Niger\'s Quality Assurance Project has improved the delivery of primary health care services and facilitated the implementation of decentralization. In the Tahoua region, a multidisciplinary Quality Improvement Team has addressed the problem of child malnutrition by arranging for children to be assessed and treated in the same day by a team of providers. As a result of this intervention, child dropout rates at the health center dropped from 40% to 20%, the nutritional rehabilitation rate rose from 7% to 34%, average counseling time increased from one to five minutes, and the average waiting time was reduced from four hours to 40 minutes. Collaboration between the Tahoua departmental and district health services and the Quality Assurance Project has strengthened the analytical skills and action-oriented decision-making capabilities of district-level staff. On the basis of the Tahoua region\'s successful experience, the Government of Niger is considering the integration of quality assurance measures into broader health sector reform.

The family planning program of the Republic of Korea has been quite successful, yet it has not been able to extend its services to all couples of childbearing age. There still exists a group of couples who want no more children and yet are not currently using any contraceptive method. The word pong-eem which literally means being neglected, i.e. untouched by the family planning program, was coined to describe this group. National surveys have shown that the proportion of women of reproductive age in this group is significant. The study on which this article is based focuses on the psychosocial characteristics of the group to provide policy makers, family planning administrators and workers with the specific information they need in order to reduce its size. Among the factors affecting the family planning decisions of couples is demographic pressure. However, there was no statistically significant relationship between demographic pressure and family planning status. With regard to the couples\' knowledge about contraception, the higher the respondents\' level of knowledge was, the lower was their proportion in the pong-eem group. In both the urban and rural areas, the proportion of women in the pong-eem group was higher among those who disapproved of the Government\'s population policies. The proportion of women in the pong-eem group was much higher among those who were least motivated to limit family size. The lower the level of social support for family planning, the higher was the proportion of women in the pong-eem group in both the urban and rural areas. Among the psychosocial characteristics, social support for family planning was the most closely related to the family planning status of couples no matter what measure of social support was used.

\"This analysis examines the institutional context of infant mortality in Peru using economic, social, health care, and public health measures as indicators of development and equity. Using linked data from population and economic censuses, government agencies, and health surveys on twenty-four Peruvian provinces, I explore how economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women\'s illiteracy, monthly income, Gross Domestic Product, medical care, and health facilities are compared. Then a cluster analysis identifies institutional contexts that have internal similarities.... My conclusion is that understanding regional inequities--defined in terms of economic development, social institutions, and health services--leads to enhanced explanations of disparities in health outcomes.\"
Increasingly, attention is being given to institutional contexts to explain differential demographic and health outcomes. Regional inequality in terms of economic development, social institutions, and health services leads to regional disparities in health outcomes, especially infant mortality. The author uses linked data from population and economic censuses, government agencies, and health surveys on 24 Peruvian provinces to explore how differential economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women\'s illiteracy, monthly income, gross domestic product, medical care, and health facilities are compared, with a cluster analysis identifying institutional contexts which have internal similarities. These contexts are able to discriminate differences in infant mortality. The analysis demonstrates that infant mortality in Peru varies systematically with social, economic, and medical contexts. Economic development, income and subsistence levels, women\'s literacy, and the amount of medical care and public health services influence health outcomes. It is clear that understanding such regional inequities can help explain disparities in health outcomes.

Civil war has raged in southern Sudan from 1955 to 1972 and again from 1983 to the present. This situation has been compounded by regional conflicts in other parts of Sudan and wars in neighboring countries. The consequences of war are taking their toll on the entire region and are intensified by environmental hazards, desertification, drought, and famine. The socioeconomic and educational infrastructure has been destroyed in southern Sudan, taking the family support system with it. The atmosphere of continued fighting has made it all but impossible for relief agencies to provide services. The innocent victims of the war are civilians who are forced to choose between disastrous alternatives: if they flee, they lose their homes, their livelihoods, and their communities; if they stay, they watch these things being destroyed around them. Women and children are suffering the most. Hunger and disease are widespread, and immunization programs have been curtailed. Very few school-age children are receiving an education, and children are subject to kidnapping and abuse from soldiers. There may be as many as 3 million people displaced, with 1.5 million living in settled areas and 707,000 in camps in the Khartoum area. Relief aid in the camps is unreliable, and the displace women arrive with no assets or skills. They survive through domestic work, begging, petty trading, or beer-brewing and prostitution (the latter 2 are illegal). Children are left to fend for themselves all day or to find work in situations where they are exploited. In addition to depriving the children of their health, education, and economic stability, the war has resulted in cultural deprivation as ethnic groups lose their sense of identity. Psychological problems are the natural consequence of this situation, and aggressive behavior is seen in the displaced children, while trauma and anxiety plague the children in the war zones.

