Back to Home pageUnited States of America (New York) 18
STUDIES IN FAMILY PLANNING
MAY-JUNE 1996 - VOLUME 27, NUMBER 3
97.18.1 - English - Elisha P. RENNE, Woodrow Wilson School, Office of Population Research, Princeton University, Princeton, NJ 08544-2091 (U.S.A.)
Perceptions of population policy, development, and family planning programs in Northern Nigeria (p. 127-136)
In this article, local perceptions of family planning programs and federal population policy are examined, based on responses to a childbirth survey and on interviews with a range of individuals in one northern Nigerian town. The respondents' differing perceptions of the relationship between population and national development reflect distinctive ideas about political authority, population policy, and family planning programs, about development, and about domestic and international political affairs. Local suspicions about the Nigerian population policy and family planning programs suggest that they cannot be implemented in isolation from broader political and economic concerns. This distrust has ramifications for current family planning programs and reproductive health initiatives undertaken by Western-sponsored aid projects. (NIGERIA, PUBLIC OPINION, POPULATION POLICY, FAMILY PLANNING PROGRAMMES)
97.18.2 - English - John A. ROSS, The Futures Group, 80 Glastonbury Boulevard, Glastonbury, CT 06033-4409 (U.S.A.), and W. Parker MAULDIN, Research Division, The Population Council, New York (U.S.A.)
Family planning programs: Efforts and results, 1972-94 (p. 137-147)
In this article, time trends and differentials for family planning program effort are presented for most developing countries for 1972, 1982, 1989, and 1994. Overall program effort for the developing world increased sharply from 1972 to 1982, and again from 1982 to 1989, but only modestly thereafter. Some countries had already reached ceiling levels. A few with very low fertility rates deliberately weakened their programs, and other programs deteriorated for reasons that are unclear. On the other hand, within the small overall rise, numerous countries with weak programs improved their scores substantially. Regions with the lowest 1989 ratings improved the most, mainly on policy positions, and they improved least on availability of contraceptive methods. The relationship of program strength to socioeconomic setting has steadily weakened across the 22-year period studied. The stronger programs overall are stronger on essentially all 30 features of effort. Programs that have improved over the years have changed to resemble the profiles of the stronger programs. (DEVELOPING COUNTRIES, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, COMPARATIVE ANALYSIS)
97.18.3 - English - Rose Maria LI and Susan F. NEWCOMER, Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Boulevard, Room 8B13, Bethesda, MD 20982 (U.S.A.)
The exclusion of never-married women from Chinese fertility surveys (p. 148-154)
Never-married women have been regularly excluded in official national surveys of fertility in China, even in light of evidence of increasing premarital sexual activity. Likewise, never-married women in the United States were consistently excluded from national fertility surveys prior to 1982 because of the perceived sensitivity of questions about contraceptive use and sexual activities. Data on sexual and fertility behavior from all women of reproductive age, regardless of marital status, can provide direct measures of sexual activity and unintended pregnancies, as well as facilitate modeling of social networks underlying the sexual transmission of diseases. China's need for such information, however sensitive, will become more difficult to ignore given increasing pressures to attend to the health needs of their never-married but sexually active population. (CHINA, SPINSTERS, FERTILITY SURVEYS, SEXUAL BEHAVIOUR, PUBLIC HEALTH)
97.18.4 - English - Dale HUNTINGTON, Barbara MENSCH and Vincent C. MILLER, The Population Council, New York (U.S.A.)
Survey questions for the measurement of induced abortion (p. 155-161)
Underreporting of induced abortion in survey research is a ubiquitous problem. The use of all indirect interview technique in which questions were asked about abortion in the context of unwanted pregnancy was described earlier as holding promise for increasing the response rate. This report reviews the mixed results from multicountry studies that used the indirect technique. Exploratory qualitative studies are needed to identify a setting-specific context for discussing abortion. Because the subject of induced abortion is inherently sensitive, survey measurement of this practice is less precise than that of other, less controversial maternal health-care practices. This lack of precision should not deter the pursuit of the study of this critically important public health-care concern. (INDUCED ABORTION, DATA COLLECTION, METHODOLOGY, SURVEYS, UNDERENUMERATION)
97.18.5 - English - Kristin A. COONEY, Breastfeeding and MCH Division, Institute for Reproductive Health, Georgetown University Medical Center, Department of OB/GYN, 2115 Wisconsin Avenue, NW, Washington, DC 20007 (U.S.A.), Thérèse NYIRABUKEYE, Secrétariat national d'action familiale rwandaise, Kigali (Rwanda), Miriam H. LABBOK, Institute for Reproductive Health, Georgetown University Medical Center, Washington, DC (U.S.A.), P. Henryk HOSER, Secrétariat national d'action familiale rwandaise, Kigali (Rwanda), and Elisa BALLARD, Institute for Reproductive Health, Georgetown University Medical Center, Washington, DC (U.S.A.)
