A model for other countries.

PIP: In 1964 Thailand had 1 of the highest rates of population increase at 3.32%. In 1990 that figure had dropped to 1.24%, qualifying Thailand as 1 of the most successful countries in implementing family planning programs. Between 1970-90 the contraceptive prevalence rate rose from 15% to 75%. During this same time the infant mortality rate dropped from 80/1000 to 35/1000 live births. This was accompanied by an increase in the quality of life and health of the Thai people. The National Family Planning Program was strengthened by: 1) public information campaigns that promoted 2-child families and contraceptive use; 2) increased service delivery of all 7 contraceptive methods through 8000 government health outlets; 3) paramedical training increased the number of health care providers by training nurses to handle IUD insertion and post-partum sterilization, midwives were taught to give injections and insert IUDs, and villages volunteers were trained in prescribing pills and condoms; and 4) coordination programs that allow all related government ministries and 6 private associations to work together. The result of all this effort is a 40-fold return on every dollar spent on family planning. Without these programs the Thai population was estimated to be 67 million instead of 54 million. This resulted in savings in social and economic development planning as well as educational expenditures. Income from rice exports was created, which would have had to feed the extra 13 million births that were avoided by the program between 1970-89. The program still has a great deal of work to accomplish. Thailand's population is projected to grow to 63.5 million by 2000. The number of women of reproductive age is currently 14 million which means that 28 million people must be reached and encouraged to delay their 1st child and space their 2nd child farther. The goal is to have 77% of married women using contraception by 1996. This is especially true of the women in the 15-25 age group, 50% of whom currently use contraceptives. The sterilization rate must also be increased from 30% to 40% for women with 2 children.^ieng

Integrated birth spacing and MCH Program in Narativas Province.

PIP: The author describes the birth control situation and the success achieved by the intensification of the Maternal and Child Health (MCH) service in Narativas, one of the provinces of Thailand. In Narativas the contraceptive prevalence rate (CPR) in 1984 was 25.9, while the national average was 64.6 percent. The "Expansion of Maternal and Child Health and Birth Spacing Program" was introduced in order to alter the situation. As a result, CPR increased to 34.3 percent in 1989, and the number of new acceptors doubled from 4,337 in 1983 to 8,299 in 1988. Since 78% of the population is Moslem, birth control methods cannot be introduced directly. Emphasis was laid on the role of religious leaders who were trained centrally. Community involvement in birth control was stimulated by selecting model mothers fulfilling strict criteria. Village health volunteers, traditional birth attendants and auxiliary midwives contributed to the project. Teams visited the villages at definite times to give information about birth spacing, conduct routine examination of pregnant mothers and children, administer immunizations and dispense drugs. Women already motivated to use modern contraceptives were offered services. 2 teams doubled the increase of MCH and birth spacing acceptors. The strategy, described in the review in detail, increased MCH coverage and reduced infant mortality. The service served 5,064 mothers in Narativas. Altogether 5,542 new family planning acceptors were referred to health centers for contraceptive services during the period of June 1985 - December 1988.^ieng

Assessing the acceptability of NORPLANT implants in four countries: findings from focus group research.

In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.

PIP: In 1986-87, a qualitative research project was done in Thailand, Egypt, Indonesia, and the Dominican Republic to expand knowledge of the acceptability of NORPLANT contraceptive implants beyond continuation rates. In each of the 4 studies, in-depth interviews or focus group discussions were held with current NORPLANT users, potential acceptors, discontinuers, husband of women in the 3 groups, and service providers. The 4 countries were chosen because of their diverse cultures and religions. Most participants favored family planning. Many had used other contraceptives. Men and women in all countries were worried that oral female contraceptive agents (the pill) caused cancer. There were many objections to the IUD. In all countries but Thailand, there was little knowledge of NORPLANT. In the Dominican Republic, NORPLANT was used mostly as a child spacing method. In Indonesia, it was used for child spacing and termination of childbearing. Perceived advantages were alike in all countries. Pain during insertion and removal was a big concern of potential users. Men and women in all countries said that religion and traditional beliefs did not influence their family planning decisions. But many said that religion influenced their tolerance of side effects. In Egypt and Indonesia sterilization is unpopular because it is seen as violating Islamic law. Irregular bleeding was the major side effect and the main reason for discontinuation. Many satisfied users felt that the advantaged outweighed the side effects. Primary reasons for removal in all countries were irregular bleeding, amenorrhea, and the desire to give birth. The need for information was mentioned in all countries. In Egypt, Indonesia, and Thailand services providers reported the need for more thorough training in insertion and removal as well as continuing education sessions.