In 1970, a Dutch medical team began work in the city of El Kef in Tunisia on a project designed to bring family planning into rural areas. The project aimed to persuade the rural people to use urban health centers, but this approach failed partly because of the remoteness of the communities and their reluctance to discuss personal matters with strangers. Funded by UNFPA, a new project began to recruit and train local girls as home health visitors or aides-familiales, an approach which became the central focus of the El Kef project. The International Planned Parenthood Federation (IPPF) took over the project and expanded it to include nutrition, health care, health education, family planning, disease prevention and domestic crafts. 4 goals were fixed for the project: total vaccination coverage for children; elimination of severe malnutrition; reduction of infant mortality; and use of family planning practice by at least 1/2 the women of childbearing age. An efficient recordkeeping system enabled the project to be carefully evaluated and provides much-needed data, showing where it has achieved its aims and where new efforts should be directed. The project resulted in large numbers of women receiving ante-natal advice, child care and family planning from their local health centers. 860 pregnant women were followed up during the 3-year study period. Some 57% of pregnant women went for advice; only 15% went for postnatal care, but 50% of the women under 50 attended child welfare sessions during the study period for weight checks, nutrition advice, vaccination and treatment for minor ailments. Over the 3 years, the number of contraceptive users more than trebled, from 14% to 54%. The IUD was the most popular method. The most successful aspect of the project was the emphasis on maternal and child health, and the home visits were the most motivating feature. Vaccination became more popular. A further aspect of the project was the training in home improvement skills, like sewing, knitting and gardening. After 4 years in the field the aides familiales were a valuable resource of skill and experience. Family planning was integrated with maternal and child health in the government program through the health infrastructure.

This issue of The Family Planning Manager presents a narrative of a fictional workshop for District Health Officers on consolidation of vertical family planning (FP) programs into integrated reproductive health programs that offer a full range of services. In the main session of the workshop, participants are told that the progress of a reproductive health program can by tracked by: 1) identifying the main reproductive health program areas, 2) identifying national and local indicators for each program area, 3) developing baseline objectives for each indicator, 4) preparing an indicator panel that will allow comparison of the current situation with objectives, 5) collecting and analyzing data on a periodic basis and entering data on the indicator panel, and 6) determining how well objectives for each indicator are being met and devising a management action to improve the program. The workshop than breaks into small groups representing various districts, and the narrative follows one such group as it creates a chart identifying the main reproductive health program areas for the district, identifying local indicators for each program area, assigning local-level data to each indicator, and establishing year-end objectives. The resulting chart presents 11 indicators for six reproductive health areas (FP, infant health, maternal health, infant nutrition, reproductive tract infection/sexually transmitted disease/HIV services, and adolescent health). Additional activities presented (and completed) are to 1) identify two possible sources of data collection for each indicator, 2) analyze progress meeting objectives based on quarterly statistics, and 3) list management actions that would help the program reach each objective.

This is an account of the immediate and long-term effects of an abortion law enacted in 1966 in Romania to reverse decreasing fertility. The author discusses the previously existing situation, in which 80 percent of pregnancies were terminated, and the consequences of the abrupt change to tight restrictions on both abortion and divorce. The decree\'s consequences in terms of illegal abortion, quality of medical care, maternal and infant mortality, and unwanted children are considered. It is noted that women have found ways to reduce fertility in spite of the state\'s actions to stimulate it.

This paper is culled from a report presented by Dr. Mahmoed at the Workshop for the Development of an Integrated Project held in Ho Chi Minh City, Vietman, from October 16-23, 1986. The Indonesian Planned Parenthood Association (IPPA) central office and its local branch in the Majene Regency, while developing a strategy to help the people accept and practice the concept of small family size, noticed the problem of parasites, especially the hookworm, which affected sanitation and nutrition. In 1981, a small project was started in one of the villages, integrating family planning with community development and self-reliance through the development of women\'s skills and establishment of cooperatives. The project objective was to increase the acceptance and practice of small family size, through integration with parasite control, nutrition, and sanitation efforts, backed up by community participation and self-reliance. The family planning project has achieved qualitative and quantitative results. As for the sanitation problem, the village people have been provided a clean and safe water supply. In regard to parasite control, anthelmintics are now sold under a cooperative scheme. For the local government, the project has served as a model of a suitable strategy for an integrated project.

The government of Bangladesh considers the population problem to be the major problem for the country. For the purpose of economic planners, the estimation of births averted under a program is an important aspect of any evaluation. The estimation of births averted is a measure of the quantitative change in the expectations, assessed in terms of probabilities, of future births to a cohort of women resulting from the adoption or modification of birth control practice by them or their husbands. The data used represent a cross section of women in rural society. The age specific continuation rates are calculated by single decrement life table technics. After calculating the estimates of births averted by the sample of acceptors, these numbers are converted to a ratio of births averted/1000 acceptors. The births averted/1000 women are 70 after 3 months, 142 after 6 months, 172 after 9 months, and 218 after 12 months. Findings relate only to use of oral contraception; additional births are averted by acceptors who, upon discontinuing their method for 1 reason or another, switch to another method. Based on the number of live births averted, the Uthali Family Planning Program will make an important contribution to fertility decline in Bangladesh\'s rural areas in the following decades.

The infant mortality rate is a sensitive indicator of a country\'s or area\'s economic, cultural, and health care conditions, and in particular, it reflects the quality of health care for women and young children. Since liberation, great progress has been achieved in Shanghai\'s health and medical care in general as well as in health care for women and young children, and the infant mortality rate has dropped notably. However, the omission of reports on infant deaths is still a very serious problem. In order to control such omissions in reporting, the Shanghai municipal government and Department for Public Health have improved the methods of reporting deaths. Health care units are required to fill out a report on births and deaths, and census registers in the city government are responsible for registering all new births and deaths and preparing complete statistics on new births and deaths. At the end of each year, special investigators are sent to various hospitals to check on omissions of reports on infant deaths and they also help households to report infant deaths to census registers. The new measures have proved to be very effective. According to a new report released in 1980, the omission of reports on infant deaths has been reduced by 94.01% as compared with the 1972 statistics.