RESUMEN

In this study, patterns of Norplant use in Indonesia are reviewed to assess the implications of this experience for the introduction of new contraceptive methods. Data from the Norplant Use-Dynamics Study and the 1994 Indonesia Demographic and Health Survey are analyzed, and patterns of acceptance, continuation, and removal are described. Acceptance of Norplant has increased steadily since it was first introduced. The method is now used by more than 5 percent of all married women of reproductive age. Continuation rates among Norplant users are higher than among users of the IUD. One factor behind high continuation rates may be that a substantial proportion of acceptors were not told that removal before five years was possible. Results indicate that deficits occurred in the quality of service delivery and that a need exists for improved provider training, better supervision, and clearer and better-enforced guidelines regarding women's right to have Norplant removed on demand.

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PIP: Norplant implants, introduced to Indonesia's national family planning program in 1986, are currently used by more than 5% of married women of reproductive age. Most Indonesian Norplant acceptors are rural women 25-34 years of age with some primary education and 2 or more living children; they tend to receive the implants from public health centers, private midwives, and health posts. A substantial proportion of Norplant users had the implants inserted during mass campaigns (safaris) in Indonesia's rural areas. On the basis of continuation rates, Norplant appears to be more popular among Indonesians than the IUD or sterilization. This report, based on data from the Norplant Use Dynamics Study and the 1994 Indonesia Demographic and Health Survey, assesses the service quality associated with introduction of this method. The survey data indicate that, although acceptors are aware of Norplant's 5-year effectiveness, few were counseled about potential side effects or the possibility of early removal. The data further identified deficiencies in terms of provider training, supervision, and clear guidelines regarding a woman's right to have the implants removed on demand. Lacking in Indonesia is the presence of consumer groups and advocates to play a watchdog role and disseminate information to potential acceptors. The inadequate counseling received by many Norplant acceptors requires attention from family planning program managers. Also needed is a policy shift from a preoccupation with increasing the numbers of family planning acceptors to an emphasis on client satisfaction.

Asunto(s)

Países en Desarrollo , Servicios de Planificación Familiar/estadística & datos numéricos , Levonorgestrel , Adolescente , Adulto , Femenino , Humanos , Indonesia , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Garantía de la Calidad de Atención de Salud , Población Rural

RESUMEN

PIP: Women, in Nepal, suffer from low levels of literacy, limited access to health care, and widespread poverty. This article describes the health status of Nepalese women, major interventions, and constraints. Nepalese women face 10 major critical health issues. Women have little choice in determining marriage partners, number of children, or family planning (FP). Women's status is measured by the number of sons. Women's security is tied to the childbearing capacity. Women lack property rights and access to independent resources. Clause 9 of the Law permits men to remarry and leave their wives destitute: if the woman is incurably mentally ill; if the woman has an infectious, incurable venereal disease; if the woman is an invalid; if the woman is infertile after 10 years of marriage; or if the woman is living separate and taking her share of ANSA. The 6th 5-Year Plan offered the integration of FP within other development programs. Population policy included, for the first time, women's programs. Four major women-oriented strategies were included in the 1984 National Population Strategy: 1) the encouragement of women's employment through training and job opportunities in health, education, and agricultural industries; 2) provision of institutional support that accommodates women's needs; 3) integration of women's development within Integrated Development Projects; and 4) distribution of appropriate technology. Future actions should focus on reproductive health, FP for adolescents and men, women's control of their own fertility, and the education of the girl child.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Fertilidad , Indicadores de Salud , Esperanza de Vida , Bienestar Materno , Trastornos Nutricionales , Política Pública , Abastecimiento de Agua , Derechos de la Mujer , Asia , Conservación de los Recursos Naturales , Demografía , Países en Desarrollo , Enfermedad , Economía , Ambiente , Infecciones por VIH , Salud , Longevidad , Mortalidad , Nepal , Organización y Administración , Población , Dinámica Poblacional , Factores Socioeconómicos , Virosis

RESUMEN

From 1987 to 1997, approximately four million Indonesian women had a Norplant insertion. Concerns have been raised about the timely removal of the implant within a few days of the user's request or at the end of the recommended five years of use and about the possibility of a large and rapidly increasing backlog of removal cases developing. This study of 2,979 Indonesian women in 14 provinces, all of whom had had Norplant inserted five or more years before they were interviewed, reveals that 66 percent had obtained removal by the end of the fifth year of use and 90 percent had done so by the end of the sixth year of use. The data from this study strongly suggest that no large backlog of removal cases exists, particularly after the sixth year of use. The major reason for the underreporting of removals is probably clients' use of nurse/midwives, of caregivers in the private sector, and of mass safari camps, because records from each of these sources are poor or nonexistent.

