Ms Goh's GP blog

3. How far do you agree that family planning should be a responsibility of the state rather than the individual?

Number attempted: 17
No. passed: 7 (41.2%)
No. failed: 10 (58.8%)
Mark range: 15 – 28

Strengths
• Most scripts showed some knowledge of family planning policies, primarily those implemented in China and Singapore.
• The better scripts were able to discuss, to some extent, the tussle between individual preference and societal good.

Weaknesses

1. Question interpretation
a. Failure to recognise command words
• Command words tell you what you are supposed to do with the question, how you should begin your essay, what tone you should adopt etc…
• “How far do you agree” suggests that the question is not to be completely agreed or disagreed with. Hence, essays which failed to consider both the roles of the state and the individual would fail to show balance, and hence, be penalised.
• “… should be … rather than …” demands the need to look at the tussle between the state and the individual, to acknowledge the dilemma inherent the issue.
b. Failure to formulating arguments based on the key words
• You should be able to identify the key words of the question that bring out the controversy of the issue. These would be “state” and “individual”, not so much “family planning” because the latter is the topic itself.
What is wrong with the following approaches to the question?
- How family planning can be carried out by the government.
- How family planning is done by countries such as China and Singapore.
- The advantages and disadvantages of family planning.

2. Paragraphing and paragraph development
a. Absence of topic sentences
• This is a serious problem because without topic sentences, your paragraphs lose relevance to the question. Even if the material or example presented is valid, the essay, on the whole, would not be answering the question.
• Topic sentences serve the purpose of addressing the key and command words in the question, and give you the chance to show the reader that you are not out of point. Do not wait till the end of the paragraph to state an argument.
• As a rule of thumb, if the reader were to read only the topic sentences of your essay, he should get an effective summary of it.
b. Lack of distinct paragraphing
• Many scripts had arguments that “run”, that is, the same argument is presented over a few paragraphs. Note that the danger here is not just the lack of paragraph coherence, but the tendency to describe more than argue.

3. Introduction and conclusion – the first and last impressions
a. Introduction
• Before you pen the introduction, ask yourself:
- What is the controversy behind the question?
- Why was the question asked the way it was?
- What is its relevance in this time and age?
- Are there absolute words? Or words that need defining?
These questions should help you paint a background to the topic without losing focus of the question. Never plunge into writing with a vague picture of the issue. Anything that starts hasty and hazy probably won’t find its way out of the fog.
• Write about 80 to 100 words.

Why is the following an effective introduction?

Family planning is an integral stage in a couple’s life where they make the decision of whether to give birth and carry out the responsibility of reproduction. While it is an individual choice, it also concerns the future and survival of a state or country. This decision by individuals determines the population and workforce that drive the state’s economy. As such, for the long-term survival and prosperity of a nation, the state has an indirect responsibility to ensure that family planning by individuals does not jeopardize this progress and survival. In our modern age, this responsibility of the state has become more evident as the consequences of poor family planning in many countries show that individuals have failed to exercise proper family planning by themselves. (125 words)
Lai Guohao, 34/04

b. Conclusion
• Avoid a one-liner.
• Avoid introducing a new argument.
• Avoid a stand that contradicts the one stated in the introduction.

4. Content knowledge
A rule of thumb is if your essay planning does not produce more than 3 ideas, drop that question. If you know nothing about family planning except China’s one-child policy and Singapore’s efforts to up the fertility rate, you should not be doing this question because everybody else knows these too.

A suggested approach

Introduction
• Introduce the idea that family planning has found its way into more countries’ political agenda today than before.
• State how over- or under-population will prevent a country from achieving optimum growth and utilising its resources in the best possible way. Seen from this perspective, the government has the right to control the country’s numbers to maximise its potential.
• Acknowledge the dilemma in the question by looking at how modernisation has given humans more rights in many aspects of their lives, and surely an issue as personal as setting up a family should be left to the individuals.
• State your stand.

Body
• From a utilitarian and practical point of view, family planning should fall under the purview of the government as it would know the country’s carrying capacity, and hence, plan and utilise its human resources in the best possible way.
• Only the state has the capacity to implement family planning policies and campaigns that have the scope to impact the nation’s fertility rates, and that in itself is a good reason for the state to shoulder the responsibility. These will also help people make informed choices about family planning.
• Family planning also enables better provision of facilities and incentives, as well as better distribution of resources. Family planning can also be tied more coherently to more overarching government aims and concerns.
• On the other hand, individuals have their rights and, unless there is state legislation, the final say with regard to birth issues.
• There is also the need to consider how an individual’s perception can be influenced by other factors such as religion or culture, and sensitive issues like abortion, adoption, usage of contraceptives, surrogate motherhood and others will surface. In more rural societies where children are wealth and status symbols, family planning will sound illogical and ludicrous. The question to ask then is how do these factors measure up, vis-à-vis the State.

