World Development Report 1984
World Development Report 1984
World Development Report 1984
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health facilities. But less than 1 percent of the forty years old, who smoke and are over thirty-five<br />
NGO facilities offered daily family planning serv- years old, who are breastfeeding, or who have a<br />
ices, and only 7 percent offered part-time services. history of stroke, thromboembolism, cancer, liver<br />
A new project is creating family planning service damage, or heart attack. The IUD is undesirable<br />
delivery points in at least thirty of the NGO facili- for women with pelvic infection or a history of<br />
ties. In addition, both government and NGO rep- ectopic pregnancy. Some women cannot be propresentatives<br />
will sit on a National Council on Pop- erly fitted with diaphragms.<br />
ulation and <strong>Development</strong> that will coordinate * If the side effects of one method cannot be<br />
national efforts in population information, educa- tolerated, the availability of other methods<br />
tion, and communications. improves the chance that couples will switch<br />
Governments have also removed legal and regu- rather than stop using contraception altogether.<br />
latory obstacles that restrict commercial distribu- For example, in Matlab Thana, Bangladesh, 36 pertion.<br />
In Egypt the sale of oral contraceptives cent of women had switched methods within sixthrough<br />
private pharmacies does not require a teen to eighteen months after initial acceptance.<br />
physician's prescription, although their provision And a study in the United States showed that marthrough<br />
government clinics serving rural areas ried white women aged twenty-five to thirty-nine<br />
does. Several countries-including China, Mexico, had used an average of more than two methods;<br />
Morocco, the Philippines, and Thailand-allow more than a third of those aged twenty-five to<br />
pills to be distributed in facilities other than phar- twenty-nine had used three or more.<br />
macies or health centers. Other options for stimu- * Couples' preferences are influenced by their<br />
lating the private sector include removal of import fertility goals-postponing a first birth, spacing<br />
tariffs on contraceptive supplies (Korea recently between children, or limiting family size. Women<br />
eliminated a 40 percent tariff on raw materials for using the pill tend to be younger and to have had<br />
domestically produced contraceptives); active gov- fewer births than those protected by sterilization;<br />
eminment promotion of condoms, spermicides, and<br />
pillsnth beomeasilyof supplied therougicomer - many of the former are spacing births, while the<br />
pills that can be easily supplied through commer- latrhvcopedteifmles<br />
cial outlets; and training of private pharmacists<br />
and physicians who frequently have little knowl- * Some methods of fertility control may be reliedge<br />
of modern family planning methods. giously or culturally unacceptable. Two-fifths of<br />
the world's countries, comprising 28 percent of its<br />
population, either prohibit abortion completely or<br />
Improving quality permit it only to save the life of the mother. For<br />
The quality of family planning services matters in religious reasons, sterilization is illegal in several<br />
all phases of program development. In the early countries. When couples regard periodic abstistages<br />
services are new, and contraception still nence as the only acceptable form of birth control,<br />
lacks social legitimacy. Once programs are well programs should provide information on proper<br />
established and accessible, quality counts because timing of abstinence, although this method carries<br />
other costs of family planning-such as physical higher risks of unwanted pregnancy.<br />
side effects-have replaced access as the factor lim- Due to sheer lack of alternatives, early family<br />
iting the success of the program. Three ingredients planning programs offered only a limited range of<br />
of quality-the mix of contraceptive methods, the contraceptive methods. In the late 1950s and early<br />
information and choice provided, and program 1960s, the Indian program had to rely on rhythm,<br />
follow-up-have contributed much to program the diaphragm, and the condom. Today, most<br />
success (see Box 7.6). national programs offer a wider variety of methods,<br />
although the number available at any given<br />
THE METHOD MIX OF PROGRAMS. The number and outlet is often fewer than that implied by official<br />
characteristics of available contraceptive methods statements. Some governments still promote a sinaffect<br />
the ability and willingness of clients to prac- gle method because such an approach is easier to<br />
tice birth control. Additional options are likely to administer or because certain methods, such as<br />
increase acceptance, permit switching, and reduce sterilization and the IUD, are viewed as more<br />
discontinuation rates. 'effective" and require less follow-up over the<br />
* Some women have medical conditions that long run than do other methods. For example,<br />
rule out certain methods. Oral contraceptives India, Korea, and Sri Lanka continue to emphasize<br />
should not be prescribed for women who are over sterilization. Until recently, Indonesia had almost<br />
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