PIP: Family planning in Malaysia is discussed. Family planning began in Malaysia about 15 years ago through the efforts of voluntary family Planning Associations in the various Malay states. In 1966 the Malaysian Parliament passed the National Family Planning Act setting up the National FAmily Planning Board to formulate policies and methods for the promotion and spread of family planning knowledge and practice on the grounds of health of mothers and children and welfare of the family. In 1967, the board set a target of 40,000 new acceptors of family planning and 90% of the target was reached. This represents 3% of the child-bearing married women aged 15-49. The target for 1968 of 65,000 new acceptors is being achieved. A survey of acceptors is to be carried out from December 1968 to April 1969 to ascertain how many women who accepted family planning continue to practice it. Malaysia's crude birth rate declined from 46.2 in 1957 to 37.3 in 1966 before the government program was instituted. Abortion attempts have been frequent. The main method of contraception used is oral contraceptives. According to a 1957 survey, 31% of the married women in the metropolitan areas and 2% of rural women were using contraception. Presently, in Malaysia there is a need to: 1) train personnel to provide services, 2) inform and motivate families to accept family planning, 3) continue a broad educational program, 4) reform Malaysia's antiquated abortion law, and 5) integrate family planning services more fully into the general health services of the country.
PIP: What proved to be a lively yet highly technical conference on the assessment of the acceptance and use-effctiveness of family planning methods was held in Bangkok last June by ECAFE on the initiative of Dr. C. Chandrasekaran, the regional demographic adviser. The meeting was attended by a strong contingent of demographers, sociologists and statisticans from the USA and by workers from Hong Kong, India, Indonesia, Korea, Malaysia, Pakistan, the Philippines, Singapore, Taiwan and Thailand. There were representatives of FAO, WHO and the Population Division of the UN. The conference considered and debated a wide range of issues involved in evaluation, from the definition of terms to detailed procedures in the calculation of indices and the detection of fertility trends. A certain amount of new ground was broken with the introduction of the concept of "extended use-effectiveness" (the study of pregnancy rates among acceptors of a method beyond the point of discontinuance) and the presentation of new methods of calculating births prevented by contraceptive use. Some progress was made towards laying down standards for the frequency of performance of surveys, both of K.A.P. in populations at large, and of contraceptive continuance and event-rates among acceptors. Attention was given to the special problems of evaluation presented by oral contraceptives, and by data on abortions and sterilizations. The proven usefulness of the life-table method of studying use-effectiveness was reaffirmed, and work on refining this now basic tool of evaluation was reported. A number of quite different schemes of data collection and processing for study of the characteristics of acceptors was described, and it was accepted by the participants that, although as much standardization as possible was desirable, each programme must make its own selection from the range of possibilities in the light of specific conditions. In addition to the main lines of analysis of use-effectiveness and programme effectiveness, the conference spent some time on discussion of such subjects as cost analysis, sensitive indices of fertility change, and the use of models in connection with programme study and evaluation. The specific evaluation needs and procedures of a number of countries in the ECAFE region were described. Although the conference fell far short of providing a comprehensive and agreed set of rules for the evaluation of family planning programmes. Indeed this was not its objective it admirably performed the function of acquainting theoretical and practical workers with each other's problems, and ensuring that all concerned were brought up-to-date on the progress being made in the region in the development and use of evaluation tools.
PIP: 292 village midwives (bidans) in Malaysia were interviewed between January 1969 and December 1970 as they came to report for training. The mean age was 47.3, 80% had had no schooling, 43% had practiced less than 10 years (32% between 10 and 20 years, 21% between 20 and 30 years, and 4% more than 30 years). On the average each bidan reported attending 3 deliveries during the past month and 26 during the past year. The average charge per delivery was about U.S.$2.00. Of 267 who responded to a question concerning other services they provided, 50% said they performed massages, 30% performed massages combined with other services, 12% said they did not do anything other than midwifery and 7% prescribed herbs and performed abortions. 67% said they first had contact with the mother during the seventh to ninth month of pregnancy, 42% between the fourth and sixth month, and 7% at or before the third month. 40% said the postpartum care lasted less than 1 week, 40% from 1-2 weeks and 19% between 2-7 weeks. Only 2 out of 198 bidans disapproved of family planning services. 99% were not worried that this would affect their job in conducting deliveries. 62% had been approached by women about family planning information services during the last 3 months. 95% thought they could help to promote the government's program by recruiting patients and distributing contraceptives. Since oral contraceptives are the most frequently used contraceptive in Malaysia, bidans could resupply the women with the pill. They could play an important role in promoting contraceptive continuation in rural areas by providing women with a continuous motivation through their constant contact. The success of using bidans in rural family planning services will greatly depend on their supervision. They can be paid with a flat salary-type payment, with an incentive scheme alone, or a combination of the two.
