[Population policy in Mexico]. / Politicas de poblacion en Mexico.

PIP: The author reviews the history of population policy in Mexico. Sections are included on antecedents of official population policy; the radical change in orientation since the enactment of the third General Law of Population in 1973; institutional bases of Mexican population policy; the National Family Planning Plan, 1977-1982; and an evaluation of the results of the population policy.^ieng

[Population policy: substantial but insufficient advances]. / Politica de poblacion. Avances sustanciales, pero insuficientes.

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

Costa Rica saves infants' lives.

PIP: Even though Costa Rica is underdeveloped economically, life expectancy has been increasing over the past decade and the illiteracy rate was only 7% in 1984. Infant mortality rates have plummeted since 1972 when the 1st national health plan and social security were instituted (pre-1972: 2.3% annual reduction in infant mortality; 1972-1980: 13% decline annually). Decreased risk in the 1st postnatal month of life was responsible for 34% of the decrease from 1972-1980. Control of disease, especially diarrhea and acute respiratory infection, accounted for most of the decline (51%). Immunizations accounted for 8%, prevention of infectious diseases for 10%, control of malnutrition for 5%, and control of death due to premature birth for 14% of the decrease in mortality. Infant death due to pregnancy and delivery complications and congenital defects did not decrease during this period. Socioeconomic conditions normally influence survival rates strongly, but socioeconomic change in Costa Rica during 1970-1980 accounted for only 1/3 of the reduction in infant mortality. These improvements included an increase in the number of educated women, economic growth and decline in fertility (a decrease from 7.6 to 3.4 births between 1960-1980). The majority of the reduction stemmed from utilization of family planning techniques and the reduction of health risk factors. By 1980, the health program initiated in the 1970's provided primary care to 60% of the population, immunized 95% of the children against poliomyelitis, diptheria, pertussis, tetanus, and measles, and by 1984, provided almost all households with a sewage system. Analyses of the impact of socioeconomic development, fertility regulation, hospital care, outpatient services, and primary health care on infant mortality showed that, before 1970, those areas with better economies had a lower mortality rate, and after 1970, the economy and mortality rate had become independent variables. Furthermore, the introduction of health programs in the 1970's correlated with the accelerated decrease in mortality.^ieng

[Medical assistance for health and human reproduction]. / Assistencia medica e a saude e reproducao humana.

PIP: Brazil's federal health policy is examined, with separate focus on the periods before and after 1964. Special attention is given to sanitation and to maternal and child health care. The impact of government involvement on health policy development and the policy's subsequent effects on demographic processes, especially fertility, are also discussed. Data are from official and other published sources. (SUMMARY IN ENG)^ieng

[Integration in family planning programs]. / La integracion en los programas de planificacion familiar.

PIP: The question of whether family planning programs should be integrated with other activities or limited strictly to contraception has been debated for years without achievement of consensus. Profamilia, the Colombian family planning organization, has been a firm advocate of a vertical program without other activities. A large body of economic and demographic data and evaluations of numerous programs in numerous places support the Profamilia position that both economic development and family planning programs are important in achieving demographic objectives, but if only 1 is possible in a given country, a good family planning program gives better results. Profamilia, a private, nonprofit organization, is responsible for 2/3 of the contraception practiced in Colombia. Profamilia's success appears to demonstrate that an effective program, even in a country no more promising otherwise than any of its neighbors, can achieve excellent results. For government-run programs, it may be politically impossible to avoid an integrated family planning program; the public is likely to question the emphasis on family planning if other urgent health needs go unattended. But even government-run programs may create separate structures with separate funding and personnel for specific problems such as malaria control, suggesting recognition of their greater efficiency. A nongovernmental organization such as Profamilia, faced with a continuing struggle for funding, must concentrate its resources on fulfilling its mission of allowing couples to decide freely on the timing and extent of their reproduction. Vertical programs, tolerant if not enthusiastic governments, and abundant demand are the 3 factors that have led to high rates of contraceptive usage in some countries; sthe contraceptive prevalence rate is 60% in Colombia. A number of studies in the late 1970s and early 1980s have shown that funds directed to family planning have a far greater demographic impact than do equal amounts directed to rural female education, nutrition, or control of infant mortality. Verticality in a family planning program should be understood to include all activities that attract potential family planning acceptors, as well as all services which generate funds that can be channeled to family planning programs and that contribute to program efficiency. Pregnancy tests, Pap smears, gynecological or urological consultations, social marketing, antiparasite campaigns, and treatments of infertility, sexually transmitted diseases, or sexual dysfunctions are all appropriate components of a vertical family planning program. True and unacceptable integration views contraception as a remote and secondary goal, while the type of "false" integration described above views family planning as its epicenter and does everything possible to promote and facilitate contraception.^ieng

