RESUMO
PIP: Women typically do not make decisions about contraceptive use and family planning on their own, and many women often have little, if any, decision-making power in the home. Strategies are therefore needed to empower women, educate family members, and involve men in reproductive health programs. Policymakers should expand the range of male services and encourage the greater use of male contraceptive methods. Furthermore, health programs should include counseling to help men and women improve their communications skills and conduct education campaigns to inform men about the roles they can play in family planning. Men should also learn about the side effects of both male and female methods, since concern over method side effects can frustrate their support of family planning. Appropriate strategies can be tailored to meet individual group needs. Programs in Madagascar, Bangladesh, Honduras, and Nepal are described as examples of how the support of family members can positively affect family planning use and reproductive health.^ieng
Assuntos
Comportamento Contraceptivo , Características da Família , Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde , Relações Interpessoais , Medicina Reprodutiva , Educação Sexual , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Bangladesh , Comportamento , América Central , Anticoncepção , Países em Desenvolvimento , Economia , Educação , Saúde , Honduras , América Latina , Madagáscar , Nepal , América do Norte , Comportamento Social , Fatores Socioeconômicos , Direitos da Mulher , Humanos , MasculinoRESUMO
PIP: IEC programs increase the knowledge and motivation of decision makers with power over determinants of population growth and socioeconomic development. Information may improve the awareness of public and private officials of population questions and of the form in which they are treated. Information activities involve demographic growth and spatial distribution of the population, the demographic and health benefits of family planning, and the danger of sexually transmitted diseases and AIDS. The mass media are the main source of information, but in developing countries various forms of folk media enjoyed by the public may also be used. Technical journals and other information networks are available for the professional audience. Population communication promotes acceptance and use of family planning. Radio and television series that incorporate family planning themes, popular music that mentions population problems, and broadcasts of telephone question and answer programs have been influential in some countries. Such informational programs may be very important in regions with low levels of literacy. Programs targeted to adolescents may help resolve problems of early pregnancy. More than 80 countries include population education in their school curriculum. The objectives vary, but they generally include making students aware of population problems and of their own responsibilities. Population questions are also included in many professional training programs.^ieng
Assuntos
Serviços de Informação , Educação Sexual , Educação , Planejamento em Saúde , Organização e AdministraçãoRESUMO
PIP: Misinformation about sexuality, reproduction, and contraception is widespread among Mexican adolescents and existing sex education programs have been limited in both scope and availability. To address this situation, the Instituto Mexicano de Investigacion de Familia y Poblacion (IMIFAP) designed a comprehensive sex education program based on data gathered in a 1986 diagnostic survey of 865 adolescents 12-19 years of age and interviews with 365 pregnant adolescents. As part of this preliminary research, one group of teens was exposed to a traditional sex education course while another participated in a program that used participatory learning techniques and emphasized communication skills, assertiveness training, value clarification, peer support, and decision making processes. The latter, more effective approach served as the basis for design of a course, Planeando Tu Vida. Operational evaluations of this course conducted at completion and four and eight months later indicated significant increases in knowledge about contraception, but no effect on age at first intercourse. On the other hand, adolescent males who took the course before onset of sexual activity were significantly more likely to use contraceptives at first intercourse than those in traditional courses. This finding underscores the importance of early initiation of sex education programs. To date, the curriculum has been used in over 100 public and private schools, reaching more than 30,000 adolescents. IMIFAP has since developed more than 70 additional health education course guides aimed at children from preschool through high school, all of which emphasize a participatory approach to learning.^ieng
Assuntos
Adolescente , Currículo , Planejamento em Saúde , Pesquisa , Educação Sexual , Ensino , Fatores Etários , América , Demografia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , América Latina , México , América do Norte , População , Características da PopulaçãoRESUMO
PIP: In Honduras, a 38-year-old mother of 8 children from Catacamas in Olancho Province has attended a motivational program hosted by the Honduran Family Planning Association (ASHONPLAFA) and speaks about how it dispelled her misconceptions about oral contraceptives. This program uses educational messages and public relations campaigns to reach urban and rural populations to dismiss the rumors about family planning (FP) methods. ASHONPLAFA uses loudspeakers mounted on mobile unites to announce its FP services and the availability of educational material. I hopes to increase use of FP services, to promote acceptance of FP and to encourage better use of available services. Radio programs, training and counseling, mass distribution of written materials, and outreach activities comprise the program. ASHONPLAFA also has talks about reproductive health, sexually transmitted diseases, and AIDS designed to reach teachers, students, parents, and community leaders. Inadequate education and socioeconomic factors causing marginalization are the determining factors for the high birth rate among 12-19 year olds. Systematic and objective education are the only way to effect changes in human sexual behavior. Mean family size in Olancho Province is 8.95, considerably greater than the national fertility rate of 5.2. Illiteracy stands at 50.6%. Olancho has one of the highest infant mortality rates in Central America (55.8/1000 live births). Since ASHONPLAFA launched its motivational campaign in November 1991, the monthly average rate of IUD users has increased from 16.7 to 20.1%. Training of new surgical contraception users has also increased (48.5 to 66.8%). The program's coordinator notes that the people in Olancho indeed want to use FP.^ieng
Assuntos
Comunicação , Planejamento em Saúde , Serviços de Informação , Motivação , População Rural , Educação Sexual , População Urbana , América , Comportamento , América Central , Demografia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Honduras , América Latina , América do Norte , Organização e Administração , População , Características da População , PsicologiaRESUMO
A programme of community health development is reported from two villages in Haiti. It involves close cooperation between a district hospital, a local dispensary, and, most importantly, the inhabitants themselves. The programme is simple, financially realistic, adapted to local conditions, and linked to activities designed to meet basic requirements, such as those of food production and water supply.
