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From its beginning in 1885, the Hull House was beacon for social progress and urban reform. Founders Jane Addams and Ellen Gates Starr recruited talented, passionate partners from diverse fields to address issues from street sanitation to education in Chicago’s immigrant communities. Among residents’ many projects, their involvement in the “social hygiene” movement for sex education and contraception is perhaps the least recognised, in part because the Hull House did not save materials directly related to these services. As a result, the professional activities of Hull House residents Drs Rachelle Yarros and Alice Hamilton reveal a productive relationship between the Hull House and the social hygiene movement. Part of their critical work was to dismantle the cultural association of contraceptives and sex education with “fallen women” and reframe these services as necessities for maternal health. The papers of their professional organisations chronicle their delicate efforts to challenge assumptions about reproductive healthcare while preserving Victorian ideals about sex as a private, procreative endeavour strictly between married, monogamous people. Rachelle Yarros was particularly active, producing a dearth of literature on sexual health, teaching classes on the subject, and overseeing the opening of Chicago’s first public birth control clinics. Each of these advancements, including the birth control clinic, was available on Hull House grounds. By capitalising on the financial and medical resources available to them as physicians and reformers, Yarros and Hamilton achieved significant gains in women’s healthcare and initiated a national conversation about sexual health as a human right. [ABSTRACT FROM AUTHOR]

Context: Ambivalence in pregnancy intentions is well-documented in sub-Saharan African (SSA) settings and has been associated with inconsistent use of contraception, thereby exposing women using contraception to the possibility of unintended pregnancies. A better understanding of the potential role for client counseling interventions in enabling women to achieve their pregnancy intentions is essential for aiding program efforts to reduce unintended pregnancies. Objective: To measure ambivalence in pregnancy intentions longitudinally and determine its association with the quality of care received, controlling for demographic, socio-economic and contextual factors among a cohort of family planning (FP) clients in Kenya. Methods: This paper uses data drawn from a prospective cohort study of FP clients to investigate the relationship between the quality of care received during FP service delivery and the decisiveness of their pregnancy intentions over time. The study tests the hypothesis that higher quality of care enables women to be less ambivalent about their pregnancy intentions. Binary logistic regression with random effects and multinomial logistic regression were used to assess the predictive effect of the quality of care received by a woman on the decisiveness or ambivalence of her pregnancy intentions, and on any shifts in ambivalence over time, controlling for background characteristics. The study recruited 1,957 women aged 15–49 years attending twelve family planning clinics in four counties in Central Kenya; of these, 1,053 women were observed for four rounds of data collection over a period of 24 months and form the sample for analysis. Findings: A substantial proportion (43%) of women expressed ambivalence about their intentions to become pregnant at some point during the study period, while over half (57%) remained unequivocal throughout the study. Almost one third of women (31%) shifted from being unequivocal to ambivalent and 12% shifted from ambivalence to being unequivocal. Women experiencing higher quality of care have lower odds of ever expressing ambivalence and higher odds of remaining unequivocal over time, net of other factors. Quality of care was not associated with a shift in ambivalence over time. Conclusion: FP programs offering higher quality of care are likely to support women to be more decisive in their pregnancy intentions. Improving the quality of care can contribute to reduced ambivalence and consequently reduced likelihood of unintended pregnancy among contraceptive users. This study provides further evidence of the benefits gained through providing high quality services. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background The mere availability of family planning (FP) services is not sufficient to improve reproductive health; services must also be of adequate quality. The introduction of new contraceptive methods is a means of improving quality of care. The Standard Days Method (SDM) is a new fertility-awareness-based contraceptive method that has been successfully added to reproductive health care services around the world. Content Framed by the Bruce-Jain quality-of-care paradigm, this paper describes how the introduction of SDM in developing country settings can improve the six elements of quality while contributing to the intrinsic variety of available methods. SDM meets the needs of women and couples who opt not to use other modern methods. SDM providers are sensitised to the potential of fertility-awareness-based contraception as an appropriate choice for these clients. SDM requires the involvement of both partners and thus offers a natural entry point for providers to further explore partner communication, intimate partner violence, condoms, and HIV/STIs. Conclusion SDM introduction broadens the range of FP methods available to couples in developing countries. SDM counselling presents an opportunity for FP providers to discuss important interpersonal and reproductive health issues with potential users. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study in 2007–08 on the abortion experiences of teenage women from deprived backgrounds in Hong Kong. Twenty-nine young women aged 13–24 who had undergone one or more induced abortions in their teen years were interviewed and participated in group empowerment sessions. Ten were unemployed, four were students, the rest were employed on low pay in unskilled occupations. Abortion services are legal and available in public and private services, but they charge fees ranging from HK$310 to $10,000, and do abortions only up to 24 weeks of pregnancy. Many young women resort to poor quality illegal clinics and clinics in mainland China because the cost is lower, they do not wish to tell their parents, who would be asked for consent, and/or they want to protect their sex partners, who may be reported and prosecuted if the girl is under-age. There is a need to strengthen services for teenage women in Hong Kong, especially those who are pregnant and from deprived backgrounds. There is also a need for professionals who deliver adolescent health and social welfare services, and for society to rethink and re-examine its views and attitudes towards teenage pregnancy, sexuality and abortion. En 2007–08, une étude qualitative a porté sur les expériences de l'avortement d'adolescentes issues de milieux défavorisés à Hong Kong. Vingt-neuf jeunes femmes âgées de 13 à 24 ans qui avaient avorté une ou plusieurs fois pendant leur adolescence ont été interrogées et ont participé à des séances d'autonomisation de groupe. Dix étaient au chômage, quatre étaient étudiantes, les autres occupaient des emplois non qualifiés et peu rémunérés. Les services d'avortement sont légaux et disponibles dans des services publics et privés ; mais ils perçoivent des honoraires allant de HK$310 à HK$10 000 et ne pratiquent les avortements que jusqu'à 24 semaines de grossesse. Beaucoup de jeunes femmes ont recours à des centres illégaux de mauvaise qualité ou des centres en Chine continentale car ils sont moins coûteux, elles ne souhaitent pas le dire à leurs parents qui devraient donner leur consentement, et/ou elles veulent protéger leur partenaire sexuel, qui pourrait être dénoncé et poursuivi si la fille est mineure. Il faut renforcer les services pour adolescentes à Hong Kong, en particulier celles qui sont enceintes et issues de milieux défavorisés. On a également besoin de professionnels qui assurent des services de santé et de protection sociale des jeunes alors que la société devrait repenser et réexaminer ses idées et ses attitudes à l'égard de la grossesse, la sexualité et l'avortement chez les adolescentes. En este artículo se informa acerca de un estudio cualitativo realizado en 2007–08 sobre las experiencias de aborto de mujeres adolescentes de clases carenciadas en Hong Kong. Se entrevistaron 29 jóvenes de 13 a 24 años de edad, que habían tenido uno o más abortos inducidos entre los 13 y 19 años, quienes también participaron en sesiones de empoderamiento en grupo. Diez estaban desempleadas, cuatro eran estudiantes y el resto de ellas estaban empleadas en ocupaciones no especializadas de bajo salario. Los servicios de aborto son legales y accesibles en establecimientos públicos y privados, pero estos cobran entre HK$310 y $10,000 y realizan abortos sólo hasta las 24 semanas del embarazo. Muchas jóvenes recurren a clínicas ilegales de mala calidad y a clínicas en China continental porque el costo es más bajo, no quieren informar a sus padres, a quienes se les pediría su consentimiento, y/o quieren proteger a su pareja sexual, quien podría ser denunciada y enjuiciada si la niña es menor de edad. Es necesario fortalecer los servicios para mujeres adolescentes en Hong Kong, especialmente para aquéllas que están embarazadas y son de clases carenciadas. Además, es necesario que la sociedad y los profesionales que proporcionan servicios de salud y asistencia social a las adolescentes reconsideren y reexaminen sus puntos de vista y actitudes hacia el embarazo, la sexualidad y el aborto en la adolescencia. [ABSTRACT FROM AUTHOR]

Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice. [ABSTRACT FROM AUTHOR]

The low contraceptive prevalence rate and the existence of unmet demand for family planning services present a challenge for parties involved in family planning research in Tanzania. The observed situation has been explained by the demand-side variables such as socioeconomic characteristics and cultural values that maintain the demand for large families. A small, but growing body of research is examining the effect of supply-side factors such as quality of care of family planning services on the demand for contraceptives. This paper analyses the demand and supply factors determining contraceptive use in Tanzania using the Tanzania Service Availability Survey (1996) and the Tanzania Demographic and Health Survey (1996) data sets. The results show that access to family planning services and quality of care of services are important determinants of contraceptive use in Tanzania even after controlling for demand-side factors. [ABSTRACT FROM AUTHOR]

Family planning was once a sensitive issue in Indonesia, but today it is considered essential. This paper reports on a study in 1997–98 of the role of village family planning volunteers and the cadres who worked under them in West Java, Central Java and DI Yogyakarta, in implementing the national family planning programme in Indonesia. A total of 108 village family planning volunteers, 108 family planning cadres, 108 local leaders and 324 couples eligible for family planning from 36 villages in the three provinces were interviewed. The volunteers and cadres have made a significant contribution to the implementation of the family planning programme. They promote family planning, organise meetings, provide information, organise income-generation activities, give savings and credit assistance, collect and report data and deliver other family welfare services. Teachers, wives of government officials and others recognised by the community as better off in terms of education and living conditions were most often identified to become family planning volunteers. Because they are women and because they are the most distant arm of the programme, their work is taken for granted. As their activities are directed towards women, especially in women's traditional roles, the programme tends to entrench the existing gender gap in responsibility for family planning and family welfare. La planification familiale était jadis une question sensible en Indonésie, mais elle est aujourd'hui jugée essentielle. Une étude, menée en 1997-98 à Java occidental, Java central et DI Yogyakarta, a analysé le rôle des bénévoles villageois de planification familiale et des cadres qui ont travaillé sous leur direction dans l'application du programme national de planification familiale en Indonésie. Elle a interrogé 108 bénévoles villageois et 108 cadres de planification familiale ainsi que 108 décideurs locaux et 324 couples pouvant prétendre aux services de planification familiale de 36 villages dans les trois provinces. Les bénévoles et les cadres ont fait une contribution importante à la réalisation du programme. Ils encouragent la planification familiale, organisent des réunions, distribuent des informations, créent des activités rémunératrices, apportent une aide pour l'épargne et le crédit, recueillent et transmettent les données et assurent d'autres services de protection familiale. Le plus souvent, ce sont des enseignantes, des épouses de fonctionnaires et d'autres personnes jugées plus instruites ou plus aisées par la communauté qui ont été choisies pour devenir bénévoles. Parce que ce sont des femmes et qu'elles sont le bras le plus éloigné du programme, leur travail semble aller de soi. Comme les activités sont axées sur les femmes, particulièrement dans les rôles féminins traditionnels, le programme tend à conforter l'écart existant entre les sexes dans la responsabilité de la planification familiale et du bien-être de la famille. Antes un tema delicado en Indonesia, la planificación familiar (PF) es considerada esencial hoy en día. En este artículo se informa de un estudio realizado en 1997–98 de la función de los voluntarios de planificación familiar y los sub-voluntarios bajo su mando en Java Occidental, Java Central y DI Yogyakarta, en la implementación del programa nacional de PF en Indonesia. Se entrevistó a un total de 108 voluntarios comunitarios en PF, 108 sub-voluntarios en PF, 108 líderes locales y 324 parejas elegibles para la PF provenientes de 36 poblados en las tres provincias. Los voluntarios y sub-voluntarios han ayudado en gran medida a implementar el programa de PF. Ellos promueven la PF, organizan reuniones, proporcionan información, organizan actividades para generar ingresos, brindan ayuda con ahorros y crédito, recolectan e informan datos y proporcionan otros servicios para el bienestar de la familia. Los maestros, las esposas de los funcionarios gubernamentales y otros reconocidos por la comunidad por estar en mejor posición en cuanto a su formación y condiciones de vivienda, fueron señalados con más frecuencia como buenos candidatos para ser voluntarios en PF. Por ser mujeres y el brazo más distante del programa, su trabajo no es valorado. Dado que sus actividades están dirigidas hacia las mujeres, especialmente en sus papeles tradicionales, el programa tiende a afianzar la brecha actual entre sexos en la responsabilidad de PF y el bienestar de la familia. [ABSTRACT FROM AUTHOR]

This paper evaluates the effectiveness of the ‘Spot the Hazard’ farm safety resource which employs 3-D visual stimuli to develop rudimentary risk assessment skills in children. Primary school children from three local schools in north-west New South Wales were presented with the resource and talked about the farm hazards present. Children’s recall of the hazards and the extent to which they compared the resource to their own farm was assessed after an initial presentation at post-tests of 1, 14 and 28 days, across three experimental groups. Individual differences in achievement were controlled for using the Wechsler Individual Achievement Test-Screener (WIAT). Analysis revealed that children exposed to the resource recalled significantly more hazards and made more comparisons to their own farm experiences than controls. However, differences on individual achievement were observed between groups due to a lack of randomisation. Farm safety educational resources for children are more effective when verbal and nonverbal strategies are used and when children are exposed to such cues repeatedly. The development of farm safety educational resources for children which employ spatial cues is encouraged. Further clarification of results would entail a more rigorous randomised control trial. [ABSTRACT FROM AUTHOR]

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services. [ABSTRACT FROM AUTHOR]

The article presents information on a sampling of various kinds of programs and contraceptive services offered by family planning agencies for hard-to-reach populations like substance abusers and the disabled. The paper also examines some of the problems that agencies encounter in their efforts to serve these groups. Some agencies provide services at their clinics, while others conduct outreach and provide education and family planning services in substance-abuse treatment centers, homeless shelters, prisons and other nontraditional sites where hard-to- reach populations live or congregate.

Abstract: This paper analyzes the evolution of the federal family planning program from 1960 to 1980. Political pressure to offer family planning raised the question how, best to organize services. Longstanding providers preferred a categorical approach in order to maintain a diverse political coalition for an historically invisible service. In addition, categorical funding meant financial support for non-traditional providers. A compelling argument was also made for service integration, Given an expanded definition of health and the medicalization of contraceptive technology, the health delivery system presented itself as the appropriate service provider. Neither group prevailed. By 1980, federally supported family planning services were provided in autonomous clinics but also were integrated into existing maternal and child health programs. The debate continues but under the Reagan Administration, terms and motivations differ from those of the past. [ABSTRACT FROM AUTHOR]