Role of private sector in family planning service delivery.

PIP: This study relied on the 1996 Thai National Contraceptive Prevalence Survey to determine the market role of the private sector (PS) in contraceptive distribution. Contraceptive prevalence increased from 53.4% to 72.2% during 1978-96. In 1996, the PS share was 24.7%. The PS supplies few IUDs and sterilization. The share of the market has remained stable for the PS, but the share by method has fluctuated. The market share of the IUD declined from 20% to 6.5% during 1978-96. Sterilization declined from 33% to 23%. Pill share increased from 26.2% to 45.1%. Condom share declined from 70.1% to 53.9%. The PS expanded in urban areas, especially in Bangkok, where 3 of 5 contraceptive acceptors relied on private sources. The Central region had the highest number of private acceptors. Drugs stores were the major source of supply of condoms and pills. Private clinics provided injectables, male sterilization, and IUDs. Private hospitals provided female sterilization services. In urban areas, the drug store and private clinics provided most supplies in 1987, although the role of the private clinic declined by 1996. In rural areas, the role of the drug store and private clinic remained the same in both years. The drug store dominated the market in all regions in 1987, except the South. By 1996, the private clinic had the market share in the South and Northeast. The drug stores and private clinics accounted for 81% and 89%, respectively, of all private sources in 1987 and 1996.^ieng

[An optimum population for Thailand].

"In Thailand to date, the systematic analysis to determining an appropriate size of the population using economic, social, political and cultural criteria has not been attempted, let alone conducting a research on an optimum population. What have been made to date are analyses indicating that the rate of population growth at certain [periods] tends to be too low or too high...thus leading to the policy to increase or reduce the rate of population growth. Difficulties in determining an optimum population [are] due to the dynamic nature of population development and the fact that all other factors affecting the welfare of population are always changing, [thus] it is not cost effective to conduct research for determining an optimum population for the purpose of policy formulation." (SUMMARY IN ENG)

Health services providers and users' opinions on maternal health services in Bangkok metropolis.

PIP: Morbidity from pregnancy complications was 19.6% of inpatients in 1990 in Bangkok Metropolis. This study examines the impact of local customs on prenatal, delivery, and postpartum care; the factors affecting use of health services for prenatal care and delivery; and the nature of women's involvement in IEC for maternal health. Data was obtained from a community survey in May 1992 among 526 ever married women, 15-40 years old, from low-income communities in Bangkok Metropolis. In-depth interviews with hospital personnel were conducted at two general hospitals and three health centers, and focus groups were conducted in two communities. Findings show that Hospital A received 220 old and 80 new prenatal patients daily; Hospital B accommodated 130 old and 50 new ones. According to nurses, the major hospital problem was doctors' attitudes toward nurses. Comprehensive services were available at both hospitals. Hospital B encountered patient health problems of minor malnutrition, syphilis, and hepatitis, while Hospital A treated diarrhea and high blood pressure problems. A lack of medical personnel was reported in both settings. Low level of education was reported as related to noncompliance. Incorrect practices were identified as adherence to food taboos that led to deficiencies, consumption of whiskey with traditional medicine, which contaminated breast milk, and discarding mother's first milk. At health centers, which included family planning, doctors only saw high risk patients; complications generally were for swelling, high blood pressure, and vaginal bleeding. Not all centers had a prenatal care diagnostic manual or licensed nurses. Obstacles to delivery of health care included a lack of nurses, refusals at referral centers by low level personnel, and a poor rapport between nurses and patients, which improved with bribes. Poorly educated patients had trouble understanding their health condition. Nurses and focus groups reported that services were not convenient for patients. Migration interfered with keeping appointments. Male doctors were preferred to female doctors as nicer to patients.^ieng

[[The population of Thailand after the reproductive revolution]].

The "population of Thailand is one among the few population groups in [modern times] which has experienced [a] rapid decline in fertility level within two decades. Thailand's population completed the reproductive revolution process so quickly that its age structure has not had time to adjust and still holds the potential for growth for several decades to come.... During the period of reproductive revolution from 1970 to 1990, the population increased by 20 million.... As for the effect of reproductive revolution on the age structure of the population, the pattern is that the proportion of children (under 15 years of age) declines while the number and proportion of population in working-age group (15-59 years of age) and the elderly (60 years and over) tend to increase.... The reproductive revolution also results in a number of positive economic and social implications such as a higher per capita income, [a larger] work force, a gradual reduction in the number of new entrants into the labour market and the decrease in the number of school age population." (SUMMARY IN ENG)

Knowledge and perceptions about AIDS among married women in Bangkok.

