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: A traditional birth attendant, also known as an indigenous midwife, is the main provider in many developing countries of obstetric services. Due to this unique position, the traditional birth attendant has been considered as possibly the ideal person to deliver family planning services in her local community. This consideration has influenced program policy in many countries and consequently there is information available to aid in the determination of whether to involve traditional birth attendants and, if so, how to best use them. There have been 2 opposing views in response to the involvement of traditional birth attendants. 1 view regards them as potential innovators. She is seen as ideally placed both physically and socially to act as a representative of the family planning program to her patients. The traditional birth attendant is the acknowledged and often prestigous expert on obstetrics matters, including at times traditional methods of birth control. The alternative view is less hopeful for rather than identifying the traditional birth attendant as an innovator it regards her as a firm opponent of innovation, a determined conventionalist. Pro gram experience in India, Pakistan, Indonesia and East Java and experime ntal studies in the Philippines, Malaysia, and Thailand along with anthr opological inquiries generally support the skeptical view but none of the findings imply that the traditional birth attendant should be ignored by the family planning programs. In the intermediate positions of many actual programs, the wisest plan seems to be to ensure that the potential contribution of the traditional birth attendant is neither overlooked nor exaggerated