 - Quality of Care in China: Scaling Up a Pilot Project into a National Reform Program
Joan Kaufman is Director, AIDS Public Policy Project, John F. Kennedy School of Government, Harvard University and Senior Scientist, Heller School of Social Policy and Management, Brandeis University, Mailstop 035, Waltham, MA 02454–9110. Zhang Erli is former Director-General of Statistics and Planning Department, National Population and Family Planning Commission, China, and Xie Zhenming is Deputy Director, China Population and Development Research Center. E-mail: joankaufman@levineonline.com. China’s family planning program ranks as history’s most intensive effort to control national population growth. Although advocates for global population control have lauded China’s effort to limit births as a fundamental part of its sustainable development goals, the country’s population policy has also generated much international criticism. As China enters the new millennium, a long-overdue reform of its approach to implementing its family planning program has begun to refocus the program on clients’ needs, informed choice of contraceptives, and better-quality services. Originally inspired by the 1994 International Conference on Population and Development held in Cairo, the reform program began as a pilot project among six counties and has now become a blueprint for reorienting the national family planning program. This article reviews the process by which a small, innovative pilot project was scaled up into a national reform effort and the key lessons learned about scaling up sensitive but necessary innovation in a difficult political environment. (Studies in Family Planning 2006; 37[1]: 17–28)
- Farming with Your Hoe in a Sack: Condom Attitudes, Access, and Use in Rural Tanzania
Mary L. Plummer is Lecturer, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK. Daniel Wight is Nonclinical Scientist, Social and Public Health Sciences Unit, Medical Research Council, Glasgow. Joyce Wamoyi is Graduate Researcher, NIMR/AMREF/LSTM/LSHTM Collaborative Projects, Mwanza, Tanzania. Gerry Mshana is Research Scientist, National Institute for Medical Research, Mwanza, Tanzania. Richard J. Hayes is Professor, and David A. Ross is Reader, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London. E-mail: mary.plummer@lshtm.ac.uk. This study examines condom knowledge, attitudes, access, and practices in rural Mwanza, Tanzania. From 1999 to 2002, six researchers carried out participant observation in nine villages for a total of 158 person-weeks. Many villagers perceived condoms negatively for multiple reasons, for example, the method’s association with infection or promiscuity, reduced male sexual pleasure, and cultural understandings of meaningful sex. Men controlled the terms of sexual encounters and reported that they would use condoms only with risky partners, but few perceived their partners as such. Use of condoms appeared to be very low, primarily as a result of limited demand, although barriers to access also existed. These qualitative findings contrast with inconsistent survey reports of relatively high condom use in the same population. Intervention efforts should address the tradeoff between possible short- and long-term consequences of condom use, particularly for men, for example, reduced pleasure versus reduced HIV risk. If possible, surveys should assess the validity of reported condom use through comparison with other data, including qualitative findings and distribution/sales records. (Studies in Family Planning 2006; 37[1]: 29–40)
Cynthia K. Stanton is Assistant Professor, Department of Population and Family Health Sciences, and Sara A. Holtz is a doctoral candidate, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail: cstanton@jhsph.edu. Evidence suggests that cesarean birth rates are high and increasing in some developing countries. The objectives of this study are to compile the best current estimate of cesarean birth rates for developing countries, to estimate regional rates, and to document trends nationally and by urban/rural residence where data permit. A database of cesarean birth rates was compiled representing 90 percent of births in the developing world, resulting in an estimated cesarean birth rate for the developing world of 12 percent, with regional rates ranging from 3 to 26 percent. Data representing 45 percent of births in the developing world show that a majority of countries experienced increases in cesarean birth rates during the 1990s, except in sub-Saharan African countries, where little if any change occurred. Cesarean birth rates must be monitored routinely to call attention to rapidly changing practices. These data can, in turn, trigger investigation into the appropriateness of the rate in a given context. (Studies in Family Planning 2006; 37[1]: 41–48)
- The Quality of Hospital-based Antenatal Care in Istanbul
At the time this study was conducted, Janet Molzan Turan was Researcher, Nuriye Ortaylı was Obstetrician/Gynecologist, and A. Arzu Koloğlu Akalın was Resident, Family Health Department, Institute of Child Health, Istanbul University. Currently, Ayşen Bulut is Director and Hacer Nalbant is Research Assistant, Family Health Department, Institute of Child Health, Istanbul University. Correspondence should be directed to Janet Molzan Turan, 103 Hoskins Court, Apartment 102, Stanford, CA 94305. E-mail: jmturan@gmail.com. The aim of this study was to gather comprehensive data from three hospitals in Istanbul, Turkey, in order to gain in-depth understanding of the quality of antenatal care in this setting. The Bruce-Jain framework for quality of care was adapted for use in evaluating antenatal care. Methods included examination of hospital records, in-depth interviews, exit questionnaires, and structured observations. The study revealed deficiencies in the quality of antenatal care being delivered at the study hospitals in all six elements of the quality-of-care framework. The technical content of visits varied greatly among the hospitals, and an overuse of technology was accompanied by neglect of some essential components of antenatal care. Although at the private hospital some problems with the technical content of care were identified, client satisfaction was higher there, where the care included good interpersonal relations, information provision, and continuity. Providers at all three hospitals felt constrained by heavy patient loads and a lack of resources. Multifaceted approaches are needed to improve the quality of antenatal care in this setting. (Studies in Family Planning 2006; 37[1]: 49–60)
Book Reviews Population Association of Pakistan
Population Research and Policy Development in Pakistan: Fourth Annual Research Conference Proceedings, 9–11 December 2003
Amy O. Tsui is Professor, Population and Family Health Sciences Department, Johns Hopkins Bloomberg School of Public Health Sandy Ruxton, editor
Gender Equality and Men: Learning from Practice
Margaret E. Greene is Associate Professor and Interim Chair, Department of Global Health, School of Public Health and Health Services, George Washington University
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