[Interposing voices]

[Narrator:] It is thewomen of childbearing age

who are the firsttrue beneficiaries

of a national familyplanning program.

If under that programfamily planning services

reach and help them, thedelivery system has succeeded.

If for whatever reasonservices do not reach them,

the delivery system has failed.

And in almost everycorner of the world,

it is already toolate to risk failure.

[Children and adults,indiscriminate chatter]

[Music]

[Delivering FamilyPlanning Services]

[Reaching Out]

[Music fades out]

[...]

[Dramatic musical sting]

[Dramatic music]

[Visual montage ofa populated city]

[Rural setting]

[Visual montage of people in a busy city]

[Narrator:] The factors whichbear upon the establishment

of a national program and theconstruction of a delivery

system are many and variousand occasionally delicate,

where they deal in the endwith that most sensitive

of all social considerations,human sexuality.

Between the decision to createa program and the formation

of a services networklie a host of obstacles,

human, mechanical,cultural, even spiritual.

[Music continues]

The basic problemseems simple enough,

provide to every fertilecouple desiring it

the means of spacing orlimiting their families.

The mechanism of accomplishingthis is not simple,

but success storiesfrom many countries

attest that it is possible.

[Zoom out to revealcity landscape]

[...]

Dr. Benjamin Viel,executive director

of the Western hemisphere regionof the International Planned

Parenthood Federation,discusses with young members

of a seminar group the optionsopen to fertile couples today.

[Speaker 1:] Dr. Viel,at the present time

which method offertility control

do you think is the mostor the most effective?

[Doctor:] Well, you have to keepin mind that the perfect one

hasn't been yet found. 

In general, all themethods available up to now

could be dividedinto two main groups,

the non-clinical methods.

Among them you have theabstinence, of course,

not very popular.

You have the coitusinterruptus that was

practiced long ago in Europe.

You have the mechanicalbarriers, like the condom.

You have the chemicalbarriers like the jellies.

And you have thehormonal barriers,

the so-called,commonly "the pill",

which is a very good method.

And all of them has the biggestadvantage, that they do not

require theintervention of a doctor

and could be learnedby the human couple.

out of very simple instructions.

The clinical methodsrequire the intervention

of medical professionals orat least paramedical personnel

properly trained.

Among them, you havethe intrauterine devices,

the interruption of pregnancy,and the surgical methods

for sterilization, theso-called vasectomy

in men's, and tuballigation among the females.

Which group of methodsyou should choose

depends entirely onthe type of community

in which you are going to work.

If there is ashortage of doctors,

the problem is to maintainan adequate supply

of the non-clinical methods.

The clinical methods requirethe training of personnel.

If a sufficient numberof trained personnel

are available, all of themcould be used quite safely.

In countries, especiallythe underdeveloped countries

where the medicalprofession is very scarce.

I believe that thenon-clinical method

has a very important role.

[Narrator:] Young women ina Trinidad, health center

learn about contraception.

[Speaker 2:] How many of youall who are just married

would like to have a baby, butyou will say that you are not

ready to have a baby yet, youwould like to build a house

or maybe you wouldlike to go out a bit?

Now this ispostponing pregnancy.

Now some of you all who havehad six or seven babies.

You might say, well,I've had enough,

and this is what we callpreventing pregnancy.

Now family planning is not onlyfor postponing and preventing

pregnancy.

It's also for thosewho cannot have babies.

These are the differentmethods of contraceptive

we have available at our clinic.

Now you have the IUD orthe loop, the rubber,

which the man uses.

You have vaginal spermicide.

You have foam.

You have foam in tablet.

You have cream.

You have the pill.

You have different types ofpills, and you have diaphragm.

[Speaker 3:] Have you had touse these condoms before,

the colored ones?

[Speaker 4:] Once or twice.

[Speaker 3:] Once or twice, thecolored ones, very good.

That's the plain one, butthese are the colored ones.