Family planning can be more efficiently carried out if it is the responsibility of the state. When family planning is done by the state, schemes and other government policies can accompany it to ensure its smooth implementation. If family planning is done by the individual, there will be less help to aid that person in carrying out the plan. Singapore is now actively encouraging families to have more children. To achieve this, the government has tagged many money grants and cash bonuses for families having three or more children. They include tax relief and cheaper education for the child. All these encourage families to follow the plan. In the urban cities of China, the government has made abortion compulsory for women conceiving a second child. One-child families also receive tax rebates. If family planning was to be done by the individual, there would be less government aid and more difficulties in carrying out the plan. Thus, family planning should be a responsibility of the state and not the individual.
Shawn Ting Yi Kuang, 22/04

Conclusion
• An easy way to conclude would be to sum up key arguments and restate your stand.
• You can also come to a generalized conclusion about family planning on a global level, that it is a difficult concept to drive across to people, simply because of the cultural, religious, technological and economic factors that complicate the situation. The less developed parts of the world have difficulties reducing fertility rates while the more developed ones have difficulties upping them.
• To produce a more substantial conclusion, you can provide some insight by looking towards the future, and question the relevance of the issue then. Will it become more/less serious? What likely changes in people’s attitudes and perceptions will there be? Which political/social/economic/technological changes in the future will impact the way this controversy unfolds and how is this done?
SOME USEFUL CASE STUDIES/EXAMPLES

• It is not humanly possible to learn and remember all these, but do look through and try to keep some of these in mind. You never know when such knowledge will come in handy.

Africa (PATH): Tapping into the positive potential of the life-shaping role of culture in Africa.
Africa (World Bank): Incorporating local knowledge, customs and values into projects, primarily in Africa.
Africa and Asia (UNICEF): Communication, advocacy, and mobilization packages that focus on practices harmful to girls in Southern Asia and Eastern and Southern Africa.
Bangladesh: Multi-angle approach to improving the quality of family planning services through planning, supervision, training, and referral services.
China: The introduction of interpersonal communication and counseling skills into a family planning training program.
Uganda (Busoga Diocese): Expanding family planning programs to include HIV/STI services.
Uganda (Sabiny Elders, REACH, NGOs): Working to convince communities to end female genital mutilation, with a focus on positive cultural values.
Uganda (The Straight Talk Foundation): Addressing adolescents' sexual and reproductive health concerns through innovative publications and programs.

Case study 1: Bangladesh

With a population almost half that of the United States in an area less than 2 percent the size, Bangladesh relies heavily on family planning services to enable men and women to limit family size. Yet use of clinical contraceptives has been declining, in part because the quality of services is often inadequate. As part of a Bangladeshi government initiative to address these problems, EngenderHealth (formerly AVSC International) implemented a project from July 1995 to March 1997 in five thanas, or counties, in the Sylhet and Jhenaidah districts. Its goal was to improve the quality of family planning services and the variety of contraceptive methods available by strengthening four components of the family planning system: planning at the local (thana) level, supervision, training, and referral services.

Through COPE (Client-Oriented, Provider-Efficient services) exercises, staff identified several factors hindering service quality:
• Routine examinations were not being performed due to lack of laboratory facilities.
• Sterilization services were offered in few locations and at limited times, owing to staff vacancies and insufficient numbers of staff trained in the procedures.
• Norplant implant services were not available at all in the thanas.
• Clients had limited access to information about clinic services, schedules, and service charges.
• There was no regularly scheduled pre- and post-natal counseling, no counseling arranged for male clients, and often no separate room available for counseling.
• Provider supervision and training were insufficient, as was providers' knowledge about sexually transmitted infections and infection prevention procedures.
• Linkages between services also were lacking.

To solve these problems, local staff developed and implemented action plans, which were reviewed monthly. Training courses were attended by 183 service providers. Refresher courses were given on all contraceptive methods, counseling, and infection prevention, with comprehensive training given in sterilization, Norplant implants, and injectable contraception. Through facilitative supervision workshops, the supervisors learned new approaches to supporting providers in improving quality.

Providers who participated in the COPE exercises and trainings indicated overwhelmingly that they were becoming more aware of and responsive to clients' needs and rights. They also paid greater attention to counseling, client screening, and infection prevention procedures, reporting that the clinics had become cleaner than before. And client referrals and coordination between sites increased substantially. In addition, supervisors found that after participating in the workshops, they were better able to identify staff training needs, and their supervisory style became less directive and more helpful. They also gained a better understanding of what was expected of them, and since supervision became easier to perform, they provided it more systematically.

