WEBVTT

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[Film leader]

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[Tone]

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[Singing and drum beating]

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[To The People]

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[Singing and drum beating]

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[Drumming]

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[Car horn]

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[Narrator:] The population
issue is not simply

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a matter of numbers of people.

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It is also, with
increasing urgency,

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the need of those
people for services

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which modern life at
any level demands.

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Transport and housing,
schools and health care.

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[Background conversation]

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Worldwide, as people
have come to recognize

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the long-term health
and social implications

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of their own fertility,
and have begun

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to demand a reasonable means
to regulate that fertility,

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a compelling
problem emerges, how

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to respond to that
demand in a manner which

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is appropriate to each
culture and respectful

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of each individual
within that culture?

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Traditionally, family
planning services

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have been provided
through clinics.

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[Graphic animation]

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Couples seeking guidance
on contraceptives

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had to go to the
clinic, regardless

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of the distance from their
home, the inconvenience

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of the journey, the cost
in transport or fees,

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and the sacrifice of
inherent reticence.

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Access to contraceptives has
increased dramatically when

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commercial outlets
and village supply

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centers have
shortened the distance

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and simplified the
procurement process.

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Household delivery aims
to surmount these barriers

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completely by placing
contraceptives

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in each household containing
an eligible couple.

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This final step in making
supplies fully available

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provides not only the best
possible initial information,

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but overcomes the obstacles of
distance, cost, inconvenience,

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and lack of knowledge.

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[Vehicle engine running]

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Within the last
few years, a number

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of living laboratories to
test the validity of taking

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contraceptives
directly to the people

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have been set up in
countries which offer

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a variety of unique problems.

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In Tunisia, a basic problem was
the presence, at some distance,

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from urban settlements of
a substantial population

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of eligible couples not normally
reached by modern health care.

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The project recruited
and trained interviewers,

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who not only collect
information, but distribute

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oral contraceptives.

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They visit every household
in a defined geographic area

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and offer contraceptives
to all eligible women.

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Eligible, being
defined in Tunisia,

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as under 45 years
of age, currently

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married with husband
present, not pregnant,

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not known to be sterile--

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[Goat bleating]

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--and with no health
contraindications

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against pill usage.

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[Goat bleating]

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Project director,
Dr. Lillian Toomey.

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[Dr. Toomey:]
[Speaking Arabic]

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[Interpreter:] We thought
that the best way to begin

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was to choose girls
from this region

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and train them to talk to
women, to explain the idea

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and methods of family planning.

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We knew that the
women here would

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have more confidence
in local girls

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who speak the same
language, and that they

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would listen to these girls
in this very personal family

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planning program.

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[Women conversing]

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[Narrator:] Let us watch
a typical home visit

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in the village of Biʾr ʿAlī
in the province of Sfax,

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as Dr. Toomey explains
the rationale behind it.

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[Dr. Toomey:] [Speaking Arabic]

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[Interpreter:] We have
arranged the work

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so that we send the girls to
the homes in groups of two.

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They go to the homes,
talk to the women,

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and give them a supply
of pills for six months.

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They have been trained
to explain fully

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how to take the pills and what
to do if they have reactions

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or get sick.

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We give them a card,
and they can take it

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to the clinic for
examination by a doctor.

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If all goes well, they can
take the full six-month supply

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of pills.

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Before the supply is exhausted,
we will come back to them

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in about five months and,
again, question them carefully

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and report all that they say,
their reactions, and so on.

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And if everything
is satisfactory,

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we will give the women
another six-months supply.

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[Home visit staff:] [Speaking Arabic]

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[Dr. Toomey:] First,
the young visitor

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fills out all her papers,
and has determined

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that the woman is eligible.

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Then she begins to talk.

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[Home visit staff:] I am giving you
two packages of pills.

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In each package, there are
three smaller packages.

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You open one of the
packages five days

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after you begin your period.

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Count carefully.

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One, two, three, four, five.

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Now on the fifth
day at night, you

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start by taking this
first pill, the white one.

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You swallow this white pill
and you follow this line,

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taking one pill every night
until you finish this row.

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Then you go back and
start the second row.

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Then the next, and the next.

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These are the last you take.

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Do you understand?

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[Rural woman:] Yes.

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[Home visit staff:] [?]

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Now if you should
get signs of blood

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while you are taking
the white pills

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or if you should not get the
blood while you are taking

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the red pills, you had
better come to the doctor

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for an examination.

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[Rural woman:] Do I get the blood
while I'm taking the white pills?

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[Home visit staff:] No, you should
get the blood only while you

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are taking the red pills.

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[Rural woman:] When I get the blood
do I come for examination?

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[Home visit staff:] Only if you get it while
you were taking the white pills.

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But if you get it while you
are taking the red pills,

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that is normal and you
don't need an examination.

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The pills will
regulate your bleeding.

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White means no blood.

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Red means blood.