[Narrator:] Historically,one of the oldest

contraceptivemethods, the condom,

has evolved dramaticallyin style and effectiveness

in its long history andhas the considerable virtue

of being available at lowcost almost everywhere.

The oral pill is the long soughtalmost infallible contraceptive

of modern times.

In its relativelyshort life, it has

become the most popular, mosteffective, and most generally

appropriate of all methods.

Almost everywhere inthe world it is now

dispensed by auxiliaryhealth personnel.

[Paper rustle]

[Health care worker chatter]

[Narrator:] A pill program doesdemand strong uninterrupted

logistic support, but mostnational family planning

programs acknowledge andaccommodate themselves

to this need.

[Health care worker prepares forvaginal examination of patient]

In areas where trained personnelis sufficient to the task,

such clinical methods asthe intrauterine device,

requiring a lower degree oflogistic support and less

constant attentionfrom its users,

have earned wide acceptance.

[Health care worker:] That'sa good girl.

[Worker adjustingmedical device]

[Narrator:] The search for betterIUDs, like the continuing

search for betteroral contraceptives,

occupies the intenseattention and massive research

investment of both publicand private sector agencies.

[Loud noise from othersin the clinic]

Increasingly, forcouples who already

have the children theywant, sterilization

is being made available.

An impressive number ofinternational organizations

are spendingconsiderable resources

in developing methods whichwill make female sterilizations

as quick and uncomplicatedas our vasectomies for males.

[Operating theater]

Such procedures, aslaparoscopic tubal ligation,

have come veryclose to this ideal.

The operation can bedone in about 10 minutes

under mild anesthesia throughan abdominal incision so small

that a Band-Aid issufficient to cover it.

A few hours of rest sufficefor patient recovery.

[...]

[Rubber glove snaps]

[...]

The key is the laparoscope,which permits the doctor

to see directly insidethe abdominal cavity

as he separates andseals the tubes.

Clearly, such proceduresmake heavy demands

both on equipment budgetsand medical personnel.

Comparable ingenuityhas gone into procedures

for easier and safertermination of early pregnancy.

An inexpensive kit for vacuumaspiration of uterine contents,

and a technique for its usewhich can be easily taught

have gone a longway toward making

the operation safe and simple.

[Speaker 5:] After fixing thecannula on to the syringe,

the valve is closed inside.

So now the cannula isattached to the syringe.

And then a vacuum iscreated by pulling

the piston of the syringebackwards like this.

[Plastic syringe clicks] 

Up until the time that theshoulders come and rest

on the--

the flanges come andrest on to the shoulder.

And within 20 seconds or soon doing the rotary motion,

you can see that the menstrualfluid comes through the cannula

and into the syringe.

[Spanish conversation]

[Narrator:] A nationalprogram must first

decide which methods to offerand the agency through which

to offer them.

Many countries have,like Costa Rica,

elected to add theirfamily planning delivery

system to the GovernmentHealth Organization.

However, a few governmenthealth organizations

come anywhere nearsatisfying health needs.

It is estimated that in lessdeveloped countries as a whole

not more than 10 percent to15 percent of the population

is served by officialgovernment health services.

[Patient enters exam roomas door closes behind her]

[Door banging]

[Indiscriminate chatter]

More often, still, theGovernment Health Network

is too limited evento begin the task.

To help make a start,Iran has called

on the members of itsNational Service Corps,

whose young men and womenstaff health outposts

in remote communities.

The young people cometo be liked and trusted,

even by the eldersof the village

and capitalize on thattrust by persuading

the women of thisconservative world

to begin to takesome responsibility

for their own destinyas wives and mothers.

Familiar with localcustoms and attitudes,

these young womencan extend the reach

of the health professionalas no stranger could do.

[Speaking Farsi]

[Engine motor]

In a crowded urbandistrict of Hong Kong,

the Family PlanningAssociation has established

a unique purpose clinic,which is superficially

quite different.

In substance, it issimilar in its adherence

to the role ofneighborhood clinic,

offering informationand service to women

who learn to know anddepend on the clinic staff.

