INTERNATIONAL FAMILY PLANNING PERSPECTIVES

United States of America (New York) 76

DECEMBER 1994 - VOLUME 20, NUMBER 4

98.76.1 - English - Li Yong PING, Institute of Population Studies, Peking University, Beijing (China), Katherine L. BOURNE, UNFPA consultant, Beijing (China), Patrick J. ROWE, WHO Special Programme of Research, Development and Research Training in Human Reproduction, Zhang De WEI, Shanghai Family Planning Research Institute, Shanghai (China), Wang Shao XIAN, Beijing Medical University, Beijing (China), Zhen Hiao YIN, Institute of Population Studies, Peking University, Beijing (China), and Wu ZHEN, China Population Information and Research Center (China)

The demographic impact of conversion from steel to copper IUDs in China (p. 124-130)

China's family planning program relies heavily on the IUD, which accounts for 80% of reversible contraception. The most widely used IUD is the stainless steel ring, which has a failure rate in the first year of use that is six times that of the Copper T. The higher cost of the Copper T is often cited as a barrier to its more widespread use. However, if beginning in 1993, all IUD insertions had been Copper Ts, the effect would have been to avert 41 million pregnancies (some 26 million abortions and 14 million live births) over the next 10 years - pregnancies that would result from method failures with the less effective steel ring. Changing over to copper IUD use at rates that are moderate (within four years) or slow (within seven years) could avert nearly 32 million pregnancies and 24 million pregnancies, respectively. (CHINA, IUD, CONTRACEPTIVE EFFECTIVENESS, BIRTHS AVERTED)

98.76.2 - English - Barbara JANOWITZ, Service Delivery Research Division, Family Health International, Research Triangle Park, NC (U.S.A.), Kanchana KANCHANASINITH, Regional Health Promotion Center, Region I, Bangkok (Thailand), Nanta AUAMKUL, Office of the Permanent Secretary, Ministry of Public Health, Bangkok (Thailand), Pornsinee AMORNWICHET, Research and Evaluation Section, Family Health Division, Ministry of Public Health, Bangkok (Thailand), Kusol SOONTHORNDHADA, Institute for Population and Social Research, Mahidol University, Bangkok (Thailand), and Robert HANENBERG, Family Health International, Research Triangle Park, NC (U.S.A.)

Introducing the contraceptive implant in Thailand: Impact on method use and costs (p. 131-136)

A pilot project to study the impact of providing the hormonal contraceptive implant as part of Thailand's National Family Planning Program compared 11 hospitals where nurses were trained to provide the implant with 11 control hospitals. At the former hospitals, nurses provided implants to an average of 38 acceptors per month per hospital during the six months after the training period, compared with a per-hospital average of only eight acceptors per month at control hospitals. However, interviews with 550 implant acceptors indicate that 96% would have used another modern method if the implant had not been available. Moreover, in most cases, the cost per couple-year of protection is higher for the implant than for the IUD or for hormonal injectables: For example, the cost of three couple-years of protection is about US$ 9.40 for the implant, compared with around $ 5.00 for injectables and about $ 1.40 for the IUD. Thus, introducing the implant or significantly expanding its use in Thailand will cost more than expanding the use of the IUD or of injectables. Although the implant has the potential to become an important method in Thailand, the national program will have to choose between spending an increasing proportion of its resources on the implant, charging users higher prices or rationing the implant through administrative means. (THAILAND, CONTRACEPTIVE IMPLANTS, CONTRACEPTIVE USAGE, COSTS)

98.76.3 - English - Cheri PIES, Department of Health Science, San Jose State University, San Jose, CA (U.S.A.), Malcolm POTTS and Bethany YOUNG, School of Public Health, University of California at Berkeley, CA (U.S.A.)

Quinacrine pellets: An examination of nonsurgical sterilization (p. 137-141)

The quinacrine method of nonsurgical female sterilization has been studied for over a quarter of a century, but knowledge of its recent availability has aroused significant interest and concern. In the early 1970s, some attention to this method was generated by the shift from a liquid "slurry" method to slow-release pellets, although by that time many commentators saw the method as having an unacceptably high failure rate and as presenting serious risks. Findings from field studies in 1989-1992 in Vietnam have captured the attention of women's health activists and advocates, contraceptive researchers, policymakers, family planning providers and others affected by the development and use of this nonsurgical procedure. Of particular interest is the scientific rigor with which the field trials have been conducted, and the potential short-term and long-term health effects associated with the use of quinacrine pellets. (VIET NAM, FEMALE STERILIZATION, CHEMICALS, EVALUATION)

98.76.4 - English - Youssef COURBAGE, Institut National d'Etudes Démographiques, Paris (France)

Fertility transition in Syria: From implicit population policy to explicit economic crisis (p. 142-146)

