Abstract

PIP: Frequent surveys have produced detailed information on demographic trends in Colombia and the use of various contraceptive methods. The annual rate of population growth declined from 2.5% in 1974 to a projected 1.65% in 1987. The decline of 34% is 1 of the most significant in Latin America. The number of fertile aged women increased by 53% between 1974 and 1987, from 3,036,000 to 4,660,000, as the large cohorts born 15-25 years ago reached childbearing age. The distorted age structure represented by the large cohorts is a serious demographic challenge for the country and a logistical challenge for family planning programs. Although young fertile aged couples exhibit more moderate fertility behavior than their parents did, their larger numbers will cause the crude birth rate to increase. Contraceptive use has increased from 38% in 1974 to 63% in 1986 and possibly 65% in 1987. The number of women who must be supplied with contraceptives has increased from 1,150,000 in 1974 to a projected 3,000,000 in 1987. Among women using contraception in 1986, 25.4% used pills, 28.6% used sterilization, 17.4% used IUDs, 3.2% injectables, 3.2% each vaginal methods and condoms, 7.9% rhythm, 9.5% withdrawal, and 1.6% other methods. In 1976, 37.2% of women using contraceptives used pills, 11.6% sterilization, 23.2% IUDs, 14.0% rhythm, 11.6% withdrawal, and 2.3% other methods. In 1986, 17.4% of couples used the less effective methods of rhythm and withdrawal. In 1987, 9-10 million cycles of pills will be used, 110,000 IUDs will be inserted, 122,000 sterilizations will be performed, and 12 million condoms and the same quantity of vaginal tablets will be distributed. Much time consuming and complex training for natural family planning users will also be required. Colombia's success in family planning over the past 2 decades, despite a relatively unpromising start, was not due simply to the existence of demand for contraceptive information and services, which also was present in other Latin American countries which have not had such great success in family planning. Colombia's government has never openly opposed family planning, although successive administrations have varied in their degree of support. The success of Colombia's family planning program may have been due to the early creation of a dynamic and efficient private organization which introduced modern family planning the country and confronted the church, politicians, and physicians each time it was necessary. PROFAMILIA was created as a nonprofit nongovernmental organization in 1965 and has grown steadily ever since. At present it operates 40 family planning clinics and some 4000 community distribution posts. It provides about 60% of contraceptive services in Colombia. Another 20% is provided by the government and the rest by private physicians. 4 population subgroups are still underserved and require special program efforts: the very young, the rural population, the coastal population, and urban squatters.