How Cultural Factors May Be Used To Enhance Effectiveness of Family

INTRODUCTION

Culture of people is deferent; it differs from country to country. Even if they’re the same country we have different cultural groups depending heterogeneity of the population. Even within a homogeneous population we do find different in cultural and subculture.

The word “family planning” when it was first introduced in Southern Africa. It was bound by a lot of misconceptions, some religious; others political while others were purely out of ignorance and lack of foresight and knowledge. It meant that women should not give birth which is against the cultural traditional role of a woman. Especially in African Culture, which bases the essence of marriage on procreation and fertility, the major function of a woman was to bear children, as it seems a complement if a woman has many children. A woman who had no child was disrespected and may even be ignored if not divorced by her husband. Infertility was and it is still to some extend a curse to a woman.
Children were regarded as an insurance policy to look after you when you grow old. This is no more the case. It does not matter how many children you may have you still have to look after yourself when you grow older. The traditional African family did not have “empty nest” syndrome, but now most parents are left alone as children are scattered thought the country in search for greener pastures.

FAMILY PLANNING TRADITIONAL CIRCUMCISION SCHOOLS AND FORMAL EDUCATION SCHOOLS

It is cultural that a man is the dominant figure in the family. He takes all the decisions on himself and on behalves of his wife. Patriarchal society. There are occasions that are highly respected and all information from such institutions are taken very serious. The boys are usually taken to the field or maintain to be taught “MANHOOD” The way of handling a woman and be head of the family. If a family planning program can include education on men at their circumcision school. This would dispel the myths about it and likely to make it be easy accepted by men. It would that be easy for men to pass their education to this law a siding wives. As this school are attended at a very young age usually before they become sexually active, inclusion of family planning teaching at this age may greatly enhance the effectiveness of family planning.

For a family planning to be acceptable to the local people it should be easily intergraded into the society. The norms, tradition and culture of the society should be taken into consideration. In an adult dominated society, adults should first be educated on the value of family spacing, the importance of the impact of declining economy on the education and the future of the family. They should also be involved in the structuring thereof. In a nutshell the people must be part and parcel of the programs. They must feel that it belongs to them. The community should have a sense of pride and responsibility about the family planning program. That is one way to ensure that it does not collapse but utilized to its fullest. The education should start from adults to their children. That way adult doesn’t feel to be hearing from children. If the adults are not well informed and involved in the family planning program, they may regard it is a children endeavor and have nothing to do with it. It may be interpreted as a measure of promoting premantal sex, female delinquency and thus encouraging teenage sex and pregnancy.

Cultural institutions such as a tribal office may be used as a place to offer family planning. In this way it will be perceived as a tribal projects and endorsed by the community leaders. Familiar community member with training in family planning may offer their services to educate and dispense the contraceptives. When the whole community is well educated about the dangers of teenage pregnancy, the program may gradually infiltrate the schools where the target group will be reached. At school also it should start with the teachers who should be exemplary, to empower them with knowledge so as to remain in the forefront of any teaching, including contraception and sexuality. As for the community approach this will prevent situation where children seem to know more than their teachers and lose the respect. Teachings on sexuality and sexually transmitted diseases should be taught at schools to both sexes.
Tablets may be offered at school to the learners, condoms may be freely available to males and females at school. This approach cuts the cost of going to clinics, which may be for, or to local doctor’s when are likely to charge. It is also a time saving factor as the clinics and doctor’s rooms often has long queues with long waiting time.

The community does not have to set time aside to go to family planning, it is intergraded as part of their daily activities.

I fit was imposed upon them. As usual the first reaction to any thing that is imposed on a person is to reject it or to think that there might be an evil motive behind it.

Community involvement and transparency in the program will avoid the above named misinterpretation. In South Africa we have build a culture of relies, and workshops. This should be used as platforms to start and sustain an effective family planning program. Important days such as Women’s day, national aids day and breastfeeding week should be used to preach the value of safe sex and family planning. Expects in family planning and politicians with their influence on the community can be invited to give speeches at this gatherings to the vulnerable group, which is the youth, the reproductive age-group.