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Do you understand?

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Now suppose you want
to stop taking the pill

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because you want to
get pregnant again.

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Don't just stop
taking the pills.

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Finish the cycle
first, then stop.

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The best way would
be to check with us.

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Another thing.

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Don't forget to take your
pills, even for one day.

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Don't jump a day.

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It is bad for you, and
you might get pregnant.

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Now show me how you are
going to take the pills

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so I can be sure
you understand.

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[Dr. Toomey:] This is the sort
of careful interview

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for which there is rarely
time in a crowded clinic,

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and yet it is
essential if a woman

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is to understand and use
the pill in a way which

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will help her.

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In simple country terms,
it provides the best sort

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of foundation for continued use.

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[Home visit staff speaking with the women]

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We will come back
before the end of six months.

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Now, here is a card for
a doctor's examination

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if it is needed.

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Dr. Toomey will be coming
to the clinic many times

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during the next six months.

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[Home visit staff speak with women]

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[Conversation continues]

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[Home visit staff:] Put these
packages away and keep them out

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of the children's reach.

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Don't start taking them until
you get your next period.

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Another thing I want to say.

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After you start taking the
pill, you may get a headache.

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Don't worry about it.

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It only happens because the pill
is something new you have not

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taken before.

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Or you might get a stomach pain.

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But if you do, don't
throw away the pills.

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Go on taking them.

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You will be all right.

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We would not give you anything
that could really harm you.

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But if you get truly sick for
any reason, then come to us

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or send word to
us so you can get

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an examination by the doctor.

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Now, take good care of yourself
and take care of the pills.

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Take them with you wherever
you go and take them regularly.

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Do you understand?

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[Rural woman:] [?]

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[Home visit staff speaking with women.]

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Now we leave
you with God.

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And if anything goes wrong,
we will come back and take you

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by car to the doctor.

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[Salama]

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[Footsteps]

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[Narrator:] Dr. Masry Shakir,
director of the National Family

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Planning Office, sees the
program in broad terms.

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[Dr. Shakir:]
[Speaking Arabic]

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[Interpreter:] We have
promoted family planning

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programs because
we consider them

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fundamental to the philosophy
of family well-being.

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[Dr. Shakir:]
[Speaking Arabic]

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[Interpreter:] They are part
of a humane consideration,

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of a way in which we can
bring mankind to a better

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level of life with dignity.

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A way to guard the health
of mothers and children,

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and to create truly healthy
generations for the future.

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[Dr. Shakir:][Speaking Arabic]

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[Interpreter:] This is our work.

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Our ultimate goal is to
create healthier generations

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of informed citizens.

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We consider that man is
the most precious capital

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asset of the state.

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If we take care of him, he can
create the national wealth.

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Indeed, he is the wealth.

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With him, we can
achieve our aims

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of development and progress.

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[Leaves thrashing]

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With the solid assurance
of full government support,

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Tunisia plans an expansion of
the household delivery system

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into three more provinces,
with a total population

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of more than 100,000 people.

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[Leaves rustling]

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The pilot project grew out of
the needs and characteristics

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of the people themselves,
truly an Indigenous program.

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The expansion will
capitalize upon the findings

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of that project.

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[Light music]

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[Goats bleeting]

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[Farm landscape]

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[Music]

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The lush Green Valley of the
River Nile is Egypt's pride,

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but the waters irrigate
only a limited area.

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97 percent of the nation's people
are crowded together

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on the 4 percent of the
land which is arable,

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giving it one of the world's
greatest population densities.

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People who are unconvinced
by demographic cries of doom

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tend to point to empty land
areas as proof that population

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can expand without penalty.

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But the cost of making desert
land habitable is enormous.

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Even the provision of basic
subsistence is expensive.

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[Ancient Egyptian sculpture]

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[Busy street sounds]

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[Horn blaring]

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Egypt's population grows at
the rate of one million a year,

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with attendant pressure
on all public services.

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Recognizing the special
problem of a population so

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concentrated, the
government of Egypt

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has included family planning
in its health services.

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But the burden on these
services demonstrates the need

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for supplementary
means of distribution

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if contraceptives are to
be made widely available.

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Dr. Saad Jadallah has been
active in Shanawan household

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delivery since it began.

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He believes that it is
essential to the success

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of any such project
that the whole health

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community be apprised of it.

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And, when appropriate, prepared
to play a supportive role.

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[Dr. Jadallah:]
[Speaking Arabic]

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[Narrator:] Here, he

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reminds health workers of the
importance the state attaches

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to family planning, and explains
the plans to expand household

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delivery to other
villages in their area.

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[Dr. Jadallah addressing a group]

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[Village market]

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Shanawan is an agricultural
village North of Cairo.

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The project began,
here as elsewhere,

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by sending a research
team to become

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acquainted with the
village and its people.

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[Villagers walking]

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[Dr. Jadallah:] Our household
distribution in Shanawan

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was certainly a success.

