Approximately 37 percent of the patients were 20-24 years of age, 21 percent were 15-19 years of age, and 20 percent 25-29 years of age. In general, white patients were somewhat older than the nonwhite patients. The oral contraceptive was selected as a method of family planning by 66 percent of the patients, followed by the IUD which was adopted by 18 percent of the patients. The oral contraceptive was relatively more popular among low parity women. The proportion of women adopting IUD increased with increasing parity. Approximately 68 percent of the patients had some high school education, 17 percent had grade school education, 10 percent had college education, and 4 percent reported no formal education. The National Center for Health Services Research and Development is supporting four projects directly concerned with the development and utilization of family planning services: (a) A grant at Johns Hopkins University is developing an exemplary genetics counselling clinic equipped to perform diagnostic studies necessary for adequate genetic advice and to provide informed advice related to family planning. (b) Another genetics counselling clinic, established by the Washington University School of Medicine at St. Louis, Missouri, serves as a referral center for the diagnosis of and counselling on genetic disease for the State of Missouri and bordering areas. (c) In London the Institute of Community Studies is analyzing the part played by the family physician in relation to family planning and the effect the physicians' attitudes have on the patients' views and actions. (d) A project at the Christian Medical College at Punjab, India, first proposed to determine ways in which rural health centers can be used for family planning activities. Later the scope of the contract was enlarged to include the analysis of the interaction of family planning services with different combinations of health services in India, in an effort to define motivational factors which influence the utilization of family planning methods. The National Institute of Mental Health (NIMH) encourages research in the mental health and social behavioral aspects of family life, including fertility and related areas of family planning. The NIMH continues to encourage and support family planning services provided through community mental health facilities. The Institute recognizes the special contributions that can be made in this area by mental health personnel. In order to meet the needs for trained manpower, the NIMH plans to support programs to train personnel in disciplines related to family planning. Through training and educational support programs, NIMH will continue to stimulate family planning programs for the training of public health nurses, teachers, social workers and others involved in sex and health education or who have direct contact with those groups and individuals having the greatest need for family planning services and information. The Center for Studies of Child and Family Mental Health provides the focus for NIMH family planning activities. Examples of research grant projects supported by the NIMH dealing directly with various aspects of family planning are: 1. Developing a taxonomy of family problems and problem-solving processes, and a study of the effects of sociocultural milieus, family structure, personality and other variables on family planning and problem solving. 2. Developing scales for appraising sexual attitudes and use of 3. 4. 5. 6. 7. Constructing a typology of childbearing motivations and conflicts, and relating this to pregnancy and postpartum out comes. Investigating the role resolutions of young mothers to deter- Studying child rearing practices of "hippies," including parental role, attitude of parents toward children, experiences with own parents, and physical care of children. Evaluating a program of intensive aftercare with discharged psychotic mothers of young children and conducting a survey of family planning knowledge, and attitudes and practices of the women. Studying a variety of issues of social policy, including family planning, for which marital and family variables are determined to be important. In addition, a large group of research grant projects bear indirectly on the topic; communication and decision-making within families, patterns of family life, motivation, sex education, and population characteristics. The Center for Studies of Child and Family Mental Health broadens its concept of family planning to include investigations into the structure of the American family; i.e., what factors contribute to breakdown in the family structure in the affluent suburban household; problems of role identification as a father for the third generation AFDC recipients. The NIMH Division of Intramural Research is carrying out projects on family formation, child spacing, and animal studies of population density. National Institutes of Health Summary of Programs Related to Family Planning The basic research programs of the Department in the field of population and human reproduction are directed by the Center for Population Research in the National Institute of Child Health and Human Development (NICHD). Section 444 of the Public Health Service Act authorizes the NICHD to conduct and support research and training relating to maternal health, child health, and human development, including research and research training in the special health problems and requirements of mothers and children and in the basic sciences relating to the processes of human growth and development, including prenatal development. Expenditures by the NICHD in fiscal year 1970 for Population Research were $18.7 million. In addition, Section 1004 of Public Law 91-572, "The Family Planning Services and Population Research Act of 1970," authorizes the Secretary of Health, Education, and Welfare to make grants and enter into contracts "...to promote research in the biomedical, contraceptive development, behavioral, and program implementation fields related to family planning and population...." Other components of the National Institutes of Health provided $3.9 million in fiscal year 1970 to support a variety of extramural activities with important implications for population research. Reproductive