- The Seoson County Family Planning/Maternal & Child Health Service Research Project, Korea .
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S Bang, T H Cho, S J Lee, S H Han, K J Lim, M Y Ahn
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Korean J Prev Med. 1983;16(1):163-192.
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- In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has undertaken a service research project. The project has employed a quasi-experimental study design introducing interventions that provide crucial factors lacking in the ongoing government programs such as midwives and qualified regerral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selected townships of Seosan County. In this sample survey of both the study and control areas, 2,484 eligible women (97% response rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning( 45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 2. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm of withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women). Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE; In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery. About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity. And they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregnancies. In the Korean rural setting, the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.
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- Study on the Acceptability and Effectiveness of an Oral Contraceptive Among Iud Drop-outs in Rural Korea.
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J M Yang, S Bang, S W Song, B B Youn
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Korean J Prev Med. 1968;1(1):51-66.
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- During a period of about one year(November '66 an December '167), the Yonsei University, College of medicine conducted a field trial of the oral contraceptive (Ovulen) in order to study its acceptability and use-effectiveness among IUD drop-outs in Koyang country. we can summarize the outstanding finding from this investigation as follows; 1. 61.4% of the IUD drop-outs interviewed (911 women) wanted to use the pill. Host of the reasons for not wanting to use it(359 women) pertained to either use of other contraceptive methods(98) or subfecundity(150) following IUD terminations. Only 83 out of 911 women gave reasons related to the difficulty of obtaining pills. Therefore, we can state that most IUD drop-outs If still in need of a contraceptive methods ,are in favor of trying the pill, and especially so if this method is conveniently available. 2. The 467 women or 37% of those who terminated IUD use actually visited the clinic for medical screening, and only 11 of them or 2.4% were rejected because of pregnancy and other medical reasons such as cervical erosion, myoma, breast mass, etc. 5.5% or 25% of the 456 women who received the first cycle did not take a single pill during the study period. 3. When we defined those 431 women who accepted and took once or more tables we tales we found that women over age 30, with 4 or more children, and/or with a higher educational level were the best prospects for recruitment. 4. In accuracy of use, about two thirds of the users started taking the pill on the 5th day as directed for the first three cycles, but the percentages rose sharply to about 80% on later cycles. Tardiness in starting pill use in the first cycle may have occurred partly because they had to return to the clinic monthly to get each new cycle. Among accepters who did not quit between cycle, 80 to 90% were regular users, missing two or less tablets in each cycle. 5. More than 60% of the users felt well and sometimes lost their pre-acceptance systems, especially dymenorrhea. However, 27.4%(58 women) had side effects attributable to the pill compound as nausea, vomiting, indigestion, breast tenderness, decreased lactation or break through bleeding 25.0% (53 women) also complained of medical diseases or symptoms not related to the pill, especially during the first three cycles. However, as the confidence and experience of the client and the field workers grew, the incidence of unrelated medical complaints quickly fell to a lower level in the later cycles. 6. As of the end of this study, on December 31, 1967, 492%(212 women) had discontinued the use of the pill for medical reasons as well as for the non medical reasons. Only one case terminated use due to a pregnancy after taking pills. The cumulative continuation rates (by the life table method), were 58.9%, 51.9%, 41.0% at the end of 3 months. 6 months and one year, respectively. These rates are lower than in the U S. students. Even when we add the retaking group to the first segment, the continuation rate goes up only about 5% above the first segment rates mentioned above. Possible explanations are different dosages, the newerness of the method and the use of only one point for pill distribution in the country together with a monthly return for cycle 1, 2, 3, and 4-6.
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