FAMILY PLANNING AND THE CHURCH

Missionaries brought the most of religion and education in Africa. They won the confidence of the majority of the people. Most religion with the exception of Roman Catholic Church accept family planning as a means of fertility and population control. The church should accept cultural factors for it to be to be effective in winning the trust of the people. One example of such a church is Zion Christian church.

According to the Z.C.C a man periodically receive orders not to engage in sexual relation with his wife for a specific period or even at specific time of her menstrual cycle. During these times certain rituals are done which keep the couple busy not to be tempted into sex. Unfortunately these abstinence periods are not physiological. If the church can be used to insure such instruction such that coincides with the fertile period of the woman’s cycles, they will then be a good rhythm method of contraception.

Some Protestant churches that preach salvation completely forbid sex before marriage. This could be used in reducing teenage pregnancies and unplanned pregnancies. The teaching of gospel to the fertile age group, which is in essence a cultural norm in the Christian communities in it, can enhance the affectivity of family planning programs.

Teenage Management

Examining traditional practices and cultural child rearing practices in African context, sex is totally forbidden before marriage and there was no need to engage into love relation in order to get married. Marriage was guaranteed. Girls had to preserve their virginity and be proud of it till marriage. Teenage pregnancy was a taboo, a girl who had a baby before marriage was an out-cast. These cultural values discourage early sex and the consequent unwanted pregnancies. There were thus no unwanted children, delinquent children and single parent families’ teenage mothers.
The western influence with its liberal child rearing practices came with contraception, which according to the study by Awoyi T.A. lead to sexual freedom and all its consequences like teenage pregnancies, STDs and PID. It says that this was regarded as advancement with the rest of the world. But Africa being the child world cannot afford the preventive measures like an effective family planning. On the other hand, cultural norms and practices if strictly adhered to may lead to maladjustment in a child who lives in the modern society.

The Role of Males in the Family Planning.

Across all cultures, males seem to be more of pronatalists than females as males are main decision markers in the family. They should first be targeted, educated even more than females to ensure that there be an effective family planning program. It is traditional that a male should provide for the family, this provision should include family planning, which is in most instances ignored and omitted. If they can be taught to realize the cost involved in giving children a brighter future, they will be once the forefront of the family planning.

Personal experience in that by 1985, it was very difficult to convince a traditional African to allow his wife to have tubal ligation irrespective of the number of children they have or the underlying medical condition that makes pregnancy a treat to a women’s life. Now almost 10 years by 1995 men come to doctors to request that their wives should be persuaded to undergo sterilization or have any form of effective contraception. Men tent to be less resistant to male dependent methods of family planning like vasectomy and condom. The use of cultural forums such as traditional gatherings and traditional circumcision school may empower males with the importance of family and make them feel they are in control of their own procreation ability.

Freeman in his study on factors affecting acceptance of family planning also emphasized the importance of the husband’s approval before the couple can engage in contraception. He stated that the attitudes of the health care workers, which are not in line with the people’s culture, might discourage family planning. He found that community initiated programs might be more accepted and effective than government programs. He emphasizes that every community takes pride in their own efforts, thus community programs have better chances of success than state programs.

The Social Aspects Like:

Freedman has studied reproductive behaviors in various communities. Before any family planning program can be planned for a community, a thorough social science study should be done on the community in order to understand the social, economic, political factors that potentially effect directly or indirectly, the whole biosocial reproductive system and family planning. Then the program is tailored according to the community characterizing. This implies that there is no inform global program that can be suitable to all communities transculturally.
Scientific knowledge about family planning should be adapted to different cultural circumstances.

A central point is that carefully monitored pilot projects are desirable before launching full-scale national program.

