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Brazil assessment finds unmet needs in the public sector.


 An assessment conducted in municipalities in four of Brazil's nine states in 1993 revealed high rates of unwanted fertility. As many as 58% of pregnant women reported that their current pregnancy was either unwanted or mistimed. Despite Ministry of Health approval for the provision of oral contraceptives, IUDs, condoms, spermicides, diaphragms, and natural family planning methods, public-sector programs generally offered a limited range of contraceptive options and frequently were out of supplies. Also observed by the assessment team was a strong medical (as opposed to primary health care) orientation among contraceptive providers and a lack of training of physicians and nurses in family planning. On the basis of this assessment, the team recommended that efforts be directed toward strengthening the provision of methods that are often unavailable (e.g., IUDs, barrier methods, and lactational amenorrhea) rather than expanding contraceptive options. Research currently underway in Sao Paulo state seeks to identify the operational and management changes necessary to broaden contraceptive choice and improve the quality of reproductive health services. A data collection and information retrieval system has been set up to record health post activities, and a family planning training and referral system has been established. The Brazil assessment was conducted according to a three-stage model devised by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction.
