[Film leader]
[Tone]
[Singing and drum beating]
[To The People]
[Singing and drum beating]
[Drumming]
[Car horn]
[Narrator:] The populationissue is not simply
a matter of numbers of people.
It is also, withincreasing urgency,
the need of thosepeople for services
which modern life atany level demands.
Transport and housing,schools and health care.
[Background conversation]
Worldwide, as peoplehave come to recognize
the long-term healthand social implications
of their own fertility,and have begun
to demand a reasonable meansto regulate that fertility,
a compellingproblem emerges, how
to respond to thatdemand in a manner which
is appropriate to eachculture and respectful
of each individualwithin that culture?
Traditionally, familyplanning services
have been providedthrough clinics.
[Graphic animation]
Couples seeking guidanceon contraceptives
had to go to theclinic, regardless
of the distance from theirhome, the inconvenience
of the journey, the costin transport or fees,
and the sacrifice ofinherent reticence.
Access to contraceptives hasincreased dramatically when
commercial outletsand village supply
centers haveshortened the distance
and simplified theprocurement process.
Household delivery aimsto surmount these barriers
completely by placingcontraceptives
in each household containingan eligible couple.
This final step in makingsupplies fully available
provides not only the bestpossible initial information,
but overcomes the obstacles ofdistance, cost, inconvenience,
and lack of knowledge.
[Vehicle engine running]
Within the lastfew years, a number
of living laboratories totest the validity of taking
contraceptivesdirectly to the people
have been set up incountries which offer
a variety of unique problems.
In Tunisia, a basic problem wasthe presence, at some distance,
from urban settlements ofa substantial population
of eligible couples not normallyreached by modern health care.
The project recruitedand trained interviewers,
who not only collectinformation, but distribute
oral contraceptives.
They visit every householdin a defined geographic area
and offer contraceptivesto all eligible women.
Eligible, beingdefined in Tunisia,
as under 45 yearsof age, currently
married with husbandpresent, not pregnant,
not known to be sterile--
[Goat bleating]
--and with no healthcontraindications
against pill usage.
[Goat bleating]
Project director,Dr. Lillian Toomey.
[Dr. Toomey:][Speaking Arabic]
[Interpreter:] We thoughtthat the best way to begin
was to choose girlsfrom this region
and train them to talk towomen, to explain the idea
and methods of family planning.
We knew that thewomen here would
have more confidencein local girls
who speak the samelanguage, and that they
would listen to these girlsin this very personal family
planning program.
[Women conversing]
[Narrator:] Let us watcha typical home visit
in the village of Biʾr ʿAlīin the province of Sfax,
as Dr. Toomey explainsthe rationale behind it.
[Dr. Toomey:] [Speaking Arabic]
[Interpreter:] We havearranged the work
so that we send the girls tothe homes in groups of two.
They go to the homes,talk to the women,
and give them a supplyof pills for six months.
They have been trainedto explain fully
how to take the pills and whatto do if they have reactions
or get sick.
We give them a card,and they can take it
to the clinic forexamination by a doctor.
If all goes well, they cantake the full six-month supply
of pills.
Before the supply is exhausted,we will come back to them
in about five months and,again, question them carefully
and report all that they say,their reactions, and so on.
And if everythingis satisfactory,
we will give the womenanother six-months supply.
[Home visit staff:] [Speaking Arabic]
[Dr. Toomey:] First,the young visitor
fills out all her papers,and has determined
that the woman is eligible.
Then she begins to talk.
[Home visit staff:] I am giving youtwo packages of pills.
In each package, there arethree smaller packages.
You open one of thepackages five days
after you begin your period.
Count carefully.
One, two, three, four, five.
Now on the fifthday at night, you
start by taking thisfirst pill, the white one.
You swallow this white pilland you follow this line,
taking one pill every nightuntil you finish this row.
Then you go back andstart the second row.
Then the next, and the next.
These are the last you take.
Do you understand?
[Rural woman:] Yes.
[Home visit staff:] [?]
Now if you shouldget signs of blood
while you are takingthe white pills
or if you should not get theblood while you are taking
the red pills, you hadbetter come to the doctor
for an examination.
[Rural woman:] Do I get the bloodwhile I'm taking the white pills?