PIP: The Albert Schweitzer Hospital in the Artibonite Valley of central Haiti was founded by William Larimer Mellon in 1956 to serve about 175,000 people. Early in 1977, the hospital decided to create a community health department and provide curative, preventive, and promotive health programs through 7 dispensaries. A mobile immunization team was established. In 1988, 2 villages with a total population of 1459, in the catchment area of the Plassac dispensary, were selected for a research and development project with a comprehensive baseline survey. Among children aged up to 5 years, 36% were of normal nutritional status, while 41%, 18%, and 4% suffered from first-, second- and third-degree malnutrition, respectively. Of these children, only 31% were completely immunized. 21% of the children had tuberculosis, malaria, and upper respiratory tract infections. The illiteracy rate was around 85%. A village development committee was elected by the community. Voluntary health workers, elected or selected among mothers, were trained in health promotional activities, and each was made responsible for 15-20 families. These workers, with the dispensary's health agents, delivered a minimum health care package, comprising maternal and child care, family planning, immunization, treatment of simple diseases, health and nutrition education, and environmental sanitation. In less than 2 years, there was a strong indication of declining mortality and malnutrition among children aged 1 to 3 years. No more cases of third-degree malnutrition were seen in the dispensary, and some 90% of children were fully immunized. Changes were evident in the health knowledge, attitudes, and practices of the population. It is expected that during 1993 the whole catchment area of the Plassac dispensary, with around 20,000 people, will be covered. The dispensary had to be upgraded to a community health center with 2 or 3 beds for emergency cases.
Assuntos
Serviços de Saúde Comunitária/tendências , Participação da Comunidade/tendências , Países em Desenvolvimento , Saúde da População Rural/tendências , Controle de Doenças Transmissíveis/tendências , Agentes Comunitários de Saúde/tendências , Haiti , Humanos , Pobreza/tendênciasRESUMO
PIP: The Program of Information, Education, and Services for Basic Family Health Care in Magdalena Medio and Bajo was designed to increase knowledge and use of contraception and to improve basic health practices and nutrition in the region, which includes municipios belonging to 9 different departments and a total population of 1,720,000. Poverty levels in the area are high. During the 1st year of the project, which was underway from February 1988-May 1991, home visits were made to inform each family about basic family health, to weigh and measure children under 5 not receiving health care elsewhere, and to refer families to the nearest health services. Talks were presented to small groups on family planning, intestinal parasites, sexually transmitted diseases, nutrition, vaccination, cancer prevention, malaria, acute diarrhea, and acute respiratory infection. Community workshops were presented in the 2nd year. Community distribution posts were created for contraceptive and other health product distribution. Information and communication materials from PROFAMILIA were used, and other materials were specially designed for the project by the Foundation for Development of Health Education in Colombia. PROFAMILIA's system of service statistics was used for quantitative evaluation of the information and education activities and sales of contraceptives, antiparasitics, and oral rehydration packets of each instructor. In the 3 years of the program, 89.086 cycles of pills, 398,772 condoms, 29,080 vaginal tablets, 209.791 antiparasitics, and 49,305 oral rehydration packets were sold. 9295 talks were presented to 143,227 residents of the region. 22,000 children were enrolled in the growth monitoring program, and almost 40,000 women were referred for prenatal care and cytology. The instructors gave 900 talks to distributors of contraceptives, antiparasitics, and oral rehydration packets. Surveys of women aged 15-49 residing in the municipios covered by the project were conducted at the beginning and end of program activities in order to assess project impact. 1673 women were interviewed in the 1st survey in June-July 1988 and 1660 were interviewed in the 2nd survey in March-April 1991. In general terms, the region of Magdalena Medio and sand Bajo showed important changes in contraceptive prevalence, maternal-child health, knowledge of AIDS, and family violence over the 3 years of the project. Knowledge of contraception improved throughout the region, especially in rural areas. The proportion of women in union using a method increased from 56.7% to 58.0%. There were no overall changes in the proportions of children vaccinated.^ieng
Assuntos
Atenção à Saúde , Educação em Saúde , Planejamento em Saúde , Pobreza , Avaliação de Programas e Projetos de Saúde , Pesquisa , Educação Sexual , América , Colômbia , Países em Desenvolvimento , Economia , Educação , América Latina , Organização e Administração , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