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When we started our research
projects in Shanawan in 1969,

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the prevalence of
contraceptive use was 4 percent.

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Through our efforts in family
planning communication,

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the percentage of contraceptive
use reached 8 percent in 1972.

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And we continued our work with
the family planning clinics,

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and was providing information
about family planning

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and contraceptives until
1974, when in November 1974,

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the proportion using
contraceptive methods

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in the village was 15 percent.

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We then did our household
distribution in November 1974,

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and in November
1975 the proportion

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of contraceptive users
increased to 31 percent.

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And this success prompted us to
expand the project in 20 health

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units serving 40 villages, with
a population of 200,000 people

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in Malofieieva governorate.

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What I would really
like to emphasize

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is that our household
distribution does not conflict

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with the present family
planning services in the clinic.

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It does not replace the
present family planning

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services in the clinic, but
it enhances and supports

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these services.

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[Workers chatting during
household distribution]

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[Narrator:] The most important
fact about household delivery

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is that it works.

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Demonstrably, wherever
it's been tried,

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it works, to take the record
of only four programs.

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[Graphic overlay]

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In Egypt, at the outset of
the household distribution

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program in Shanawan,
contraceptive prevalence

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was 15 percent.

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In one year, this
figure rose to 31 percent.

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[Traffic sounds]

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Korea had an active
family planning program

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before household distribution.

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[Graphic overlay]

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Prevalence was 30 percent.

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In only four months,
it had risen to 40 percent.

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[Graphic overlay]

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[Women and children outdoors]

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[Chatter]

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In Bangladesh, when the
household distribution program

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began, prevalence was
estimated at less than 1 percent.

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Within one year, the
figure increased to 12.5 percent.

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[Inhabitants speaking Arabic]

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[Narrator:] In Tunisia, the
rate in the test area was 4.7 percent.

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Within six months,
prevalence had risen to 10 percent.

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[Graphic overlay]

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Out of experience
represented by projects

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which have been operative
long enough to be evaluated

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objectively, certain
fundamental truths have emerged.

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Contraceptives
can be distributed

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to households without
serious adverse incidents,

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whether in urban Korea
or rural Tunisia.

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A packet of
contraceptives in hand

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is the most persuasive
information tool available.

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Despite predictions
to the contrary,

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contraceptives,
although free of charge,

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are perceived as valuable.

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They may not be
used immediately,

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but they will be kept and
used eventually or given

19:11.466 --> 19:12.966
to neighbors.

19:12.966 --> 19:16.599
And the leap in contraceptive
usage in every case

19:16.600 --> 19:20.733
is too dramatic
to be overlooked.

19:20.733 --> 19:23.399
Worldwide experimental
programs are

19:23.400 --> 19:28.033
proving the correlation between
availability and acceptance.

19:28.033 --> 19:33.566
Be it commercial distribution,
village supply centers,

19:33.566 --> 19:36.632
or household
delivery, the concept

19:36.633 --> 19:39.533
of bringing contraceptives
directly to the people

19:39.533 --> 19:43.966
is a growing phenomenon
around the globe.

19:43.966 --> 19:46.499
The act of giving
a woman the means

19:46.500 --> 19:47.933
of controlling her fertility--

19:47.933 --> 19:48.566
[Tunisian music]

19:48.566 --> 19:52.599
--erases not only the barriers
surrounding clinic-based family

19:52.600 --> 19:55.433
planning services, but
also the differences

19:55.433 --> 19:59.599
of income, education
social level,

19:59.600 --> 20:04.066
which have been thought so
important in acceptance rates.

20:04.066 --> 20:09.066
She holds in her hand something
new, a little strange, but not

20:09.066 --> 20:11.199
frightening.

20:11.200 --> 20:16.200
For the first time,
the hope of change.

20:16.200 --> 20:23.800
[Music]

20:23.800 --> 20:26.100
[An Airlie Production]

20:26.100 --> 20:28.900
[Executive producer: Murdock Head, M.D.]

20:28.900 --> 20:31.666
[Project Coordinators:
Thomas McMahon, Douglas Larson]

20:31.666 --> 20:35.032
[Photography: Paul Noonan, David Nash]

20:35.033 --> 20:37.233
[Sound: James Reid]

20:37.233 --> 20:39.333
[Writer: Miriam Bucher]

20:39.333 --> 20:41.499
[Editor: Gordon Heerman]

20:41.500 --> 20:44.600
[Produced by: The George Washington University, School of Medicine and Health

20:44.600 --> 20:47.700
Sciences, Department of Medical and Public Affairs]

20:47.700 --> 20:51.166
[Music]

20:51.166 --> 20:54.599
[This project was supported by the
Office of Population, U.S. Agency
for International Development,

20:54.600 --> 20:56.766
AID/csd-3643] 1977.

21:02.600 --> 21:05.366
[End trailer]