endocrinology research activities supported by the National Institute of Arthritis and Metabolic Diseases required approximately $2.0 million in fiscal year 1970 to increase knowledge of basic mechanisms in reproduction. These studies provide useful information for development of new methods for controlling normal reproductive processes. The fundamental interests of the National Cancer Institute in reproductive endocrinology and other physiological functions is highly relevant to understanding normal function and fertility control. In fiscal year 1970, $0.3 million was spent to support these studies. Approximately $0.1 million was spent by the National Institute of General Medical Sciences in support of grants for research training in reproductive physiology, demography and population dynamics. The National Heart and Lung Institute in investigations of the broader aspects of blood clotting mechanisms or circulation physiology have included studies of the effects of estrogens, progestagens, or steroid contraceptives. And, several studies in reproductive neuroendocrinology are supported by the National Institute of Neurological Diseases and Stroke. Support by both these Institutes totals about $0.4 million. The Division of Research Resources is responsible for the administration of approximately $1.1 million in general research support relevant to the population field particularly in primate research centers. The Bureau of Health Manpower Education promotes and supports the education, training, utilization and practice of professional and allied personnel in all areas of health. Bureau activities, therefore, are generally noncategorical but encourage the incorporation of specific content, based on new or continuing public health problems, into educational programs, projects and demonstrations. Bureau support in this area, to a major extent, is provided through the use of grant funds for the training of health personnel in family planning, population control, demographic studies, maternal and infant care, and related content. Information and services of the Bureau specifically related to family planning are provided to educational institutions and State and local health agencies through the Bureau's training consultants in the Central Office and Regional Offices. Current and Projected Population and Family Planning Activities National Institute of Child Health and Human Development In its own laboratories, through the intramural research program, NICHD has assembled a staff of scientists to collaborate on research in reproductive biology. Staff, space, budget and breadth of studies have increased substantially during the past year in order to do some of the fundamental scientific work on which practical solutions to population problems will be based. The Reproduction Research Branch of NICHD is involved in six major areas of study: 1. 2. 3. 4. 5. 6. The mechanism of action of hormones The physiology of the menstrual cycle and female infertility Protein hormone isolation and characterization These studies have various applications. Infertility clinics for both men and women have been established in conjunction with some of these studies, and one cause of female infertility has been identified. Patients are now being accepted for treatment. Research on early pregnancy is adding to knowledge about the causes of early abortion (miscarriage). Work on male and female reproductive biology and on protein hormones may help lead to development of new contraceptive methods and improvement in present methods, including rhythm: The Center for Population Research was established in August 1968. In July 1969, NICHD grants in reproductive biology research and training and personnel of the Population and Reproduction Grants Branch were transferred into the Center. Two primary functions formed the Center's charter: (1) to organize and direct a contract program in population research, carried out by the Contraceptive Development, Fertility Regulating Methods Evaluation, and Behavioral Sciences Branches and (2) to be the focus of coordination and information for the variety of population research efforts through the Federal establishment. This latter function is the responsibility of the Program Liaison Branch. Contraceptive Development The contraceptive development program began in 1968 and to date has consisted primarily of directed fundamental research on topics considered relevant to the eventual development of new contraceptives. In fiscal year 1970, the Center negotiated 108 contracts for such research. -1 These studies are forming a solid base for developing new contraceptives. At any stage in the reproductive process from the production and release of pituitary hormones initiating sperm and ovum formation, to implantation of the developing embryo in the uterus it may be possible to alter the sequence of physiological events and prevent pregnancy. Research emphasis is on: basic studies into normal and abnormal reproductive biology the role of the pituitary gland in control of ovulation and sperm formation the role of immunological processes in controlling . fertility processes regulating formation of egg and sperm prostaglandins and their role in the control of corpus The ideal contraceptive would be effective, safe, inexpensive, reversible, self-administered, and acceptable to various population groups. No existing method fits all these criteria. Probably no single method will be universally satisfactory; the goal of population research is to develop many contraceptives, suitable to many kinds of people. To develop rapidly a variety of new contraceptives, new approaches are planned in the following areas: development of new anti fertility drugs use of drugs introduced intravaginally to control the development of new techniques for reversible female the search for male hormones with low virilizing During 1971, the contraceptive development program will become more product oriented and by the end of 1972 it will include many phases of drug development, from synthesis through clinical testing, necessarily involving close cooperation with the pharmaceutical industry. The Institute's goal is the development of several new methods of fertility regulation before the end of this decade. |