Dorothy Nortman

CONTRACEPTIVE PRACTICE REQUIRED TO MEET A PRESCRIBED CRUDE BIRTH RATE TARGET: A PROPOSED MACRO-MODEL (TABRAP) AND HYPOTHETICAL ILLUSTRATIONS

TABRAP (TArget Birth Rate Acceptor Program) is a computer programmed model that provides a direct solution to the problem of determining the total annual numbers of contraceptive acceptors required to achieve a prescribed crude birth rate target path. Applied to an initial population for which age structure, the fertility schedule, and expected trends in life expectancy and age-specific proportions of females married are known, TABRAP incorporates the following factors: age at acceptance, with acceptors drawn from currently married nonusers; age-method-specific attrition rates of users; a potential fertility schedule of acceptors that allows for aging and sterility; and allowances both for postpartum anovulation and nine months for gestation to time properly the averted births. TABRAP generates annual data on acceptors, couple-years of use, births averted and age-specific fertility rates that meet the crude birth rate target. Resulting changes in population size, age structure and crude vital rates, also yielded, are invariant with respect to acceptor age and method mix. Assuming a target to reduce the crude birth rate from 45 to 30 in ten years, TABRAP is illustrated for seven mixes of acceptor age-method combinations applied to a population approximating that of Thailand, circa 1965.

A method for calculating rates of induced abortion

Accurate measurement of induced abortion is necessary for understanding the fertility dynamics of a population and for making projections about the future. Changes in abortion rates can amplify or dampen the impact of changes in contraception. This paper presents a methodology for calculating marital induced abortion rates from observed marital fertility and contraceptive prevalence and for modeling the impact of substituting contraception for abortion on future fertility. The methodology is validated against observed abortion complications in three populations, and the impact of substituting contraception for abortion on expected fertility is demonstrated.

Sterilization and the birth rate.

Sterilization remains irreversible for all practical purposes, but as its procedures become more feasible in developing countries, the question of its potential contribution to fertility decline vis-à-vis other contraceptive methods has increasing significance for family planning program administrators. This question is examined by means of a model that calculates births averted in defined time durations from the acceptance of various contraceptive methods by women of different ages. The findings suggest that without ready access of the population to reversible contraceptive methods that are attractive to birth spacers and tentative birth terminators, the rate of fertility decline is not likely to be satisfactory regardless of the availability, promotion, or popularity of sterilization.

A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSSs family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexicos 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSSs family planning services.

Population policies in developing countries and related international attitudes.

Population policies of governments which specifically aim at reducin g rates of growth are a post-World War 2 phenomenon. Increasing understanding that high fertility hampers efforts at development is leading to consideration of national family planning programs in many countries of the world. Public opinion polls show that people in various parts of the world have an ideal family size and would act to limit their births to this ideal if they knew it were possible. The national population policies of India Pakistan and Korea are discussed. Malaysia Hong Kong Ceylon Puerto Rico and Barbados do not have national programs but have encouraged voluntary family planning programs. The status of selected other countries as to family planning attitudes and programs is mentioned. International action concerning population matters is also mentioned.

Quantity vs. Quality of Life.

The world population rate is thought to be still increasing. The present age structure of the world population ensures continued growth well into the next century. Among underdeveloped countries this is more acutely the case and fertility is 2-3 times the level needed for replacement. This is a serious obstacle to economic development. As a group the less-developed countries are growing at 2.5% per year and the more developed countries at 1% per year. There is no yardstick by which to measure economic development or to draw quantitative inferences concerning social and economic well-being. Per capita income as an indicator of economic development has many limitations. It is a difficult figure to compile it does not reflect differences in the purchasing power of local currencies and it is of limited value for international comparisons. Today since military strength is more a matter of technology than numbers and since populations are growing at rates that become an economic burden developing countries are adopting policies and programs designed to reduce rates of population growth. Thus far however countries have not found it technologically feasible administratively practical and/or politically strategic to advocate or enforce strong measures that go beyond family planning.