The people yet to come; avoiding the demographic trap.

PIP: The demographic trap is defined as the condition where a nation has passed through the process of lowering death rates, but has not been able to lower birth rates before ecological carrying capacity is exceeded. A minimal estimate predicts that by the year 2000, 63 countries, or 1.1 billion people, will be trapped by starvation, dependence on imported food, and resulting economic and political instability. Such a country that failed to complete the demographic transition will fall back to the original stage, of high death as well as birth rates. Most nations in Southeast Asia, Latin America, and Africa are at risk, notably Mexico, India, Nigeria, Ethiopia, because they already have falling living standards coupled with rapid growth rates. Most governments are unaware of the subtle signs that carrying capacity has been exceeded. Even those that are able to understand such events, often practice ineffective policies. For example, the U.S. has dropped U.N.F.P.A. support ostensibly because one nation, China, allowed forced abortions. On the other hand, some third world countries have initiated novel campaigns to reduce births, for example popular media campaigns in Mexico, free dissemination of birth control pills to all women in Brazil, and a separate family planning ministry in Zimbabwe.^ieng

A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSS's family planning services.

PIP: A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The results indicate that the IMSS family planning program considerably reduced the demand on its maternal and infant care services. As a consequence of its family planning program, IMSS was able to divert a total of 318 billion pesos (1983 currency) from maternal and infant care to payments for pensions and general health services. In other words, for every peso that IMSS spent on family planning services to its urban population in 1972-1984, the agency saved 9 pesos. Consistent findings lend credence to estimates of the demographic impact of the IMSS family planning program on its urban population. Among the IMSS urban population, sterilization accounts for 57% of the prevalence rate. Another measure of the demographic impact is the decline in the total fertility rate from 6.5 children per woman in 1972 to 2.93 in 1985. The cost data for this analysis are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states.

Recent fertility trends in Suriname.

PIP: A rapid decline in fertility took place in Suriname between 1962 and 1974, and then stopped. While this sudden stabilization is surprising, it is not unusual. Similar trends have occurred in some Caribbean and Latin American countries. This article analyzes the post-1960 trend in fertility in Suriname and seeks to determine whether the 1962-74 fertility decline resulted from changes in socioeconomic conditions or was caused by the activities of the Suriname Family Planning Association. The measures used are the general fertility rate, the total fertility rate by ethnic group as well as by 5-year age groups, and gross and net reproduction rates by ethnic group. All the measures point to a rapid continuing decline of fertility between 1962 and 1974, followed by a rise. The data suggest that major socioeconomic changes had already been under way for some years, when fertility started to fall in 1962. The Suriname Family Planning Association was not founded until 1968, which implies that the organization did not start the decrease. However, once the organization was founded, it continually expanded its activities and made an obvious contribution to the use of contraceptives that increased significantly in the 1970s. It is concluded that the drop in fertility resulted from the process of modernization along with the rapid increase in the use of contraceptives.^ieng

Mexico's population policy turnaround.

