World Development Report 1984

medical examination was not always conducted who attracts and retains the most clients for a varibefore
insertion, and there was little in the way of
treatment or referral for side effects. For years
ety of different methods.
afterward, IUDs were shunned. With a fuller FOLLOWING UP ACCEPTORS. In their early stages,
explanation of side effects and greater care paid to family planning programs devoted much time to
screening and medical backup, the IUD is now recruiting new clients. It is now obvious that susregaining
popularity. When private pharmacies in tained use cannot be assumed-follow-up support
Colombia provided their customers with pam- is needed. Follow-up support includes medical
phlets explaining effectiveness, proper use, and backup and referral for side effects; encouraging
side effects, sales of contraceptives increased. clients to change contraceptive methods if their ii-
Virtually all family planning programs provide tial choice has caused problems or if their needs
some information to clients about methods, but have changed; reassuring them that they are using
fully informed choice is still only an ideal in many contraceptives properly; and reminding them of
countries. Family planning workers still tend to the benefits.
doubt the ability of couples to use effectively meth- Follow-up is most important in the first few
ods such as the condom and pill, thereby discour- mo st incertant is whe side
aging their use. Staff may also fail to mention
megthodefwic h. Sth y dispo such m as th
metho o n, r stherilizatin.Wen inctvs are
months after acceptance, since this is when side
effects are first experienced, when clients are learn-
ing to use methods properly, and when they need
offered to staff for recruiting acceptors of some reassurance in the face of social disapproval. A
methods but not of others, the information promethds
nt o oters,theinfrmaton ut
rovided
to clients may be biased. Sometimes clients
are ive inccurte r icomleteinfrmaion
bause famenilypannurateoringcstaffparetheirmse no
study in Calabar State, Nigeria, found that 11 per-
cent of pill acceptors never took even the first
c ent p of accep ill s ne d o n percent
month's allotment of pills, and only 53 percent
were using the pill three months later. A lack of
properly informed about methods and their side concern with follow-up is believed to be the major
effects, A survey of the Dominican Republic,
Kenyt, A hey P .. p bte Uominited Ntio
contributory cause of the low continuation rates
among IUD and pill users in Korea. According to a
Fuaand f Pop l pionA es . UnFPAd .int
Fund for Population Activities (UNFPA) in the
survey of contraceptive acceptors, only 24 percent
weefloe'pathm rrtre tohat
mid-1970s found that workers felt that their train- were followed up at home or returned to health
ing in methods had been inadequate. A study in centers for consultation on side effects. Korea's
India, Korea, the Philippines, and Turkey demonstrated
the strong influence of providers of serv-
program sets targets for the number of acceptors,
ices on clients' choice of method: clients given a Follow-up cannot be left to clients, who are likely
thorough explanation of all available contraceptive to return to the family planning center only if they
methods chose a very different mix of methods are living close by or if they experience severe side
than did those prior to the study, who had not effects that they cannot correct even by abandonbeen
given this information. ing contraception. Follow-up is best provided by
From the manager's viewpoint, what are the crit- fieldworkers and by community-based services.
ical requirements for better information? First is But in areas in which family planning is still
appropriate training. Workers must be trained to regarded with suspicion, some clients would like
explain properly the methods available to clients to be spared the embarrassment of a follow-up
and to encourage them to participate in the choice. visit from a family planning worker. Some pro-
Informal explanation works better than formal pre- grams have managed this by having fieldworkers
sentations that use technical or anatomical terms. deliver health services as well.
As new contraceptive methods are included in With or without an extensive field network, famprograms,
staff must receive prompt training. Sec- ily planning programs can improve follow-up.
ond is more and better supervision of workers to 0 They can change policies that encourage staff
ensure that they are not holding back information to recruit new acceptors but not to follow up on
on methods because of their own prejudices or them. Targets and incentives can be offered to staff
because they are receiving financial incentives for on the basis of the number of current users of conencouraging
some but not all methods. The incen- traception or of the number of checkups, rather
tive structure might also be altered by offering than only on the basis of the number of new accepfinancial
or other awards (such as educational tors. Training must also emphasize follow-up
opportunities or additional training) to the worker procedures.
146