An assessment of the nine-month lactational amenorrhea method (MAMA-9) in Rwanda (p. 162-171)
This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modifieded lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form offamily planning. These results are promising and provide guidancefor the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding. (RWANDA, NATURAL FAMILY PLANNING, BREAST FEEDING, POSTPARTUM AMENORRHOEA, METHODOLOGY)
JULY-AUGUST 1996 - VOLUME 27, NUMBER 4
97.18.6 - English - Deborah MAINE, Murat Z. AKALIN, Prevention of Maternal Mortality Program, Center for Population and Family Health, Columbia University School of Public Health, 60 Haven Avenue, B-3, New York, NY 10032 (U.S.A.), Jyotsnamoy CHAKRABORTY, Andres de FRANCISCO, Matlab Maternal and Child Health-Family Planning Programme (Bangladesh), and Michael STRONG, National Office of Population, Addis Abeba (Ethiopia)
Why did maternal mortality decline in Matlab? (p. 179-187)
In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the physicians at the Matlab maternity clinic. Their ability to refer patients to higher levels of care was important. The data further indicate that the decline in deaths depended upon the functioning of the government hospital in Chandpur, where cesarean sections and blood transfusions were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangladesh. (BANGLADESH, MATERNAL MORTALITY, MORTALITY DECLINE, TRAINED MIDWIVES)
97.18.7 - English - P. Stanley YODER, Robert HORNIK, Annenberg School for Communications, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104-6220 (U.S.A.), and Ben C. CHIRWA, Health Education Unit, Ministry of Health (Zambia)
Evaluating the program effects of a radio drama about AIDS in Zambia (p. 188-203)
This study describes an approach to the analysis of data that is designed to isolate program effects for evaluations and applies that approach to a program in Zambia designed to disseminate AIDS information. Evidence is considered that a radio drama broadcast for nine months had an impact on knowledge and behavior related to AIDS among Bemba speakers in northern Zambia. Using results from large sample surveys (1,600 men and women), conducted before and after the drama was broadcast, the analyses compare changes in knowledge and behavior in those most likely and least likely to have listened to the broadcast. While the population as a whole had improved its knowledge substantially, and some people reported having reduced risky behavior, attributing these changes to the program itself was not possible. (ZAMBIA, AIDS, PROGRAMME EVALUATION, RADIO, METHODOLOGY)
97.18.8 - English - James F. PHILLIPS, Research Division, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.), Mian Bazle HOSSAIN, Maternal and Child Health and Family Planning Extension Project, International Centre for Diarrhoeal Disease Research (Bangladesh), and Mary ARENDS-KUENNING, Department of Economics, University of Michigan (U.S.A.)
The long-term demographic role of community-based family planning in rural Bangladesh (p. 204-219)
Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh -- where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive-use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed. (BANGLADESH, PROGRAMME EVALUATION, FAMILY PLANNING PROGRAMMES, CONTRACEPTION CONTINUATION, METHODOLOGY)
97.18.9 - English - James A. HANLEY, Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Avenue West, Montréal, H3A 1A2 (Canada), Catherine A. HAGEN, Department of Family Practice, University of British Columbia, Prince George, BC (Canada), and Tesfaye SHIFERAW, Department of Community Health, Jimma Institute for Health Sciences, Jimma (Ethiopia)
Confidence intervals and sample-size calculations for the sisterhood method of estimating maternal mortality (p. 220-227)
The sisterhood method is an indirect method of estimating maternal mortality that has, in comparison with conventional direct methods, the dual advantages of ease of use in the field and smaller sample-size requirements. This report describes how to calculate a standard error to quantify the sampling variability for this method. This standard error can be used to construct confidence intervals and statistical tests and to plan the size of a sample survey that employs the sisterhood method. Statistical assumptions are discussed, particularly in relation to the effective sample size and to effects of extrabinomial variation. In a worked example of data from urban Pakistan, a maternal mortality ratio of 153 (95 percent confidence interval between 96 and 212) deaths per 100,000 live births is estimated. (PAKISTAN, MATERNAL MORTALITY, MORTALITY MEASUREMENT, METHODOLOGY, SAMPLING ERRORS)
SEPTEMBER-OCTOBER 1996 - VOLUME 27, NUMBER 5
97.18.10 - English - Siân L. CURTIS, Macro International, Inc., 11785 Beltsville Drive, Calverton, MD 20705 (U.S.A.), and Charles F. WESTOFF, Office of Population Research, Princeton University, Princeton, NJ (U.S.A.)