PIP: It is probably not possible to implant a family planning program that will have a reasonable demographic impact in areas lacking awareness of the disadvantages of overly high fertility. Rural-urban migration, increasing educational levels, women's labor force participation, and declining infant mortality are all factors that have been found to correlate with demand for family planning services. It has been recognized since the Bucharest World Population Conference in 1974 that development and family planning are both required for the fertility transition to begin. Where these conditions exist, a family planning program appropriate to the needs, limitations, preferences, and expectations of the target population has an excellent chance of success. Expanded and improved coverage results from tailoring programs to the specific groups served. Most programs are directed toward women. It has been found most effective to provide services for men in separate sessions. It is also useful to distinguish between services for adolescents, who require more information and fewer services, for mature women who require more services than information, and for premenopausal women whose needs for information and services are both declining. Contraceptive preferences vary with social class, but family planning programs in developing countries should concentrate on the lower middle and lower classes which comprise 80% of the population. Rural areas and marginal urban areas require special attention. In order to provide services that will attract all potential users, the maximum possible variety of methods should be available. A family planning program offering a variety of methods throughout the country and financially accessible to the population should be successful. Family planning programs, whether public or private, require adequate financial resources and the support or at least tolerance of the government. Knowledge of contraception is now almost universal. A major challenge of family planning programs is to prompt women who say they want to limit their reproduction but who do not practice family planning to adopt a method. Program leadership and interpersonal relations with clients should be competent. The experience of PROFAMILIA in Colombia suggests that charging fees for all services offered by the family planning program is a positive feature allowing the client to avoid feeling like a charity recipient and the program to account for materials and services more easily. Goals and objective indicators stimulate performance and allow progress to be assessed. It is recommended that client education focus on a synthesis of information concerning available methods and provision of somewhat greater detail on the method chosen. Integration of services is usually an enemy of family planning because, despite theoretical advantages, it usually means neglect of family planning in favor of curative care.^ieng
Assuntos
Países em Desenvolvimento , Diretrizes para o Planejamento em Saúde , Planejamento em Saúde , Organização e Administração , Filosofia , Desenvolvimento de Programas , Educação Sexual , Educação , Serviços de Planejamento FamiliarRESUMO
PIP: Family planning (FP) and social marketing messages must utilize the rules concerning artfulness developed in the private sector for effective communication in the mass media around the world. They have to compete for the attention of television program viewers accustomed to receiving hundreds of 30-second messages. There are some rules essential to any effective communication program: 1) Command attention. In the US over 1350 different mass media messages vie for attention every single day. FP messages are sensitive, but dullness and passivity is not a requisite. 2) Clarify the message, and keep it simple and direct. Mixed messages equal less effective communication. 3) Communicate a benefit. Consumers do not only buy products, they buy expectations of benefits. 4) Consistency counts. The central message should remain consistent to allow the evaluation of its effectiveness, but execution should vary from time to time and medium to medium. 5) Cater to the heart and the head. Effective communication offers real emotional values. 6) Create trust. Words, graphics, sounds, and casting in the campaign should support 1 central key promise to a single prime prospect. 7) Call for action. Both commercial and social marketing campaigns can calculate results by quantifiable measurement of sales (of condoms) transactions (the number of IUD insertions), floor traffic (clinic visits), attitude shifts, and behavior change. The PRO-PATER Vasectomy Campaign of 1988 in Sao Paulo, Brazil successfully used the above rules for effective communication. During the 1st 2 months of the campaign, phone calls increased by over 300%, new clients by 97%, and actual vasectomies performed by 79%.^ieng
Assuntos
Publicidade , Comunicação , Marketing de Serviços de Saúde , Meios de Comunicação de Massa , Educação Sexual , Televisão , Vasectomia , América , Brasil , Países Desenvolvidos , Países em Desenvolvimento , Economia , Educação , Serviços de Planejamento Familiar , América Latina , América do Norte , América do Sul , Esterilização Reprodutiva , Estados UnidosRESUMO