The role of the voluntaryagency wants a national program

as fully establishedis often uncertain,

but it has doneimportant groundwork.

And it would be ungrateful,as well as impractical,

to overlook the fact.

Experience indicatesthat such an agency

can evolve most usefully intoa training center, the operator

of a model clinic, an agencyfor information and education,

and a pioneer in testinginnovative approaches

in technology andoperational patterns.

[Cuff being inflated]

Typical of a multi-purposegovernment clinic

with a strong familyplanning element

is this modest establishmentin rural Philippines.

[Clinic worker:] You notice that wehave quite a heavy caseload

in this clinic.

And we average about80 cases a day.

And with the one position,giving out family

planning servicesdirect to their clients,

you can see the need forutilizing the paramedics

in giving familyplanning service

to the rural population.

In the Rural Health Unit projectof the Department of Health,

we have around 5,000paramedics, exclusive

of about 1,500 doctorsdoing the direct services

to the family planning clients.

Now these doctorsconstitute about 25 percent

of the medical andparamedical personnel, us

against 75 percent of the paramedics.

Now you can imagine how muchaugmentation we can have

and how much more servicewe can deliver if we

augment this staff by 75 percent.

So I would venture toguess that we should

be able to increase ournumber of acceptance

by 50 percent as much as 70 percent.

[Narrator:] One of the mostsuccessful sites for a family

planning clinic isan urban hospital,

particularly if publictransportation facilities are

adequate for travelfrom outlying areas,

as they are in Central Thailand.

A large hospital not only hasa broad range of facilities,

but it usually enjoysthe distinction

which attaches to areputation for authority

and dependability.

Chulalongkorn Hospital has beena pioneer of family planning

efforts.

And its present strength isin moving toward training

of graduate medical students,not only in the most

modern techniques of maternaland child health care,

but in all phases offamily planning effort.

Recently, Thai endeavorshave concentrated

upon the use of auxiliaryhealth personnel

to perform all but a fewof the duties associated

with contraceptive techniques.

[Doctor/instructor speaking Thai]

[Narrator:] Particularly, indeveloping countries,

this may emerge asthe central factor

in expanding family planningdelivery systems, the training

of nurses and midwives as activetechnicians of family planning.

Modern midwiferycenters in the capitals

and in upcountry stationsconcentrate primarily

on the basic job ofdelivering healthy babies

to healthy mothers.

[Speaking Thai]

[Speaking Thai]

[Nurse converses with patients]

[Narrator:] Success in this fieldcan have a strong secondary effect

on the family planning record,

by reducing infant mortalitythrough improved birth

techniques and infant care.

The new midwives help toerase the ancient conviction

that a woman must bearmany babies to ensure

that at least a few survive.

[Nurse speaking]

[...]

[Nurse speaking]

[Narrator:] Indigenous midwivesmay be wholly untrained

in Western medicine, butotherwise deeply experienced.

How can they dependent forincome on a babies they deliver

be induced to promotefamily planning?

First, by beingcompensated for acceptors

they bring into theprogram, second,

by learning the long-termvalue of helping their clients

to be healthierand more prosperous

through child spacing.

The warmth andinformality of these women

is one reason whymothers cherish them

and one area in whichbetter trained midwives

may fall short.

[Instructor:] I knowthat most of you...

[Narrator:] The training of clinicpersonnel in the Philippines

has recognized the crucialimportance of this element

and is using behavioraltraining techniques

to teach self-confidentyoung health

personnel the possibleerror of their ways.

[Instructor:] In training, we havea little bit of role-playing.

You have this in yourbasic training course,

and you had this twoor three days ago.

This is called therole playing technique.

We do this for fieldmotivators, social workers,

and now we are going todo a little bit of it.

I will pose as the nursemidwife and maybe one of you

could pose as the acceptor.

Let's see now.

Oh, Dr. Curtis, would you liketo be the potential acceptor

and help us with thislittle role playing?

Let's go.