Intention to use contraceptives and subsequent contraceptive behavior in Morocco (p. 239-250)
In this article, the relationship between stated intention to use contraceptives and subsequent use during a three-year period in Morocco is examined. Longitudinal data are drawn from two Demographic, and Health Surveys: the 1992 Morocco DHS and the 1995 Morocco Panel Survey. Reported contraceptive intentions in 1992 have a strong predictive effect on subsequent contraceptive use even after controlling for other characteristics of respondents, and the strength of the effect is second only to that of previous contraceptive use. Women who in 1992 said they intended to use contraceptives in the future but did not do so are the most likely to have had an unmet need for contraception in 1995. Weakly held fertility preferences reported by some of the women surveyed in 1992 appear to have been a contributing factor in the subsequent failure of these women to act upon their, intention to practice contraception. (MOROCCO, CONTRACEPTIVE USAGE)
97.18.11 - English - Ruth SIMMONS, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029 (U.S.A.)
Women's lives in transition: A qualitative analysis of the fertility decline in Bangladesh (p. 251-268)
The fertility decline that began in Bangladesh in the late 1980s and continues has prompted diverse theories to explain it. In this qualitative analysis of 21 focus-group sessions with rural women ranging in age from the teens to late 40s and living in the villages of the Matlab area, the women's perceptions of their changing society and of the influence of the family planning program are examined. The women's statements reveal their awareness of the social and economic transition they are undergoing and their interest in family-size limitation, which is bolstered by a strong family planning program. Although the shifts in economic and social circumstances are not large, in conjunction with the strong family planning program they constitute a powerful force for change in attitudes, ideas, and behavior among these women. (BANGLADESH, RURAL WOMEN, FERTILITY DECLINE, FAMILY PLANNING PROGRAMMES)
97.18.12 - English - H. Volkan ÇAKIR, Policy Project, Abidin Daver Sokak, No. 7/7, Çankaya 06550, Ankara (Turkey), Stephen J. FABRICANT, Health-Policy-Reform Technical Assistance Project, Palestinian Health Authority, and F. Nilgün KIRCALIOGLU, Family Planning Service Expansion and Technical Support Project (SEATS), Ankara (Turkey)
Comparative costs of family planning services and hospital-based maternity care in Turkey (p. 269-276)
The costs of running a recently established family planning program in the Turkish social security system were measured and compared with the costs of providing the medical services and non medical benefits for pregnant women. The undiscounted cost savings from averting pregnancy were estimated to exceed the program's recurrent costs by 17.6 to 1. Cost savings represent only 1 percent of all of the system's medical expenditures, but the family planning program is in an early stage, and potential savings could influence management decision making regarding investments in specialized maternity hospitals. (TURKEY, FAMILY PLANNING PROGRAMMES, HOSPITALS, COST ANALYSIS)
97.18.13 - English - Dale HUNTINGTON, Kate MILLER and Barbara MENSCH, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (U.S.A.)
The reliability of the Situation Analysis Observation Guide (p. 277-282)
The use of direct observation to assess the quality of family planning services is a central element of situation analysis studies. The interrater reliability of observational data from a study in Turkey was assessed using teams of multiple observers. Overall, the findings suggest a strong degree of reliability. Observers were more likely to agree when rating physical actions than verbal cues and when both observers were of similar backgrounds. The high degree of reliability in the situation analysis observation guide is considered to be due to a relatively low level of measurement and the use of crude indicators for several dimensions of quality. The guide's reliability makes this sort of study particularly valuable to family planning clinicians, program managers, and policymakers. (FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, METHODOLOGY, RELIABILITY)
NOVEMBER-DECEMBER 1996 - VOLUME 27, NUMBER 6
97.18.14 - English - Stan BECKER, Population Dynamics Department, School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205-2179 (U.S.A.)
