Back to home pageJANUARY/FEBRUARY 1994 - VOLUME 25, NUMBER 1
94.18.01 - English - Ruth SIMMONS, Population Planning and International Health and Public Health Policy and Administration, The School of Public Health, University of Michigan, Ann Arbor, MI (U.S.A.), and Christopher ELIAS, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.)
The Study of Client-Provider Interactions: A Review of Methodological Issues (p. 1-17)
In recent years, increased focus on the quality of family planning and other reproductive health services has led to a better understanding of women's reproductive health needs and has drawn attention to program-client interactions as a critical and neglected dimension of program effort. In this article, the relevant methods and experience related to studying client-provider interactions within family planning programs in southern countries are reviewed. The policy relevance of this work is highlighted first by stressing the operational usefulness of examining what happens when people engage with service-delivery systems that offer family planning or reproductive health services. Subsequently, the content areas encompassed by program-client interactions are clarified by identifying manifest and latent dimensions and by distinguishing the variables that define these interactions from variables related to their determinants and consequences. Finally, a critical review of existing methods is presented, with examples of research and a discussion of ethical issues. (FAMILY PLANNING PROGRAMMES, METHODOLOGY, ETHNICS)
94.18.02 - English - Barbara MENSCH, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.), Andrew FISHER, Ian ASKEW and Ayorinde AJAYI
Using Situation Analysis Data to Assess the Functioning of Family Planning Clinics in Nigeria, Tanzania, and Zimbabwe (p. 18-31)
Situation analyse conducted in Nigeria, Tanzania and Zimbabwe have revealed problems in the functioning of many of the subsystems of family planning service delivery, namely in supplies of commodities; in facilities and equipment; in staffing and training; in information, education, and communication; and in record keeping. Although a clear pattern of clinic use exists, in that only a few service-delivery points provide contraceptive services to the majority of new family planning acceptors in the three countries, an attempt to explain how clinics with more clients differ from those that are visited less frequently revealed only a weak association between subsystem functioning and use. (AFRICA, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION)
94.18.03 - English - Indra P. KAMBO, R.N. GUPTA, A.S. KUNDU, B.S. DHILLON, H.M. SAXENA and Badri N. SAXENA, Indian Council of Medical Research, Ansari Nagar, New Delhi 110 029 (India)
Use of Traditional Medical Practitioners to Deliver Family Planning Services in Uttar Pradesh (p. 32-40)
This pilot study conducted in Muzaffarnagar district in the state of Uttar Pradesh, India, demonstrates the potential for using traditional medical practitioners in the delivery of family planning services after a brief training period. Practitioners participated continuously in the program for an intervention period of two years during which their services were accepted by the community. The impact of their involvement was reflected in increased knowledge of permanent as well as reversible contraceptive methods and in higher contraceptive use rates, especially of reversible methods adopted by women younger than 25 years (from 8% to 37%), in the intervention villages, as compared with increased knowledge and use (from 13% to 25%) of permanent methods alone in the control villages. (INDIA, FAMILY PLANNING PROGRAMMES, EXPERIMENTATION, MEDICAL PERSONNEL)
94.18.04 - English - Carla MAKHLOUF OBERMEYER, Department of Population and International Health, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115 (U.S.A.)
Reproductive Choice in Islam: Gender and State in Iran and Tunisia (p. 41-51)
This report examines the extent to which reproductive choice is compatible with Islamic principles. It presents the argument that the impact of Islam on reproductive choice is largely a function of the political context in which gender issues are defined. Indicators of reproductive health in countries of the Middle East are reviewed and the way these relate to constraints on reproductive choice is assessed. The examples of Tunisia and Iran are used to illustrate the way in which Islam is invoked to legitimate conflicting positions concerning women and their reproductive options. (IRAN, TUNISIA, ISLAM, FERTILITY, WOMEN'S STATUS)
94.18.05 - English - Philip D. HARVEY, DKT International, 1120 19th Street, NW, Suite 610, Washington, DC 20036 (U.S.A.)