PIP: The Mexican Family Planning Foundation (MEXFAM) operates the Japanese supported Integrated Project (IP) which includes family planning, maternal and child health, and primary health care. MEXFAM is targeting youth in marginal areas. Its staff promote health education among adolescents using 38 projectors, 81 adolescent health films, and 37 sets of a magnetic board for teaching reproductive processes (Magnel Kit) purchased by the Voluntary Deposit for International Aid administered by the Ministry of Posts and Telecommunications of Japan. 40 MEXFAM supported physicians use this equipment as part of their afternoon health education activities in IP areas. MEXFAM helps physicians set up a consultation clinic and provides basic equipment in isolated areas. The community doctor program encourages the physicians to be self reliant in 2-3 years. The Municipal Coordinating Committee for Bicycle Assistance (MCCOBA) has donated reconditioned bicycles to these community doctors so they can contact the 15,000 people they are obliged to provide services to in peripheral areas of cities and isolated rural areas. The physicians also advise and educate communities. MCCOBA has also donated reconditioned bicycles to youth brigades who promote family planning and provide sex education and to community volunteer promoters who advance MEXFAM's program in each village. In October 1991, an additional 150 bicycles arrived for the IP. In 1990, it received 75 bicycles. In July 1991, the Tochigi Health Service Association donated a reconditioned mobil X ray van to MEXFAM. The Queretaro branch office of MEXFAM uses it to reach people in rural areas.^ieng
Assuntos
Recursos Audiovisuais , Serviços de Saúde Comunitária , Educação em Saúde , Planejamento em Saúde , Serviços de Informação , Centros de Saúde Materno-Infantil , Médicos , Gravidez na Adolescência , Atenção Primária à Saúde , Pesquisa , Educação Sexual , Meios de Transporte , América , Ásia , Atenção à Saúde , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Educação , Serviços de Planejamento Familiar , Ásia Oriental , Fertilidade , Saúde , Pessoal de Saúde , Serviços de Saúde , Japão , América Latina , México , América do Norte , Organização e Administração , População , Dinâmica Populacional , Comportamento Sexual , EnsinoRESUMO
PIP: Among objectives of PROFAMILIA's Center for Youth in Bogota were to provide information and education to adolescents and their teachers on prevention of adolescent pregnancy and of sexually transmitted diseases as well as on sexuality and adolescence. Nearly 18,500 adolescents participated in information and education sessions in the Center's 1st year. Nearly 500 teachers participated with their students, and another 197 received training in a workshop on prevention of adolescent pregnancy. The great demand for information and education services on the part of schools and institutions working directly with adolescents demonstrates the need to train educators in the areas of sexuality and family planning. 211 adolescents aged 13-19 participated in workshops to train multipliers to provide a message of sexual responsibility in an informal atmosphere to their peers and classmates. In the 1996 sessions held in the 1st year, a high proportion of adolescents were encountered who feared they were pregnant. Although they had obviously received some information on human reproduction, it did not have a positive or permanent effect in deterring early and unprotected sexual relations. The Center for Youth aspires to replace the usual biological focuses on sexuality with a training in sexuality in which adolescents in grades 6-8, who are 13-15 years old, will receive information and participate in activities stressing self esteem, family communication, decision making, and prevention of pregnancy and sexually transmitted diseases. 53% of the 861 pregnancy tests requested by adolescent participants were positive. Adolescents requesting pregnancy tests shared characteristics such as absence of the father from the household, deficient family communications, lack of affection, low self esteem, and little knowledge or use of contraception. The great majority of these pregnancies were unwanted. Adolescents frequently somaticize their personal, family, and social conflicts and have other specific health needs. They require a more personal kind of medical care that would allow the true causes of their complaints to be identified. PROFAMILIA is considering creating centers especially for adolescents. 4 programs in existing PROFAMILIA clinics have been created to provide educational and medical attention to adolescents as well as educational activities in their schools.^ieng
Assuntos
Adolescente , Planejamento em Saúde , Gravidez na Adolescência , Educação Sexual , Comportamento Sexual , Fatores Etários , América , Comportamento , Colômbia , Demografia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Fertilidade , América Latina , População , Características da População , Dinâmica Populacional , América do SulRESUMO
