1.  Peer Reviewed Title: Three methods of estimating births averted nationally by contraception. Author: Liu L; Becker S; Tsui A; Ahmed S Source: Population Studies. 2008;62(2):191-210. Abstract: This paper compares the performance of three methods applicable to national-level demographic data of estimating births averted as a consequence of contraceptive practice. Two are based on the relationship between the general fertility rate (GFR) or total fertility (TFR) and contraceptive prevalence, while the third uses Bongaarts' proximate determinants (PD) model. Estimates of the number of births averted and the percentage by which the number would have increased in the absence of contraception are consistent between the GFR-based and TFR-based methods, but in general lower than the estimates generated by the PD-based method, except for a few high-contraceptive-prevalence countries. For 156 countries and areas around the world the estimated number of births that would have occurred in a recent year in the absence of contraception--the average of the estimates of the three methods--is approximately 230 million, which is more than the estimated 129 million births that actually occurred. (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | METHODOLOGICAL STUDIES | THEORETICAL MODELS | BIRTHS AVERTED | CONTRACEPTIVE USAGE | ESTIMATION TECHNIQUES | FERTILITY RATE | CONTRACEPTIVE PREVALENCE | Research Methodology | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Contraception | Birth Rate | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 327512 |
2.  Peer Reviewed Title: Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT Program in California, 1997-1998. Author: Foster DG; Klaisle CM; Blum M; Bradsberry ME; Brindis CD Source: American Journal of Public Health. 2004 Aug;94(8):1341-1346. Abstract: The California Family Planning, Access, Care, and Treatment Program was implemented in 1997 to provide family planning services for uninsured, low-income women and men. We estimated the impact on fertility of providing 500000 women with contraceptives. Paid claims and medical record review data were used to estimate pregnancies averted. Pregnancies women experienced while enrolled in the program and pregnancies they would have experienced given methods used before enrollment were modeled as a Markov process. One year of Family Planning, Access, Care, and Treatment services averted an estimated 108 000 unintended pregnancies that would have resulted in 50 000 unintended births and 41 000 induced abortions. Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California. (author's) Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | FAMILY PLANNING ACCEPTORS | LOW INCOME POPULATION | FAMILY PLANNING PROGRAM EVALUATION | MARKOV CHAIN | PREGNANCY, UNPLANNED | BIRTHS AVERTED | Developed Countries | North America | Americas | Family Planning Programs | Family Planning | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Probability | Statistical Studies | Studies | Research Methodology | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 273655 |
| 3. Peer Reviewed Title: Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Author: Raymond E; Taylor D; Trussell J; Steiner MJ Source: Contraception. 2004 Jan;69(1):79-81. Abstract: The standard method for estimating the effectiveness of emergency contraceptive pills (ECPs) uses external data to calculate the proportion of expected pregnancies averted by the treatment. Because these data may not be applicable to ECP study populations, this approach could result in substantial overestimation of effectiveness. We used data from two published randomized trials of the levonorgestrel and Yuzpe ECP regimens to calculate the minimum effectiveness of the levonorgestrel regimen. Conservatively assuming that the Yuzpe regimen was entirely ineffective in these trials, we estimate that the levonorgestrel regimen prevented at least 49% of expected pregnancies (95% confidence interval: 17%, 69%). Because physiologic data suggests that the Yuzpe regimen does, in fact, have some efficacy, the effectiveness of the levonorgestrel regimen is likely to be higher than our minimum estimate. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CONTRACEPTION RESEARCH | WOMEN | EMERGENCY CONTRACEPTION | LEVONORGESTREL | CONTRACEPTIVE EFFECTIVENESS | MEASUREMENT | BIRTHS AVERTED | Developed Countries | North America | Americas | Contraception | Family Planning | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Research Methodology | Family Planning Program Evaluation | Family Planning Programs Document Number: 189970 |
| 4. Peer Reviewed Title: Estimation of births averted due to breast-feeding and increases in levels of contraception needed to substitute for breast-feeding. [Estimation des naissances évitées en raison de l'allaitement et augmentation des taux de contraception nécessaires pour se substituer à l'allaitement][Estimación de nacimientos impedidos debido a la lactancia materna y aumentos en los niveles de anticoncepción necesarios para sustituirla] Author: Becker S; Rutstein S; Labbok MH Source: Journal of Biosocial Science. 2003 Oct;35(4):559-574. Abstract: After contraceptive use, breast-feeding duration is the major determinant of the birth interval length. Three methods of estimating births averted by breast-feeding, and the increase in contraceptive use needed to substitute for breast-feeding, are presented. Method 1 simply utilizes Bongaarts’ C(i), and the other two are based on mean birth intervals with and without breast-feeding. Estimates for each method are derived for six countries with DHS surveys from the mid-1990s: Burkina Faso, Uganda, India, Indonesia, Brazil and Peru. The estimated percentage of additional births that would occur if there were no breast-feeding ranged from 1–4% in Brazil to about 50% in Burkina Faso and Uganda, reflecting very low breast-feeding in Brazil and very high levels in the sub-Saharan African nations. Strengths and limitations of the three methods are considered. (author's) Spanish Abstract: Después del uso de anticonceptivos, la duración de la lactancia materna es el principal determinante de la duración del intervalo entre nacimientos. Se presentan tres métodos de estimar los nacimientos impedidos por la lactancia materna y el aumento en el uso de anticonceptivos necesario para sustituirla. El primer método simplemente utiliza el modelo de Bongaarts (C[i]) y los otros dos se basan en los intervalos medios entre nacimientos con y sin lactancia materna. Se derivaron estimaciones de cada método para seis países con Encuestas de Demografía y Salud de mediados de la década del 90: Burkina Faso, Uganda, India, Indonesia, Brasil y Perú. El porcentaje estimado de nacimientos adicionales que se producirían si no hubiese lactancia materna osciló de 1 - 4 % en Brasil a aproximadamente el 50% en Burkina Faso y Uganda. Estos porcentajes reflejaban bajos niveles de lactancia materna en Brasil y muy altos en las naciones de África subsahariana. Se consideraron las ventajas y limitaciones de los tres métodos. (del autor) French Abstract: Après utilisation d'un contraceptif, la durée de l'allaitement est le principal déterminant de la durée de l'intervalle entre les naissances. Trois méthodes d'estimation des naissances évitées par allaitement et l'augmentation nécessaire de l'utilisation des contraceptifs pour se substituer à l'allaitement sont présentées. La méthode 1 utilise simplement le modèle (indices) de Bongaarts et les deux autres reposent sur des intervalles moyens entre les naissances en période d'allaitement ou non. Les estimations de chaque méthode proviennent de six pays ayant subi des enquêtes EDS au milieu des années 90 : Burkina Faso, Ouganda, Inde, Indonésie, Brésil et Pérou. Le pourcentage estimé des naissances supplémentaires qui se produiraient s'il n'y avait pas d'allaitement variait de 1 à 4 % au Brésil à environ 50 % au Burkina Faso et en Ouganda, ce qui reflète un allaitement minoritaire au Brésil et des taux très élevés dans les pays de l'Afrique sub-saharienne. Les points forts et limites des trois méthodes sont considérés. (de l'auteur) Language: English Keywords: BURKINA FASO | UGANDA | INDIA | INDONESIA | BRAZIL | PERU | DEMOGRAPHIC AND HEALTH SURVEYS | BIRTH SPACING | BIRTHS AVERTED | BIRTH INTERVALS | CONTRACEPTIVE USAGE | BREASTFEEDING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Africa, Eastern | Asia, Southern | Asia | Asia, Southeastern | South America, Eastern | South America | Latin America | Americas | South America, Western | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Family Planning | Family Planning Program Evaluation | Family Planning Programs | Fertility Measurements | Fertility | Contraception | Infant Nutrition | Nutrition | Health Document Number: 188416 |