Despite rapid population growth, Syria's government has been reluctant to intervene directly, preferring to rely on economic development and the education and employment of women to reduce family size. During the 1970s, despite prosperity and great gains in women's education, the birth rate remained consistently high. Education of women did not lead to their widespread employment until the 1980s, when a stagnating economy made it necessary for families to seek a second income. Since the mid 1980s, the birth rate has fallen sharply, from 45 births per 1,000 population in 1985 to 33 per 1,000 in 1990. (SYRIA, DEMOGRAPHIC TRANSITION, FERTILITY TRENDS, EDUCATION OF WOMEN, FEMALE EMPLOYMENT, ECONOMIC DEVELOPMENT)

98.76.5 - English - John STANBACK, Jason B. SMITH, Barbara JANOWITZ, Service Delivery Research Division, Family Health International, Research Triangle Park, NC (U.S.A.), and Fadel DIADHIOU, Department of Obstetrics and Gynecology, Université Cheikh Anta Diop, Dakar (Senegal)

Safe provision of oral contraceptives: The effectiveness of systematic laboratory testing in Senegal (p. 147-149)

A 1988-1989 respective study of mandatory laboratory testing to obtain the pill in Senegal found that less than 3% of 410 women who had requested oral contraceptives for the first time had medical contraindications to their use. The laboratory tests were used to detect cervical cancer, diabetes, high cholesterol, anemia and liver function problems. Upon initial testing, 20 women were found to have contraindications to using the pill. Among nine who returned for retesting, only one woman was confirmed as having a contraindication to the pill. The other eight women who were retested all had negative results. The cost to the client of the required laboratory tests was estimated at US$ 55-$ 216, as much as five times the monthly per capita income in Senegal. (SENEGAL, ORAL CONTRACEPTIVES, CONTRAINDICATIONS, PROGRAMME EVALUATION)

SEPTEMBER 1996 - VOLUME 22, NUMBER 3

98.76.6 - English - J. Timothy JOHNSON and Beth A. MACKE, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (U.S.A.)

Estimating contraceptive needs from trends in method mix in developing countries (p. 92-96)

Contraceptive prevalence has grown substantially in developing countries, creating problems for donor agencies and program managers trying to estimate the need for contraceptive supplies. Data from 106 national surveys conducted in 35 countries between 1974 and 1992 permit calculation of changes in total and method-specific prevalence and of annual rates of change, upon which contraceptive forecasts can be based. In all, 44% of women in the most recent surveys were practicing contraception; 36% were using a modern method. Between the first and most recent surveys, total contraceptive prevalence rose at an annual rate of 5%, and modern method use increased by 6% annually. The increases were most rapid in Sub-Saharan Africa (9-10% annually) and slowest in Latin America and the Caribbean (3-4%). Whereas reliance on sterilization grew by 8% yearly, increases in prevalence of the pill, IUD and condom were 2% or less annually. In most regions, reliance on sterilization has changed at a much quicker pace than use of other methods; the exception is North Africa and the Middle East, where the annual increase for sterilization has been modest, but IUD use has climbed quite rapidly. (DEVELOPING COUNTRIES, CONTRACEPTIVE PREVALENCE, CONTRACEPTIVE METHODS, NEEDS, ESTIMATES)

98.76.7 - English - John KNODEL, Department of Sociology, University of Michigan, Ann Arbor (U.S.A.), and Anthony PRAMUALRATANA, Institute for Population and Social Research, Mahidol University, Bangkok (Thailand)

Prospects for increased condom use within marriage in Thailand (p. 97-102)

The transmission of the human immunodeficiency virus (HIV) from infected husbands to their wives is now an important component of the AIDS epidemic in Thailand. Although the value of condoms in reducing the spread of HIV is well-known among Thai men and women, the rate of condom use for contraception among married couples has never exceeded 2%. Focus groups and individual interviews with both urban and provincial Thai men and women reveal a number of formidable barriers to increasing the rate of marital condom use: Condoms are widely perceived as interfering with male sexual pleasure, and they are primarily considered to be a prophylactic for use with prostitutes. The potential for increasing the use of condoms as a method of marital contraception appears limited, as highly effective alternatives are widely available. Thus, condoms will need to be promoted directly as a prophylactic. Findings suggest that general promotion of condoms for use during extramarital sex, together with advocacy of voluntary HIV testing for individuals at high risk of infection and counseling for those testing positive, are practical recommendations. (THAILAND, AIDS, COUPLE, CONDOM, CONTRACEPTIVE USAGE)

98.76.8 - English - Annika JOHANSSON, Department of International Health and Social Medicine, Unit of International Health Care Research, Karolinska Institute, Stockholm (Sweden), Le Thi Nham TUYET, Nguyen The LAP, Centre for Research on Gender, Family and Environment in Development, Hanoi (Vietnam), and Kajsa SUNDSTRÖM, Karolinska Institute, Stockholm (Sweden)

Abortion in context: Women's experience in two villages in Thai Binh province, Vietnam (p. 103-107)