[Footsteps]

[Dr. Curtis:] Miss, I wantto know something

about family planning.

[Instructor:] At thistime of the day?

It's 12:15.

Our quitting time is at 12 noon.

Come back tomorrow.

[Dr. Curtis:] Oh, miss, I can'tcome back tomorrow.

Please help me.

[Instructor:] Well, you see Idon't really care because I'm

supposed to go home.

I've been workingso hard all morning,

and now you're hereso very much late.

Some other time you could comeback, but be sure it's earlier.

[Dr. Curtis:] Okay.

[Narrator:] A potential acceptertreated brusquely or carelessly

maybe lost to theprogram for all time.

It is not enough that a clinicbe convenient, well-equipped,

well-staffed.

It must offeracceptable service.

It must permit a woman,however, poor or ill

educated to retain herdignity in this encounter.

The success ofthis concentration

on compassion and humanityand client encounters

is reflected in agrowing acceptance rate.

[Instructor:] Now when you goback to your respective clinics,

think about this,and maybe you will

be better prepared toserve your coworkers

and to interact inthat particular clinic.

And in so doing, you willhave a better relationship,

and you can exude warmththrough your acceptors later on.

[Nurse:] [?] Our family planning [?]--

[Narrator:] Expansionand strengthening

of a clinic network andimprovement of clinic personnel

performance go a long waytoward reaching family planning

service goals, but theywill never be quite enough.

A delivery systemmust avail itself

of every possible opportunityto draw women into a program.

[Nurse:][Non-English speech]

[Narrator:] Some of the greatesttriumphs in family planning history

have come when a programhas made an intensive effort

to persuade postpartumwomen to have IUDs inserted.

To begin taking oralpills, or to use

conventional contraceptives.

[Nurse:][Non-English speech]

[Narrator:] Women who havejust given birth seem

susceptible to the suggestionthat they should not

do so soon again, particularlyif they are recovering

from the experience lyingtwo in a bed

in a humid maternity ward.

[Nurse:][Non-English speech]

[Narrator:] The search fortargets of opportunity

to sell family planningmust be unremitting.

Increasing numbers offactories are setting up

consultation and supply stationsto distribute information

and condoms to their employees.

The enlightenedinterest of an industry

which is obliged to providematernity help to its employees

families assuredlypoints toward the wisdom

of promoting limitationor spacing of childbirth.

[Doctor:] Good afternoon,Mrs. Thompson.

[Mrs. Thompson:] Good afternoon,doctor.

[Doctor:] I see from thecard here that you'd

like to get some adviceon some contraceptives--

[Narrator:] Although thedesign of a delivery system

normally concentratesupon the public sector,

it is important to rememberthe unique strength

of private medicine.

Doctors who accept familyplanning principles,

and there are few who do not,are in a special position

to help their patients adoptappropriate contraceptive

methods, to follow up ontheir subsequent condition,

and to provide the sortof individual attention

which is hardly possible toan organization physician.

[Applause]

[Non-English speech]

[Narrator:] Underlyingall successful delivery

systems must be a continuingform of public education.

Historically, thishas been the job

of women volunteers armedwith a little knowledge

and great enthusiasm.

Women to reach women, wantingonly to raise their sights

and perhaps, lift their hearts.

[Volunteer speaks to women in a maternity ward, discussing birth control options.]

[Volunteer speaks to women in a maternity ward, discussing birth control options.]

[Narrator:] And men to reach men.

Whatever the culturalsegregation in the society,

both sexes must bereached and convinced.

[Planning diagram]

As delivery of services reachesfarther into the rural areas,

it is important todefuse, in advance,

any explosion ofconservative opposition such

as might be expected from therural men of the Middle East.

It is essential that they begiven a broad choice.

Even rhythm, withdrawal,and abstinence

are better thannothing, since they

may lead to a desire formore effective contraception.

But a wise program will urgeproved effective methods

from the outset.

[Male volunteer speaks to other men gathered outdoors.]