PIP: Organizational and content features of various national family planning programs are reviewed. The Thai program is cited as an example of a family planning program organized on a massive unipurpose compaign basis. The Korean and Taiwan programs have utilized special field workers while upgrading the general health care network. 3 major problems with family planning programs are: 1) the lack of experience with such programs; 2) lack of commitment at the highest political levels; and 3) medical conservatism. Utilization of all available contraceptive methods instead of reliance on 1 method would improve most programs. Nursing and auxiliary personnel could be trained to take over the work of physicians in family planning programs. This is already being done with IUD insertion and pill prescription in several programs. The postpartum tubal ligation approach has proven effective and should be extended. There is a place in all national programs for both the private and the commercial sectors. Incentives for clinics, personnel, and acceptors might spread family planning more rapidly.
PIP: In Thailand "granny" midwives are being tested and trained to take part in modern family planning and public health programs. In Malaysia a survey of conditions relating to an increase in induced early termination or abortion of pregnancies is in progress. The International Development Research Centre (IDRC) supports these projects as well as others in Asia. Local paramedical workers, like the "barefoot doctors" in China, are being trained. In Thailand a growth plan is attempting to reduce the annual rate of population increase from about 3.3% to 2.5%. Many granny midwives have been contacted. Several methods of incentive and training are being tried and will be evaluated. Eventually granny midwives in all of Thailand's 60,000 villages will be enlisted in the national planning program. Of Thailand's 6 million married women of reproductive age less than half use modern birth control methods. Abortion is illegal in Thailand which is a predominantly Buddhist country. The project in Malaysia is being carried out by the University of Malaysia and the Federation of Family Planning Associations. Abortion is also illegal in Islamic Malaysia, although there are illegal abortion clinics. Trends so far reported to IDRC indicate that 1) lower class women are more cooperative interviewees than others, 2) most couples use some method of birth control, 3) many wish to interrupt their pregnancies, 4) poorer families have more children than wealthier ones, 5) the Chinese and Indian people show a greater tendency to limit families than do the Malays, and 6) most couples want 3 or 4 children.
PIP: Observations are made related to the review of family planning activities in East Asia in 1973. The number of new acceptors for the region increased from 2.7 million in 1972 to 3.4 million in 1973. The leaders were Indonesia, which almost doubled its achievement of calendar year 1972, the Philippines, and Korea. In Thailand, the number of new acceptors dropped by about 10%. South Vietnam is the only country in the region without an official policy. Most couples still think that the ideal number of children is 4, with at least 2 sons. Some religious opposition does exist, particularly with reference to sterlization and abortion. More attention is being paid to women in their 20s. Sterilization and condoms are becoming more popular. Korea reports a sharp increase in vasectomies. Better methods and continuation rates should be stressed. In Taiwan a couple who start with 1 method and continue to practice some method lower their reproduction rate by 80%. More responsibility is being delegated to nurses and midwives, but too slowly. In Indonesia, the number of field workers rose from 3774 in 1972 to 6275 in 1973. The Philippines and Thailand are experimenting to see what kind of workers get best results and under what kind of salary and incentive arrangements. In-service training tends to be neglected, but preservice training is improving. Costs, in general, have risen, though in Korea the cost per acceptor has dropped from US$8.00 to US$7.80. Korea and Taiwan have reduced their annual population growth rates by more than 1/3 in 10 years, from 30 to 19-20 per 1000 each. Singapore's rate is 17 and Hong Kong's 14 (exclusive of inmigration). The number of couples currently practicing contraception in Singapore is 71%. Target systems assigning quotas to clinics are generally used except in Thailand and Malaysia, where programs emphasize maternal and child health, rather than population planning. Most programs require about 10 years to get the annual growth rate down to 2% by voluntary family planning. To get it down to 1.5% will probably take another 10 years.