| 5. Title: Contribution of family planning programme to fertility decline in Botswana. Author: Letamo G; Oucho JO Source: Demography India. 2002;31(1):79-91. Abstract: This paper seeks to demonstrate that family planning has contributed to fertility decline in Botswana. Using data from three Botswana Family Health Surveys, the paper employs age specific and method-specific prevalence methods to determine the contribution of family planning in the country's fertility decline. It is established that increased use of modern family planning has resulted in averting births thereby reducing fertility. (excerpt) Language: English Keywords: BOTSWANA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | INTERVIEWS | WOMEN | FAMILY PLANNING PROGRAMS | BIRTHS AVERTED | CONTRACEPTIVE PREVALENCE | AGE SPECIFIC FERTILITY RATE | HIV | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Data Collection | Research Methodology | Family Planning | Programs | Organization and Administration | Family Planning Program Evaluation | Contraceptive Usage | Contraception | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | HIV Infections | Viral Diseases | Diseases Document Number: 186495 |
| 6. Title: Impact of some biosocial variables on infant and child mortality. Author: Biswas SC; Rahman IK; Maleque MA Source: Demography India. 2000 Jul-Dec;29(2):211-21. Abstract: This paper presents further evidence on the effects of biosocial variables on infant and child mortality based on the analysis of a data set of the Bangladesh Demographic and Health Survey 1993-94. It also compares infant, second-year, and childhood mortality to ascertain similarities and differences among them employing Cox's proportional hazard model. Overall, the estimates for all the age groups show that the risk of dying decreases with increasing duration of breastfeeding. The early cessation of breastfeeding results in a considerably higher risk of dying for the child even when the influences of a number of factors on mortality including birth intervals are controlled statistically. Breastfeeding appeared to be a prime factor influencing infancy, second year, and early childhood; a crucial determinant, which overrode the influence of the next pregnancy interval and preceding birth interval factors. Other factors that have greatest potential for reducing infant and childhood mortality include spacing pregnancies more than 2 years apart and averting births beyond birth order 3-4. Language: English Keywords: BANGLADESH | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | INFANT MORTALITY | CHILD MORTALITY | BREASTFEEDING | BIRTH SPACING | BIRTHS AVERTED | PREVENTION AND CONTROL | Asia, Southern | Asia | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Mortality | Infant Nutrition | Nutrition | Health | Family Planning | Family Planning Program Evaluation | Family Planning Programs | Diseases Document Number: 160213 |
| 7. Title: Pregnancies averted among U.S. teenagers by the use of contraceptives. Author: Kahn JG; Brindis CD; Glei DA Source: Family Planning Perspectives. 1999 Jan-Feb;31(1):29-34. Abstract: An analysis of the number of adolescent pregnancies and pregnancy outcomes that are averted in the US each year by contraceptive use highlighted the importance of continued and expanded access on the part of young people to contraception. In this analysis, published estimates of contraceptive effectiveness were applied to 1995 National Survey of Family Growth data on sexual and contraceptive practices among US teenagers. Four scenarios of contraceptive access--from current levels to highly restricted access--and sexual and fertility control practices in response to such restrictions were constructed. The 651 sexually active female adolescents enrolled in the national survey had used contraception during 80% of the times in which they were at risk of pregnancy. Current levels of contraceptive use averted an estimated 1.65 million pregnancies among 15- to 19-year-old US women in 1995. If these adolescents had been denied access to prescription and over-the-counter contraceptive methods, an estimated 750,000 to 1.25 million additional pregnancies would have occurred, assuming some decrease in sexual activity. These pregnancies would have resulted in 480,000 live births, 390,000 induced abortions, 120,000 miscarriages, 10,000 ectopic pregnancies, and 37 maternal deaths. The prevalence of adolescent sexual activity would have to decrease by 83% over current levels to avert the same number of pregnancies that are presently prevented by contraceptive use. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | ESTIMATION TECHNIQUES | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | BIRTHS AVERTED | CONTRACEPTIVE USAGE | CONTRACEPTIVE AVAILABILITY | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Contraception Document Number: 140264 |
| 8. Title: An evaluation of family welfare programme in Tamil Nadu -India. Author: Ramadurai Source: In: Family planning: the Afro-Asian scenarios, edited by G.N. Rao. Thiruvananthapuram, India, Centre for Development Studies, 1999. :222-30. (Research Monograph Series: Vol. 5) Contains shortened student project reports. Abstract: This report presents an evaluation of the family welfare program in Tamil Nadu, India. The evaluation attempts to: 1) analyze the inter-district differences in the Couple Protection Rates (CPR) due to family planning (FP) methods; 2) analyze levels and trends of FP acceptance by various methods at state and district levels in 1980s; and 3) relate the program results to the inputs utilized in the program. By adding couples who accepted FP in the study period to those who had accepted the program in the previous year, and minus those who have dropped out because of mortality, aging, removal and expulsion of IUD, and failure of the method; the evaluation arrived at the total number of couples protected in a year. Users of conventional contraceptives and oral pills in the previous year were not taken into account because there is no carry over effect in these temporary methods. Overall, the implementation of FP in Tamil Nadu is encouraging. The state had exceeded the CPR of 50% and sterilization contributed to over 40% of the CPR. Hence, it is imperative that spacing methods should be encouraged in the future. Tables are provided to support the data given. Language: English Keywords: INDIA | FAMILY PLANNING PROGRAMS | COMMUNICATION PROGRAMS | PROGRAM EFFECTIVENESS | CONTRACEPTIVE USAGE | COUPLE YEARS OF PROTECTION | BIRTHS AVERTED | Asia, Southern | Asia | Developing Countries | Family Planning | Programs | Organization and Administration | Communication | Program Evaluation | Contraception | Family Planning Program Evaluation Document Number: 156097 |
| 9. Title: Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Author: World Health Organization [WHO]. Special Programme of Research, Development, and Research Training in Human Reproduction. Task Force on Postovulatory Methods of Fertility Regulation Source: Lancet. 1998 Aug 8;352(9126):428-33. Abstract: A previous study suggested that provision of two 0.75 mg doses of levonorgestrel for emergency contraception caused less nausea and vomiting and was more effective than the Yuzpe regimen of combined oral contraceptives (two doses of 100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel). These two regimens were evaluated further in a double-blind, randomized World Health Organization study of 1998 women recruited from 21 centers worldwide who requested emergency contraception within 72 hours of unprotected intercourse. Among the 1955 women for whom the outcome was known, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group and 3.2% (31/979) in the Yuzpe group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% confidence interval, 0.18-0.70). The proportion of pregnancies prevented was 85% in the former group and 57% in the latter group. Nausea and vomiting occurred significantly less frequently in the levonorgestrel group (23.1% and 5.6%, respectively) than in the Yuzpe regimen group (50.5% and 18.8%, respectively). The efficacy of both treatments declined significantly (p = 0.01) with increasing time since unprotected intercourse. These findings confirm that the levonorgestrel regimen may be more effective and is better tolerated than the current standard in emergency contraception. Language: English Keywords: GLOBAL | RESEARCH REPORT | COMPARATIVE STUDIES | LEVONORGESTREL | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, POSTCOITAL | FERTILITY CONTROL, POSTCOITAL | CONTRACEPTIVE EFFECTIVENESS | BIRTHS AVERTED | VOMITING | WHO | EMERGENCY CONTRACEPTION | Studies | Research Methodology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods | Family Planning Program Evaluation | Family Planning Programs | Nausea | Signs and Symptoms | Diseases | UN | International Agencies | Organizations Document Number: 135442 |
