Back to home page
JULY/AUGUST 1994 - VOLUME 25, NUMBER 4
95.18.1 - English - Michael H. BERNHART, University Research Corporation, Dhaka (Bangladesh), and Ghulam M. KAMAL, University of Puget Sound, School of Business and Public Administration, 1500 North Warner, Tacoma, WA 98416-0126 (U.S.A.) Management of community distribution programs in Bangladesh (p. 197-210)
In Bangladesh, five high- and five low-performing nongovernmental organization-supported community distribution projects were studied to determine which management, supervisory, and field activities differed between the better and poorer performers. A total of 37 variables were studied, and differences between the higher- and lower-performing projects were noted for nearly all of the variables. In general, project effectiveness was associated with higher service quality, more proactive field supervision, and greater organizational clarity. No project performed all of the 37 activities well. No one or two variables predicted project success, and none of them was found to be a necessary condition for project success. Higher performance was associated with doing well on many of these variables. (BANGLADESH, CONTRACEPTIVE DISTRIBUTION, PROGRAMME EVALUATION)
95.18.2 - English - Sidney Ruth SCHULER, Empowerment of Women Program, JSI Research and Training Institute, 1616 North Fort Myer Drive, Arlington, VA 22209 (U.S.A.), Maria Eugenia CHOQUE, Taller de Historia Oral Andina, La Paz (Bolivia), and Susanna RANCE, The Population Council, La Paz (Bolivia) Misinformation, mistrust, and mistreatment: Family planning among Bolivian market women (p. 211-221)
Results of an ethonographic study suggest that, despite stereotypes to the contrary, urban Aymara women in Bolivia want to regulate their fertility, and sociocultural norms support fertility regulation. However, the norms also make such regulation difficult to achieve. One barrier is a deep suspicion of modern medicine and medical practitioners, who are not seen as reliable sources of information. This suspicion is reinforced when the quality of health services is inadequate. Among urban Aymara, the level of acceptability of most modern methods of contraception is low. Many would prefer to use traditional methods, even when use of these methods entails considerable sacrifice and risk of conflict with their partners, unwanted pregnancies, and recourse to unsafe abortion. (BOLIVIA, INDIGENOUS POPULATION, FAMILY PLANNING, SOCIAL NORMS)
95.18.3 - English - Poo Chang TAN and Nai Peng TEY, Department of Statistics, Faculty of Economics and Administration, University of Malaya, Lembah Pantai, 59100 Kuala Lumpur (Malaysia) Do fertility intentions predict subsequent behavior? Evidence from Peninsular Malaysia (p. 222-231)
Data from the 1984 Malaysian Population and Family Survey were matched with birth registration records for 1985-87 to determine the accuracy of statements regarding desired family size that were reported in a household survey in predicting subsequent reproductive behavior. The findings of this study were that stated fertility intention provides fairly accurate forecasts of fertility behavior in the subsequent period. In other words, whether a woman has another child is predicted closely by whether she wanted an additional child. Informational, educational, and motivational activities of family planning programs would, therefore, have greater success in reducing family size if fertility intentions were taken into account. (MALAYSIA, DESIRED FAMILY SIZE, FAMILY SIZE)
95.18.4 - English - Ricardo VERNON, Anne STAUNTON, The Population Council, Mexico City Office (Mexico), Mario GARCIA, Juan José ARROYO and Raul ROSENBERG, Family Planning Unit, Ministry of Health (Guatemala)
A test of alternative supervision strategies for family planning services in Guatemala (p. 232-238)
This report presents results of an operations research project that tested the impact and cost-effectiveness of alternative supervision schemes of reproductive health services in Guatemala. The strategies tested were (1) indirect supervision, in which one of the two annual supervised visits to each health unit was replaced by a one-day meeting at the district level with the supervisor, and (2) self-assessment, in which one supervised visit was replaced by a two-day workshop where participants filled out self-assessment checklists identifying quality of care problems and made a plan to solve identified problems during the following months. Health units in the two experimental groups showed greater increases in productivity than units receiving traditional supervision. In both alternative strategies, supervisors were able to reach a larger proportion of health units and service providers than through the traditional supervision system. The supervised cost per unit was also lower in the two experimental groups than in the control group. Few differences were observed between the experimental and control groups in terms of the satisfaction of service providers with their jobs and of clients with services received. (GUATEMALA, FAMILY PLANNING PROGRAMMES, METHODOLOGY, PROGRAMME EVALUATION)
SEPTEMBER/OCTOBER 1994 - VOLUME 25, NUMBER 5
95.18.5 - English - Ann P. RILEY, Department of Demography, Georgetown University, 236 Poulton Hall, Washington, DC 20057 (U.S.A.), M. Kathryn STEWART, Demographic and Health Surveys/Macro International, and Jyotsnamoy CHAKRABORTY, Health Services, Matlab Station, International Centre for Diarrhoeal Disease Research, Dhaka (Bangladesh)
Program- and method-related determinants of first DMPA use duration in rural Bangladesh (p. 255-267)