[Home visit staff:] No, you shouldget the blood only while you
are taking the red pills.
[Rural woman:] When I get the blooddo I come for examination?
[Home visit staff:] Only if you get it whileyou were taking the white pills.
But if you get it while youare taking the red pills,
that is normal and youdon't need an examination.
The pills willregulate your bleeding.
White means no blood.
Red means blood.
Do you understand?
Now suppose you wantto stop taking the pill
because you want toget pregnant again.
Don't just stoptaking the pills.
Finish the cyclefirst, then stop.
The best way wouldbe to check with us.
Another thing.
Don't forget to take yourpills, even for one day.
Don't jump a day.
It is bad for you, andyou might get pregnant.
Now show me how you aregoing to take the pills
so I can be sureyou understand.
[Dr. Toomey:] This is the sortof careful interview
for which there is rarelytime in a crowded clinic,
and yet it isessential if a woman
is to understand and usethe pill in a way which
will help her.
In simple country terms,it provides the best sort
of foundation for continued use.
[Home visit staff speaking with the women]
We will come backbefore the end of six months.
Now, here is a card fora doctor's examination
if it is needed.
Dr. Toomey will be comingto the clinic many times
during the next six months.
[Home visit staff speak with women]
[Conversation continues]
[Home visit staff:] Put thesepackages away and keep them out
of the children's reach.
Don't start taking them untilyou get your next period.
Another thing I want to say.
After you start taking thepill, you may get a headache.
Don't worry about it.
It only happens because the pillis something new you have not
taken before.
Or you might get a stomach pain.
But if you do, don'tthrow away the pills.
Go on taking them.
You will be all right.
We would not give you anythingthat could really harm you.
But if you get truly sick forany reason, then come to us
or send word tous so you can get
an examination by the doctor.
Now, take good care of yourselfand take care of the pills.
Take them with you whereveryou go and take them regularly.
Do you understand?
[Rural woman:] [?]
[Home visit staff speaking with women.]
Now we leaveyou with God.
And if anything goes wrong,we will come back and take you
by car to the doctor.
[Salama]
[Footsteps]
[Narrator:] Dr. Masry Shakir,director of the National Family
Planning Office, sees theprogram in broad terms.
[Dr. Shakir:][Speaking Arabic]
[Interpreter:] We havepromoted family planning
programs becausewe consider them
fundamental to the philosophyof family well-being.
[Dr. Shakir:][Speaking Arabic]
[Interpreter:] They are partof a humane consideration,
of a way in which we canbring mankind to a better
level of life with dignity.
A way to guard the healthof mothers and children,
and to create truly healthygenerations for the future.
[Dr. Shakir:][Speaking Arabic]
[Interpreter:] This is our work.
Our ultimate goal is tocreate healthier generations
of informed citizens.
We consider that man isthe most precious capital
asset of the state.
If we take care of him, he cancreate the national wealth.
Indeed, he is the wealth.
With him, we canachieve our aims
of development and progress.
[Leaves thrashing]
With the solid assuranceof full government support,
Tunisia plans an expansion ofthe household delivery system
into three more provinces,with a total population
of more than 100,000 people.
[Leaves rustling]
The pilot project grew out ofthe needs and characteristics
of the people themselves,truly an Indigenous program.
The expansion willcapitalize upon the findings
of that project.
[Light music]
[Goats bleeting]
[Farm landscape]
[Music]
The lush Green Valley of theRiver Nile is Egypt's pride,
but the waters irrigateonly a limited area.
97 percent of the nation's peopleare crowded together
on the 4 percent of theland which is arable,
giving it one of the world'sgreatest population densities.
People who are unconvincedby demographic cries of doom
tend to point to empty landareas as proof that population
can expand without penalty.
But the cost of making desertland habitable is enormous.
Even the provision of basicsubsistence is expensive.
[Ancient Egyptian sculpture]
[Busy street sounds]
[Horn blaring]
Egypt's population grows atthe rate of one million a year,
with attendant pressureon all public services.
Recognizing the specialproblem of a population so
concentrated, thegovernment of Egypt
has included family planningin its health services.
But the burden on theseservices demonstrates the need
for supplementarymeans of distribution
if contraceptives are tobe made widely available.