The couple or community characteristics should be taken into consideration. On a particular African societies. The extended family dynamics may be utilizes to culture the spirit of collective family planning. In such a society, where every child belong to the community. There is no nuclear family system, if a man does not have many children, he does not feel less of a man, the same applies to woman. Contraceptive behavior may be integrated as part of family norms. Woman may be able to borrow tablets from each other or in a cohort go to a clinic for contraceptive injection. The same applies to men. They may be made to fell free to contribute condoms among each other and free to talk about various family planning methods.

There are lot of unrest reeds in every community. One of their needs is the devise for smaller families.
In Network summer edition of 1999 it is stated that are in four married woman in developing countries wants to avoid pregnancy but does not use contraception. There are millions of couple who want weather to delay or to avoid pregnancy but does not use contraception may form of contraception.

The reason for not arising contraception are malitifactiorial, including lack of knowledge about contraception, fear of side effects, opposition from husbands, ambiguous feeling about contraceptives dissatisfaction wit the method and poor illness to or limited range of contraception choice.

In terms of total population with these unrest needs, Asia has the largest member followed by India at 31 million couples. However in terms of percentage of married couples of productive age the sub Sahara Africa leads the list.
The reason for unmet needs often overlap because of cultural factors that tends to influence sexual practices and reproductive health needs.

Studies from women found major reason been lack of knowledge, health concern and ambivalence about future childbearing. Other importance reasons depending the country and culture included opposition by family members and side effects.

“Many assumes that if couples just had access to a methods, they would use it, but this is a wrong assumption”, says Dr Nancy Yinger, who co-ordinated several recent studies on the causes of unmet needs for contraception through the U/S based International Centre for Research an women (ICRIO). “The causes and solutions are much more complicated than just lack of knowledge. Many potential users have a lost of fear and a formidable social and cultural banners to arising contraception.”

Dr John Ross who co-ordinates a U-S based organization a reproductive issues says, “About 40 % of unmet needs fall within the first year post partum. Working to join needs across the institutional gap can help address this needs.”
Lacking family planning with childhood immunization, Overrehydration treatment, and other childhood services can make family planning easily available and accessible.

The status of woman in a society also affects the success and failure of family planning program. In the societies where control over fertility and family planning are not discussed with women and women do not participate in decision concerning reproductive matters, implementation of any program is doomed to failure as many effective methods are female centered.

In ESTIDIO research centre for Family Health International, it was shown that the barriers to the success of family planning program are part of larger social and cultural patterns in the society.

MASS MEDIA

It has become cultural to listen to radios, read newspapers and even Internet will soon be a cultural mode of disseminating information. Many societies no more have their pure culture. The modern technology has been integrated as part of the day to day life. This does not mean acculturation of the culture but refinement of people’s ways of life.

Using in depth interviews and focus group decision along with survey “data, studies in Ghana, India, Pakistan, the Philippines and Zambia found that, although men and women have equal access to information on Radio and television and other sources, many of them do not have an opportunity to discuss these matters with each other face to face. The topic seems to be very sensitive to engage in and it is the cultural upbringing that affects the couples behavior and attitude towards reproductive matters.

Breaking the culture barrier is too difficult and far to anticipate. The solution may be to intergrade the culture into discussion about family planning. Integration implies involvement of cultural attitudes and norms as a means of driving the family planning program. Although cultural factors may diminish the affectivity of the program, it is better to have a less effective program than to have none at all.

Family Role

Navrogo community health and family planning project in Ghana reached their communities through chiefs and headmen. In this way men are the first targets in the program and their barrier role is minimized and use is made of their superiority in the families. This centre saw men as important in decision-making about contraception. They utilized their dominance. Influence and even dictatorship to the benefit of the family and population. The managed to have a breakthrough in the reduction of birth rate, infant mortality rate and family size. Although the end does not necessarily justify the means, the desired goal was achieved.

