many men favor family planning. Even in Africa--once considered the strong

Radio reaches almost everybody. Worldwide, there are an estimated 1600 million radio receivers--1 for every 3 people--and nearly 32,000 radio stations. Thus radio has great potential to being family planning and related health messages to the world's people. A number of new projects are putting radio to work for family planning. In Latin America songs by 2 popular young artists, Tatiana and Johnny, encourage sexual responsibility among young people. In Jamaica Naseberry Street, a soap opera set in a famil

Contraceptive social marketing (CSM) programs use commercial marketing techniques, mass media, and existing commercial networks to distribute, promote, and sell products. These programs now sell condoms, pills, and other contraceptives at subsidized prices, through retail stores, in 13 countries. A well-managed, publicized, and adapted program can usually reach 5-15% of all reproductive age couples; but programs in Bangladesh, Colombia, and Egypt reach 30% of current family planning users. The other major CSM progr

Family planning programs, first undertaken nationally in the 1960s, have lowered fertility even when other factors such as lower death rates have worked to increase population growth. Socioeconomic conditions, such as higher literacy and greater urbanization, also influence fertility directly by increasing personal motivation to have smaller families. A dozen major cross-national studies have compared the effects of family planning programs and socioeconomic indicators on fertility; the most recent, by Mauldin and Lapha

Clearly, modern methods of reversible contraception -- oral contraceptives (OCs), injectables, condoms, spermicides, and IUDs -- are reversible. Despite rumors of infertility or birth defects, recent large studies provide evidence that couples become fertile again and have healthy children after using modern family planning methods. More than 20 years of research with thousands of women have shown that hormonal contraceptives -- OCs and injectables such as Depo-Provera -- do not cause permanent infertility. There m

Because family planning meets individual and community needs, it can be effectively incorporated into primary health care programs. Most, if not all, methods of contraceptives can be supplied by nonphysicians, including nurses, paramedics, and trained lay workers. Family planning can effectively reduce high maternal and infant mortality rates. When compared with other drugs and surgical proceedures and when compared with childbearing, family planning methods are safe and free from substantial risk of major complica

This document assesses the current status of population and family planning assistance throughout the world and provides brief sketches of the available sources including national governments, intergovernmental agencies such as the UNFPA and other UN entities, and nongovernmental funding, technical assistance, or funding and technical assistance organizations. The descriptions of aid-granting organizations describe their purposes, sources of funding, and activities, and give addresses where further information may be sought.

Focus is on the following areas in this examination of population and birth planning in the People's Republic of China: organization of the birth planning program (decentralized policy implementation and the health care delivery system); the 3rd birth planning campaign (reproductive norms and numerical targets and the use of persuasion and education); contraceptive methods and their use (IUDs, sterilization, steroidal contraceptives, condoms, abortion, and new male methods); birth planning program results (quality of the dat

Studies show that breastfeeding is ideal for infant nutrition and is an important means of spacing births. Breast milk provides some immunological protection to the infant, protects against infection and malnutrition, satisfies the infant's nutritional needs, and costs less than other feeding substitutes. Breastfeeding also protects against pregnancy, although the length of the contraceptive effect cannot be predicted. Analysis of breastfeeding trends and patterns shows that although most women in developing countr

This Population Report examines films which may be used as a component of family planning programs. Films are categorized as general, informational, instructional, and motivational and have certain advantages over written or spoken material. Films have the capacity to be entertaining and can increase knowledge by teaching facts to people at various levels; they are also useful in trying to alter attitudes or behaviors. For example, a motivational family planning film could inspire some viewers to accept contracepti

The goal of social marketing projects is the development of a mass market for contraceptives sold at the lowest feasible prices. Experiences of more than 30 social marketing programs in 27 countries show that social marketing projects, a hybrid of health oriented-social action-commercial marketing programs, do work. At least 50% of a dozen projects with 3 or more years experience were able to improve contraceptive availability and sales of contraceptive products. In addition, they were able to spread family plannin

Between 60-80% of deliveries in the developing world are attended by traditional midwives, usually nonliterate, older women who learned their skills through apprenticeship and experience rather than formal education and training. Even where countries have tried to replace them with young, literate, trained health personnel, traditional midwives continue to practice and their services to be demanded. Midwives can and do learn new concepts if they are presented in an appropriate way, and some will encourage family plannin

Nonclinical delivery systems have been developed primarily because of the need to provide greater access to a majority of the people, particularly in rural areas and urban poor neighborhoods. Poor distribution of appropriately trained health personnel and physical limitations have prevented the clinic-based system to expand. Nonclinical delivery systems are designed to minimize service delivery costs and such barriers to clients as distance, costs to clients, administrative difficulties, and ignorance of contraception.&

For more than half the world's couples the fundamental decision whether or when to have a child is seldom a real decision at all. Despite the progress of the last decade, few of these 600 million men and women have adequate information about the health implications of ill-timed childbearing; few receive feedback on the impact of their fertility decisions on their community; and few have access to modern family planning methods.

This edition on Population Reports is intended to serve family planning administrators as a general guide to the major sources of assistance for ongoing program activities. Others seeking assistance for new programs may also find it useful.

Medical studies have revealed that family planning is an essential component of health strategies. Women who bear children too early or too late in life, women who bear too many children, and those who bear children too close together, put themselves and their children in danger. Reproduction-related risks would be minimized if: 1) women did not bear children before reaching the age of 18-20, 2) births were spaced at least 2 years apart, 3) no woman had more than 4 children, 4) women did not bear children after age

This report presents data on six media and their use in population/family planning information campaigns: telephone, mailings, newspapers, film, radio, and television. The report is based on a selection of available materials from 25 countries.