Couples and reproductive health: A review of couple studies (p. 291-306)
Traditionally, fertility and family planning research and programs have focused on women. With the expansion of the field to include reproductive health following the 1994 International Conference on Population in Cairo, the more appropriate focus for most reproductive health components appears to be the sexually active couple. This review of studies of couples and reproductive health outcomes examines reports of objective reproductive events, of attitudes and reproductive intentions, of the effect of each partner's attitudes and intentions, of reproductive outcomes, and of the effectiveness of interventions that target couples compared with those that target one partner or the other. For couples' statements about reproductive events, studies throughout the world typically show identical reports less than 90 percent of the time. Concordance between partners on subjective matters is in the range of 60 to 70 percent. Data based on reports of reproductive intentions from both partners have been shown to lead to better predictions of behavior than have data from only one partner. Finally, reproductive health interventions that target couples are found to be more effective than those directed to only one sex. The evidence clearly justifies a focus on couples. (HEALTH, FERTILITY, FAMILY PLANNING, COUPLE, METHODOLOGY)
97.18.15 - English - John KNODEL, Population Studies Center, University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48104 (U.S.A.), Vipan Prachuabmoh RUFFOLO, Institute of Population Studies, Chulalongkorn University, Bangkok (Thailand), Pakamas RATANALANGKARN, Social Statistics Division, National Statistical Office, Bangkok (Thailand), and Kua WONGBOONSIN, Institute of Population Studies, Chulalongkorn University, Bangkok (Thailand)
Reproductive preferences and fertility trends in post-transition Thailand (p. 307-318)
Two large national surveys in 1988 and 1993 provide new evidence on trends in family-size preferences in Thailand at a time when the Thai fertility transition is reaching its conclusion. Although the average preferred number of children has continued to decline, a resistant lower bound of two children is found for the vast majority of respondents, stemming, apparently,from a pervasive, although not inflexible, desire to have one child of each sex. Moreover, new evidence from birth-registration data indicates that the decline in the total fertility rate appears to have leveled of fat about replacement level. These findings challenge the view that fertility in Thailand will continue to fall well below replacement level, and contradict recently expressed alarmist predictions of population decline in the foreseeable future. (THAILAND, IDEAL FAMILY SIZE, FERTILITY DECLINE, SEX PREFERENCE)
97.18.16 - English - Susan FAWCUS, Department of Obstetrics and Gynaecology, Grooteschuur Hospital, Observatory 7925, Cape Town (South Africa), Michael MBIZVO, Department of Obstetrics and Gynaecology, University of Zimbabwe (Zimbabwe), Gunilla LINDMARK, Department of Obstetrics and Gynaecology, University Hospital, Uppsala (Sweden), and Lennarth NYSTRÖM, Department of Epidemiology and Public Health, Umeå University, Umeå (Sweden)
A community-based investigation of avoidable factors for maternal mortality in Zimbabwe (p. 319-327)
A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability. Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of the 61 urban deaths. Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively. Lack of transportation delayed or prevented access to health facilities in the rural area, a major problem in 28 percent of the cases studied. Suboptimal clinic and hospital management was identified in 67 percent and 70 percent of rural and urban deaths, respectively. Lack of appropriately trained personnel contributed to suboptimal care. In both settings, the severity of patients' conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment. Appropriate community and health-service interventions to reduce maternal mortality are discussed. (ZIMBABWE, MATERNAL MORTALITY, MORTALITY DETERMINANTS, MEDICAL CARE)
97.18.17 - English - Pavalavalli GOVINDASAMY, Demographic and Health Surveys, Macro International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (U.S.A.), and Anju MALHOTRA, Center on Population, Gender and Social Inequality, University of Maryland (U.S.A.)
Women's position and family planning in Egypt (p. 328-340)
In this report, data from the 1988 Egypt Demographic and Health Survey are used to address some of the most frequently raised questions about the relationship between gender inequality and reproductive behavior. The findings from binomial and multinomial logit models show that while the relationship between women's position and fertility control in Egypt is complex, some clear, broad patterns exist that have important theoretical and policy implications. First, although women's status in Egypt is clearly multidimensional, the reproductive aspect of women's position has a strong connection with the nonreproductive dimensions. Second, the case for the continued use of education and employment as proxies of women's position, especially in relationship to fertility control, is considerably discredited by the results. Finally, the findings indicate that Egyptian culture supports gender equality in the form of interaction and negotiation rather than women's autonomy. (EGYPT, WOMEN'S STATUS, FAMILY PLANNING)
Back to Home page