| 10. Title: Poverty and contraceptive use in rural Mexico. [Pobreza y uso de anticonceptivos en zonas rurales de México] Author: Gómez de León J; Hernández D Source: Paris, France, Committee for International Cooperation in National Research in Demography [CICRED], 1998. Presented at the seminar, "Poverty, Fertility and Family Planning", Mexico City, Mexico, June 2-4, 1998. [18] p. Also available in Spanish. Abstract: In addition to a more extensive use of contraceptive methods, the proportion of married or cohabiting women who have never used contraception has diminished. For analytical purposes three categories of the female population will therefore be considered, i.e. women who used a contraceptive method at the time of the survey (current users); women who have used contraceptives in the past, but who are not using them at the time of the survey (ex-users); and women who have never used a contraceptive (non-users). The percentage of married or cohabiting women in the third category has considerably diminished between 1976 and 1995. In the 70s, more than half had never used a family planning method, while today the share is only 19.7%. Nevertheless, while the use of methods for regulating fertility in the country is significantly increasing, important differences can still be observed among different population groups. Thus, women in urban areas with little formal education and those living in poverty use less contraceptives. The purpose of this paper is to analyze the practice of fertility regulation among women belonging to these types of households. (excerpt) Spanish Abstract: Además de un uso más extensivo de los métodos anticonceptivos, ha disminuido la proporción de mujeres casadas o que cohabitan con su pareja que nunca han usado anticoncepción. Por lo tanto, para fines analíticos, se considerarán tres categorías de la población femenina: mujeres que usaban métodos anticonceptivos en el momento de la encuesta (usuarias actuales); mujeres que usaron anticonceptivos anteriormente, pero que no lo hacía en el momento de la encuesta (ex usuarias); y mujeres que nunca han usado anticonceptivos (no usuarias). El porcentaje de mujeres casadas o cohabitantes de la tercera categoría ha disminuido considerablemente entre los años 1976 y 1995. En la década de 1970, más de la mitad nunca había usado métodos de planificación familiar, mientras que hoy esa porción es sólo el 19,7%. Sin embargo, si bien se registra un aumento en el uso de métodos para regular la fertilidad en el país, se observan diferencias importantes entre los diferentes grupos de población. De esta manera, se registra una cantidad menor de uso de anticonceptivos en las mujeres de las áreas urbanas con escasa educación formal y en las que viven en la pobreza. El objetivo de este trabajo es analizar la práctica de la regulación de la fertilidad entre las mujeres pertenecientes a estos tipos de familias. (extracto) Language: English Keywords: MEXICO | CRITIQUE | FAMILY PLANNING SURVEYS | RURAL POPULATION | LOW INCOME POPULATION | FERTILITY RATE | POVERTY | CONTRACEPTIVE USAGE | BIRTHS AVERTED | FAMILY PLANNING PROGRAMS | NEEDS | North America | Latin America | Americas | Developing Countries | Family Planning | Population Characteristics | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Birth Rate | Fertility Measurements | Fertility | Population Dynamics | Contraception | Family Planning Program Evaluation | Programs | Organization and Administration Document Number: 276843 |
| 11. Title: More than eight million births averted in Shandong. Author: Zhu H Source: CHINA POPULATION TODAY. 1998 Aug;15(4):19. Abstract: This short article discusses implementation of the Shandong Family Planning Regulations, in 1987, which has resulted in fewer but healthier births, and by which the public has learned to keep their reproductive behavior within the limits of the Regulations. The third baby boom since the founding of the People's Republic, in 1949, occurred during the past decade; the population of Shandong Province increased from 80.6 million, in 1987, to 87.3 million in 1997, an increase of only 7.24 million. Approximately 8.73 million births have been averted based on the 1987 fertility level, and 87.3 billion yuan have been saved based on an average of 10,000 yuan to raise a rural child to maturity. During this period, the birthrate decreased from 17.8/thousand to 13.3/thousand, and the natural increase rate declined from 11.3/thousand to 6.6/thousand. The average number of children born to each woman decreased from 5.0 in the 1950s and 1960s, to 3.2 in the 1970s, to 2.3 in the 1980s, and to below 2.0 currently. The percentage of late marriages by women rose from 39.6%, in 1987, to over 95% in 1997. Approximately 5.1 million couples decided to have only 1 child, and 117,000 rural families chose not to give birth to a second baby. Language: English Keywords: CHINA | FAMILY PLANNING POLICY | POPULATION CONTROL | BIRTHS AVERTED | BIRTH RATE | Developing Countries | Asia, Eastern | Asia | Family Planning | Population Policy | Social Policy | Policy | Family Planning Program Evaluation | Family Planning Programs | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 136503 |
| 12. Title: Costs and benefits of Vietnam's national investment in population and family planning from 1979 to 2010. Final report. Author: Sine J; May J; Vo AD; Nguyen NQ Source: [Hanoi], Viet Nam, National Committee for Population and Family Planning, Center for Population Studies and Information, 1997 Aug. viii, 35 p. Abstract: This study concludes that the Vietnam Government's investment in population and family planning (PFP) produced "impressive results," which justified costs. Leaders at all levels in the public and private sectors should be convinced of the efficacy of family planning. This study determines the savings in social sector spending due to family planning programs. The study examines the period 1979-96 and future scenarios during 1997-2010 and high- and low-impact estimates. Data were obtained from the National Committee on Population and Family Planning, the Ministry of Health, and donor agencies. During 1979-96 total fertility declined by 1.6 children/woman, more than it would have without the program. By 2010, a decline of 2.1 children/woman is expected. 28 million fewer births would be averted during 1979-2010. By 2010, total population would be 25 million lower than otherwise. PFP expenditures grew from 47 to 406 billion Vietnamese Dong (VND) during 1979-96. PFP expenditures are expected to reach VND 612 billion by 2010. Under the low PFP scenario, expenditures grew from VND 7 to 45 billion during 1979-96 and would grow to VND 62 billion by 2010. Actual expenditures on health, education, and social security grew from VND 5.5 to 9.1 trillion during 1979-96 and would grow to VND 23.8 trillion by 2010. Under the low PFP scenario, social sector expenditures would have been VND 10.4 trillion in 1996, or VND 1.3 trillion more than under the high PFP scenario. Social sector expenditures would reach VND 35.8 trillion by 2010, or VND 12 trillion more than under the high PFP scenario. Vietnam would save VND 107.2 trillion due to high PFP investments, or the equivalent of about 90% of education expenses averted. Every VND invested will produce a savings of VND 7.6 in social sector expenses. Vietnam must face challenges in program structure, method mix, quality of services, efficiency of resource use, integration, and quality of information. Language: English Keywords: VIETNAM | TECHNICAL REPORT | RECORDS | COST BENEFIT ANALYSIS | THEORETICAL MODELS | FAMILY PLANNING PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | POPULATION PROGRAMS | INVESTMENTS | EXPENDITURES | EDUCATION | CONTRACEPTIVE USAGE | BIRTHS AVERTED | Developing Countries | Asia, Southeastern | Asia | Information Processing | Information | Quantitative Evaluation | Evaluation | Research Methodology | Family Planning Programs | Family Planning | Program Evaluation | Programs | Organization and Administration | Population Control | Population Policy | Social Policy | Policy | Financial Activities | Economic Factors | Contraception Document Number: 129334 |