The Impact of Condom Prices on Sales in Social Marketing Programs (p. 52-58)
The issue of pricing contraceptives in family planning programs is becoming more and more important. What is the relationship between consumer prices and demand, and how can we strike the correct balance between the two? This report examines the correlation between consumer prices for condoms, expressed as a percentage of per-capita gross national product, and per-capita sales of condoms in 24 social marketing programs. The correlation that emerges is strong and negative: Even when the data are controlled for age of program and other independent variables, there is a clear negative correlation between prices and contraceptive sales in these programs. The conclusion is clear that condom prices must be set very low - well below the equivalent of 1% of per-capita gross national product for a year's supply - in order to achieve satisfactory prevalence for condoms in either a family-planning or an AIDS-prevention context. (CONDOM, SOCIAL MARKETING, PRICES)
MARCH/APRIL 1994 - VOLUME 25, NUMBER 2
94.18.06 - English - Sidney Ruth SCHULER, Empowerment of Women Program, JSI Research and Training Institute, 1616 North Fort Myer Drive, Arlington, VA 222209 (U.S.A.), and Syed M. HASHEMI, Department of Economics, Jahangirnagar University, Savar, Dhaka (Bangladesh)
Credit Programs, Women's Empowerment, and Contraceptive Use in Rural Bangladesh (p. 65-76)
This article presents findings of research adressing the question of how women's status affects fertility. The effects on contraceptive use of women's participation in rural credit programs and on their status or level of empowerment were examined. A woman's level of emporwerment is defined here as a function of her relative physical mobility, economic security, ability to make various purchases on her own, freedom from domination and violence within her family, political and legal awareness, and participation in public protests and political campaigning. The main finding is that participation in both of the credit programs studied, those of Grameen Bank and Bangladesh Rural Advancement Committee (BRAC), is positively associated with women's level of empowerment. A positive effect on contraceptive use is discernible among both participants and nonparticipants in Grameen Bank villages. Participation in BRAC does not appear to affect contraceptive use. (BANGLADESH, WOMEN'S STATUS, CONTRACEPTIVE USAGE)
94.18.07 - English - W. PARKER MAULDIN and John A. ROSS, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.)
Prospects and Programs for Fertility Reduction, 1990-2015 (p. 77-95)
What is the likelihood that each of the 37 developing countries with populations of 15 million or more in 1990 will reach replacement fertility by the year 2015? These countries have a combined population of 3.9 billion, 91% of the population of all developing countries. For this article, a composite index was used as the basis for predicting future levels of total fertility. The index was constructed from socioeconomic variables (life expectancy at birth, infant mortality rates, percent adult literacy, ratio of children enrolled in primary or secondary school, percent of the labor force in nonagricultural occupations, gross national product per capita, and percent of the population living in urban areas), total fertility rates for the years 1985-90, total fertility rate decline from 1960-65 to 1985-90, family planning program effort scores in 1989, and the level of contraceptive prevalence in 1990. Eight countries are classified as certain to reach replacement fertility by 2015, and an additional thirteen probably will also. Five countries are classified as possibly reaching replacement fertility, and eleven as unlikely to do so. (DEVELOPING COUNTRIES, FERTILITY DECLINE, FORECASTS, METHODOLOGY)
94.18.08 - English - David SHAPIRO, Department of Economics and Women's Studies Program, Population Research Institute, The Pennsylvania State University, 416 Kern Graduate Building, University Park, PA 16802-3306 (U.S.A.), and B. Oleko TAMBASHE, Department of Demography, University of Kinshasa, Kinshasa (Zaire)
The Impact of Women's Employment and Education on Contraceptive Use and Abortion in Kinshasa, Zaire (p. 96-110)
This report examines contraceptive behavior and abortion among women residing in Kinshasa, Zaire's capital city, with particular emphasis on women's employment and education. A data set collected in 1990 covering 2,399 women of reproductive age was used. While the practice of contraception is a common event in Kinshasa, dominated by the rhythm method, the use of modern contraceptives remains limited, but is on the rise. Induced abortion is reported by 15% of the ever-pregnant women in the survey. Women's employment and education are strongly linked to contraceptive use and abortion, and differences in the incidence of abortion by schooling and employment status appear to play an important role in contributing to corresponding observed differences in fertility. Modern contraceptives and induced abortion appear to be used as complementary fertility-control strategies in Kinshasa, and analyses of the findings suggest that better-educated women employed in the modern sector are most likely to be in the forefront of the contraceptive revolution. (ZAIRE, CONTRACEPTIVE USAGE, INDUCED ABORTION, FEMALE EMPLOYMENT, EDUCATION OF WOMEN)