PIP: The years of adolescence are a time for loosening ties with the family and strengthening those with peers. Adolescence is a period of physical, emotional, social, and moral transition from childhood toward maturity. Before young people become parents, they should be assured that their children's basic needs for food, housing, education, and health will be met. In order to postpone the arrival of children until conditions are appropriate, they need access to contraceptive information and services. Information about contraception should be imparted to adolescents as part of a correct sex education. Another important reason for avoiding adolescent pregnancy is the elevated risk of maternal mortality and morbidity and the increased risk to the infant of prematurity, low birth weight, and mortality. Information about contraception should not be presented to adolescents in a way that will allow them to feel pressured to become sexually active. The sex education program should reflect the fact that not all contraceptives are universally accepted, for various reasons. Sex education classes should provide information and orientation, allowing each participant to decide whether or not to accept contraception or any particular method. Among available methods, withdrawal requires strong motivation and self-control on the part of the male, and its efficacy is relatively low. Condoms are appropriate for young people with sporadic sexual activity and are easily and inexpensively available. The rhythm method requires a record of the length of the preceding 12 cycles. Oral contraceptives (OCs) are highly effective and do not pose a risk to the health of adult women without risk factors. OCs should be used only by adolescents who have completed their growth and have established a regular menstrual pattern during at least 2 years. OCs are not required for very young adolescents. IUDs are not appropriate for nulliparous adolescents because of their greater likelihood of expulsion. Diaphragms are not as effective as OCs and IUds. Vaginal spermicides are innocuous and acceptable as a temporary method, but they are less effective when used without a diaphragm. They are appropriate to the sporadic sex lives of adolescents. Tubal occlusion and vasectomy are excellent and reliable methods but their irreversible character is not suited to the needs of young people. Lack of information on contraception does not deter adolescents from sexual activity. Girls should be aware that contraception will become an important part of their sexual life until menopause.^ieng
Assuntos
Adolescente , Anticoncepção , Gravidez na Adolescência , Educação Sexual , Fatores Etários , Demografia , Educação , Serviços de Planejamento Familiar , Fertilidade , População , Características da População , Dinâmica Populacional , Comportamento SexualRESUMO
PIP: Institutional studies and demographic surveys have demonstrated that side effects or fear of side effects are by far the most important factor in discontinuation of usage of modern contraceptives. The most recent information in Mexico, from the 1987 National Survey of Fertility and Health, indicates that 15-24% of women who accepted IUDs, oral contraceptives (OCs), and injectable contraceptives reported discontinuing usage during the 1st year because of real or feared side effects. Discontinuance because of side effects is much less frequent with traditional methods, but such methods have much higher failure rates than do the modern methods. The reasons given for discontinuing use given by women in surveys correspond to their perceptions. Side effects thus include fears of possible future effects and effects attributed by users to the methods but which are not actually related, as well as real effects of varying severity and importance. In a recent survey, 2/3 of women who experienced contraceptive side effects were not aware of the possibility that they would arise at the time they began use of the method. This finding indicates that information services are lacking for the temporary methods promoted by institutional family planning programs. In case of female sterilization the couple is not able to terminate method use. It would be expected that a careful and fully informed decision process would precede acceptance of sterilization. But 1 out of 10 sterilized women interviewed for the survey stated they would not undergo sterilization again if they were able to choose. The women most likely to state they would not repeat sterilization were the ones who received the least information prior to operation, experienced a deficient acceptance process, received the least medical follow-up, and waited the shortest time between the sterilization decision and the actual operation. Such problems are more common among less educated and rural women. A basic condition for assuring that childbearing decisions are free and responsible is access to complete and accurate information. The reports of these women indicate that this condition is not being met.^ieng
Assuntos
Anticoncepção , Motivação , Pacientes Desistentes do Tratamento , Percepção , Educação Sexual , América , Comportamento , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , México , América do Norte , PsicologiaRESUMO