| 13. Title: The cost-effectiveness of family planning service provision. Author: Hughes D; McGuire A Source: JOURNAL OF PUBLIC HEALTH MEDICINE. 1996 Jun;18(2):189-96. Abstract: Family planning services are amongst the most highly utilized services in the National Health Service. There have, however, been few empirical studies of the cost-effectiveness of these services. Two measures of output were used to calculate the cost-effectiveness of family planning services. The first measure is based on the number of pregnancies averted. The second measure uses the couple year of protection as the measure of output. Accordingly, two cost-effectiveness ratios are calculated: cost per pregnancy averted and cost per couple year of protection. The direct cost per pregnancy averted is between 48 and 167 pounds for reversible and 18 and 21 pounds for nonreversible methods. The cost per couple year of protection is between 49 and 184 pounds for reversible and 17 and 21 pounds for nonreversible methods. For both approaches, if averted NHS costs associated with family planning services are included, these translate into resource savings to the NHS resulting from the provision of these services. From the perspective adopted in this study, family planning services are highly cost-effective. According to calculations made in this paper, these services provide a high rate of return to the NHS and, when the resource consequences of unplanned pregnancies in the health sector as a whole are considered, result in resource savings. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | LONGITUDINAL STUDIES | FAMILY PLANNING PROGRAMS | NATIONAL HEALTH SERVICES | COST EFFECTIVENESS | COST BENEFIT ANALYSIS | COUPLE YEARS OF PROTECTION | CONTRACEPTIVE METHODS | REVERSIBILITY | BIRTHS AVERTED | FAMILY PLANNING PROGRAM EVALUATION | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Family Planning | Programs | Organization and Administration | Health Services | Delivery of Health Care | Health | Evaluation Indexes | Quantitative Evaluation | Evaluation | Contraception Document Number: 115305 |
| 14. Title: Sterilisation as a method of contraception: recent trends in Great Britain and their implications. Author: Murphy M Source: JOURNAL OF BIOSOCIAL SCIENCE. 1995 Jan;27(1):31-46. Abstract: Data from the 1989 General Household Survey were analyzed by standard life table techniques to examine patterns and trends in sterilization among women, men, and couples aged less than 50 in the UK. The percentage of contraceptive sterilizations that were male and female were essentially equal (about 50% each). Female sterilization rates tended to increase earlier (by about 2 years) than male sterilization rates. Women were only somewhat more likely to be sterilized than men. If one examined only contraceptive sterilization, however, men were more likely to be sterilized than women. Couples were more likely to undergo sterilization shortly after a third birth than after a second birth. Contraceptive use trends were relatively steady over the recent decades. The percentages of women and men who had undergone sterilization and then entered into another partnership (about 2%) were quite small, thus sterilization had little effect on preventing births in subsequent unions. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | LIFE TABLE METHOD | STERILIZATION, SEXUAL | BIRTH ORDER | BIRTHS AVERTED | CHANGES | Developed Countries | Europe, Western | Europe | Demographic Analysis | Research Methodology | Family Planning | Family Relationships | Family Characteristics | Family and Household | Family Planning Program Evaluation | Family Planning Programs | Social Change Document Number: 103241 |
| 15. Title: Contraceptive sterilisation in South Africa: the resultant averted births. Author: Hofmeyr BE Source: South African Journal of Demography. 1994;4(1):83-97. Abstract: The demographic implications of contraceptive sterilisation is assessed by estimating the number of births averted per woman by the end of her reproductive period. The analysis is based on the Demographic and Health Survey, undertaken by the Human Sciences Research Council during 1987-1989. Using a method developed by Westoff, et al., figures are obtained to quantify the effectiveness of female and male sterilisation in reducing the birth rate. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | DEMOGRAPHIC ANALYSIS | STERILIZATION SEEKERS | ETHNIC GROUPS | STERILIZATION, SEXUAL | BIRTHS AVERTED | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Family Planning | Cultural Background | Population Characteristics | Demographic Factors | Population | Family Planning Program Evaluation | Family Planning Programs Document Number: 292985 |
| 16. Peer Reviewed Title: Using parity-progression ratios to estimate the effect of female sterilization on fertility. Author: Stupp PW; Samara R Source: STUDIES IN FAMILY PLANNING. 1994 Nov-Dec;25(6 Pt 1):332-41. Abstract: Two methods are used to show the impact on fertility of sterilization: births averted in a single five-year period before the survey and the parity progression ratio approach for 1979-84 and 1984-89 used to estimate births averted by birth order and duration since first union. The births averted analysis revealed that fertility among nonsterilized women declined from 5.93 in 1979-84 to 5.01 in 1984-89. The births averted approach showed almost no change in total births averted and a shift in the distribution of births averted by marital duration. Births averted were greater during 1984-89 among marital durations under 15 years and during 1979-84 at marital durations of 15-24 years. The actual percentage of ever married women who were sterilized increased over the decade, but the hypothetical proportions being sterilized in a given duration remained almost unchanged. This approach underestimated births averted, because it did not account for future declines in fertility among nonsterilized women. The parity progression ratio (PPR) approach indicated a nonsterilized fertility decline of 1.28 births per woman and a marital fertility decline of 1.04 births. Between the two periods, sterilization contributed to a reduction of 0.24 births. The preferred PPR approach accounted for the effects of sterilization on individual PPRs and proportions of ever-married women. This method offered consideration of increased sterilization prevalence, but declining births averted by sterilization. A comparison of both methods shows that the parity progression approach yielded higher estimates of the average number of births averted by sterilization and higher total nonsterilized marital fertility rates (total marital fertility rates in the absence of sterilization). Marital fertility rates remained similar. Data are obtained from the 1989 Ecuador Demographic and Health Survey and the World Fertility Surveys of 1979 and 1989. Language: English Keywords: ECUADOR | METHODOLOGICAL STUDIES | PARITY PROGRESSION RATIO | DEMOGRAPHIC AND HEALTH SURVEYS | WORLD FERTILITY SURVEYS | STERILIZATION, SEXUAL | BIRTHS AVERTED | FERTILITY RATE | South America, Western | South America | Latin America | Americas | Developing Countries | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Demographic Surveys | Fertility Surveys | Family Planning | Family Planning Program Evaluation | Family Planning Programs | Birth Rate Document Number: 101749 |