94.18.09 - English - T. RAJARETNAM and R.V. DESHPANDE, Population Research Centre, JSS Institute of Economic Research, Vidyagiri, Dharwad (India)
Factors Inhibiting the Use of Reversible Contraceptive Methods in Rural South India (p. 111-121)
In two rural districts in South India, the contraceptive prevalence rate for all modern family planning methods was 41%, and that for all reversible methods was only about 2% in 1990. Interviews with 35 health program professionals, 815 currently married women of reproductive age, 136 of their husbands, and 60 community leaders revealed that neither the demand for reversible methods nor the supply of services was strong in the study areas. Program managers and field-workers were not popularizing reversible methods, and therefore couples were unable to learn about their benefits. According to the authors, a strong commitment from program managers at all levels is needed to increase reversible-method use, and adequate services should be made available at clinics and in villages. (INDIA, CONTRACEPTIVE PREVALENCE, FAMILY PLANNING PROGRAMMES)
94.18.10 - English - Howard I. GOLDBERG, Behavioral Epidemiology and Demographic Research Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K35, 4770 Buford Highway, NE, Atlanta, GA 30341-3724 (U.S.A.), and Aykut TOROS, Department of Demography, Hacettepe Institute for Population Studies, Hacettepe University, Ankara (Turkey)
The Use of Traditional Methods of Contraception among Turkish Couples (p. 122-128)
About half the users of contraceptives in Turkey employ traditional methods of family planning, particularly withdrawal. This report presents data from a 1988 national survey to examine Turkish couples' use of and opinions about these methods. Use of traditional methods is widespread across all geographic, demographic, and socioeconomic groups. The principal reasons reported for not using methods generally considered to be highly reliable were fear of health problems and side effects and the opposition of husbands to such methods. Most couples who practice withdrawal also feel that it is as effective as modern methods. These findings imply that a major focus of family planning efforts should be the education of women, of their partners, and of health-care and family planning providers concerning the benefits, risks, and failure rates of both traditional and modern contraceptive methods. (TURKEY, CONTRACEPTIVE USAGE, TRADITIONAL CONTRACEPTION)
MAY/JUNE 1994 - VOLUME 25, NUMBER 3
94.18.11 - English - Suet-ling PONG, Population Research Institute, The Pennsylvania State University, 409 Rackley Building, University Park, PA 16802 (U.S.A.)
Sex Preference and Fertility in Peninsular Malaysia (p. 137-148)
This study uses data from the Second Malaysian Family Life Survey, conducted in 1988, to examine parents' preferences for the sex of their children within each of Malaysia's three ethnic groups. While Malay and Indian parents do not show a consistent sex preference, Chinese parents prefer to have all sons, or a combination of sons and daughters, with more sons than daughters, or at least an equal number of them. Son preference among the Chinese does not seem to be a constraint to fertility decline among that population. Since 1970, Chinese fertility has dropped rapidly; at the same time, Chinese son preference has become more pronounced. Evidence indicates that further reductions in Chinese fertility, through the reduction in sex preference, would be small. (MALAYSIA, ETHNIC GROUPS, SEX PREFERENCE)
94.18.12 - English - Uche C. ISIUGO-ABANIHE, Department of Sociology, University of Ibadan, Ibadan (Nigeria)
Reproductive Motivation and Family-Size Preferences among Nigerian Men (p. 149-161)
Data collected from 3,073 couples in four Nigerian cities and one semiurban settlement were used to examine reproductive decisionmaking and male motivation for large family size. The report concludes that the characteristic male-dominant and patrilineal traditions support large family size and that men's reproductive motivation, to a large extent, affects the reproductive behavior of their wives. Therefore, the factors influencing men's reproductive outcomes and intentions are considered important for fertility transition in Nigeria. Male education, age at marriage, monogamy, interspousal communication, and intention not to rely on children for old-age support are significantly related to smaller actual family size and preferences for smaller families, while being in a male-dominant family setting has a strong relation with large family size and preferences for larger families. The policy implication of this study is the need for programs targeted at men and designed to change their attitudes about population matters and motivate them, and hence their wives, to produce smaller families. (NIGERIA, FERTILITY, MEN'S ROLE, DESIRED FAMILY SIZE)
94.18.13 - English - Karen BECK WADE, Institute for Applied Social and Policy Research, The Claremont Graduate School, 160 East Tenth Street, Suite 4, Claremont, CA 91711-4168 (U.S.A.), Francisco SEVILLA, Centro Médico de Orientacion y Planificacion Familiar, Quito (Ecuador), and Miriam H. LABBOK, Breastfeeding and Maternal and Child Health Division, Institute for Reproductive Health, Georgetown University, Washington, DC (U.S.A.)