During the project period, there were no dramatic changes in the mix of contraceptive methods used. However, more clients started using clinical contraceptive services than before. Just as important, client exit interviews indicated high levels of satisfaction with the services received during the project period. Almost all clients said that the problem that had brought them to the clinic had been resolved, and all said they felt comfortable discussing the problem with the provider. The clients also believed that they had been treated well by the provider, and said they would recommend the services to friends and relatives. Of those clients who had also received services within the past year, many noted such improvements in the clinics as the addition of partitions for client privacy, a much-needed fan, greater cleanliness, and better lighting. Because of the project's success, the interagency evaluation team has recommended extending it for another three years. Ultimately, it is expected that these improvements in quality will result in more individuals and couples requesting clinical contraceptive services.

Case Study 2: China

Studies on communication efforts have shown that mass media and educational tools such as brochures and posters are useful for transmitting information to large numbers of people, but that their influence on behavior change can be limited. Interpersonal communications and counseling (IPC/C) provide the needed catalyst and personalized attention to needs and concerns that make a major contribution to behavior change.

One of the strategies the Chinese government has chosen to improve the quality of its family planning program is to strengthen services in the rural areas, where 70 percent of the population—about 870 million people—live (PRB 1998 World Population Data Sheet). In the early 1990s, the government decided to upgrade the skills and knowledge of family planning workers at the township and village level through its five-year Counseling Training Project. The Counseling Training Project was launched in 20 of China's 30 provinces and served as a pilot project for a larger program. This project addressed key aspects of quality of care in China's national family planning program—in particular the quality of information and counseling given to clients, and interpersonal relations between service providers and clients.

As a first step, national project staff learned about local realities by conducting knowledge, attitudes, and practice (KAP) surveys with villagers and family planning workers at the grassroots level. The information from this study was used to develop training programs and materials, and was used as baseline data for project evaluation. A "pyramid" training program was designed in which a small group of core trainers from the provincial and prefecture training stations received training, who then trained a larger group of master trainers from their province. The master trainers then trained an even larger number of staff at the county and township levels, who in turn trained village-level workers. Ultimately, 80,000 rural family planning providers were trained.

Trainers acquired skills in IPC/C, adult learning principles, participatory training methods (such as group discussion and skill practice), and development of training materials based on the needs of the audience. Later, trainers learned IPC/C-training skills specifically tailored to rural Chinese situations and counseling skills related to help clients select appropriate family planning methods and prevent STI/ HIV.

Post-workshop evaluations showed that family planning workers understood the concept of informed choice and that counseling is important in a family planning program to achieve client satisfaction and effective use of methods. Family planning workers also liked the participatory learning techniques used in the trainings and reported that they learned far more than they had previously through the usual lectures. Feedback also showed that family planning managers and local government officials who had been trained in IPC/C were more likely to support the local workers in their efforts to improve the quality of services for clients.

Case Study 3: Zambia

The Government of the Republic of Zambia adopted a National Population Policy in 1989 as part of its fourth National Development Plan. This policy recognized the effects of rapid population growth on Zambia's socioeconomic development and the need to incorporate population concerns into the national development and planning process.

The main objective is to ensure that all couples and individuals can exercise the basic right to decide freely and responsibly the number and spacing of their children and have the information, education, and means to do so. Other specific objectives include slowing the nation's high population growth rate, enhancing the health and welfare of all, and preventing premature death and illness, especially among high-risk groups of mothers and children.

To help the national and district levels in the planning and implementation of the family planning component of their reproductive health programs, a policy framework was developed. The first section of the document describes the framework for family planning supported by the Ministry of Health. The second section, "Strategies for Providing Family Planning within Reproductive Health" addresses the challenges of providing family planning within the context of the broader context of reproductive health as defined at the International Conference on Population and Development (ICPD) in 1994. It looks at the status of various aspects of reproductive health in Zambia, especially family planning and proposes specific strategies for improving access to and quality of family planning care. For example, the importance of addressing the reproductive health needs of couples throughout their reproductive lives is emphasized. The third section, "Family Planning Methods," contains a technical description of all family planning methods available in Zambia and includes guidelines for service provision based on the revised WHO medical eligibility criteria.
Some specific recommendations include:
• ensuring that providers are trained in all available modern methods;
• making barrier methods, particularly condoms and spermicides, available through a range of channels;
• making combined oral contraceptives available through community-based providers who will use checklists based on the eligibility criteria; and
• making family planning methods available to women seeking postabortion care.

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