| 17. Title: The effect of family planning program on fertility in Egypt (1980-1991). Author: Yehia AM Source: In: CDC 23rd. Annual Seminar on Population and Development Issues in the Middle East, Africa and Asia. CDC Annual Seminar, 1993, [compiled by] Cairo Demographic Centre. Cairo, Egypt, Cairo Demographic Centre, 1994. :713-34. (Cairo Demographic Centre Research Monograph Series No. 23) Abstract: This family planning program evaluation uses the Bongaarts prevalence method to estimate births averted due to the impact of contraceptive use and the corresponding reduction in the birth rate in 1991. Data were obtained from the 1991 Egyptian Maternal and Child Health Survey among ever married women. The program impact is the difference between observed fertility and potential fertility. Nonprogram contraception is the difference between natural and potential fertility. This article describes the methods for calculating natural fertility, the fertility impact of contraceptive prevalence, births averted, the impact on the birth rate, and method-specific results. Data for the calculations include contraceptive prevalence, observed age-specific fertility rates, the number of women of reproductive age in 5-year age groups, use-effectiveness of different contraceptive methods, age-specific proportions of fecund women, and total population size. Findings indicate that 1,332,414 births were averted by contraception. The birth rate effect of contraception was 24.7 births/1000 population compared to the observed birth rate of 33.1/1000 in 1991. The natural crude birth rate was 57.8 births/1000 population, or the number of births if there had been no contraceptive use in 1991. The total birth rate effect was 24.7 births/1000 population, of which 0.40 was due to sterilization, 13.50 was due to the IUD, 8.42 was due to the pill, and 2.39 was due to other methods. The crude birth rate declined by 55% due to the IUD. The pill caused a decline of about 34%. The reduction in the total fertility rate due to contraceptive use was 3.75 births in 1991. The fertility rate of 4.15 would have been higher by 3.75 births, that is, 7.90 children/woman. The total fertility rate declined by 47% due to contraceptive use. Language: English Keywords: EGYPT | RESEARCH REPORT | BIRTH RATE | CONTRACEPTIVE USAGE | BIRTHS AVERTED | FAMILY PLANNING PROGRAMS | Africa, Northern | Africa | Developing Countries | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Contraception | Family Planning | Family Planning Program Evaluation | Programs | Organization and Administration Document Number: 117455 |
| 18. Title: Zero growth rate a distant goal. Source: FOCUS ON POPULATION, ENVIRONMENT, DEVELOPMENT. 1993 Apr-Jun;7(2):7. Abstract: A summary is provided of the annual report for 1992-93 of the Indian Department of Family Welfare on progress toward zero population growth. The prospects are slim that even with a net reproduction rate of unity (NRR-1) zero growth will not occur for several decades. NRR-1 means a birth rate of 21/1000, a death rate of 9/1000, and a natural population growth rate of 1.2%. The goals of the National Health Policy of 1983 are to achieve NRR-10 by the year 2000. The report targets a new deadline of 2011-2016. The Eighth Plan targets a birth rate of 26/1000, infant mortality of 70/1000, and a couple protection rate of 56%. Obstacles to achieving NRR-1 are identified as deep-rooted customs, traditions, and sociocultural beliefs that favor large family size. Population growth shows a decline. The states with the highest growth rates in the past decade are Haryana, Madhya Pradesh, and Rajasthan, which has the highest rate of growth of 2.5%. Rates lower than 2.3% are recorded in Gujarat, Himachal Pradesh, Karnataka, Orissa, Punjab, Tamil Nadu, and Kerala, which has the lowest growth rate of 1.34%. Crude birth rates are noteworthy in Goa state (16.8), Kerala (18.1), and Tamil Nadu (20.7). The national average is 29.3 in 1991. States with higher rates include Assam (30.9), Bihar (30.5), Haryana (33.1), Madhya Pradesh (35.8), Rajasthan (34.3), and Uttar Pradesh (35.1). Infant mortality rate (IMR) patterns follow similar highs and lows by state. Kerala has an IMR of 17/1000 live births, while Madhya Pradesh has an IMR of 122/1000, Orissa has an IMR of 126/1000, and Uttar Pradesh has an IMR of 93/1000. The total fertility rate is 3.9. Poor performing states include Bihar (5.1), Haryana (4.4), Madhya Pradesh (4.7), and Uttar Pradesh (5.2). The number of estimated births avoided since the beginning of the family planning program and March 31, 1992 is given as 142.98 million. The annual number of births averted has risen from 4.9 million during 1980-81 to 8.1 million during 1990-91 and 12.7 during 1991-92. Language: English Keywords: INDIA | DATA AGGREGATION | INFANT MORTALITY | BIRTHS AVERTED | BIRTH RATE | COUPLE YEARS OF PROTECTION | COMPARATIVE STUDIES | MULTIREGIONAL ANALYSIS | Asia, Southern | Asia | Developing Countries | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Fertility Measurements | Fertility | Studies Document Number: 092849 |
| 19. Title: Cost effectiveness analysis of family planning programs. Author: Population Council Source: In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. :[2] p. (NEP-01) Abstract: Data from surveys conducted in the late 1970s and early 1980s reveal continuing high levels of fertility and low contraceptive prevalence in Nepal. In order to provide policymakers and program managers with information on the relative efficiency of the existing strategies for delivering family planning (FP) services, an operations research study was undertaken, at a cost of US $23,993, to provide cost-effectiveness ratios for the services offered by Nepal's 4 major FP projects: the FP/maternal and child health project (FP/MCH), the contraceptive retail sales (CRS) project, the FP Association of Nepal (FPAN), and the integrated community health services development project (ICHSDP) during the periods 1974-75, 1979-80, and 1982-83. Comparative cost-effectiveness ratios for individual contraceptive methods, including breakdowns of costs for recruitment of new acceptors and for maintenance of continuing users were also to be developed. Raw financial data and service statistics for the years to be studied were provided by the 4 agencies. The acceptor data were processed using assumptions about continuation rates and contraceptive effectiveness to produce estimates of couple years of protection (CYP) and births averted, permitting refinement of the cost-effectiveness measures. In order to estimate method-specific cost-effectiveness ratios, more information on time allocation was needed to disaggregate cost data. 51 clinics and health posts were visited by researchers who interviewed personnel and observed operations. This established how much time was spent on FP versus other health activities and allowed disaggregation of FP time by method and by time spent on initial acceptors and continuing users. The unavailability of disaggregated data on sterilization camps meant that it was possible only to relate costs for total integrated (health plus FP) services to FP output measures (acceptors, CYP, and births averted. Considering the noncomparable nature of the cost ratios, there was surprisingly little variation in cost (from Rs. 716 for CRS to RS. 1085 for FP/MCH per birth averted) among the 4 agencies in fiscal year 1982-83. The cost ratios for the FP/MCH project and the FPAN project declined during the early 1980s, while the cost per birth averted of the ICHSDP project doubled (probably attributable to increasing emphasis on non-FP activities). If a valid cost analysis is to be conducted, the accounting and recordkeeping procedures should be changed or analyses should be designed and implemented prospectively, with full cooperation of the FP agencies involved. Language: English Keywords: NEPAL | COST BENEFIT ANALYSIS | FAMILY PLANNING PROGRAM ADMINISTRATION | FAMILY PLANNING PROGRAM EVALUATION | OPERATIONS RESEARCH | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | COMPARATIVE STUDIES | CONTRACEPTIVE METHODS CHOSEN | FAMILY PLANNING ACCEPTORS, NEW | CONTRACEPTION CONTINUATION | COUPLE YEARS OF PROTECTION | BIRTHS AVERTED | Developing Countries | Asia, Southern | Asia | Quantitative Evaluation | Evaluation | Family Planning Programs | Family Planning | Program Evaluation | Programs | Organization and Administration | Research Methodology | Primary Health Care | Health Services | Delivery of Health Care | Health | Studies | Contraceptive Usage | Contraception | Family Planning Acceptors Document Number: 093305 |
