visit, the patient is given an addressed, stamped postcard with her clinic number on it, and is instructed to mail the card when her birth control supplies are running low. The same day the card is received, the product is wrapped, another postcard is enclosed (with an appointment reminder if that is due soon) and a copy of the Family Planning Flyer, the monthly newspaper, are sent to the patient. There should be only a two-day interval between the time a woman mails her card and the time she receives her supplies. REGION VII Kansas City, Missouri Project interchange of data among clinics is facilitated by use of an information folder, available for computer processing and compatible with the reporting form required by HEW. The project statistician has worked with the City Health Department to initiate coding of information on birth certificates that will provide the project with a "vast storehouse of statistics." An evaluation system is being developed based on statistics and patient response to questionnaires. The ultimate aim is to measure the progress, quality, accessibility, and effectiveness of the project itself; its impact on other medical care programs as well as on such environmental programs being administered by the city as housing, rat control, and air pollution. "In other words, an attempt will be made to discern just what role family planning can play in breaking the poverty cycle." The interview itself consists of various questions and information needed to pass on to the consumer: Inquiries about whether the referral was completed, and whether it was completed to the patient's satisfaction; inquiries about the patient's health and if there were any complications. Does the consumer feel that the general welfare of the family is adequate, and, if not, what additional referrals must the Health Department make? REGION VIII Denver, Colorado Some of the family planning sessions are held in conjunction with other Public Health Service clinics such as postpartum and VD clinics. A male teacher conducts evening classes for men. REGION IX San Bernardino County, California A Planned Parenthood team meets each month with women who are to be paroled from the California Institution for Women at Frontera. The County Health Department has initiated a similar program for women drug addicts being discharged from the California Rehabilitation Center at Patton. Prenatal and postpartum patients from San Bernardino General Hospital and County Health Department clinics are referred to accessible clinics for family planning services. REGION X Idaho One Public Health nurse travels with the migrant stream from Texas to Idaho throughout the year; she is paid by the Idaho State Health Department when the migrants are residing in Idaho. She was a migrant herself and is bilingual. Several of the other nurses and the aides are bilingual. The Center for Disease Control through the Epidemic Intelligence Service (EIS) officers of Family Planning Evaluation Activity, Epidemiology Program, has been engaged in training and supporting health personnel in the evaluation of family planning programs through reimbursable agreements with the Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, and the National Center for Family Planning Services, Health Services and Mental Health Administration. In FY 1967, three officers were assigned to family planning evaluation projects in three cities. Six additional officers were assigned to projects in FY 1968. Five additional officers were assigned during FY 1969. Four more officers joined the program in FY 1970 and six in FY 1971. Five new officers were assigned in FY 1972. At present, ten officers provide assistance to State and local health departments in evaluating family planning clinic services, implementing the design of data processing systems for family planning service statistics, and studying continuation of contraceptive use. They also conduct investigations and special studies of problems related to contracep— tive use. In addition, there are four professionals in the central offices providing guidance and technical assistance. EIS officers also provide epidemiologic assistance in the investigation of abortion-related deaths and clusters of abortion complications. Surveillance of legal induced abortion practice is maintained by means of a nationwide reporting system. The Community Health Service continues to emphasize the integration of family planning services into the programs of comprehensive health care centers supported through Project Grants for Health Services Development (314 (e) program). There are currently 55 such centers located in 27 States and D.C. These centers are generally located in areas with a high concentration of urban and rural poor and provide access to a broad range of comprehensive health services to a target population of 2.7 million people. The Family Health Center Program, initiated in 1972 under the 314 (e) grant mechanism, offers another means for improving access to care in medically underserved areas. Expected to be somewhat smaller than the typical Comprehensive Health Center, the Family Health Center will provide a basic package of medical, nursing and outreach services--including family planning services. In addition, CHS supports 120 migrant health projects. These are designed to provide health care services to migrant agricultural laborers and seasonal farmworkers and their families. Many of the se projects include family planning services. Under the Formula Grant Program (314 (d)), the States receive on a continuing basis an amount of funds which gives them the ability to meet the special health needs of people or to launch new programs which result from their own planning. Many of the States are utilizing the flexibility of this funding mechanism to expand their services into areas such as family planning. The Comprehensive Health Planning Service finds that State and areawide comprehensive health planning agencies are devoting increasing attention to family planning services. A 1970 review of areawide agencies found approximately half of the agencies concerned in some way with family planning. CHP concern has been expressed in the design of programs ranging from a Family Planning Information Center to participation in the development of programs to provide direct family planning services to those who want them. The Federal Health Programs Service provides comprehensive family planning services to eligible beneficiaries through its system of hospitals and outpatient clinics. These family planning services may include the prescription and provision of pharmaceutical preparations including oral contraceptives and mechanical devices, surgical sterilization, and counseling. All postpartum patients are offered family planning information and services as part of the follow-up medical care at the Public Health Service Hospitals which have obstetrical services (Staten Island and New Orleans). All USPHS hospitals and clinics provide family planning services upon request. There were an estimated 13,000 family planning services visits in fiscal year 1969, 15,000 visits in fiscal year 1970, and 15,500 visits in fiscal year 1971. Community oriented family planning services are provided at the Boston Public Health Service Hospital through an agreement with the Massachusetts State Department of Health and St. Elizabeth's Hospital and at a Neighborhood Health Center in Washington, D.C., through an agreement with the D.C. Department of Health. The Division of Federal Employee Health, through the health unit operations, provides the following family planning education and counseling services upon request: 1. Family planning literature. 