Dr. Saad Jadallah has beenactive in Shanawan household
delivery since it began.
He believes that it isessential to the success
of any such projectthat the whole health
community be apprised of it.
And, when appropriate, preparedto play a supportive role.
[Dr. Jadallah:][Speaking Arabic]
[Narrator:] Here, he
reminds health workers of theimportance the state attaches
to family planning, and explainsthe plans to expand household
delivery to othervillages in their area.
[Dr. Jadallah addressing a group]
[Village market]
Shanawan is an agriculturalvillage North of Cairo.
The project began,here as elsewhere,
by sending a researchteam to become
acquainted with thevillage and its people.
[Villagers walking]
[Dr. Jadallah:] Our householddistribution in Shanawan
was certainly a success.
When we started our researchprojects in Shanawan in 1969,
the prevalence ofcontraceptive use was 4 percent.
Through our efforts in familyplanning communication,
the percentage of contraceptiveuse reached 8 percent in 1972.
And we continued our work withthe family planning clinics,
and was providing informationabout family planning
and contraceptives until1974, when in November 1974,
the proportion usingcontraceptive methods
in the village was 15 percent.
We then did our householddistribution in November 1974,
and in November1975 the proportion
of contraceptive usersincreased to 31 percent.
And this success prompted us toexpand the project in 20 health
units serving 40 villages, witha population of 200,000 people
in Malofieieva governorate.
What I would reallylike to emphasize
is that our householddistribution does not conflict
with the present familyplanning services in the clinic.
It does not replace thepresent family planning
services in the clinic, butit enhances and supports
these services.
[Workers chatting duringhousehold distribution]
[Narrator:] The most importantfact about household delivery
is that it works.
Demonstrably, whereverit's been tried,
it works, to take the recordof only four programs.
[Graphic overlay]
In Egypt, at the outset ofthe household distribution
program in Shanawan,contraceptive prevalence
was 15 percent.
In one year, thisfigure rose to 31 percent.
[Traffic sounds]
Korea had an activefamily planning program
before household distribution.
[Graphic overlay]
Prevalence was 30 percent.
In only four months,it had risen to 40 percent.
[Graphic overlay]
[Women and children outdoors]
[Chatter]
In Bangladesh, when thehousehold distribution program
began, prevalence wasestimated at less than 1 percent.
Within one year, thefigure increased to 12.5 percent.
[Inhabitants speaking Arabic]
[Narrator:] In Tunisia, therate in the test area was 4.7 percent.
Within six months,prevalence had risen to 10 percent.
[Graphic overlay]
Out of experiencerepresented by projects
which have been operativelong enough to be evaluated
objectively, certainfundamental truths have emerged.
Contraceptivescan be distributed
to households withoutserious adverse incidents,
whether in urban Koreaor rural Tunisia.
A packet ofcontraceptives in hand
is the most persuasiveinformation tool available.
Despite predictionsto the contrary,
contraceptives,although free of charge,
are perceived as valuable.
They may not beused immediately,
but they will be kept andused eventually or given
to neighbors.
And the leap in contraceptiveusage in every case
is too dramaticto be overlooked.
Worldwide experimentalprograms are
proving the correlation betweenavailability and acceptance.
Be it commercial distribution,village supply centers,
or householddelivery, the concept
of bringing contraceptivesdirectly to the people
is a growing phenomenonaround the globe.
The act of givinga woman the means
of controlling her fertility--
[Tunisian music]
--erases not only the barrierssurrounding clinic-based family
planning services, butalso the differences
of income, educationsocial level,
which have been thought soimportant in acceptance rates.
She holds in her hand somethingnew, a little strange, but not
frightening.
For the first time,the hope of change.
[Music]
[An Airlie Production]
[Executive producer: Murdock Head, M.D.]
[Project Coordinators:Thomas McMahon, Douglas Larson]
[Photography: Paul Noonan, David Nash]
[Sound: James Reid]
[Writer: Miriam Bucher]
[Editor: Gordon Heerman]
[Produced by: The George Washington University, School of Medicine and Health
Sciences, Department of Medical and Public Affairs]
[Music]
[This project was supported by theOffice of Population, U.S. Agencyfor International Development,
AID/csd-3643] 1977.
[End trailer]