Lapas attēli
PDF
ePub

29

Health Resources Administration

The National Center for Health Statistics (NCHS) derives its authority in population from the general data collection and research provisions of Sections 304 and 306 of the Public Health Service Act, and from the transfer of certain functions relating to vital statistics from the Census Bureau to the Public Health Service. NCHS is responsible for collecting and analyzing the wide range of health and demographic statistics needed for health planning and program evaluatic

The 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 has just completed the first phase of 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. It was 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. Data from the survey will be released early in 1976.

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 has been prepared and disseminated 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. This reporting system was developed in two stages. NCHS worked with governmental and private family planning groups to initiate a provisional family planning reporting system. This provisional system 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.

The

Based on the experience gained from operating the provisional system, NCHS developed the National Reporting System for Family Planning Services (NRSFPS) for use by all Federally-supported family planning programs, clinics, and service points, and by other agencies wishing to participate in the reporting system. NRSFPS currently provides monthly, quarterly, and annual reports essential for the efficient and effective development, operation, and evaluation of family planning programs throughout the Nation.

A second NCHS program for providing information on family planning services (The National Inventory of Family Planning Services) was initiated in 1974. The National Inventory is a comprehensive listing of all sites in the United States that provide family planning services, whether these services are medical or nonmedical. Annual censuses of the Inventory provide basic data on each facility, including information on staffing and services offered. The Inventory is also expected to provide the base for special sample studies from which additional, more detailed information can be acquired.

The Bureau of Health Resources Development develops, supports and evaluates State and areawide health planning programs that work to improve the health status of their respective populations. These programs consider the whole range of health concerns including family planning.

[ocr errors][merged small][merged small]

The Center for Disease Control (CDC) provides training to Epidemiologic Intelligence Service (EIS) officers. Some individuals in the program are being trained in an epidemiologic approach to evaluating family planning and population programs. The Family Planning Evaluation Division, CDC, provides assistance to State, local, and international health agencies in the evaluation of family planning programs. EIS officers and Public Health Advisors (PHA) are assigned in Georgia, New York, Tennessee, and California to develop and maintain data processing systems for family planning service statistics, to analyze contraceptive use and effectiveness, and to conduct special studies based on these analyses. In addition to these continuing assignments, short term assistance is given to family planning programs for improving program management, designing service statistics systems, and evaluating family planning program performance.

As State abortion laws became less restrictive in 1967, data concerning abortion mortality and the practice of legal abortion became increasingly important. CDC maintains surveillance of abortion practice and abortion deaths through a nationwide reporting system. In 1969 approximately 22,000 legal induced abortions were reported to CDC on a voluntary basis by State and local health departments. The following year more than 180,000 abortions were reported; in 1972 that number increased to 586,760; in 1973 the number increased to 615,831. Since 1972, New York City, Dallas, Philadelphia, Buffalo, Chicago, Portland (Oregon), and the States of New York, Arkansas, and Kansas have been assisted in assessing abortion-related health problems and in determining the measures necessary to prevent them. From the mid-1950's through the mid-1960's, abortion mortality did not decline even though other causes of maternal death decreased substantially. Since then, abortion mortality has continued to decrease. In 1969, 132 abortion-related deaths were reported. In 1970 there were 140 such deaths and, in 1971, 120 occurred. A marked decrease occurred in 1972 when 79 deaths were reported, and data for 1973 indicated a further decline to 47 abortion-related deaths. Data indicate that the risk of mortality increases with the length of gestation. CDC is undertaking a study to determine why women who decide on abortion delay that decision. Federal and State cooperation is necessary if the favorable trend in abortion mortality is to continue.

Epidemiologic field investigations of the medical consequences of drugs, devices, and techniques employed in family planning programs are being conducted. Morbidity and mortality associated with the use of the intrauterine device (IUD) was one of the studies conducted. Questionnaires were sent to physicians considered most likely to have inserted IUDs or to have examined women with IUD complications. More than 3,900 hospitalizations and five deaths occurred during the first six months of 1973. signed CDC the task of monitoring Federally-funded sterilizations on minors and those incapable of providing legal consent. Implementation of the Sterilization Surveillance Project is pending finalization of regulations.

DHEW has as

31

[ocr errors]

Alcohol, Drug Abuse, and Mental Health Administration

The National Institute of Mental Health (NIMH) is authorized to serve as the principal focus for research and training in the behavioral and basic sciences related to the causes, diagnosis, treatment, and prevention of disorders in the biological and psycho-social factors that determine human behavior and development. Under this broad mandate many activities related to family planning are supported.

The National Institute of Mental Health 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 views family structure as it relates to the larger social structure and to such social structure variables as occupation, social class, economic status, and life style. Since the Institute recognizes that programs of family planning must be modified to fit the facts of a diverse society, it seeks to determine these facts as they relate to mental health issues.