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PIP: Approximately 4 million Indonesian women received Norplant contraceptive implants in 1987-97. Concerns have been raised about the timely removal of the implants within a few days of the user's request or at the end of the 5-year recommended period of use. According to some estimates, a backlog of 467,000-650,000 overdue removals exists. To assess the validity of these concerns, 2979 Indonesian women from 14 provinces who had Norplant inserted five or more years earlier (1987-91) were interviewed in 1996. 27% had undergone removal and had a second implant inserted, 41% had undergone removal and switched to another contraceptive method, 25% had undergone removal and were currently not using any method, and 8% had not yet undergone removal. Major reasons for not having the implants removed included forgetting the recommended removal date, fear of the removal process, and the high cost of removal. Given the finding that 66% of removals were performed by nurses or midwives and 23% occurred in safari camps, it is possible that a sizable number of removals were not recorded in the service statistics system. Although many women may use Norplant past the recommended time for removal, these findings suggest that there is no large backlog of removal cases, particularly after the 6th year of use. Creating service delivery conditions that allow women their right to easy access to removal is essential, however.

Asunto(s)

Conducta Anticonceptiva , Anticonceptivos Femeninos/uso terapéutico , Servicios de Planificación Familiar/organización & administración , Levonorgestrel/uso terapéutico , Adulto , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Indonesia

RESUMEN

PIP: This report summarizes the findings of a study designed to identify the reasons for non-use of family planning among Nepalese women who want to space or limit childbirth. The study's initial phase involved focus group sessions of women with unmet need for family planning who were asked their reasons for non-use. Researchers used this information to develop an in-depth questionnaire. Researchers then randomly selected a total sample of 5,152 women. After interviewing the women, researchers concluded that 31.6% the sample had unmet need for family planning. Consequently, researchers administered the questionnaire to the unmet demand population, which was almost equally divided among women who want to either spacing or limit childbirth. The study analyzes both reasons for the general non-use of contraception and reasons for the non-use of specific contraceptive methods (oral contraceptives, laparoscopy, and vasectomy). Although varying among the different contraceptive methods, the most commonly cited reasons were: 1) causes headache, weakness, nausea; 2) causes weight loss; 3) causes heavy bleeding; 4) insufficient money for nutritious foods; 5) causes weakness and cannot work; 6) currently in poor health; 7) husband disapproves; and 8) affects breastfeeding and dries breast-milk. Explaining the benefits of the study, the report indicates that the information can be incorporated into the training curriculum of health workers, and can be used to target information, education, and communication campaigns. Furthermore, evident in the responses that cite lack of nutritious foods and weakness, the study reveals that nutrition and food supplement programs could help increase contraceptive use.^ieng

Asunto(s)

Intervalo entre Nacimientos , Anticonceptivos Orales , Servicios de Planificación Familiar , Cefalea , Conocimientos, Actitudes y Práctica en Salud , Hemorragia , Laparoscopía , Acetato de Medroxiprogesterona , Náusea , Fenómenos Fisiológicos de la Nutrición , Investigación , Encuestas y Cuestionarios , Vasectomía , Asia , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos , Recolección de Datos , Países en Desarrollo , Diagnóstico , Enfermedad , Endoscopía , Salud , Nepal , Examen Físico , Muestreo , Signos y Síntomas , Esterilización Reproductiva