This article examines the determinants of first-time use durations of the injectable contraceptive Depo Medroxy Progesterone Acetate (DMPA) for rural Bangladeshi women. The method's side effects were defined by 200 first-time users in Matlab district during lengthy, open-ended interviews. Women with many children used the method longer than did women of low parity. Those who experienced side effects had shorter use durations than those who did not, and those who cited heavy bleeding as their main problem discontinued use soonest. Women whose husbands approved of family planning had significantly longer use durations than those whose husbands disapproved. Respondents who adopted DMPA because of perceived positive aspects of the drug used it longer than those who chose it for other reasons. Results of the study underscore the importance of viewing side effects in a specific social and cultural context. Expanded side-effects counseling for women and their husbands is needed. (BANGLADESH, INJECTABLES, CONTRACEPTIVE USAGE, ADVERSE EFFECTS)
95.18.6 - English - Ian ASKEW, Africa Operations Research and Technical Assistance Project, Programs Division, The Population Council, Nairobi (Kenya), Barbara MENSCH, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.), and Alfred ADEWUYI, Operations Research Unit, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife (Nigeria)
Indicators for measuring the quality of family planning services in Nigeria (p. 268-283)
This article presents the Situation Analysis approach as a means of collecting data that can be used to assess the quality of care provided by family planning service-delivery points (SDPs), and describes the quality of services offered in Nigeria. Elements of the quality of services provided at 181 clinical service-delivery points in six states of Nigeria are described. The substantive results from the study suggest that although most of the 181 service points sampled are functional, the quality of care being provided could be improved. Illustrative scores for these indicators and elements of the Bruce-Jain framework are given. By comparison with contraceptive prevalence surveys, the Situation Analysis approach is still in its early stages. Some methodological issues are raised here and future directions for strengthening the validity and applicability of the approach are discussed. (NIGERIA, PROGRAMME EVALUATION, METHODOLOGY)
95.18.7 - English - Dorace A. TR0TTIER, Linda S. P0TTER, Barbara A. TAYLOR and Lucinda H. GLOVER, Family Health International (FHI), P.O. Box 13950, Research Triangle Park, NC 27709 (U.S.A.) User characteristics and oral contraceptive compliance in Egypt (p. 284-292)
Results from the 1988 Egypt Demographic and Health Survey show that many women are not taking oral contraceptives in a manner that ensures full protection by the method. Reports from 1,258 current pill users show a range of incorrect use; 63% of women surveyed reported an interruption in their use of the pill in the past month, and of those women, only 40% took the correct action when they missed a pill. The majority (89%) did not wait the correct number of days between packs. Multivariate analysis revealed that rural women were more likely to take pills out of sequence, compared with their urban counterparts. Failure to take a pill within the previous month was strongly associated with the experience of side effects. The younger women surveyed were more likely to know the correct interval between pill packs than were older women; and women who wanted more children were more likely to know the correct interval than those who did not. The use patterns exhibited by the pill users may be the result of their receiving confusing, incorrect, or incomplete information, and highlight the need to provide women with accurate, updated, and comprehensible information about oral contraceptives. (EGYPT, ORAL CONTRACEPTIVES, CONTRACEPTIVE USAGE)
95.18.8 - English - Leela VISARIA, Pravin VISARIA, Gujarat Institute of Development Research, Gota 382 481, Ahmedabad (India), and Anrudh JAIN, Program Division, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.)
Estimates of contraceptive prevalence based on service statistics and surveys in Gujarat State, India (p. 293-303)
This report demonstrates that the estimates of contraceptive prevalence based on surveys are substantially lower than those based on the service statistics generated by the Indian family planning program. The reasons for this discrepancy were examined by contacting a subsample of acceptors recorded by female health workers as users in their registers. This inquiry indicated that the health workers themselves knew that 15-39% of the women who had been recorded as users of reversible methods were not really using them. About 19-27% of the recorded users of IUDs and only 3-4% of the recorded condom users confirmed use of the devices. Overall, the nonusers formed 59 and 64% of the recorded users contacted in Bharuch and Panchmahals districts, respectively. The estimates of nonuse of contraceptives in the follow-up survey are high enough to reconcile most of the observed discrepancy between the two sets of estimates of contraceptive prevalence. (INDIA, CONTRACEPTIVE USAGE, QUALITY OF DATA, METHODOLOGY)
95.18.9 - English - Dewa Nyoman WIRAWAN, Department of Public Health, Faculty of Medicine, Udayana University, Jalan P.B. Sudirman, Denpasar, Bali (Indonesia), and Michael LINNAN, International Health Program Office, Centers for Disease Control, Atlanta, GA (U.S.A.) The Bali indirect maternal mortality study (p. 304-309)
The Bali Indirect Maternal Mortality Study (BIMMS) was conducted in Bali Province, Indonesia in 1991. The objective of the study was to evaluate the indirect sisterhood method for estimating maternal mortality, using a prospective (direct) community-based survey undertaken from 1980 to 1982 among women of reproductive age (Reproductive Age Mortality Survey, or RAMOS) as a comparison. The BIMMS maternal mortality ratio was 331 per 100,000 live births adjusted for 1982. This ratio is similar to the RAMOS one prior to its adjustment, of 359 per 100,000 live births. The sisterhood method was faster, cheaper, and appears to be as accurate as direct methods. (INDONESIA, MATERNAL MORTALITY, ESTIMATES, METHODOLOGY)
Back to home page