PIP: Rather than a commentary on a specific article, this work contains reflections on the concept of quality in provision of family planning services and its possible use to deflect family planning efforts. Quality is a difficult concept to define precisely. Applied to family planning, it may be defined as the totality of attributes possessed by a program that does not place impediments in the way of comfortable adoption of a contraceptive method. Another definition of quality, achievable only by a long list of ideal characteristics which are often expensive and sometimes unattainable, has been and continues to be used by enemies of family planning to slow its diffusion; they hold that if perfect quality is not offered, it is better to offer nothing. A specific tactic of this group is to oppose the quantity of services with their quality. The hard-fought campaign to discredit the measurement of concrete goals and results is part of this strategy. But it is apparent that without a reasonably satisfactory quality of service, no program would achieve significant growth. People would not continue to come, and in growing numbers, to a program where they received poor quality service. Each goal, each statistic, each percentage represents human problems confronted and resolved by programs and personnel. Profamilia has become 1 of the largest nongovernmental family planning organizations. Profamilia has always paid attention to the quality of its services and has conducted numerous studies to assess results and identify shortcomings. The high percentage of positive results attests to the quality of Profamilia programs. In an age of scarce resources and tight budgets, the objective of family planning programs is to provide an austere but acceptable quality of attention so that the quantity of services will be sufficient to meet demand. Program elements that have a real cost without offering a measurable benefit should be avoided. Another problem is that integrated programs that aim to combine family planning with maternal-child health or other services often end by neglecting the family planning component. Profamilia believes that good information should be provided with services, but it is limited to what is needed for proper and safe use of each method. And integration is not presently needed to disguise or dress up family planning programs. It is justifiable only when for political reasons there is no alternative or when it can provide other resources to subsidize family planning programs.^ieng
Assuntos
Eficiência Organizacional , Estudos de Avaliação como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Planejamento em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Projetos de Pesquisa , Educação Sexual , América , Atitude , Comportamento , Colômbia , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Pesquisa sobre Serviços de Saúde , América Latina , Organização e Administração , Psicologia , Pesquisa , América do SulRESUMO
PIP: Research indicates that in-school adolescents in Mexico have their first sexual contact at the average age of 15.5 years. In 50% of cases, such contact is with a boyfriend or girlfriend, 28.1% with a fiance, and 18.3% with a prostitute. First sexual intercourse occurs with a spouse in only 1.3% of cases. Since only one in six young people in Mexico use a form of contraception, many unwanted pregnancies outside of marriage result. 450,000 births in 1989 were to mothers below 20 years old, with 15% of births annually being among teenage mothers. An estimated three million abortions occur annually in Mexico, and abortions are the fifth major cause of death at the national level. Teen pregnancy is decisively linked with poor living conditions and life expectancy, a relatively lower level of education, and rural residence. As for psychological and anthropological variables, most teens who become pregnant belong to large, unstable families with poor family communication, and are characterized as submissive, highly dependent, and of low self-esteem. Targeting students, workers, and other youths, the MEXFAM Youth Program selects and trains program coordinators over age 21 and volunteer promoters of both sexes aged 16-20 in urban/marginal communities. Promoters offer information to their peers and other youths in their local communities, distribute barrier contraceptives, and channel medical, psychological, and legal services to young people in need. Program procedure is described.^ieng
Assuntos
Adolescente , Agentes Comunitários de Saúde , Preservativos , Currículo , Atenção à Saúde , Educação , Planejamento em Saúde , Gravidez na Adolescência , Pesquisa , Educação Sexual , Comportamento Sexual , Estudantes , Voluntários , Fatores Etários , América , Comportamento , Anticoncepção , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , Fertilidade , América Latina , México , América do Norte , Organização e Administração , População , Características da População , Dinâmica PopulacionalRESUMO
A comprehensive education strategy is presented that links training, community education, research, and mass-media efforts to enhance breastfeeding practices. Breastfeeding promotion models, an administrative system, and lessons learned during the project are described. The keys to effective breastfeeding promotion are shown to be accurate information; appropriate education, training, and follow-up; and a supportive administrative system.
