TOPICAL INVESTIGATION AND ANALYSIS OF NUTRITIONAL SUPPLEMENTS IN FAMILY PLANNING PROGRAMS IN INDIA AND PAKISTAN

This report uses a modified systems analysis approach to test these hypotheses in India and Pakistan in terms of such variables as numbers of births and deaths, nutritional levels, and numbers of FP acceptors. The nine hypotheses tested commonly assumed that improved infant and maternal nutrition increases infant survival and decreases the number of children desired; that providing food supplements at FP clinics increases the number of clients; and that decreased infant mortality resulting from improved maternal nutrition lengthens the birth interval, thus reducing birth rates. Test results were as follows: (1) declines in infant mortality precede declines in birth rates by as little as 10-20 years; (2) FP is used when desired family size is achieved and the survival of at least one male is assured (except if a woman experiences the death of her own child); (3) malnutrition affects up to 50% of the people, primarily infants and preschoolers; (4) high infant and child mortality is partially due to poor maternal and child nutrition; (5) malnutrition lowers fecundity by increasing fetal wastage and infant mortality; (6) nutrition interventions motivate persons to visit FP centers only when actual family size approaches desired family size; and (7) a decrease in mortality at ages 0-4 years does not significantly increase population growth for 20 years; after which the rapid population growth rate, due to high numbers of persons entering their reproductive years, is offset by a reduction in total fertility rates. Recommendations based on these results include combining nutrition interventions with sanitation and child health programs; establishing experimental nutrition interventions for children aged 4-18 months; and collecting baseline data on factors such as changes in death rates by age and cause and in fertility rates by age and child mortality experiences. A seminar on the most current findings is also recommended. A 75-item bibliography (1945-70) is appended.