People's knowledge and perceptions about AIDS are critical in efforts to combat the further spread of this disease. Using data from a study on "Determinants and Consequences of Contraceptive Use Patterns in Thailand", this paper investigates the knowledge and perceptions about AIDS among ever-married women in Bangkok Metropolis. Differentials in knowledge and perceptions are investigated by socio-economic subgroups. The results indicate the need to inform and educate people about AIDS, especially those in low-income groups or with lower levels of education.

[Fertility and family planning in Thailand, 1987].

PIP: Using data from a study of Determinants and Consequences of Contraceptive Use Patterns in Thailand, it was found that fertility was still higher in the rural areas than in the urban areas. Regional fertility differentials were still evident. However, there were no differences in contraceptive prevalence rates between urban and rural areas due to the widespread presence of government contraceptive outlets. Nevertheless, there were still some differences in contraceptive prevalence rates among regions. Female sterilization was the most popular method, followed by pills and injectables. Natural and traditional methods were used by only a few. The majority of contraception used were female methods. About 1/2 of contraceptive users in Bangkok and urban areas received services from the private sector. The methods were mainly condom and pills through drugstores. The private sector made little contribution in the rural areas.^ieng

Impact of the introduction of NORPLANT implants into the national family planning program of Thailand.

PIP: This paper analyzes the impact of the planned introduction of Norplant implants as an additional method of contraception in the family planning service delivery system of Thailand. Results of the analysis indicate that Norplant implants may contribute to the increase in contraceptive prevalence rate of currently married women in reproductive age but not significantly. As for its impact on the acceptance of existing non-permanent contraceptive methods, approximately 25, 12 and 7% of current pill, IUD and injectable users are estimated to switch to NORPLANT implants had this contraceptive method been made available nationally. Its potential impact on the acceptance of permanent contraceptive methods is inestimable due to the lack of necessary information. The highest proportion of resources needed to include Norplant implants as an additional method of contraception is the cost of supplies. Consequently the paper recommends that the study on cost effectiveness of norplant implants be contemplated. The paper also recommends a series of important social science and operations research issues needed to be addressed for the purpose of policy formulation and program planning.^ieng

Migration plans of the rural populations of the Third World countries: a probit analysis of micro-level data from Asia, Africa, and Latin America.

PIP: This study 1) examines the extent to which a given set of microlevel factors has predictive value in different socioeconomic settings and 2) demonstrates the utility of a probit estimation technique in examining plans of rural populations to migrate. Data were collected in 1977-1979 in Thailand, Egypt, and Colombia, 3 countries which differ in culture, extent of urbanization, and proportion of labor force engaged in nonextractive industries. The researchers used identical questionnaires and obtained interviews in 4 rural villages with the "migration shed" of each country's capital city. There were 1088 rural-resident men and women interviewed in Thailand, 1088 in Colombia, and 1376 in Egypt. The researchers gathered information about year-to-year changes in residence, marital status, fertility, housing, employment status, occupation, and industry. While in all 3 countries return moves are relatively frequent, especially among males, the proportions of migrants who have moved 3 or more times do not rise above 10%. The model used portrays the formation of migration intentions of the individual as the outcome of a decision process involving the subjective weighing of perceived differentials in well-being associated with current residence and 1 or more potential destinations, taking into account the direct relocation costs and ability to finance a move. The researchers used dichotomous probit and ordinal probit techniques and 4 variations on the dependant variable to generate some of the results. The only expectancy variable significant in all countries is age. Education is also positively and significantly associated with intentions to move for both sexes in Colombia and Egypt. Marital status is a deterrent to migration plans for males in Colombia and both sexes in Egypt. Previous migration experience fails to show any significant relationship to propensity to move. Conclusions drawn from the data include: 1) the effects of age and economic status appear to increase, both in strength and significance, for males in countries as the likelihood of a move increases; and 2) the effect of the kin and friend contract variable in Colombia appears to be related to its usefulness in explaining th initial consideration of a move rather than the plans that carry a probability or certainty of implementation. The careful measurement of strength of migration intentions and the application of ordinal probit estimation methods to the analysis of prospective migration may contribute to the refinement of our understanding of the process of migration decision making across a range of geographical, cultural, and developmental contexts.^ieng

Sterilization acceptance in Thailand: trends and prospects.