RESUMEN

PIP: The prevalence and length of breastfeeding (BF) in Nepal is presented and some socio-demographic factors influencing BF and determinants of BF are discussed. Data are based on the Nepal Fertility and Family Planning Survey 1986. 3774 currently married women aged 15-50 from rural areas and 1255 women from urban areas were interviewed. Data on duration and prevalence of BF was gathered for the last 2 live births. For those who did not breastfeed, reasons were sought. The duration of BF of the last closed interval was used as the dependent variable. The results may not be bias-free because a large majority reported duration of BF in multiples of 6 months. 81% of the urban women and 76% of the rural ones reported duration in multiples of 6 months. 2 demographic variables were chosen: the women's age and parity, along with 4 socioeconomic variables: 1) geographical region; 2) place of residence; 3) woman's education; and 4) work status. 51% of the urban women had 2.3 live births compared with only 42% of women in rural areas; 27% of all urban women have some education compared with only 5% of rural women. 56% of the urban women are from the "terai" compared with only 45% of the rural women. The length of BF (measured in mean months for the closed birth interval) vary only slightly between urban and rural areas. Less than 5% do not breastfeed. The prevalence of contraceptive use in the last closed interval is lower for the rural than urban women, about 2% vs. 9%. The average length of BF is slightly lower among women who use contraception during the last closed interval than among those who did not use it; the difference is slightly bigger among urban women compared with their rural counterparts. Younger women tend to have a slightly shorter length of BF than older ones. Women of higher parity. The length of BF varies little between categories of socioeconomic variables. The maximum difference in adjusted deviations between categories is only 2 months. Results of the multiple regression analysis are based on a simple additive model which does not include interaction terms; it shows that the % of variation in the length of BF explained by 5 factors (education, age, parity, place of residence, and geographical region) is around 6%.^ieng

Asunto(s)

Factores de Edad , Lactancia Materna , Conducta Anticonceptiva , Demografía , Escolaridad , Empleo , Servicios de Planificación Familiar , Paridad , Dinámica Poblacional , Análisis de Regresión , Características de la Residencia , Población Rural , Muestreo , Factores Socioeconómicos , Estadística como Asunto , Factores de Tiempo , Población Urbana , Asia , Tasa de Natalidad , Anticoncepción , Países en Desarrollo , Economía , Fertilidad , Geografía , Salud , Fenómenos Fisiológicos Nutricionales del Lactante , Nepal , Fenómenos Fisiológicos de la Nutrición , Población , Características de la Población , Investigación , Clase Social

RESUMEN

PIP: The study's purpose was to test whether new survey questions on strength of fertility motivation, included in Nepal's 1986 Fertility and Family Planning Survey, enable improved prediction of current contraceptive use. Intent to use contraception in the future was also tested, over and above the effects of socioeconomic background. While controlling selected demographic and socioeconomic background characteristics of the respondents, the authors found the effect of the strength of fertility motivation on current contraceptive use to be substantial and highly significant statistically. Nevertheless, the background factors largely captured the effect of motivational strength on current use when motivational strength was deleted from the model, inasmuch as measures of global fit declined only slightly as a consequence of the deletion. These findings indicate that respondents' demographic and socioeconomic background characteristics affect motivational strength, so that motivational strength does not have a large independent effect on use. These results raise the question of whether strength of fertility motivation can be affected by educational efforts mounted by family planning programs to increase contraceptive use. The analysis shows that strength of motivation does have some independent effect on contraceptive use, and it is quite possible that this independent effect could be enhanced by educational programs operating independently of the socioeconomic characteristics of program recipients. Because the 1986 survey lacks relevant data, we have not been able to explore this possibility empirically.^ieng

Asunto(s)

Conducta , Conducta Anticonceptiva , Demografía , Economía , Motivación , Dinámica Poblacional , Población , Investigación , Conducta Sexual , Factores Socioeconómicos , Estadística como Asunto , Asia , Anticoncepción , Países en Desarrollo , Escolaridad , Servicios de Planificación Familiar , Fertilidad , Geografía , Nepal , Características de la Población , Psicología , Características de la Residencia

RESUMEN

This study examines the importance of availability and accessibility of family planning services in relation to current contraceptive use in Nepal. The proportion of women who knew of a family planning services outlet in Nepal increased sharply between 1976 and 1981, from 6 percent to 33 percent. The Contraceptive Prevalence Survey data of 1981 indicate that an inverse relationship exists between the prevalence of current contraceptive use and travel time to an outlet. Unfortunately, a majority of current users in Nepal still need more than one hour to reach an outlet. The effects of education and place of residence on contraceptive use become weaker when the analysis is confined to women who have access to an outlet within a half-hour's travel time.

