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Introduction Public Definitions and Private Lives PART ONE: POLITICS, POLICY AND THE LAW Issues in the Study of 'The Family' - John Muncie and Roger Sapsford Family Policy and Political Discourse - John Muncie and Margaret Wetherell Families and the Law - Hilary Land Patterns of Diversity and Lived Realities - Rudi Dallos and Roger Sapsford PART TWO: INTERACTIONS AND IDENTITIES Constructing Family Life - Rudi Dallos Family Belief Systems Social Structure, Ideology and Family Dynamics - Margaret Wetherell The Case of Parenting The Psychoanalytic Approach to Family Life - Margaret Wetherell A Feminist Looks at the Family - Lynne Segal Endnote - Roger Sapsford Public and Private

This essay was written in response to a critical review made by Ross of one the authors previous publications. The authors agree with Ross about the unproductive nature of the debate over whether increased distribution is more important than service improvements in increasing contraceptive prevalence and about the fact that satisfactory access to modern contraceptives remains problematic in developing countries. In fact the authors made these points in the work which Ross critiqued. Ross was inaccurate when he said that the authors believe that access is not a problem. Instead the authors agree with Ross that access must include a range of contraceptive choices but they also note that access involves the additional factors of adequate counseling about side effects and opportunities to switch methods. Another issue remaining to be resolved is the role that access has in explaining unmet need. Women with unmet need can be broadly defined as those for whom access is the dominant issue and those for whom other obstacles are more important. As access improves women in the second group constitute a larger percentage of remaining unmet need. Thus for most women with an unmet need access is not more important than survey data indicate. Unmet need will remain a problem unless programs improve the quality of information given to clients and deal with social concerns underlying contraceptive nonuse.

The Population Council continues to resist setting quality of care standards for family planning programs. It contends that professionals responsible for each family planning program must define intended and achievable levels of care. The Population Council does claim however that a high quality program is client-oriented and assists clients in reaching their reproductive goals. Even though a high quality program would reduce fertility by increasing contraceptive use it must not execute fertility reduction policies that conflict with clients well being. 6 components of quality care include appropriate choice of methods responsible information technical competence interpersonal relations mechanisms to encourage continuity and appropriate mixture of services. A key problem with setting universal standard is that each country or program must validate the standards and make them work. For example standards may require providers to understand clients reproductive intentions and to help them choose a method which meets their needs yet the standards cannot define how they should do so. The standard setting process for individual countries and programs should include the technical and affective aspects of care and address the following: What quality of care does a program propose to offer can it offer is actually offered and is received by clients? Rapid assessment techniques can be used to compare the quality of care a program wants to offer and the care that is actually given to clients. Program managers can then discern gaps between intention and reality and reasons to improve service standards. In conclusion solutions to problems with quality of family planning care are only found locally.

A survey of abortion facilities in New York City revealed the existence of adequate resources for both early and late terminations of pregnancy. Several important weaknesses have been noted which can be related to the policies and practices of the performing institutions: less than adequate provision of postabortal contraceptive care, and counseling, primarily in private hospitals; wide variation in restrictive admission policies to minors; and substantially higher costs in private facilities. On the whole, private patients are more likely to be receiving less than adequate care than non-private patients with respect to counseling and contraception. This has implications for several long-term risks, namely: repeat and recurring abortion with the possibility of increased risk of premature delivery or spontaneous abortion, and other hazardous outcomes of pregnancy.

There are today some 200 women's health centers in the United States providing information and, in many cases, direct health and family planning services to women in a manner responsive to their needs and preferences, and that involves them in the design and provision of services. This approach to delivering services was specifically recommended by the International Conference of Family Planning in the 1980's held in Indonesia in April 1981. in addressing the challenges facing family planning programs in the decade ahead, the conference noted that in many parts of the world, women often have little control over decisions related to their own fertility. Furthermore, low levels of acceptance and use of family planning, which are characteristic of many programs, often reflect a failure to design and provide services in a manner that is responsive to the needs and perceptions of the users. The conference called for measures to improve the status of women, and recommended that women be involved in all aspects of program design, management, policymaking, and provision of services. In this special report, Judith Bruce describes how women-oriented services are designed and provided at one of the women's health centers, The New hampshire Feminist Health Center.