Integrating the Lactational Amenorrhea Method into a Family Planning Program in Ecuador (p. 162-175)
This paper reports the results of a 12-month implementation study documenting the process of integrating the Lactational Amenorrhea Method (LAM) into a multiple-method family planning service delivery organization, the Centro Medico de Orientacion y Planificacion Familiar (CEMOPLAF), in Ecuador. LAM was introduced as a family planning option in four CEMOPLAF clinics. LAM was accepted by 133 breastfeeding women during the program's first five months, representing about one-third of postpartum clients. 73% of LAM acceptors were new to any family planning method. Follow-up interviews with a systematic sample of 67 LAM users revealed that the method was generally used correctly. Three pregnancies were reported, none by women who were following LAM as recommended. Service providers' knowledge of LAM resulted in earlier IUD insertions among breastfeeding women. Relationships with other maternal and child health organizations and programs were also established. (ECUADOR, FAMILY PLANNING PROGRAMMES, AMENORRHOEA, BREAST FEEDING)
94.18.14 - English - Dale HUNTINGTON, The Population Council, 6 (A) Giza Street, P.O. Box 115, Dokki, 12211 Giza (Egypt), and Aristide APLOGAN, Operations Research Coordinat, Combating Communicable Childhood Diseases project in Togo
The Integration of Family Planning and Childhood Immunization Services in Togo (p. 176-183)
Improvements in the constellation of services in the African context are largely addressed through attaining better measures of service integration, which can be achieved through improved referral across categories of health programs. The use of an unobtrusive referral message that linked family planning and the Expanded Program of Immunizations (EPI) services was tested in an operations research study in Togo. The introduction of the referral message was accompanied by an 18% increase in awareness of available family planning services and an increase in the average monthly number of new family planning clients of 54%. These positive results indicate that the use of referral can have a significant and dramatic impact on family planning services in a relatively short time. In Togo, no evidence existed of a negative impact on EPI services, and a majority of the EPI providers reported satisfaction with the effect of the referral message at the close of the study. (TOGO, FAMILY PLANNING PROGRAMMES, METHODOLOGY, INFORMATION DISSEMINATION)
94.18.15 - English - Federico R. LEON, c/o The Population Council, Paseo Padre Constancio Bollar 225, El Olivar de San isidro, Lima 27 (Peru), Gustavo QUIROZ and Alfredo BRAZZODURO
The Reliability of Simulated Clients' Quality-of-Care Ratings (p. 184-190)
Evaluators of family planning programs have begun to use simulated client ratings to assess the quality of services. However, little is known about the reliability of such ratings when they are used to assess individual provider performance. This study examined the reliability of quality-of-care ratings in a Peruvian community-based distribution program by using pairs of concealed observer a simulated client and a companion. Average interrater agreement, measured by interclass correlation, was .50, indicating that ratings are not reliable enough for the evaluation of a single provider by a single rater. The study results suggest that checklist-item scores referring to specific provider behaviors will be more reliable and useful than ratings. (PERU, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, METHODOLOGY)
Back to home page