PIP: Until 1972 Mexico's officials seemed to believe that the annual population growth rate of 3.5% was not really a problem as long as the economic development rate could be kept ahead of the population growth rate. The General Law of Population of 1947 was actually promoting population growth. It was only during the 1960s that elite opinion shifted, and privately funded family planning programs became increasingly active. By 1972 the population had reached 54 million, from 20 million in 1940. President Echevarria, till then a traditional pronatalist, announced in 1972 the creation of a national family planning program, and, in 1974, the creation of a national population council. Since then the Mexican government has embarked on ambitious programs of mass communication and sex education to make the population receptive to its new attitudes. The plans have worked: by mid-1979 estimates put the population growth rate at 2.9%, within sight of the 2.5% target set for 1982 by new president Lopez Portillo. According to a survey conducted by the National Fertility Survey, by late 1976 41.50% of Mexican women of childbearing age were practicing contraception. Within the 41.50% of active contraceptors, 14.9% use the pill, and 7.8% the IUD. New channels of information and of contraceptive delivery are being explored to reach Mexico's widely scattered rural population, and to bring the average family size down to 2 children from the average of 6.5 children per woman for 1973-1975. The government goal is of a 1% population increase by the year 2000.^ieng

Declining world fertility: trends, causes, implications.

This Bulletin examines the evidence that the world's fertility has declined in recent years, the factors that appear to have accounted for the decline, and the implications for fertility and population growth rates to the end of the century. On the basis of a compilation of estimates available for all nations of the world, the authors derive estimates which indicate that the world's total fertility rate dropped from 4.6 to 4.1 births per woman between 1968 and 1975, thanks largely to an earlier and more rapid and universal decline in the fertility of less developed countries (LDCs) than had been anticipated. Statistical analysis of available data suggests that the socioeconomic progress made by LDCs in this period was not great enough to account for more than a proportion of the fertility decline and that organized family planning programs were a major contributing factor. The authors' projections, which are compared to similar projections from the World Bank, the United Nations, and the U.S. Bureau of the Census, indicate that, by the year 2000, less than 1/5 of the world's population will be in the "red danger" circle of explosive population growth (2.1% or more annually); most LDCs will be in a phase of fertility decline; and many of them -- along with most now developed countries -- will be at or near replacement level of fertility. The authors warn that "our optimistic prediction is premised upon a big IF -- if (organized) family planning (in LDCs) continues. It remains imperative that all of the developed nations of the world continue their contribution to this program undiminished."

A conceptual model for the identification, organization, and measure of influence of fertility policies and programs.

PIP: The fertility program of any government is the procedural action intended to effect the government fertility policy. There may also be unintended results of any fertility program. A conceptual model was designed to measure the effect of governmental action on fertility and to identify sociocultural factors that have the greatest influence on fertility. The model uses sociocultural variables as intervening variables between fertility programs and changes in actual fertility. The structural variables considered by the model are characteristics of the pattern of social order; the cultural variables consist of shared values and norms. Fertility trend analysis is effected by polynomial regression formulae. Puerto Rican data from 1946 to 1970 were used to test the proposed model. Analysis of the data indicated that emigration between 1940-1962 had little effect on national fertility. Governmental family planning programs, beginning in 1946, contributed to a sharp decline in fertility. It is recommended that the model be used with data from other countries to assess the effects of their family planning programs.^ieng

Integrated family planning: the Chilean experience.

PIP: To determine the most effective method for incorporating contraceptive services into a general health program, researchers analyzed the results of an IUD-based family planning program in three separate areas of Chile: two similar towns representing all social strata, and one working-class district in Santiago. From 1964 to mid-1970, IUD contraceptive services were provided in special family planning departments within hospital and outpatient clinics operated by Chile's National Health Service (SNS); information and education were offered in pediatric and obstetrical waiting rooms and postpartum wards. In 1968, SNS restricted the number of acceptors, and in mid-1970, individual family planning units were closed and contraceptive services became the responsibility of maternal-child health units. Prior to 1970, all three sample areas recorded a steady increase in the number of accumulated acceptors and a steadily decreasing birthrate; after 1971, birthrates increased and the number of acceptors declined. A 1964-1969 decrease in the number of hospitalizations for incomplete abortion, particularly in the working-class district of Santiago where a bortion has been the only known method of contraception, was reversed with program termination. Data suggests that family planning is most effectively integrated into existent health services when offered in separate facilities. Direct integration into maternal-child health units may result in the neglect of the family planning aspect of preventive health, and will deny services to two important contraceptive groups: childless women, and men.^ieng

[Changes in various indexes of maternal health observed after a program of family planning]. / Cambios en algunos índices de salud materna observados después de un programa de planificación familiar.

