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Family planning in Colombia is against-the-odds success

When a private family planning organization opened a clinic and day-care center here more than two decades ago, a local priest tried to keep people away from it by saying that the toddlers' lunches had been spiked with drugs to sterilize them. Leftist politicians said the program was a U.S. plot to decrease the Colombian population. And when the organization began offering voluntary tubal ligations for women, Bishop Alfonso Lopez Trujillo called it "mass mutilation."

But the people who founded PROFAMILIA 26 years ago kept at it. Now they have one of the world's most successful family planning organizations.

That is remarkable in a country where 95 percent of the population is Roman Catholic, where abortions are illegal and where Catholic religion classes are mandatory even in public schools.

In 1965, Colombian women had an average of 6.6 children each. Now the birthrate is down to 2.9 children. That is a drop of more than 50 percent.

Sixty-six percent of married women use some form of birth control. That is nearly the same percentage as in the United States, where 68 percent of married women use some method.

Nearly 1-million Colombian women, (about one in 16) have been surgically sterilized. About 23,000 Colombian men have had vasectomies (male sterilization).

Although contraceptive use has increased in the Third World, sterilization is the leading method of birth control. In all, 156-million of the world's couples, particularly those in developing countries, rely on sterilization.

Still, in Colombia, 25 percent of pregnancies end in abortion, said Gabriel Ojeda, director of planning and research for PROFAMILIA. The organization says it never has performed abortions or counseled women on abortion.

PROFAMILIA receives as much as 40 percent of its funds from foreign grants, including U.S. government aid.

Because it does not use or promote abortion as a means of family planning, PROFAMILIA will not be affected by last week's U.S. Supreme Court ruling upholding a ban on distribution of aid to overseas health-care organizations that do so.

But there are numerous smaller clinics in Bogota that do perform what they sometimes advertise as "adjustment of menstrual cycle."

To an outsider, it seems peculiar that family planning has been so successful in a mainly Catholic country. But Maria Lucia Diaz, director of a clinic and day-care center in the Las Colinas neighborhood of Bogota, explained that many Catholics simply believe that the church has made a mistake in saying that Catholics should not use artificial methods of birth control. "You can't demand that a poor country not plan (family size) if we are starving to death," she said.

Maria Ceneth Lara, a 36-year-old seamstress, had a tubal ligation after her fourth child was born. "For me it's very good," she said, "because I'm a person without much money."

There is a traditional Colombian saying: "Where there is food for one, there is food for two." Lara disagrees with it.

"If I had more (children) it would really be bringing people into suffering," Lara said.

She worked as a seamstress in a clothing factory until quitting her job recently to do piecework. "I earn less, but I can take care of my children," she said.

She said she decided to have her tubal ligation after doctors at a state-run Social Security clinic suggested it, but she said it was her own decision. Her husband did not like the idea, but said she could do what she wanted.

He would not have considered vasectomy "in a thousand years," she said. "I think that a man would do that perhaps because he loves his wife very much and he doesn't want her to take any risks," she said gently. Younger men are more familiar with family planning, she said, and are more likely to consider vasectomy.

Most people familiar with PROFAMILIA credit its founders for much of its success.

Dr. Fernando Tamayo, a Bogota gynecologist in private practice among Colombia's privileged classes, began to devote some of his time each week to attending the poor. Eventually this grew into a clinic, and he founded PROFAMILIA in 1965.

"Where Dr. Tamayo looks, he hits the target. He does not make a mistake," said Maria Lucia Diaz, director of the facility in Bogota's Las Colinas neighborhood.

When she heard Tamayo wanted to introduce vasectomies, she said, "I said he was crazy. Not one man in this country will do it. At the first vasectomy, I nearly fainted. When I came here I wasn't convinced about the work or the program. (The directors), with their way of working, they convinced me."

PROFAMILIA has clinics of all sizes across the country, and most Colombians are so familiar with the organization that they assume it is part of the government, although it is private.

The largest PROFAMILIA clinic, in downtown Bogota, is divided into two. One part is a clinic just for men, with a separate entrance on a different street, so men can go in discreetly if they wish.

Inside both clinics, a television set in the waiting room plays a continuous tape of health education videos for the men and women seated in rows of chairs. A poster on the wall shows a roguish-looking man with a knapsack full of children, tossing one out. "Real Men Don't Leave Children All Over the World," it says.

Inside a small glass booth, a young woman explains the types of birth control to a couple. Further inside the clinic are examination rooms, and a vast archive for the medical histories of the staggering number of regular patients _ approximately 150,000.

By 11 a.m. in the surgery, 28 women already have been operated on, and about a dozen are still recovering in a large room lined with beds. One man is having a vasectomy in an operating room inside the Men's Clinic.

Two floors upstairs, above the bustle, is one of the secrets of PROFAMILIA's success _ the quiet and computerized planning department. There people spend hours tapping numbers into keyboards. PROFAMILIA knows exactly how many surgical operations it has conducted, up until today. It has charts showing extremely detailed cost breakdowns, such as how much of a nurse's time goes into each surgery and at what cost.

All this data is used to calculate the comparative cost of a year of family planning at different clinics or the use of various birth control methods. Sterilization is by far the cheapest, because it must be done only once. Women are sterilized, on the average, 12{ years before menopause.

PROFAMILIA uses the statistics to make its programs more efficient and to brainstorm new ideas.

"It's one of the few (family planning) organizations that's run on clear objectives and measurable response," said John Townsend, senior representative for Latin America and the Caribbean of the New York-based Population Council. "Having good intentions isn't enough."