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PIP: This study examines the importance of availability and accessibility of family planning services in relation to current contraceptive use in Nepal. The proportion of women who knew of a family planning services outlet in Nepal increased sharply between 1976 and 1981, from 6% to 33%. The Contraceptive Prevalence Survey data of 1981 indicate that an inverse relationship exists between the prevalence of current contraceptive use and travel time to an outlet. Unfortunately, a majority of current users in Nepal still need more than 1 hour to reach an outlet. The effects of education and place of residence on contraceptive use become weaker when the analysis is confined to women who have access to an outlet within 30 minutes travel time. There are at least 3 possible approaches to increasing the contraceptive prevalence rate in Nepal: 1) increase knowledge about outlets with intensive information, education, and communication programs; 2) increase the number of service outlets in order to reduce travel time for services; and 3) promote a smaller desired family size. The 1st 2 approaches may not be difficult to implement. The 3rd approach may be more difficult to achieve until couples are convinced that their children have a good chance of surviving.

Asunto(s)

Anticoncepción , Servicios de Planificación Familiar , Accesibilidad a los Servicios de Salud , Adolescente , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Nepal , Población Rural , Población Urbana

RESUMEN

PIP: This 1981 study is the 1st of its kind in Nepal. Analysis using a logit-linear model showed that contraceptive use in Nepal depends on many factors. Women aged 35-49 are 3 times more likely than women aged 15-24 to use contraceptives. Women with 4 or more children are 8 times more likely to use contraceptives than women with 1 or no children, and 2.5 times more likely than women with 2 or 3 children. The use of contraceptives is greatest among women whose offspring includes more sons than daughters, and least among women whose offspring are all daughters. Women who desire no more children are 5 to 6 times more likely to use contraceptives than women who desire more children. Women who have discussed desired family size with their husbands are more than 4 times more likely to use contraceptives than women lacking this type of communication. Women with some schooling are twice as likely to use contraceptives as women with no schooling. Contraceptive use is higher among women who do nonfarm work than farm work, and higher still among women who do not work. Urban women were almost twice as likely to use contraceptives as rural women. Women with less than 1 hour access to a family planning service outlet were 2 to 3 times more likely to use contraceptives than women whose access to these facilities was greater than 1 hour. The number of previous child losses per woman had no significant effect in contraceptive use. Conclusions are based on analysis of data from the Nepal Contraceptive Prevalence Survey, 1981.^ieng

Asunto(s)

Anticoncepción , Servicios de Planificación Familiar , Conocimientos, Actitudes y Práctica en Salud , Mujeres/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal

Asunto(s)

Mortalidad , Población Rural , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Nepal , Embarazo

RESUMEN

The objectives of this analysis were to assess the probable impacts of vertical and integrated FP/MCH programs on family planning (knowledge, use, and intentions to use), family size preferences, fertility, and mortality (child and infant). The following discussion summarizes and draws conclusions regarding the results of this investigation. The vertical program showed a greater impact on knowledge of family planning than the integrated program. Increases in knowledge between 1975 and 1978 while controlling for social and demographic variables were greater in the vertical than the integrated areas. Multiple classification analysis at both household and village levels showed that the vertical program was a better predictor of knowledge and changes in knowledge than the integrated program. In addition, the vertical program showed consistently higher proportions of women with awareness of family planning among those segments of the population that could have the greatest impact on fertility reduction in the future--namely, the younger women who are either childless or just beginning their childbearing and those with husbands who have little or no education. Neither the vertical nor the integrated FP/MCH program showed an impact on current use or ever use of family planning. The very low levels and changes in levels of these factors between the programs showed almost no difference throughout the selected demographic and socioeconomic groups. In both program areas the proportions of ever use and current use increased substantially with the number of living sons, exceeding 14 percent and 10 percent, respectively, among women with three or more sons. There were virtually no family planning users or ever users among women with no sons. This appears to indicate that "son preference" (documented in the Nepal Fertility Survey) is an important factor affecting the incidence of family planning practice and may be a formidable obstacle to a substantial reduction in fertility. Family limitation generally may not be taken seriously until a couple has produced the desired number of sons. Hence, until the value of sons (perhaps as sources of labor, financial support and security in old age, and as performers of funeral rites for fathers) can be altered it is unlikely that a reduction in fertility beyond certain levels could occur. The vertical program showed a slightly greater impact on future intentions to use family planning than the integrated program.(ABSTRACT TRUNCATED AT 400 WORDS)