An accurate and timely service statistics system allows administrators to manage and evaluate family planning (FP) programs and plan for future needs; the final test of such an information system is whether it is useful to them in improving the program. As examples, the systems used in Indonesia, Mexico, Colombia, Brazil, and the Dominican Republic (covering both clinic- and community-based distribution of FP services) are described in some detail, including general organization and purposes, forms used, procedures for

This set of tables and graphs contains 4 parts: 1) A graphic presentation of age-specific fertility rates available in the 1960s and the most recent date for all countries and territories of the world having at least 20 thousand inhabitants in 1975. Empirical data assembled since 1960 from complete vital registration systems, censuses, or surveys was found for 143 (74%) of the 192 countries included. Estimates of population size and crude birth rate for 1975 are given for the 49 countries, mainly in Africa and Asia

During the 1970s some changes have occurred in the area of population policies and trends. There has been both progress and failure. The growth in world populaton has begun to slow in both developed and developing nations. The apparent decline in the birthrate of China between 1970-1975 is the most rapid of any country on record and may be regarded as family planning's greatest success story.

The risks and consequences of adolescent fertility are discussed. Childbirth before the age of 20 is more dangerous to the mother and infant than it is for older women. A growing proportion of all births is attributable to women under 20, menarche appears to be occurring earlier, but the age at marriage is increasing.

For prevention of pregnancy after coitus, the ineffectiveness of douching is recognized because sperm can be out of reach of douches and spermicides too quickly. The nonsteroidal estrogen diethylstilbestrol (DES) has been used most often. Steroidal estrogens, e.g., ethinyl estradiol and conjugated estrogens, are also effective. Progestogens may also be effective. Hormone administration should begin as soon after coitus as possible but never later than 72 hours. Estrogens are given orally, usually for 5 co

22 related aspects of the world population problem are briefly dealt with: literacy, ocean fisheries, natural recreational areas, pollution, inflation, environmental illnesses, hunger, housing, climate change, overgrazing, crowding, income, urbanization, deforestation, political conflict, minerals, health services, water, unemployment, endangered species, energy, and individual freedom. Inflation, climatic change, and ocean pollution are 3 of the most global consequences of the problem, but there are many more. The anal

Fertility levels and trends are analyzed for all countries according to type of data available, i.e.: for countries and territories with complete birth registrations (76; 43 developed and 33 developing), for those with systems other than civil registration (37), and for those with no available national statistical data on fertility since 1970 (86). Declines in birthrates have been registered in all 3 categories, each of which represents approximately 1/3 of the world's population. The effects of family planning pro

A report on breast-feeding and lactation is presented. Breast-feeding physiologically depends on the development of milk-producing tissues in the breast during pregnancy, the initiation of milk production, the maintenance of milk production, and milk ejection (let-down reflex). Prolactin and human growth hormone are of primary importance in the hormonal complex controlling the processes during lactation. If the let-down reflex fails, lactation soon ceases. Most breast-feeding problems are psychological in natu

 In a report on village and household distribution of contraceptives, the extension of family planning services into the daily lives of the people of developing nations is described, and the major requirements for a successful program listed.  The history of contraceptive distribution from over-the-counter sales to clinic distribution and finally to the nonclinical distribution that requires less investment of medical time and skill is covered in an effort to show the changes and  growth toward meet

 Factors that increase maternal health risks include high parity, short interpregnancy intervals, and pregnancy at both extremes of reproductive life.  In some countries, chronic malnutrition, excessive work, infectious diseases, poor environmental conditions, and inadequate medical care are added risks.  In these countries, death rates associated with childbearing are as high as 740/100,000 live births.  This is almost 50 times as high as in developed cou

 Traditionally, diagnosis of pregnancy is based on missed menstrual periods, nausea, and observation of the visible signs and symptoms of pregnancy.  Scientific testing supplements these, but none currently available is suitable for use in rural areas.  The immunologic slide tests are easier to transport, rapid to perform, and relatively inexpensive but less capable of early diagnosis than tube tests.  The soft cannula vacuum aspiration of the uterine cont

The training and use of nonphysicians (paramedicals, auxiliary and traditional workers) in the delivery of family planning services is reviewed.  Some advantages of utilizing nonphysicians include: 1) physician time is freed from routine tasks, 2) nonphysicians with specialized training may perform a particular task better than a nonspecialized physician, 3) they are widely accepted in  many countries, 4) they are competent when thoroughly trained and well supervised, 5) their services can be applied in

 Training programs in Advanced Techniques for Management of Fertility (ATMF), now administered by a corporation affiliated with the John Hopkins University, are reviewed.

 Evidence is emerging that fertility rates are declining in many countries, both rich and poor, on every continent.  Through the technique of "fertility silhouettes," age-specific fertility rates--the number of live births per thousand women by 5-year groups from ages 14 to 59--can be charted at different points in time.  Thus, one can view proportionate change in fertility at various ages and relate such changes to what is known concerning the time, strategy, and technology of family plan

 The principal determinant of fertility in developing countries appears to be availability and knowledge of means for fertility control.  Family planning programs have attempted to meet these demands by supplying services and supplies.  This report analyzes family planning programs and fertility data for 42 developing countries.  Silhouettes formed by plotting age specific fertility rates for different years show large declines in fertility during the 1960