Through men and community meeting, several options on methods, benefits and side effects are and entire community counseling is done. This tends to have uniform acceptance and approval from community members of both sexes. There has been a 9 % increase in contraceptive use in four years in communities where Navrogo used cultural resources to promote family planning in Ghana

The Role of Social Contacts

Everyday conversation, within various social groups can play an important role in a person’s decision to begin contraceptives use. Because of this family planning programs can work with social groups to improve their services.
Family, friends and relatives are examples of typical social network. Others include women groups, political and religious groups. Some expects believe that communication through social networks can influence the decision to initiate contraception as much as media and information provided to the client by a family planning programs.
Dr Thomas Valente, who conducted extensive research on social networks, found that most family planning programs involved social networks. Social networks have great influence in modifying human behavior.

Many people feel inadequately equipped with knowledge and confidence to use family planning. There are uncertain about health, social and economic consequences of family planning methods. This uncertainty leads people to discuss matters with peers, to seek more information or first to be reassured about the decision to start family.

Dr Valente says, “people do not necessary trust what they are told in the contraceptive experience of people who may well be from distant countries. People tend to turn to rely on others like themselves for information and advice”.
Targeting key individuals within the social networks like opinion leaders, men and politicians, the influential figures. People in key positions can help family planning program achieve reproductive health goals. Social networks can influence the success of family planning programs in two ways: By spreading the information and by influencing behavior of people.

Informal conversation can also exchange information about advantages of fewer children egg. Fewer children can promote family well being in many ways. Smaller family can mean better food, clothing, shelter and care for each family member and proper spacing of birth intervals improves the health of both mother and child.

A study in rural Kenya found that about three to fourth of 866 women questioned in a household severely had talked at least to one person about family planning and many have talked to more than one person in an informal setting. Approximately 95 % of this conversation involved other woman, especially a sister in law or co-wife, friend or sister.

According to Dr Susan Cotts, the information obtained from social contracts is weighed against the information obtained from family planning expects and other less socially distant women’s experiences, concerns about side effects, relationship with those who have power over a woman’s life like mother-in-law and husband.

In Balivia, a Media campaigned to promote family planning and detailed knowledge about contraceptive are, birth spacing and sexuality. The media propagation had to conform with social cultural values, as social influence excreted by individuals who have powers over others can pressurize family planning uses to confirm to social norms e.g. Husband or kin may forbid contraception on the woman, or community norms may threaten ostracism’s of a woman who uses birth control methods.

In a study conducted by Family Health International in west Java and North Sumatra, woman said husbands are heads of household and few woman use contraception without their husbands approval. Explaining why She is not using contraception a woman from North Sumatra said, “My husband does not permit me to use them: I am not brave enough to use them without his knowledge. We have many children already”

This emphasized the influence that the cultural hierarchy has on the success of a family planning program and the importance of educating, men, and mother in laws and other influent figures in the community before embarking on a full scale program.

What are aspiration of the husbands and mother in laws? In another study conducted by FHI in Zimbabwe it was found that most married men and mother-in-laws encouraged wives or daughter-in-laws to bear many children in orders to extend the family lineage. Most opposed the use of contraception until at least one or two children are born. Many mother in laws ignored family planning as a means of birth spacing until termination of birth is controlled by menopause inception irrespective of the number of children the couple has.

In cultures that allow polygamy. There is a pressure among wives to discourage contraceptive uses in orders to win the husband and family love and acceptance. A woman in a polygamous marriage would like to have many children if her husband’s other wives are doing so, also woman throughout the third world say motherhood brings respect. For a program to be effective it should accommodate these cultural factors.

The value of power-full allies in the success of family planning program.

Some individuals in the community or household are known to have power and authority over the couple. One such are older sister-in-laws. Usually sister-in-laws share their experiences with their brothers wives and have the power to persuade their brothers to accept family planning. In that way woman can leave a decision role in their biological family although having a submissive role in their in laws. This can be used advantageously if the interpersonal relationship between a woman and her sister in laws is healthy. Persons like local pastor, Inyanga(traditional doctor) and the educated people like teachers and lawyers in the community can be cited as role models an their status be utilized to influence the majority of the people to the benefit of the family planning program.