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PIP: An analysis of the impacts of vertical and integrated family planning/maternal child health programs on family planning, family size preferences, fertility, and infant and child mortality was conducted utilizing the 1st longitudinal sample survey data collected in Nepal. Findings indicate that neither program demonstrated an impact on contraceptive use. However, the vertical program (organized from a central office, with 4 regional offices, 40 district offices, and 492 clinic and village based service centers) was shown to have a greater impact on family planning knowledge, future intentions to use family planning, fertility, and infant mortality.

Asunto(s)

Países en Desarrollo , Servicios de Planificación Familiar/tendencias , Población Rural , Adolescente , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Nepal , Embarazo

RESUMEN

PIP: This study identifies the socioeconomic characterisitics of immigrants in Nepal, their fertility, and the incidence of family planning. These characterisitics are contrasted with the receiving or nonmigrant population and inferences drawn regarding the probable social and demographic impact immigrants may have on the "receiving" population. Demographic surveys were conducted annually from 1975 through 1978 in the Hills and Terai by the research and evaluation unit of the Family Planning/Maternal Child Health (FR/MCH) Project. In each of these geographic areas, all districts were matched on a set of social and demographic characteristics. 2 districts were then selected from each area on the basis of their similarity to each other. The sample design for all districts involved selection of panchayats (a political unit roughly equivalent to a country) and their wards (villages) on the basis of a procedure which refers to a selection of units based upon probabilities proportional to size of the population of the units. Currently married women aged 15-44 in all households of the secondary sampling units, i.e., wards, were interviewed. Both migrant women and their husbands had a higher level of educational attainment than nonmigrant women and their husbands. Indian migrants had higher proportions in the largest landholding groups than nonmigrant and lower proportions who are landless. The differential was maintained among Indians who had lived in the Terai for 10 years or less as well as 11 years or more. This finding was particularly striking since Indian migrants make up 25% of the sample. Current marital fertility (as measured by age specific and total fertility rates) was highest among Indian migrants, but cumulative fertility or past reproductive performance (as measured by the mean number of children ever-born) was highest among migrants from "other districts." With the exception of the youngest age group, migrants from "other districts" have higher proportion of "ever users" and "current users" of family planning than nonmigrants or migrants from India throughout the age structure. The highest proportion for both "ever users" and "current users" was reached at ages 35-39 years. Indian migrants in contrast had the lowest proportions of "ever users" and "current users" throughout the age structure (with the exception of the age group 35-39).^ieng

Asunto(s)

Tasa de Natalidad , Conducta Anticonceptiva , Emigración e Inmigración , Etnicidad , Fertilidad , Edad Materna , Dinámica Poblacional , Clase Social , Factores Socioeconómicos , Migrantes , Asia , Anticoncepción , Cultura , Demografía , Países en Desarrollo , Economía , Servicios de Planificación Familiar , Nepal , Paridad , Población , Características de la Población

RESUMEN

PIP: Analysis of the shift in the marital structure of Nepal between 1961 and 1971 indicates that the marital structure of 1971 is more favorable to a higher CBR (crude birthrate). Although there has been a slight inc rease in the age at marriage, over 90% of Nepali women were married by the ages 20-24 years in 1971 and the decline in the incidence of widowho od has increased the proportions of potential child-bearing women and consequently the number of births. Thus shifts in the marital structure between 1961 and 1971 could have provided little impetus to a decline in the CBR of the country.^ieng

Asunto(s)

Tasa de Natalidad , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Fertilidad , Humanos , Matrimonio , Persona de Mediana Edad , Nepal