[Analysis of the demand for family planning]. / Analisis de la demanda de planificacion familiar.

PIP: Fertility intentions and reproductive risk were used to segment Peru's potential market for contraceptives using data from the 1991-92 Demographic and Health Survey. The four programmatic groups of fertile-aged women in union included 41.4% not wanting more children and at high risk, 30.5% not wanting more children and at moderate or low risk, 12.8% wanting to space, and 15.4% wanting a child in the near future. 84.6% of fertile-aged married women thus needed a contraceptive method to avoid unwanted pregnancy or high risk pregnancy. A range of appropriate methods was identified for each of the four programmatic groups based on method efficacy, clinical contraindications, and legal restrictions. Projections of the prevalence, method mix, and sources of service took into account the range of appropriate methods, local preferences for particular methods, local availability of health posts and infrastructure, and the rational use of limited resources. The four programmatic groups were disaggregated by age to take into account recommendations for use of oral contraceptives, surgical sterilization, and IUDs. The segmentation by source of supply was done separately for type of method and rural or urban residence. Marital status, proportion of fertile-aged women, socioeconomic status and other factors were heterogeneously distributed within and between the 13 planning regions. An estimated 7% of women were infertile, 23.9% were at low reproductive risk, 25.6% at medium risk, and 50.5% at high risk because of age, parity, or a history of abortion, neonatal death, prematurity, or cesarean delivery. Among women not wanting more children at high and medium or at low risk, respectively, 66.6% and 65.1% were using a method, but only 30.0% and 32.0% were using an appropriate method. The projected method mix and sources of supply are presented for Lima as an illustration of application of the methodology. The projected method mix for Lima eliminates use of natural methods, withdrawal, and barrier methods for women wanting no more children and use of oral contraceptives for high risk women.^ieng

A method for calculating rates of induced abortion.

Accurate measurement of induced abortion is necessary for understanding the fertility dynamics of a population and for making projections about the future. Changes in abortion rates can amplify or dampen the impact of changes in contraception. This paper presents a methodology for calculating marital induced abortion rates from observed marital fertility and contraceptive prevalence and for modeling the impact of substituting contraception for abortion on future fertility. The methodology is validated against observed abortion complications in three populations, and the impact of substituting contraception for abortion on expected fertility is demonstrated.

Costs and benefits of implementing child survival services at a private mining company in Peru.

Costs and savings of child health services were studied in a private mining company in Peru. Despite considerable outlays for medical services, few children under age 5 were vaccinated, and half of their illnesses went untreated. Children who were attended at the company clinic usually received unnecessary medication. As a result of the study, the company hired additional staff to provide integrated maternal-child preventive health care and family planning and contracted for intensive training and periodic on-site supervision. In less than 2 years, vaccination coverage reached 75%, and virtually all children under age 1 were enrolled in growth monitoring. Prescriptions were reduced by 24%, including a 67% drop in antimicrobials. The cost of the new services was $13,200 for the first 2 years. Approximately $6800 has been saved in pharmaceuticals prescribed for respiratory infection and diarrhea. Recently, two more mines adopted maternal and child health and family planning services. It is hoped that cost-benefit arguments will encourage other companies to incorporate aggressive child survival measures into their health plans.

The impact of mass media advertising on a voluntary sterilization program in Brazil.

The effect of magazine advertising on vasectomy acceptance was tested in São Paulo, Brazil. Four advertisements ran for ten weeks in eight magazines. Clinic performance doubled during the campaign and stabilized at 54 percent higher than baseline. The advertisements selectively attracted the target audience without bringing in large numbers of ineligible candidates, completely avoided negative reactions, and recruited men previously unexposed to vasectomy. The cost of the advertising campaign was offset by additional revenue generated by the increase in vasectomies performed. The results suggest that while interpersonal communications can maintain performance in voluntary sterilization programs, mass media promotion may be necessary for program growth.

PIP: A simple before-and-after time-series analysis was employed to study the effect of magazine advertising on vasectomy acceptance in Sao Paulo, Brazil. The study design used the single Pro-Pater Sao Paulo clinic and a single intervention, i.e., the mass media promotional campaign. Service statistics for the years 1984-85 provided the baseline; clinic performance was continuously monitored during the intervention and for a 12-month postintervention period. The formal campaign was initiated during September 1985. 4 advertisements ran for 10 weeks in 8 magazines. By the end of the study, the patient file included 3403 records for the baseline period, 1475 records for the campaign, and 5388 records for the post-campaign period. The telephone calls file contained 4393 records and the letters file 386 records. A clear impact of the advertising campaign was demonstrated, both in terms of total number of telephone calls received and in terms of referral source. The advertisements generated 32% of all telephone calls received, 47% of calls received during the campaign itself, and 9-10% of the calls received in the 2nd half of the post-campaign year. As referrals by advertisements dropped off, they were replaced in part by increased referrals from traditional sources, providing the 1st evidence of a "multiplier effect." Magazine referrals were significantly less likely to schedule an intake interview than were callers referred by traditional sources -- 51% versus 78%. Clinic performance was positively and significantly affected by the advertising campaign. The mean daily number of new clients doubled during the campaign as compared to the baseline period and remained 60% higher in the post-campaign period. The mean daily number of vasectomies performed increased 76% from the baseline to the campaign period and stabilized at a level 54% higher than baseline during the post-campaign period. 18% of the new clients arriving during the campaign reporting having seen a magazine advertisement; this figure was 4 of the new clients in the post-campaign period. New clients referred by the campaign were, on the average, 1 year older than those referred by traditional sources. Number of living children did not vary by period. The mean educational level rose slightly during the campaign, after which it returned to baseline levels. The cost of the advertising campaign was offset by the additional revenue gained from the increase in vasectomies performed. In sum, the study findings support the conclusion that mass media that mass media advertising as an effective and cost-effective means to increase the demand for vasectomy services in Sao Paulo, Brazil.

Quarterly versus monthly supervision of CBD family planning programs: an experimental study in northeast Brazil.

The cost-effectiveness of reducing the frequency of routine supervision from monthly to quarterly was evaluated in a closely controlled field experiment conducted in a community-based distribution program in Piaui State in northeast Brazil. The results demonstrated substantial potential savings in supervisors' salaries and travel at no cost to program performance (new acceptors, revisits, distributor turnover). A possible reason for this finding was that most supervisory visits were primarily concerned with collecting inventory and service statistics, which probably contributed little to post performance. It was suggested that the number of supervisors and the frequency of supervision should be linked to productive rather than routine supervisory activities.

[Correlations of contraceptive behavior among unmarried North American university students]. / Correlaciones del comportamiento anticonceptivo entre universitarios Norteamericanos solteros.

PIP: In 1976 326 students, 149 men and 177 women, were asked to fill a questionnaire in 2 U.S. campuses to analyze interpersonal factors related to contraceptive practices. 86% of students were white, belonged to the middle class, and were of average age 19.6. The questionnaire carried questions related to demographic problems, personality, and sex behavior. Of 326 students, 113 were virgin, and 213 sexually active. Sexual activity tended to increase with age, with a notable acceleration between 16-25 for women, and 14-18 for men. About half of the participants stated not to have used contraception at their first sexual experience; for the others the methods used were coitus interruptus, or condom. In case of a lasting relationship the method used the first time was later changed for a more reliable one. Major predictors of contraceptive method were the frequency of sexual relations, the method used the first time, age, and knowledge of the physiology of reproduction. 77% of couples who lived together used the pill. Results showed that use of a reliable contraceptive method depended much more on the type of relationship, than on personality or characteristics of the individual.^ieng