PIP: An operations research project designed to determine what model of intervention was most successful in promoting breast feeding among 585 urban women in Mexico began in 1986. The interventions involved having trained promoters teach and counsel breast feeding mothers in Irapuato, program supervisors teach groups of mothers in Chihuahua, and both trained promoters and program supervisors train individuals or groups in Cuauhtemoc. Jalapa served as the control site. The breast feeding prevalence rate in the 4 communities varied from 64.5%-81.3% prior to intervention with a mean in the target group of 74.9%. The mean climbed to 88.8% for this group after intervention. Further, the breast feeding prevalence rate for Jalapa fell from 65.9%-56%. In addition, 70% of the women in the experimental group exclusively breast fed their infants during the 1st month whereas only 63.3% in the control did. Subsequent months' breast feeding prevalence rates decreased o 13.7% and 14.7% (5 months) and 9.4% and 3.3% (6 months) in the experimental and control groups respectively. Informal support groups of breast feeding mothers formed unexpectedly as a result of the educational and outreach activities. The data showed that the intervention model using the promoters was the most successful strategy. They also provided the researchers and other health care professionals interested in promoting community based breast feeding programs with guidelines. For example, supervisors should not discourage promoters from addressing other community needs since discouraging them can jeopardize their dedication to breast feeding promotion. Further, program planners should gather geographic and sociodemographic data of the area and population prior to planning and intervention.
Assuntos
Aleitamento Materno , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Serviços de Saúde Comunitária/normas , Feminino , Planejamento em Saúde , Promoção da Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , México , Recursos Humanos de Enfermagem/educação , População UrbanaRESUMO
PIP: Even though fertility in the US is 2, the population grows each year by 2.5 million people due to natural increase and immigration. The US has never had a formal population policy to influence its birth rate. Yet the US government advises other nations, especially developing nations, how they should go about reducing their fertility. Instead the US can learn from population policies of direct disincentives, such as no income tax allowance for 3 children. In Indonesia, the president and Islamic religious leaders strongly support family planning. In Mexico, both the public and private sectors provide family planning services. The US does not have experience in influencing fertility declines, since fertility declined due to economic development over a period of time. Some scholars claim that there are 3 preconditions for a sustained decline in fertility, all of which have significance for setting population policies. The 1st is called rational choice in which conditions are such in a society that women can make their own decision. For example, the existence of legislation that guarantees women the right to act in their own interest, including the right to make their own reproductive decisions. The 2nd involves policies or conditions that motivate individuals and/or couples to limit family size. Incentives and disincentives can provide the needed motivation. For example, the government pays a woman for not having a child for a specific interval. The last precondition includes the necessity of having means available to limit family size. These means include knowledge of contraceptive methods and accessibility to them.^ieng
Assuntos
Etnicidade , Política de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Legislação como Assunto , Motivação , Dinâmica Populacional , Crescimento Demográfico , Pobreza , Educação Sexual , Direitos da Mulher , América , Ásia , Sudeste Asiático , Região do Caribe , China , Anticoncepção , Cuba , Cultura , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Educação , Serviços de Planejamento Familiar , Ásia Oriental , Índia , Indonésia , Japão , América Latina , México , América do Norte , População , Características da População , Política Pública , Singapura , Fatores Socioeconômicos , Estados UnidosRESUMO
PIP: Although the government of the People's Republic of China manifested sporadic concern about the nation's rapid population growth beginning at the time of the 1953 national census, it was not until the 1970s that a small family with a maximum of 2 children began to be promoted through a national campaign of education and persuasion. With the subsequent advent of the 1-child policy in 1979, the family planning campaign became a campaign for population planning in which the government no longer limited itself to contraceptive education and distribution, but began to intervene in human reproduction to accomodate it to material production. China's population policy, despite setbacks and delays, has had notable results. No other predominantly peasant society has achieved such a significant fertility decline in such a short time, but the price has been high. The problems have included confrontation with ancient cultural traditions, interference of the government in the most intimate aspects of family life, the sacrifice of a natural desire for children, evasion of marriage and birth registration, and even female infanticide. The incentives and sanctions for the 1-child policy have been primarily economic in nature, but widespread coercion and abuse have been reported. Although China's fertility has declined steadily since 1971, the fall was considerably greater in the cities, where the expense of children and critical housing shortages have effectively discouraged childbearing. In the countryside the dismantling of the communes and substitution of a system of family responsibility for agricultural production have had a strong pronatalist effect, reinforcing the desire for children as a means of old age security. The costs of children in rural areas are insignificant compared to the cities, housing is less crowded, and fertility sanctions are harder to enforce. Rural discontent and resistence to government family planning policy nevertheless became so acute that it was probably a factor in the 1984 relaxation of the 1-child policy in certain rural areas. Despite considerable success, the Chinese government has not met its family planning goals. 32.3 million couples, or 18% of fertile-aged couples, have expressed willingness to have only 1 child. The 32.3 million include 36% of urban and 11% of rural couples. According to a July 1988 fertility survey, the crude birth rate dropped to 8.84/1000, but the rates of early marriage and adolescent pregnancy were increasing. A major problem in the next 5 years will be the arrival at marriageable age of the large cohorts born around the time of the Cultural Revolution.^ieng