2. 3. Access to a physician and/or nurse to discuss family Referral to public and private health care facilities The Indian Health Service has been active in the field of family planning since fiscal year 1965. Since that time through June 30, 1971, family planning services have been provided to 42,600 women. In fiscal year 1971, there were 28,000 medical visits by 16,600 Indian and Alaskan native women for family planning services. In FY 1971, the number of Indian women 15-44 years of age is estimated at 86,000. The National Center for Health Statistics (NCHS) collects and publishes natality, marriage and divorce, and mortality statistics. It also engages in research on the dynamics of population change and examines some of the social and economic factors associated with change. NCHS conducts annual vital records surveys. NCHS is currently developing an interview questionnaire and final operational plans for a continuing survey of family growth in the United States. This survey is designed to collect data on factors affecting the birth rate, family planning, and infant and maternal health. This survey will be conducted through the use of the field operations of a private survey organization with periodic interviewing of a representative sample of ever-married women in childbearing ages. NCHS and the Research Triangle Institute in North Carolina have collaborated in the development of a computer model intended to simulate the dynamics of population growth. A manual is being prepared to enable others, within this country and abroad, to apply the model to their own population structure and problems. NCHS is responsible for operating a uniform national family planning services reporting system. The development of this reporting system has been in two steps. NCHS has worked with the National Center for Family Planning Services, Maternal and Child Health Service, the Office of Economic Opportunity, and Planned ParenthoodWorld Population, and other governmental and private family planning groups to operate a provisional family planning reporting system. This provisional system has provided data on the utilization of family planning services which were financed at least in part by Federal funds, and for which there was an immediate program need for data. Based on the experience gained from the operation of this provisional system, NCHS has developed a national system to be used by all federally supported family planning programs, clinics, and service points, and by other agencies who wish to participate in the reporting system. This system will provide a meaningful body of data essential for the efficient and effective development, operation, and evaluation of family planning programs throughout the nation. Training for the revised system was held during December 1971 in each of the ten Federal regional cities. The persons that were trained were primarily regional personnel and personnel from certain larger projects who would be able to help the staff of other, smaller projects with their participation in the system. About 530 people were trained during the three-week period. As of January 1972, 90 new projects, representing 563 new clinics, have been enrolled in the national system. This brings the current enrollment up to about 750 projects, which include about 3000 clinics. Participating in the provisional reporting system had increased rapidly during 1971. As of December 31 of that year, a total of 451 DHEW and OEO projects, including 1,793 clinics, were active and participating. Some highlights of the data obtained in this interim system follow: During the 1971 Federal fiscal year (July 1, 1970-June 30, 1971), 1,418 clinics participated in the system. These clinics reported that a total of 633,048 patients received family planning services. These patients made a total of 991,760 visits to the clinics during this time period. Not all these clinics, of course, were active in the system during the entire fiscal year. of the total patients served during the year, 58.0 percent were new patients. About 40 percent of the patients served in the participating clinics were white, 40 percent were Black, and 20 percent were of other minority groups. Approximately 37 percent of the patients were 20-24 years of age, 23 percent were 15-19 years of age, and 19 percent were 20-29 years of age. In general, white patients tended to be younger than Black and other minority group patients. The oral contraceptive was selected as a method of family planning by 67 percent of the patients, followed by the IUD, which was adopted by 17 percent of the patients. The oral contraceptive was relatively more popular among low parity women. The proportion of women adopting the IUD increased with increasing parity. Approximately 67 percent of the patients had some high school education, 17 percent had grade school education, 12 percent had college education, and 4 percent reported no formal education. The National Center for Health Services Research and Development is supporting one project directly concerned with the development and utilization of family planning services: A project in Pakistan includes family planning services in a rural health services experiment providing comprehensive mother and child services in two experimental communities, using two additional communities as controls. The project entails substantial utilization of local lay people and healers. Medical and environmental health services are provided by inter-disciplinary teams from Lahore. There is heavy reliance on health education and family planning education. The research component involves evaluation of effects on mother and child health, infant mortality, family planning practice and improvement of environmental sanitation. Evaluation also addresses itself to the selection, training, utilization and effectiveness of local personnel. The National Institute of Mental Health (NIMH) recognizes the special contribution that can be made by mental health personnel in the area of family planning. The Institute is involved in this area of concern through its research, training, and service programs. The Institute is guided in its efforts by a view of family structure as it is related to the larger social structure and to the |