PIP: Thailand's population currently shows an annual growth rate of 2.5% and a crude birth rate of about 27.6 per 1000 persons. The rapid increase from 8.266,408 at the 1911 census to 46,269,500 in 1980, results from high and stable fertility and declining mortality. The Thai government's 1st 5-year family planning program (1971-1976) aimed to 1) reduce population growth from over 3% to about 2.5% by 1976, 2) educate women about family planning and provide services to them, and 3) integrate family planning activities with maternal and child health services. Subsequent 5-year programs were to further reduce the population growth rate. Family planning acceptance has been relatively high, but new acceptors for the pill and sterilization have declined as numbers of IUD and injectable contrceptive users have increased. In 1982 there were 9335 fewer new acceptors of all methods than in 1981. Female sterilization is the one of the most widely practiced and best known contraceptive methods, especially for urban dwellers. In 1967/1968, 14.8% of 960 Bangkok women, aged 15-44, reported that they had been sterilized, and 8.0% revealed that their husbands had been sterilized. This article uses National Family Planning Program statistics to examine trends in sterilization acceptance. Sterilization acceptors have varied from 7.2% in 1972, to as high as 17.9% in 1978, and dropped again to 14.7% in 1983. Acceptor's age and number of children are the most relevant variables in assessing sterilization's demographic impact; younger acceptors with fewer children will increse the impact. 1973-1983 data show that vasectomy and female sterilization trends stabilize around ages 33-34 for men and 29-30 for women, but that the average number of children for each new acceptor is declining. Service outlets that provide sterilization have increased substantially since 1970. From 1978-1981, mobile clinics contributed more than 30Z% of annual vasectomy acceptors, providing service to 15,500 men in 1978 alone. The private sector's increased role, and the Ministry of Public Health's decreasing role may have contributed to fewer vasectomies since 1978. The author believes that prospects for increasing the number of sterilization acceptors are still promising given past success and the number of persons needing such services.^ieng

Families, jobs and mobility: a comparison of migration streams in Thailand and Colombia.

PIP: An analysis of migration in developing countries is presented. The analysis concentrates on change at the individual level and the extent to which factors such as age, education, and length of residence can account for changes experienced by migrants in various migrant streams. The data concern Colombia and Thailand. The differences among migration streams between similar urban places, to large towns, and away from larger towns are considered.^ieng

A case study of Thailand on sterilization acceptance and its demographic impact.

PIP: Results of various demographic studies indicate that sterilization may have been known and accepted as a method of contraception by Thai urban women for a long time. The extent of sterilization acceptance among Thai married couples, however, could not be determined until 1972, the year in which the Thailand National Family Planning Program was officially initiated. The program collects data on age, number of living children, and other characteristics of new contraceptive acceptors at participating public and private clinics. Since 1972, the trends of sterilization acceptance show that the number of sterilization acceptors has increased substantially over the 7-year period, from about 33,000 acceptors in 1972 to about 170,000 in 1978, representing an increase of about 5.2 times. Consequently, the role of sterilization as 1 contraceptive method in the Thai family planning program has increased. Its proportion of all new contraceptive acceptors increased from 7.2% in 1972 to about 18.9% in 1978. The average age and average number of living children of acceptors over the 1973-78 period also indicated a declining trend. The Standard Couple-Years of Protection Method was used to determine the demographic impact of sterilization acceptance. It was found that the number of births averted/acceptor in 1977 was about 1.77. Finally, it is suggested that for the purpose of determining the impact of sterilization and other contraceptive methods acceptance, only a few more categories of information on new acceptors must be collected by the family planning program. These data, supplemented by data from other sources and periodic demographic surveys, would be adequate for the purpose of assessing the demographic impact if they are tabulated in appropriate detail on a regular basis.^ieng