| 20. Title: The fertility impact of family planning programmes. Author: Bongaarts J Source: In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. :51-70. Sponsored by the International Planned Parenthood Federation [IPPF]. Abstract: Since the 1960s the fertility rate in developing countries has dropped from above 6 children to below 4. Both socioeconomic development and family planning programs have contributed to this decline. The contribution of FP programs ranges from 3% to 40%. When assessing the impact of FP programs one set of methods (component projection, prevalence and couple years of protection) measures the gross impact, while another set (regression analysis and experimental design) estimates the net effect. The gross fertility effect is obtained by the estimation of contraceptive prevalence by source and the estimation of fertility reduction attributable to program contraception. The gross program effect in a group of 31 countries during 1985-90 was the largest in China with 3.9 births per woman. In China 37.5 million births were averted, while in all the 31 countries the total gross births averted equalled 57.5 million. Regression analysis estimated the net program effect from 1965 to the late 1980s with two explanatory variables: the level of development (human development index) and the role of the family planning program measured by the average of 1982 and 1989 program effort scores. The fertility reductions averaged 66% in countries ranking highest on both indexes. Another regression analysis measured the separate roles of development and FP programs yielding a fertility decline from 7.1% to 38.3% during the period prior to 1965 and 1985-90. In 48 developing countries in the late 1980s the decline ranged from 90% in Bangladesh to 0 in several populations. The net effect exceeded 2 births per woman in China, Mauritius, South Korea, Singapore, and Thailand. China's 21.8 million net births averted was the largest out of a total of 42.7 million averted in developing countries. The comparison of net and gross measures for 27 countries with both measures available revealed that the net to gross ratio was less than 1 with an average of 0.75; however, in Egypt the ratio was 2. Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | THEORETICAL MODELS | FAMILY PLANNING PROGRAMS | DEMOGRAPHIC IMPACT | FERTILITY DECLINE | EVALUATION INDEXES | BIRTHS AVERTED | Research Methodology | Family Planning | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Fertility Changes | Fertility | Quantitative Evaluation | Evaluation | Family Planning Program Evaluation Document Number: 110071 |
| 21. Title: The fertility impact of family planning programs. Author: Bongaarts J Source: New York, New York, Population Council, 1993. 35 p. (Research Division Working Papers No. 47) Abstract: Bongaarts provides new estimates of gross and net impact on fertility reductions from family planning (FP) programs for 31 developing countries in Africa, Latin America, and Asia. A comparison is made of net and gross measures, and the interaction with the level of development is identified. The conclusion is reached that FP has been crucial in reducing fertility in many countries. Without FP, the total annual number of births in the late 1980s would have been 164 million instead of 120 million. There is no agreed upon measure for determining the impact of FP on fertility, and estimates have ranged from 3-40%. Discrepancies in results are due to the use of multiple methodologies, of which some are unsuitable or unreliable for normal evaluation due to difference research objectives and due to conceptual differences in measurement of gross versus net impact. Gross impact refers to the reduction due to the use of contraception available from program sources. Net impact measures the reduction achieved by the presence of the program. Net and gross impact vary within each country, with net impact the smaller of the two. Gross impact usually was measured with statistics on acceptors. In this study, the prevalence method (Bongaarts modified version) was used, based on statistics on source of contraceptives. This method estimates contraceptive prevalence by source and then estimates fertility decline attributable to program contraception. The estimation procedure assigns effectiveness as 95% for modern methods and 6% for traditional methods. The prevalence estimates for program and nonprogram sources are indicated. The average equals 1.3 births/woman, which was 27% of the average observed fertility of 4.8 births/woman. China had the largest number of births averted. Net fertility reduction estimates relied on regression estimation based on the level of each country's development and the average of the 1982 and 1989 program effect scores calculated by Lapham and Mauldin and by Mauldin and Ross. The largest net effects in births averted were in China. The net weighted average was 1.39 births/woman, which implies about a 50% impact on fertility decline. Language: English Keywords: DEVELOPING COUNTRIES | METHODOLOGICAL STUDIES | BIRTHS AVERTED | CONTRACEPTIVE PREVALENCE | FERTILITY DECLINE | FAMILY PLANNING PROGRAMS | Family Planning Program Evaluation | Family Planning | Contraceptive Usage | Contraception | Fertility Changes | Fertility | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 083178 |
| 22. Title: Excess fertility. Author: Cochrane S; Sai F Source: In: Disease control priorities in developing countries, edited by Dean T. Jamison et al.. New York, New York/Oxford, England, Oxford University Press, 1993. :333-61. Abstract: This study examined current levels and trends of fertility and excess fertility by regions of the world and determined the costs of excess fertility. Strategies and costs of preventing excess fertility were estimated, and case management of unwanted pregnancies was discussed. Fertility was lowest in Latin America and the Caribbean and in Asia and highest in Sub-Saharan Africa. Fertility was also high in the Middle East and North Africa. The rate of natural increase rose in Sub-Saharan Africa, declined in Latin America and the Caribbean, and was mixed in Asia and the Middle East. The World Bank has determined that a rate of natural increase greater than 2% is detrimental to economic development. Excess fertility can be determined by the number of births needed to reduce the rate of natural increase (RNI) to 2%, to reduce total fertility (TFR) to 4, or to eliminate births at high-risk ages. The result applied to aggregate data was the requirement of a 14% decline in births to decrease RNI, a 16% decline for reducing TFR, and a 31% decline in high-risk births. Excess fertility varied by country. All countries of Africa had high levels of excess fertility. Four countries in Latin America and the Caribbean had fertility higher than 4, but all countries with the exception of Trinidad and Tobago had a RNI of 2% or higher. Excess was highest in the Asian countries of Nepal and Bangladesh, followed by India. Malaysia and the Philippines had TFRs under 4 but RNI above 2%. All countries of the Middle East and North Africa with the exception of Turkey had excess fertility for TFR and RNI. Excess fertility can be determined also by stated fertility preferences, fertility with perfect contraception, or prevalence of abortions. Although abortion rates were higher in Latin America and Asia, desired family sizes were higher in Sub-Saharan Africa. A measure of births averted from contraceptive protection and the costs per disability-adjusted life-year gained indicated the lowest costs were in the highest mortality countries of Pakistan and Bangladesh and a higher life expectancy country, Egypt. Mortality would be reduced the most through birth spacing promotion in family planning programs. The savings for society in terms of education and health were calculated. 11.6 million births were estimated as unwanted in selected countries, at a cost of $1.5 billion for averting these births or $4.2 billion annually for all developing countries. Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | DEMOGRAPHIC ANALYSIS | DIFFERENTIAL FERTILITY | FERTILITY PREFERENCES | TOTAL FERTILITY RATE | HIGH FERTILITY POPULATION | COST EFFECTIVENESS | BIRTHS AVERTED | PREGNANCY, UNWANTED | Research Methodology | Fertility | Population Dynamics | Demographic Factors | Population | Fertility Rate | Birth Rate | Fertility Measurements | Evaluation Indexes | Quantitative Evaluation | Evaluation | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Reproductive Behavior Document Number: 102952 |
| 23. Title: A comparative benefit-cost analysis of the family welfare programme in India and Orissa. Author: Nayak P; Das CR Source: JOURNAL OF FAMILY WELFARE. 1993 Dec;39(4):41-6. Abstract: A cost benefit analysis of family planning in Orissa state, India, was performed in order to gauge the value of births averted. Repetto's value of an averted birth was used and adjusted to 1981-82 prices: Rs. 7576 per averted birth. Averted births were computed as the number of equivalent sterilizations (sterilizations plus 33% of IUD insertions, 6% of conventional contraceptives, and 11% of oral pill users) due to all methods times 3, plus medically terminated pregnancies (MTP). Benefit was determined as the value of averted births minus the loss to the nation from income generation and cost to society throughout a life. Data were provided for India and Orissa state on family welfare expenditures, equivalent sterilizations, averted births by family planning, averted births by MTP, and total births averted during 1980-81 and 1988-89. The results showed a less effective program until 1984-85, improvement during 1985-86 of about 34%, stabilization, and improvement during 1988-89. The projected cost benefit ratios for India were 37.42 during 1994-95, 37.03 during 1996-97, 36.65 during 1998-99, and 36.28 during 2000-01. In Orissa, the trend was projected to be upward. Further evaluation of family welfare programs should account for age and parity of couples. Language: English Keywords: INDIA | THEORETICAL STUDIES | COST BENEFIT ANALYSIS | FAMILY PLANNING PROGRAMS | BIRTHS AVERTED | Asia, Southern | Asia | Developing Countries | Quantitative Evaluation | Evaluation | Family Planning | Programs | Organization and Administration | Family Planning Program Evaluation Document Number: 096414 |