PIP: In 1965 the National Health Service (SNS) in Chile began a family planning program with the object of reducing abortions to a minimum, reducing the number of births to multiparous women, and reducing infant mortality rates. A community that had a fairly constant population and an SNS clinic located within easy access of the populous was carefully selected to make a preliminary test of the effectiveness of the program. On the theory that education and services needed to be provided in equal measure if the program were to succeed, efforts were made to educate (mostly through talks) previous abortion seekers, as they stood a 2-5 times greater chance of having a subsequent abortion than did others.In the talks, special emphasis was placed on risks involved in induced abortion. The women were also instructed in the use of all sorts of contraceptives and costs were made as low as possible. A survey of fertility and abortion was taken prior to the initiation of the program in 1965 and was repeated in 1967. Age-specific abortion rates had dropped for all but the 15-19 group, but the only statistically significant drops occurred in the 20-24, 25-29, and 30-34 age groups. General and total abortion rates dropped by 38.1 and 39.4% respectively, both of which were highly significant. Fertility rates also dropped;the TFR was down by 20% and age-specific rates were down for all groups, though only the drops in the 30-34 and 35-39 groups were statistically significant. Fertility was, however, still high (TFR - 5.2), and infant mortality remained almost stable. The proportion of grand multiparous women was reduced from 30% to 17.5%.^ieng

[Necessity and methods of family planning in industrial and developing countries]. / Notwendigkeiten und Methoden der Familienplanung in Industrie- und Entwicklungslaender.

PIP: In the industrialized nations family planning is now the individual decision of the couples concerned. The ''pill'' complies best with the demand for reliability, tolerability, and practicality, and is the most widely used method (contraception). In developing countries of Middle and South America and almost all of Asia the ''population explosion'' is most threatening, and the state must intervene to inhibit the rapidly increasing birthrate. Methods must be found which are inexpensive, uncomplicated, and realizable on a large scale. Often birth control, rather than contraception, is more practicable, although methods vary greatly from country to country. In India sterilization (tubal ligation, vasectomy) is the most widely used and relatively successful methods. In Japan legalization of abortion has led to a rapid decline in the birthrate (from 35.1/1000 in 1949, to 17.5/1000 in 1959). In Peruto Rico, after a number of years of high abortion an sterilization rates, hormonal contraceptives are now bieng used, leading to a decine of birthrates.^ieng

Population explosion in the South Pacific.

PIP: The introduction of family planning in the populous Fiji Islands has lowered the birthrate from 41.8/1000 in 1959 to 35.9 in 1965. Studies of women taking oral contraceptives and wearing IUDs have shown that both methods are compatible with the Fiji women, although the author considers the IUD the most suitable method, being acceptable, cheap, safe, relatively free from side effects, and requiring only 1 act of motivation. Among the first 1000 IUD wearers, there were 36 pregnancies, 22 occurring with the IUD (Lippes loop) in place. Of the 67 users of oral contraceptives studied, there were no pregnancies among those who took the pills as directed. 2 women, who took them irregularly, got pregnant. Side effects were minimal and the withdrawal rate was low.^ieng

The impact of family planning programmes on incidence of abortion.

PIP: The family planning movement in Japan began when the total number of births in 1947-1949 reached 8 million and the birthrate reached 34 per 1000. This, combined with declining mortality, led to obvious population pressure. As a result of family planning efforts, birthrates fell below 20 per 1000 in 1955 and since 1960 have remained at 17-18 per 1000. Birth control is not new to Japan. It was only 100 years ago that abortion and infanticide were forbidden by law. Moral and religious objections to induced abortion and contraception were not powerful. In 1950 the Eugenic Protection Law was passed and induced abortions increased rapidly, reaching a maximum of 1,170,000 in 1955. Few were done for hereditary diseases. Family planning developed as a reaction to this unforseen widespread practice of induced abortion. Since then efforts to replace induced abortion by contraception have been pursued by the government's Population Problems Council and many nongovernmental voluntary groups. Induced abortions decreased to 843,000 in 1965 and birthrates fell from 19.4 to 18.5 in the same 1955-1965 period. Although total population increased by 9 million, the number of births increased by only 90,000 in these 10 years.^ieng