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: To determine the acceptability, practicability, and popularity of Depo-Provera as an additional contraceptive method to be offered by the National Family Planning Board NFPB of Malaysia, 550 patients of Sungai Besar, Malaysia, who accepted the Depo-Provera injection method from the start of the injection program, February 23, 1968, until the cutoff date of December 31, 1969, were studied. At the cutoff date, 318 (58%) were still receiving regular injections at 3-month intervals. The remaining 232 women discontinued use of the injection. Of those who discontinued use, 176 (32%) were interviewed, while the other 56 women were lost to follow-up, due mainly to migration. Assuming that 1 injection would protect a woman from getting pregnant for a 3-month period, the retention rates at the end of 12 and 24 months were 63% and 41%. These continuation rates were fairly high and were as good as those for the oral pill, which is the main contraceptive method provided since the beginning of the operational service program of the NFPB in May 1967. Except for a small number of Indian women with a high rate of discontinuation there was not much difference in continuing the method between the Malays (60%) and the Chinese (56%). The younger age group of women seemed to have a higher proportion of discontinuation. The findings showed that amenorrhea (35%)most bothered the women who discontinued the injection method. Irregular bleeding (20%) and other medical side effects (11%) were the other main complaints that caused women to discontinue using the injection as a contraceptive method. It was concluded that Depo-Provera (150 mg) injected once every 3 months appears to be simple, acceptable, popular, and effective as a contraceptive method among women in a rural town in Malaysia.
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.