| 24. Title: Family planning: the Indian experience. Author: Soonawala RP Source: In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. :77-87. Sponsored by the International Planned Parenthood Federation [IPPF]. Abstract: The acceptance of family planning in India dates back to the 1930s, when in Mysore a clinic was established for providing contraceptive services. Postpartum sterilization was introduced in India in 1940. In 1950 family planning was included in the first five-year plan. In 1952 the International Planned Parenthood Federation was founded in Bombay, and in 1960 the government introduced new family planning programs. An intensive IUD program resulted in the fitting of more than 3 million IUDs. However, competition between manufacturers of oral contraceptives and government agencies promoting IUDs led to a decline in acceptors of either method. Subsequently sterilization was officially endorsed and the number of colpotomy sterilizations soared. Vasectomies also increased from 1 million to about 3 million. Female acceptance of sterilization increased after the introduction of mini-laparotomy and laparoscopy. In 1972 legal abortion was introduced, officially termed medical termination of pregnancy. The law stated that a doctor could carry out the procedure up to the 12th week of pregnancy; two doctors had to authorize it beyond 12 weeks; and beyond 20 weeks of gestation abortion could performed only in specialized hospitals. Before emergency rule was introduced in 1976 an average of 4 million sterilizations had been performed annually. During the emergency more than 8 million sterilizations were done in 1 year, which invoked charges of coercion. In 1978 a setback occurred. Vasectomies averaged 0.5 million a year and female sterilizations in the range of 3.5-3.7 million a year. In 1980 the whole program was reoriented and voluntary organizations were given a high profile, with spacing methods the preferred choice. Nonetheless, the rate of growth of population is continuing unabated: in 1971 the Indian population made up only 14% of the world's population, by 1991 their share was 16%. Yet the family planning program averted 44 million births between 1971 and 1981 and a total of 133 million births by 1991. Language: English Keywords: INDIA | HISTORICAL REVIEW | POPULATION POLICY | FAMILY PLANNING PROGRAMS | POLITICAL FACTORS | INVOLUNTARY FERTILITY CONTROL | IUD | FEMALE STERILIZATION | VASECTOMY | ABORTION | BIRTHS AVERTED | Asia, Southern | Asia | Developing Countries | Social Policy | Policy | Family Planning | Programs | Organization and Administration | Family Planning Policy | Contraceptive Methods | Contraception | Sterilization, Sexual | Male Sterilization | Fertility Control, Postconception | Family Planning Program Evaluation Document Number: 110069 Notification |
| 25. Title: The Indian family planning programme: impact and prospects. Author: Vohra U Source: In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. :71-6. Sponsored by the International Planned Parenthood Federation [IPPF]. Abstract: Between 1901 and 1991 the population of India increased from 238 million to 844 million. In October 1992 the population numbered 872.94 million. At the present rate of growth it may reach one billion before the year 2000. India started the National Family Welfare Program in 1951 with the objective of reducing the birth rate. There is a nationwide network of 22,000 primary health clinics and more than 130,000 village level sub-centers providing maternal and child health care and family planning services. There have been noticeable improvements: in Kerala female life expectancy is 74 years. However, the rate of growth was still 2.14% during 1981-91, which may shift the net reproduction rate of unity to 2011-16 instead of the year 2000 as originally envisioned in 1983. The states of Uttar Pradesh, Madhya Pradesh, Bihar, and Rajasthan are the areas with the highest growth rate. Nevertheless, nationally the couple protection rate increased from 10.4% in 1970 to 22.3% in 1980, and to 43.5% in 1992. The family planning program had averted 44 million births by March 1981 and about 130 births by March 1991. Without this program the annual growth rate would have been 2.71% instead of 2.12% during 1981-91. The most important components of the family planning program are enhancing the status of women and paying more attention to child survival and poverty. Female literacy is only 23.1% in Bihar, 28.4% in Madhya Pradesh, 20.8% in Rajasthan, and 26.0% in Uttar Pradesh. In contrast, female literacy reaches 86.9% in Kerala and over 50% in Maharashtra, Punjab, and Tamil Nadu. Still, the number of illiterate women increased from 183 million in 1981 to 201 million in 1991 for the whole of India, with the 4 largest northern states in the lead. The correlation between female literacy and the total fertility rate is 0.83, whereas the correlation with the contraceptive prevalence rate is 0.59, which fact indicates the fertility reducing effect of education. The 1990s will be a watershed decade in the reduction of fertility, for which further increases in contraceptive prevalence are needed. Language: English Keywords: INDIA | CRITIQUE | POPULATION GROWTH | FAMILY PLANNING PROGRAMS | BIRTHS AVERTED | WOMEN'S STATUS | LITERACY | MORTALITY DECLINE | WOMEN | Asia, Southern | Asia | Developing Countries | Population Dynamics | Demographic Factors | Population | Family Planning | Programs | Organization and Administration | Family Planning Program Evaluation | Socioeconomic Factors | Economic Factors | Educational Status | Socioeconomic Status | Mortality Document Number: 110070 |
| 26. Title: Estimates of averted Chinese births, 1971-1990: comparisons of fertility decline, family planning policy, and development in six Confucian societies. Author: Goodkind D Source: Canberra, Australia, Australian National University, Research School of Social Sciences, 1992. 20 p. (Working Papers in Demography No. 38) Abstract: Birth control policies in China have effectively reduced fertility since the 1970s. Speculation exists, however, over how many births were averted as a result of these restrictive policies. To approximate the number of births averted through policy over the past 2 decades, assumptions must be made about how fast fertility might have declined under less restrictive policies. This paper estimated the number of births which would have been averted had the fertility decline in China followed the same trajectory as that observed among the Chinese in Singapore, Taiwan, Hong Kong, Peninsular Malaysia, and a "synthetic" population with characteristics similar to Vietnam. The author then questions the validity of these assumptions by comparing the strength of family planning policies and economic development in these areas. The results suggest that the most likely number of policy-averted births in China over the period 1971-90 was approximately 110 million, an estimate within an informal confidence interval of 45 million. This estimate is far less than that proclaimed by official government sources. Language: English Keywords: CHINA | COMPARATIVE STUDIES | FAMILY PLANNING PROGRAM EVALUATION | ANTINATALIST POLICY | BIRTHS AVERTED | ASIANS | PROGRAM EFFECTIVENESS | FERTILITY DECLINE | POPULATION POLICY | FAMILY PLANNING POLICY | ESTIMATION TECHNIQUES | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Family Planning Programs | Family Planning | Social Policy | Policy | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Program Evaluation | Programs | Organization and Administration | Fertility Changes | Fertility | Population Dynamics Document Number: 093167 |
