Since the 1990 Tblisi WHO conference focussed on the desirability of a transition from abortion to contraception in the region, most east European countries have adopted programs to introduce modern family planning as an alternative to repeated induced abortion as the chief method of birth control. Despite this large new field for application of family planning programs, little careful evaluation of such programs exists. Proposed research takes advantage of a unique programmatic setting in a country where demand for effective, safe, inexpensive contraception is extremely high. If this new direction in family planning programs can have a demonstrable effect anywhere, we believe we should be able to find it in this case. The proposed research collects and evaluates survey and vital statistics data for regions in Bulgaria with and without special family planning clinics providing subsidized contraceptives to the population. One-third of the country is served by such clinics, creating an opportunity for comparison of trends in births, abortions, and family planning knowledge, attitudes and behavior over time in the regions with clinics and those without. A baseline 1995 survey has been analyzed to address questions of program placement effects. A second survey is proposed for 2000 to capture changes in contraceptive KAB patterns. Birth statistics adequate for program evaluation already are collected and analyzed by the National Statistical Institute. A special effort compile and analyze abortion records is proposed to balance the vital statistics picture, and to remedy current deficiencies in the vital statistics system of the country, at present an extremely cost-effective proposition. Since physicians form a crucial link in provision of contraceptive services in the country, survey by the Ministry of Health will allow analysis of determinants of their attitudes and practice, and allow inclusion of such attitudes and practices as covariates in models of reproductive outcomes in the population.
|Carlson, E; Lamb, V (2001) Changes in contraceptive use in Bulgaria, 1995-2000. Stud Fam Plann 32:329-38|
|Carlson, E; Tsvetarsky, S (2000) Birthweight and infant mortality in Bulgaria's transition crisis. Paediatr Perinat Epidemiol 14:159-62|