Studies in family planning
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Female genital mutilation/cutting (FGM/C) is widely considered a human rights infringement, although communities that practice the tradition view it as an integral part of their culture. Given these vastly different views, the effectiveness of efforts to abandon FGM/C is uncertain. ⋯ The limited effectiveness and weak overall quality of the evidence from the studies appear related to methodological limitations of the studies and shortcomings in the implementation of the interventions. Nevertheless, the findings point to possible advantageous developments from the interventions.
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This study presents findings from a systematic review of evaluations of family planning interventions published between 1995 and 2008. Studies that used an experimental or quasi-experimental design or used another approach to attribute program exposure to observed changes in fertility or family planning outcomes at the individual or population levels were included and ranked by strength of evidence. A total of 63 studies met the inclusion criteria. ⋯ Findings from all programs revealed significant improvements in knowledge, attitudes, discussion, and intentions. Program impacts on use of contraceptives and use of family planning services were less consistently found, and fewer than half of the studies that measured fertility or pregnancy-related outcomes found an impact. Based on the review findings, we identify promising programmatic approaches and propose directions for future evaluation research of family planning interventions.
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Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.
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Demand is growing in developing countries for sexual and reproductive health programs for young people. However, little scientifically based evidence exists about which program approaches are most effective in shaping healthy behaviors. Careful evaluation and research must be increased, but meanwhile, planners need guidance as they expand programming. ⋯ Behavioral theories and expert opinion agree that adolescents must be taught generic and health-specific skills necessary for adopting healthy behaviors. Constraints on financial and human resources, coupled with the great size of the youth population, highlight the need to find less costly ways to reach young people. These observations generate six programming principles to help planners and communities experiment with a wide variety of programming approaching.
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Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. ⋯ Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.