| 27. Title: Waltz of the couples: change partners, please. Author: Haskey J Source: ENTRE NOUS. 1992 May;(20):5. Abstract: Marriage, cohabitation, and divorce all concern family planners, sex educators, and health educators because of their impact on childbearing. Marriage has changed in the last 2-3 decades as more couples decide to permanently cohabit or cohabit before marriage, marriage rates have fallen and 1st marriages occur later, more women have become single mothers, and divorce has increased. Divorced individuals usually remarry, especially the younger ones, although the rate for remarriage has declined sharply in the last 20 years. Evidence suggests that cohabitation is highest among the separated and divorced (apparently slowing their remarriage rate), and is lowest among the single and widowed. The highest rate for women cohabiting is invariably found in the early 20's age group: between 3-4 in every 10 in Norway, Denmark, and Sweden and between 1-2 in every 10 in Switzerland, Great Britain, France, and the Netherlands. In Ireland, Italy, and Belgium, the rate is comparatively low, suggesting wide variations between European countries. The changes in marriage are "most pronounced in the north of Europe, followed by the west, and least pronounced in the east and the south." These patterns most likely will continue for the immediate future, although divorce may be stabilizing at relatively high rates, in some European countries. Language: English Keywords: EUROPE | CRITIQUE | MARRIAGE | MARRIAGE PATTERNS | REMARRIAGE | MARRIAGE POSTPONEMENT | MULTIPLE MARRIAGES | BIRTH RATE | BIRTHS AVERTED | DIVORCE | ILLEGITIMACY | CHANGES | Developed Countries | Nuptiality | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Social Problems | Social Change Document Number: 075027 |
| 28. Title: A comparison of two methods for assessing the impact of female sterilization on fertility: Ecuador, 1979-1989. Author: Stupp PW; Samara R Source: [Unpublished] 1992. Presented at the Annual Meeting of the Population Association of America, Denver, Colorado, April 30 - May 2, 1992. 32 p. Abstract: Researchers used data on 5350 ever married women from Ecuador to evaluate the effect of female sterilization on fertility. They compared the births averted method using duration since 1st union as an indicator of fertility with period parity progression ratios using parity as an indicator of fertility. Between 1979-1989, the number of births averted/ever married woman fell from 0.67-0.64, even though the proportions of women sterilized increased, e.g., 15.8% vs. 34.4% for 40-44 year old women respectively. This occurred because the fertility of nonsterilized women fell from 5.93-5.01. Since this method did not include future declines in the fertility of nonsterilized women, it overestimated births averted. The period parity progression ratios showed, that in both years, the proportion of nonsterilized women who progressed to the next parity was higher than sterilized women for parities =or>2. Further the ratios for parities =or>3 fell significantly. For example, progression ratios in 1979 varied from .808-.930 for parities =or>4 compared to .824-.621. This indicated a decline in nonsterilized marital fertility. Further analyses showed that the effect of sterilization on marital fertility shifted from later to earlier phases of childbearing between 1979-1989 indicating that women became sterilized at lower parities. The 2 methods resulted in basically the total marital fertility rates for 1979-1989 (5.26 vs. 5.34 and 4.37 vs. 4.3 respectively). Yet the total nonsterilized marital fertility rates for 1979-1989 differed (5.93 vs. 6.54 and 5.01 vs. 5.26 respectively). Thus the estimates of mean number of births averted by sterilization were higher using the parity progression ratio (1.2 in 1979 and 0.96 in 1989) than it was for the births averted approach (0.64 in 1979 and 0.64 in 1989). The researchers concluded that the parity progression approach more closely matches the decision making process about sterilization which is based on the number of children a woman has had and not the time since 1st union. Language: English Keywords: ECUADOR | METHODOLOGICAL STUDIES | RESEARCH METHODOLOGY | COMPARATIVE STUDIES | BIRTHS AVERTED | PARITY PROGRESSION RATIO | FEMALE STERILIZATION | MARITAL FERTILITY | MARRIAGE DURATION | DECISION MAKING | EVER MARRIED | WOMEN | South America, Western | South America | Latin America | Americas | Developing Countries | Studies | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Sterilization, Sexual | Marriage | Nuptiality | Behavior | Marital Status Document Number: 073294 |
| 29. Title: Study of savings on account of an averted birth. Author: Chatterjee DN Source: Calcutta, India, Indian Tea Association, 1991 Aug. 10, [5] p. (Indian Tea Association Occasional Papers No. 2) Abstract: India's tea industry is mainly agriculturally based with the work force and their dependents living in tea estates for generations. The high fertility and resultant population growth rates in the estates increase the production cost of tea and adversely affect the quality of plantation workers' lives. A survey was conducted in 1986 to determine the cost/benefit of averting a single birth in the case of a female worker on a tea estate through the provision and acceptance of various temporary and terminal methods of family planning. 35 estates participated. By providing family planning facilities and services, management can save Rs. 6659.37 per birth averted. These savings derive from reductions in the cost of a baby from conception including antenatal care, delivery services, postnatal care, day care expenditures, maternity benefits, and the loss of production. In sum, a properly implemented family welfare program in tea estates can achieve large savings by averting the loss of productivity of female workers in plantations who now experience repeated pregnancies due to the lack of proper welfare education and family planning services. It is recommended that some of the savings be returned to employees in the form of better family welfare services. Language: English Keywords: INDIA | RESEARCH REPORT | SAVINGS | BIRTHS AVERTED | INDUSTRY | EMPLOYMENT-BASED SERVICES | FAMILY PLANNING PROGRAMS | COST BENEFIT ANALYSIS | Asia, Southern | Asia | Developing Countries | Macroeconomic Factors | Economic Factors | Family Planning Program Evaluation | Family Planning | Programs | Organization and Administration | Quantitative Evaluation | Evaluation Document Number: 122098 |
| 30. Title: Evaluation of the impact of birth control methods on fertility: the case of Shanghai. Author: Chen J Source: CHINA POPULATION RESEARCH LEADS. 1991 Jun 20;11:1-12. Abstract: Shanghai's crude birth rate stood at 12.7/1000 in 1989, and its municipal government has an exceptionally strong commitment to family planning activities. To measure the effects of family planning activities on Shanghai's declining fertility, study was conducted in 2 urban districts and 2 rural counties of Shanghai in April-May 1988. A sample of 11,073 married women representing different levels of socioeconomic development and family planning program implementation was selected. Three evaluative methods--prevalence model, reproductive process analysis, and couple-years of protection--were used to assess the demographic effectiveness of available birth control methods. The prevalence model analysis revealed substantial reductions in fertility as a result of contraceptives provided by Shanghai's family planning program, especially among women 25-29 years of age. A total of 3602 births were estimated to have been averted in this sample in 1987 as a result of contraceptive use; 77% of births averted were due to IUD use, 8% to condoms, and 5% to oral contraceptives. The reproductive process analysis indicated that the retention span of an IUD increases with age, to reach a maximum number of births averted (3.2) at ages 25-29 years. Finally, the IUD's standardized couple-years of protection was found to total 933.7 for 1987's 1029 new acceptors, with 0.36 births averted per acceptor. Language: English Keywords: CHINA | CROSS SECTIONAL ANALYSIS | CONTRACEPTIVE EFFECTIVENESS | FERTILITY CHANGES | BIRTHS AVERTED | DEMOGRAPHIC EFFECTIVENESS | IUD | COUPLE YEARS OF PROTECTION | Developing Countries | Asia, Eastern | Asia | Research Methodology | Contraception | Family Planning | Fertility | Population Dynamics | Demographic Factors | Population | Family Planning Program Evaluation | Family Planning Programs | Contraceptive Methods Document Number: 067451 |
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