Social Occasions

Some social occasions like Reeds dance in a Swazi culture are highly respected and only nulliparous girls are allowed to take part. These are an inner desire in every teen to partake in this occasion so that she can be chosen as the king’s wives. The girls are encourage and have the will to use a form of family planning method to ensure that they do qualify for the dance. At such occasion it is a form of pride and good manners to be seen taking part, irrespective of whether you are a virgin or not.

At schools some recreational cultures like beauty contests forbid porous girls from taking part. This encourages girls to keep their nulliparity and thus the use of contraceptive methods. This encourage females in their early years to take charge of their life, including sexual life. For a family planning program to involve the youth, it should be seem effective in such cultural- social gatherings and its value be stressed at those occasions.

SOCIAL CLUBS

In Kenya woman’s clubs and groups are very popular. Men also engaged in social clubs, especially sports clubs. In a study of more than 2000 women card 2000 men in Kenya found that membership was composed of people with greater awareness of modern contraception. Female club members were likely to use one form of family planning method than woman who did not belong to the club.
Further more, men and women club members were likely to discuss family planning with friends and acquaintances. Discussing family planning with acquaintances rather than with close friends is likely to result in much greater likelihood using modem contraceptives. Contacts with usual acquaintances offer better opportunities to consider new information or viewpoints, since close friends tend to share a similar views and experiences.

In present situation, with various women clubs with varying themes like cooking. Sawing singing etc, one meets a lot of acquaintances with different views and experiences which may influence her differently an matters concerning family planning

MYTHS AND FACTS ABOUT FAMILY PLANNING

For a family planning program to be successful, one should know what knowledge the community has about family planning. A lot that is known about family planning has no scientific basis and may discourage people from using contraception.

These are myths and superstitious believes are so entrenched into peoples mind that a health care worker should device a strategy to dispel them.

In rural Northern Province in South Africa it is believed that the use of contraceptives in nilliparous may lead to infertility. One should postpone contraception until the first baby is born. This has led to many teenage pregnancies. Teenage and school children should be educated out of such believes before they can be started on contraception.
The concept “family planning” should be well explained to the people. One woman in Ghana said, “how do you plan a family if you don’t have one” 12This type of reasoning greatly discourages the nulliparous women from engaging in family planning. In Zimbabwe the word “Family planning” is replaced by the word “Family spacing” Family spacing has a better meaning and has no ambiguity thus better understood and accepted by lay people.

The traditional methods of contraception like douching and herbal medicine should not first be dispelled without taking care of how far the community believes in them. The process of resolving old habits and introducing new habits of family planning must be a gradual process to be completed over a period or even generations. It may even take years to remove old believes from the community and spread the new knowledge on modern contraception and family planning.

BELIEVES ON VARIOUS FAMILY PLANNING METHODS

Intramuscularly ingestible like Depo-Provera (medroxy-progesterone accede) are very unpopular because they course amenorrhoea. Most women believe that if they don’t menstruate, the dirty blood accumulates in their bodies and make them dirty. They believe that if they don’t menstruate, blood accumulates in their body and will make them sick.
Tablets are unpopular because they lack secrecy and privacy and are likely to be seen by those family members that are anti-family planning like husband and in laws.

Condom in male dependant and men believe that it reducers the sensation and the joy of sex.

Loop has also been notorious in that if the patient is not well counseled prior to insertion, cramps that occur soon after insertion are perceived as severe pains. Irregular bleeding and spotting may be interpreted as a serious illness. It is also notorious of predisposing to pelvic inflammatory diseases if the patient is not in a monogamous relationship.
For most husbands, after been educated about a loop and the strings in the vagina, they often complain that the loop injures them during sexual intercourse and ask their wives to remove it. They say that the strings prick thee glans penis.