Assuntos
Fatores Etários , Coeficiente de Natalidade , Criança , Coerção , Economia , Política de Planejamento Familiar , Habitação , Motivação , Política , Política Pública , População Rural , Educação Sexual , População Urbana , Ásia , China , Demografia , Países em Desenvolvimento , Educação , Ásia Oriental , Fertilidade , Geografia , População , Características da População , Dinâmica Populacional , Características de ResidênciaRESUMO
PIP: Population policy was revised in Mexico in 1973 following the introduction of family planning and the abolition of rules prohibiting contraceptives. The laws of 1936 and 1947 favored population growth, but it was due to the improvement of public health (and the resulting drop in mortality rates), agricultural reform, and industrialization that an accelerated demographic expansion occurred. The National Council on Population (CONAPO) was created whose activities include family planning with modern contraceptive technology and maternal-infant health care. In accordance with the goals set in 1977, population growth is sought to be reduced to 1%/year by the year 2000. Public educational programs about reproduction, the family, and the community have been launched. The integration of women into the development of the country under the aegis of the Comision Nacional de las Mujer has not been fully achieved. The processing and analysis of demographic information for longterm policy development has also been limited. The lack of clear guidance from CONAPO has limited the involvement of state and municipal councils in the solution of Mexico's population problems. Future challenges will focus on the legal framework for reconciling public and private interests, and the interaction of population programs and economic and social development. The centralized decision making of population policy has involved more organizations, but still more needs to be done.^ieng
Assuntos
Anticoncepção , Controle da População , Avaliação de Programas e Projetos de Saúde , Política Pública , Educação Sexual , América , Países em Desenvolvimento , Educação , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , México , América do NorteRESUMO
PIP: Mexico,s family planning programs have been directed towards women of childbearing age. However, Mexico's family planning movement is now mature enough to set more ambitious goals. This paper deals exclusively with the programs for young people. MEXFAM's basic strategy has been to create, not a separate structure, but rather a movement that infiltrates all the other youth organizations. In general terms, the objectives of MEXFAM's young people's movement are to promote knowledgeable participants among those who do not have sexual relations yet, obtain active users of birth control among those who already have sexual relations, and retard the 1st pregnancy until after the woman is 20 years old. For a better chance to reach these goals, the young people's movement is using a series of untraditional methods so as to avoid the authoritarian options dictated by adult criteria. One of these educational mediums that awaken the consciousness and sense of responsibility in the youth is the video. MEXFAM's youth films are directed to different aspects of sexuality. "Dream of Reality" and "With Hands in the Pockets," deal with adolescent pregnancy; "Like Buddies" with parent-child relationships; "Escape," with drug addiction and sexual responsibility, and "The Last Train" with myths and taboos that go with 1st sexual relations. 4 of these films were produced with the help of JOICFP. 5 films planned for this year are on: the adolescent mother and communication with her own mother, communication in the adolescent couple, prostitution, the media and sexuality, and contagious sexual illness.^ieng
Assuntos
Adolescente , Educação , Educação em Saúde , Planejamento em Saúde , Serviços de Informação , Meios de Comunicação de Massa , Filmes Cinematográficos , Pesquisa , Educação Sexual , Gravação em Fita , Ensino , Gravação de Videoteipe , Fatores Etários , América , América Central , Comunicação , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , México , América do Norte , Organização e Administração , População , Características da PopulaçãoRESUMO
PIP: One of the short educational video programs produced by MEXFAM is called The Last Train, a love story of 2 teenagers which vividly describes the type of adolescent problems confronting Mexican society today. The film raises a number of questions which teenagers do not often consider. The objective of the film is to put in evidence the principles, myths, beliefs, omissions, and misinformation that exist between youth and adults regarding early genital urges. The movie aims to reach underprivileged urban youth between the ages of 11 and 20 years, as well as teachers and parents who are sensitive to youth's sex problems. MEXFAM emphasizes that the educational objective of the film should be pointed out to its audiences before it is shown. After the screening the main points recommended for discussion are: genital attraction, physical control, masturbation, virginity, and 1st sexual experience. MEXFAM also provides audiences with values sheets on which the participants are to write their reactions to certain situations in the film.^ieng