The Institute is interested in the implications of family size for the physical and mental health of family members. It is also interested in child spacing and its effect on family functioning and on the personality development of children. It seeks to determine the strengths and weaknesses of differing family forms and sizes; the effects of abortion and sterilization; the role of adoption; and the implications of working mothers, increased family incomes, and day-care centers on the family planning process.

Thus, the Institute seeks to determine the kinds of mental health services needed by families of differing sizes and forms, the adequacy of one-parent homes in providing crisis support to individual members, and the correlations between family size and the emotional characteristics of family members. Biometric data, for example, indicate that the heads of families with one child both parents present have lower admission rates to psychiatric facilities than the heads of those families which contain several children; yet, the children of one-child families both parents present have higher rates of hospitalization than children in families where siblings are present. Data of this nature have important implications for the Institute's contribution to family planning services.

The Institute encourages and supports family planning services provided through community mental health facilities. In its training and educational support programs, NIMH stimulates family planning programs in the training of public health nurses, teachers, social workers, and others involved in sex and health education. Through the Center for Studies of Child and Family Mental Health, the Institute encourages research in mental health and the behavioral aspects of family life.

Examples of research grant projects which bear indirectly on family planning are 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 investigates the structure of the American family; 1.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 carries out projects on family formation, child spacing, and animal studies of population density.

[blocks in formation]

The research programs of the Department in the population sciences are directed by the National Institute of Child Health and Human Development. Section 444 of the Public Health Service Act authorizes the Institute 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.

[ocr errors]

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 to enter into contracts "...to promote research in the biomedical, contraceptive development, behavioral, and program implementation fields related to family planning and population..." Expenditures by the Institute in fiscal year 1974 for population research were $51.0 million.

year 1975.

They are projected to be $51.0 million for fiscal

Other components of the National Institutes of Health provided $7.3
million in fiscal year 1974 to support a variety of extramural activities
with important implications for population research. Research in repro-
ductive endocrinology supported by the National Institute of Arthritis
and Metabolic Diseases totalled approximately $2.8 million in fiscal
year 1974.
These studies provide basic information essential in the
development of new methods for controlling reproductive processes.
National Cancer Institute's interests in reproductive endocrinology,
other reproductive processes, and carcinogenic effects of synthetic
estrogens are relevant to understanding normal function and fertility
control. In fiscal year 1974, $1.7 million was spent to support these
studies.

The

The National Heart and Lung Institute awarded $0.4 million for studies of the effects of estrogens, progestogens, and steroid contraceptives on blood clotting mechanisms and the physiology of circulation. Several studies in reproductive neuroendocrinology and genetic aspects of reproduction were supported by the National Institute of Neurological Diseases and Stroke and the National Institute of General Medical Sciences, respectively. Support for population research in these two Institutes totalled about $0.2 million in fiscal year 1974. The Division of Research Resources administers approximately $2.3 million in general research support relevant to the population field.

333

The National Institute of Child Health and Human Development (NICHD) and its Center for Population Research (CPR) have primary responsibility for the Federal effort in population research. This report describes research on the development of new means of fertility regulation, the evaluation of contraceptive methods currently in use, and the analysis of social and behavioral determinants and consequences of population size, composition, and distribution. It also discusses the NICHD effort in fundamental research in reproductive biology and the social sciences, upon which advances in contraceptive development and the solution to population problems are dependent. Finally, it describes the Institute's program to support institutions, develop scientific manpower, facilitate the coordination of Federal population research programs, and disseminate population research information.

[blocks in formation]

The contraceptive development program involves research aimed at new approaches to fertility regulation. During fiscal year 1974, important developments have taken place in this program.

a. Drug Development

Drug Synthesis Program. The efforts to produce better chemical contraceptives for both men and women have continued with increasing intensity. The chemical synthesis and the biological evaluation programs have cooperated closely in exploring the contraceptive utility of new chemical entities.

Estrogens (female sex hormones) are potent antifertility agents, constituting an essential component of most currently marketed oral contraceptives. However, estrogens are frequently associated with unpleasant side effects, and, in a few women, present real health hazards.

One aim of the drug synthesis program is to separate the antifertility activity of estrogens from their unpleasant side effects. In this connection, a class of compounds related to estrogen appears promising. Studies are underway in two species of primates to assess the clinical potential of two of these compounds. Information relating to these studies will be available during fiscal year 1975. If promising results are obtained, preclinical drug safety studies will be initiated which will allow their evaluation in man. Within the same class of compounds, work is in progress to find modifications having even greater separations of antifertility activity from undesirable side effects.

« iepriekšējāTurpināt »