Sterilization is also unpopular in a sense that many woman believe that they will do longer have feelings after sterilization and are likely to be left by their dear husbands. That is way the term tubal ligation is more accepted than sterilization in a counseling session. Sterilization is interpreted as making someone sterile as literally interpreted
Having seen that there are odds against any form of contraception it is better to understand fully the extend of believe that the community has on certain myths. It is not worth to try to dispel all of them at the same time. Rather intergrades this believes in the program and dispel then gradually by introduction of facts. It is better to offer the methods that are accepted with little success than to try and force a more effective methods people without any success.

ADOLESCENT

Many young adults do not use contraception at first sex. The reasons are multifunctional. One such reason is that most of the don’t have stable relationships and don’t plan their sex. Most of their sexual act are sporadic and unplanned or even emancipated. That account for them not to be on contraceptives. Most of them change partners over a very short time while some have multiple partners. Their lifestyle put then at risk of Sexually transmitted diseases including HIV.

A family planning program to adolescence should be coupled with sexuality and HIV education. The effectiveness of barrier methods and the convenience for individuals with sexual lifestyle like that of the adolescent has been recommended by:

F Theron. Barrier methods especially condom protects against STDs and AIDS while preventing pregnancy. The alternative of emergency contraceptive and the convenience and safety may have added value an teen family planning if other contraception like condom does not receive the partners cooperation and approval and even so not readily available.

This is better given by the role models in the influential figure like politicians.

Adolescence doesn’t have a fixed set of norms and values. They tend to immunities their role models. This implies that all role models should guard against leading the young adult on the wrong way e.g. the statement made by the South African president on the casualty between HIV and AIDS.

The culture of contraceptive does not necessarily come as an instinct. Information is is spread from one person to another through one or other means. In rural Bangladesh, a study conducted in 1997-98 revealed that 42% of young unmarried women in rural areas had a vivid memory of where they first heard about family planning from young age, Their sources are varied and so in the validity of such information.

The maturity of an individual when she first hear about family planning also has an effect on how she may interpret it, thus the way in which she will use this information. Psychological maturity and chronological age when one get an information has a positive effect on her attitude towards that information when one get older, that means those that knew about contraceptives when young are likely to use them than those that only knew about them late in their reproductive life.

Economic factors also may prompt cultural factors in such a way thus family planning is used appropriately. In a study of cultural believes Vietnamese population in United States of America. The sociocultural factors of the Vietnamese refugees influenced their use of family planning methods that would limit the number of future pregnancies. The findings revealed that stress associated with starting over in a new land, such as concerns about finance and leaning English influenced younger Vietnamese women to be vulnerable to accepting family planing.

This study revealed that not only culture of importance but also but also other factors like, economic situation, religion even geographic location has an influence on human behavior. For a family planning program to be successful and effective, and factors effecting human ecology should be taken into consideration.

PHYSICIANS CULTURE AND ATTITUDE ON FAMILY PLANNING

Covington examined the effect of the culture of 681 negative physicians on the family planning program. He discovered that more than half of the physicians was practicing intrauterine contraceptive device. Contrary he found that Obstetricians, Gynaecologist were likely to provide various methods depending no the needs of the patient. The choice of contraceptives did not take the patients cultural attitudes of the patient onto consideration but the preference of the Gynaecologist were likely to provide various methods depending on the needs of the patient. The choice of contraceptives did not take the patients cultural attitudes of the patient into consideration but the preference of the Gynaecologist preceded the patient sociocultural believes. This led to poor compliance and increased future rate.

Most Gynaecologists failed to introspect themselves and advanced various reasons as contributing factors to failure rate e.g. educational level and social standard of the patient.

Many physicians also believed that family planning is foreign to the culture and it promotes promiscuity. Many family physicians were reluctant to promote family planning on a wide scale because of their cultural believed.

There were also elements of cross-cultural conflicts between physicians who were not Nigerians and the indigenous population culture that were among the obstacles to the success of a family-planning program.