[Narrator:] Despite theimportance of group efforts,

there is still no substitutefor individual attention

where manpowerresources permit it.

An intensive course foraugmenting development programs

through paramilitary service,gave this young woman

basic health training andindoctrination and family

planning services.

Now she is en route from herrural clinic to a home visit.

[Footsteps, paper rustles]

[Knocking on door]

[Volunteer greets woman who answers the door.]

[Narrator:] The womanshe seeks has failed

to keep a clinic appointment.

Why?

Is she having some difficultywith the method she has chosen?

Should the clinic find anothermore suitable method for her?

Does she need medicalor psychological support

to continue as an acceptor?

Follow-up visits are vital tothe continuation of a program.

[The two women converse.]

[Narrator:] A delivery system doesnot always travel a level road.

Family planningprogram administrators,

particularly in the more remoteareas of developing regions,

have learned that their clientsmust be sought out, sometimes

with considerable effort.

Many millions of fertilecouples live and procreate

far from theneighborhood of a clinic,

well beyond the usual reachof any kind of health care.

[Automobile engine]

A delivery system canbe simple or complex.

But it must, invariably, beappropriate to the terrain

and the culture inwhich it is established.

[Engines reeving]

[Plattes clapping]

[Squeaking]

In all discussion ofmotives and methods,

of staff and structure,it is easy to forget

the housekeeping factors.

But it can be fatal to do so.

Budgets must be realistic.

Logistical systems must beappropriate to the budget

and national priorities.

A breakdown in the supplyline of commodities

can cause almostimmediate collapse,

sometimes of an entire program.

[Combustible engine]

A good general rule ishave one year's supply

of all neededcommodities on hand

and another yearsupply on order.

Even with multiple donoragencies and the vagaries

of governmentprocurement policies,

this should be anadequate safeguard

against discontinuity.

[Interposing voices]

Even the most successfulongoing delivery system

must be alert to opportunitiesfor expansion, many of which

can be found and aretoo often overlooked

in the private sector.

There have beensolid results gained

by the outright practicaluse of commercial channels

and promotion techniquesto sell family planning.

The Kinga program of Kenyais a vigorous example.

[Music - King Floyd,"Groove Me"]

[Background conversation]

[Music - King Floyd,"Groove Me"]

[Narrator:] Traveling out intorural areas, which normally

have limited contact withthe world outside, the two

small trucks, one for advanceinformation and one for sales,

are noisy and welcome arrivals.

[Vehicle approaching]

"Kinga" is the Swahiliword for "shield".

And the aim of thisproject has been

to place Kinga condoms inevery tiny general store.

Following a classic patternof country huckstering,

the condoms are exploited andsold at a low subsidized price

as commercial companiessell soap and soft drinks.

[Interposing voices]

[Narrator:] The Kingainformation officer

is prepared, notonly to show condoms,

but to discuss familyplanning in general

and to answer questions.

The Kinga men know thefarmers' reluctance

to go to a clinicfor a contraceptive,

even when he accepts the idea.

But he is willing togo to the local store

where he can retainhis freedom of choice,

his dignity, hissense that he is

in control of his own affairs.

[Storekeeper talks with customer]

[Narrator:] The deliverysystem has reached him.

Its effects will reachhis wife and his children.

[Vehicle approaching]

[Birds singing]

The delivery system of anational family planning

program is a roadwhich reaches out

to give a child-bearing woman,her man, and her children

a way to go forward, aroad whose construction

and maintenance are centralto the ultimate success

of a program.

[Music playing]

[An Airlie Production]

[Executive producer: Murdock Head, M.D.]

[Produced by: Frank Kavanaugh]

[Written by: Miriam Bucher]

[Photographed and edited by:William Livingston]

[Produced for: Office of Population, A.I.D.]

[Director: Dr. R.T. Ravenholt][Deputy Director: Dr. Willard Boynton]

[Presented by: Agency for International Development, Bureau for Population and

[Humanitarian Assistance, Washington, D.C.]

[Fade to black]

[...]