Data from Malaysia on the reproductive goals of husbands and wives are analyzed to determine level of agreement, using new scale measures on preferences for number and sex of children as well as the conventional measure of desired number of children. The level of agreement between husband and wife varies considerably depending on the focus of analysis and the measure of agreement used. Overall aggregate agreement of men and women is high but lower for subgroups of the population, particularly among various ethnic groups. For marital partners, the agreement is much lower, especially on sex preferences. The level observed depends on whether the measure is identity of responses or an index of homogeneity which allows for couple concordance based on chance or common socialization factors. The views about the reproductive goals of one marital partner cannot with confidence be assumed to represent the views of the other.
PIP: The goals of the Malaysian Family Planning Program are not only to reduce population growth from 3% to 2% by 1985 and to bring the crude birth rate to 28.2 from 30.3, but to generally improve the health of the family, and to enhance the government's efforts to raise the per capita income. The work program is divided into the Creative Unit, the Media Unit, the Production Unit, and the Field Diffusion Unit. The objectives are to build up strong support from political, community, and opinion leaders, and to run educational campaigns aimed at motivating potential acceptors. The program also runs centers training medical and paramedical personnel. The program is combined with development programs for women, especially useful among the rural population.
The unmet need for family planning services is remarkably constant across all five countries because of the interaction of fertility intentions and fertility control: as more women use contraception, more of them want fewer children.
Which factors have the greater influence on family planning performance: fixed background variables such as racial composition, urbanization, and mortality, which are affected by level of development, or program inputs such as assignment of personnel and location of clinics, which are subject to manipulation by administrators? An analysis of differences in family planning acceptance among 70 districts of Malaysia shows that two main program-manipulable variables--level of personnel deployment and accessibility of clinics--have the largest direct effect upon acceptance levels. Variations in background factors explain a smaller proportion.
PIP: The application to the Malaysian family planning program of a conceptual model in which background factors, affected by the level of development, are distinguished from program input variables, subject to program manipulation, is considered in an effort to examine reasons for variations in program performance. Focus is particularly on the inputs of workers, who provide services and distribute supplies, and clinic facilities, through which services and supplies are made available. The questions asked concerned how their availability and use are affected by background factors, which themselves reflect to some extent the population's readiness to accept family planning. Distinguishing the program-manipulable factors from the background factors involved determination of the impact of both groups of variables, separately and together on levels of program acceptance, using appropriate bivariate and multivariate techniques. The evidence shows that in addition to background factors, over which program administrators can exercise no direct influence, there is a major contribution made to program acceptance through program factors over which the planner and administrator do have control. The 2 program variables contributed more in explaining performance levels than all 5 selected background variables combined, and the relative contribution of these program factors has increased over time. The key finding emerging from the different analyses is that program manipulable inputs are the dominant direct determinants of subsequent levels of family planning acceptance in Malayasia. Clearly, higher levels of development, as reflected in the measures of background variables, have facilitated acceptance, and background variables contributed significantly. Yet, whatever the level of development, the extent of deployment of program resources does significantly influence the level of program performance.
PIP: A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.
The training and utilization of traditional birth attendants (TBAs) in maternal and child health and family planning programs in Indonesia, the Philippines, Thailand and Malaysia are discussed. Special efforts to organize and train TBAs for family planning in Malaysia are examined in detail. Import factors for successful utilization of TBAs include: (a) definite assignment of functions and tasks, (b) organization of good operational steps and (c) implementation of good supervisory activities.
PIP: It is generally believed that extended families encourage high fertility, but a review of the theoretical discussions and empirical research examining the relationship between family type and fertility fails to show any support for the customary belief. Nuclear families consist of husband, wife, and their immediate children. The extended family is broadly defined as any group of related persons living together which includes but is larger than the nuclear family. The main theoretical discussions of extended family and fertility are by Davis (1957); Davis and Blake (1956); Lorimer (1954); and Goode (1963; 1964). In the patrilocal extended family, the wife wants to have offspring as early as possible to strengthen the family line and her own status in the household. In a truly joint household the authority of the elders continues after marriage; the reproductive behavior of a couple is subject to their influence. Less intimate or less intense interspousal communication precludes the possibility of discussion on fertility-related problems and family planning. Younger age at marriage and lack of privacy contributes to higher fertility. According to Goode extended family behavior is characterized by more rules for behavior, while nuclear families emphasize the conjugal bond. Since most affinal and consanguineal kin are excluded from day-to-day decisions in the nuclear family there are weaker reciprocal controls.
PIP: Analysis of family planning clinic services offered by the FFPA and its state Family Planning Associations in Malaysia in 1978 has shown that oral contraceptives continued to be the most popular contraceptive method among family planning acceptors, but there had been notable increases in acceptance of the condom and the IUD. There was a marginal decrease from 1977 figures in the acceptance rate among the new and continuing acceptors of OCs in Peninsular Family Planning Associations. 77.1% of new acceptors chose OCs in 1978, compared with 85.3% in 1977. 15% of the new acceptors chose condoms in Peninsular Family Planning Associations last year, compared with 10.2% in 1977. The injectable contraceptive has been well received in Sawawak; 14,681 vials were dispensed in 1978.