Intergrading family planning with local cultures can increase or undermines their effectiveness. Kinship and reproductive behavior and decision-making will influence program design and organization, which varies across regions and communal and racial divisions.

According to Warwick S.P.Program implementation depends on four aspects of culture:

  • Understanding, acceptance and continued practice of family planning by clients
  • The climate in the organization responsible for fieldwork, which affect the disposition to work and the tasks to be done.
  • The ability and willingness of field workers implementers to do their work, and
  • The communities in which client live, including collective attitudes towards family planning and local pressures put on clients to participate. The above four elements were evident in Indonesian family planning program.
  • To the contrary, a program in Kenya had a more negative environment of action that led to it failure.

Summary

Many factors on the population have cultural bases. The are affected and do have an effect on culture. The nature and the extend of effect is determinable by the manner of implementation and the acceptance it receives.The same applies to family planning. The study on population culture and beliefs should proceed and attempt to design programs for the population. As each population is unique, a family planning program should be tailored to suite the cultural elements of the community it is intended for.It seems the culture itself need no modification but the family planning program implementers are the ones that needs education and so as to fit into the population they are working. Acculturation of the population is always met with resistance that originates from prior experience, which has no relationship with family planning. Such confounding factors should first be sorted out long before a family planning program can be designed and implemented.

References:

  • Mita R, Simmons R. Diffusion of the culture of contraception: Program effect on young women in rural Bangladesh. Stud Fam Plann 1995;Jan-Feb 26(1):1-1
  • Network-Family health International. 1999; 19(4):4-18.
  • Kuss T. Family planning experiences of Vietnamese women. J Community Health Nurs 19997; 14(3) 155 168.
  • Stoekel J. Differentials in fertility, family planning practice, and family size values in South Africa. 1975; Nov 6: 378-401.
  • Covington D L. Ontorio E O. Physician attitudes and family planning in Nigeria. Stud Fam Plann 1986; July- Aug 17(4) 172-180.
  • S, Del Zotti, Baruchello M. The behavior of Italian family physicians regarding the health problems of women and, in particular family planning (both contraceptive and NFP). Adv. Contracept 1997; Jun-Sep 13: 283-293.
  • Behats F M, Ward E. Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking. Sex Transm Infec 1998; Jun 74: 123-127.
  • Kaseje D.C et al. Community based distribution of family planning in Saradidi, Knya. Ann Trop Med Parasitol 1987; Apr 81 1 135 147.
  • Mbizvo M T,Adamchek D J. Family planning knowledge, attitudes and practice of men in Zimbabwe. Stud Fam Plann 1991; Jan-Feb 22: 31-38.
  • Awaniyl T A. The dilemma of traditional childhood education in Africa, South of Sahara. Ment health Soc 1978;Jan 4:9-25.
  • Warwick D P. Culture and management of family planning program. Stud Fam Plann 1988; Jan-Feb 19(1): 1-18.
  • Chissel S, Moodley J. Well woman clinics. CME 1999; Sept: 1061-1065.
  • Freedman R. The contribution of social science research to population policy and family and family planning program effectiveness. Stud Fam Plann 1987. Mar-Apr 18(2):57-52.
  • Mirza T, Kovacs G T, McDonald P. The use of family planning services by non-English speaking background women. Aust N Z J Obsstet Gynaecology 1999;Aug 29(2):341-343.
  • James O R. The benefits and risks of oral contraceptives today.1996; 2: 7-8.
  • Goosen M, Klugman B. The South African women’s Health book. 1996; 281-340.
  • Bancroft J. Human sexuality and its problems. 1989; 2: 456-535.
  • Van der Spuyz. Emergency contraception- a well kept secret. CME 1998. Oct: 972-975.
  • Department of Health. Saving Mothers – Executive Summary 1998: 1-8.
  • Theron F, Grobler C J F. Contraception – theory and practice 1995: 120-129.
  • Connel B C. Contraceptio in women over 35. The female patient. 1997; 3(30): 25-27.