The government of Vietnam adopted a two-child policy in the 1980s to curb population growth; Vietnam now has one of the highest abortion rates in the world. In rural Thai Binh Province, where some local authorities strictly enforce the national population policy through a system of financial incentives and disincentives, 114 abortions occurred for every 100 births in 1991. A survey in two villages in Thai Binh among 228 women who had abortions that year revealed that contraceptive choice was limited, the IUD was essentially the only modern method used, and many women had given it up because of side effects. On average, the women had had 2.4 live births and 1.5 abortions, most of which took place before eight weeks of gestation. The most frequent reasons for choosing an abortion were wanting to save money and to avoid being fined for exceeding the two-child limit. Husbands were the most important persons in sharing the abortion decision; parents and parents-in law often did not agree with the decision. Postabortion counseling was absent or inadequate. The village where the national population policy guidelines were more stringently enforced had twice the abortion ratio of the village where enforcement was more lenient. (VIET NAM, INDUCED ABORTION, ANTINATALIST POLICY, COMPARATIVE ANALYSIS)

98.76.9 - English - Heidi Bart JOHNSTON and Kenneth H. HILL, Department of Population Dynamics, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD (U.S.A.)

Induced abortion in the developing world: Indirect estimates (p. 108-114 and 137)

An analysis of Demographic and Health Survey data provides indirect estimates of the prevalence of abortion in 21 developing countries by rearranging Bongaarts's proximate determinants model to allow calculation of the index of abortion from the other principal proximate determinants of fertility (marriage, contraceptive use and postpartum insusceptibility to pregnancy), average total fecundity and total fertility. On average, abortion appears to have an influence on fertility similar to that of contraceptive use. This influence appears to be particularly strong in the four Latin American countries in the analysis, where abortion reduces fertility by 38-55%. In contrast, abortion's fertility-reducing effect is only 6-19% in the Near East and 0-32% in Africa. In five countries for which two sets of DHS data are available, this reductive effect appears to have increased over time. (DEVELOPING COUNTRIES, INDUCED ABORTION, FERTILITY DETERMINANTS, ESTIMATES)

98.76.10 - English - Sheitaneh SOROODI-MOGHADDAM, Tehran (Iran)

Quinacrine pellet method of nonsurgical female sterilization in Iran: Preliminary report on a clinical trial (p. 122-123 and 127)

For a study of the safety, efficacy and acceptability of female sterilization with quinacrine pellets in a private-practice setting, data on 160 women who obtained the procedure in Tehran between September 1990 and April 1994 were evaluated. Three-fourths of the women were monitored for at least one year, and more than half were monitored for more than two years. By the end of the study period, two women had become pregnant, for a gross pregnancy rate of 1.2%; neither pregnancy was ectopic. Within the first two months after the procedure, about half of the women reported complications or side effects, which were minor and easily treatable; after the first two months, the only side effect reported was delayed menses. The cost of sterilization with quinacrine pellets is one-10th that of surgical sterilization. However, knowledge about the method is not widespread within the medical community in Iran. (IRAN, FEMALE STERILIZATION, CHEMICALS, EVALUATION)

DECEMBER 1996 - VOLUME 22, NUMBER 4

98.76.11 - English - Deborah S. DEGRAFF, Bowdoin College, Brunswick, Maine (U.S.A.), and Victor DE SILVA, Family Planning Association of Sri Lanka, Colombo (Sri Lanka)

A new perspective on the definition and measurement of unmet need for contraception (p. 140-147)

A new, health-based concept of unmet need for contraception identifies women for whom pregnancy would raise the mortality risk for themselves, their expected child or their previous child because of maternal age, short birth interval or high birth order. When applied to Demographic and Health Survey data for Sri Lanka, the method classifies 4-23% of currently married women as being in need of contraception, depending on whether women who are pregnant, abstaining or using traditional methods are considered as potentially in need. The usual concept of unmet need, based on women's stated fertility preferences, classifies 6-31 % as in need. The preference-based approach identifies 50-90% of the women with health-based unmet need, performing better when women using traditional methods and those abstaining from sex are included as potentially in need and when pregnant women are not. The health-based approach identifies 43-65% of those with preference-based unmet need, performing better when pregnant women are included and women using traditional methods are not. (SRI LANKA, CONTRACEPTIVE PREVALENCE, NEEDS, METHODOLOGY)

98.76.12 - English - Susheela SINGH and Renee SAMARA, The Alan Guttmacher Institute, New York (U.S.A.)

Early marriage among women in developing countries (p. 148-157)

A study using data from 40 Demographic and Health Surveys shows that a substantial proportion of women in developing countries continue to marry as adolescents. Overall, 20-50% of women marry or enter a union by age 18, and 40-70% do so by their 20th birthday. Early marriage is most prevalent in Sub-Saharan Africa and in South Asia, and least common in North Africa, the Middle East and Southeast Asia. Women aged 20-24 are less likely to have married by age 20 than are women aged 40-44; the differential is at least 10 percentage points in most countries and reaches 30-40 percentage points in some countries. Education and age at first marriage are strongly associated both at the individual level and at the societal level: A woman who has attended secondary school is considerably less likely to marry during adolescence, and in countries with a higher proportion of women with a secondary education, the proportion of women who marry as adolescents is lower. (DEVELOPING COUNTRIES, EARLY MARRIAGE, WOMEN'S STATUS, EDUCATION OF WOMEN)

98.76.13 - English - Ruhul AMIN, Yiping LI and Ashrad U. AHMED, Institute for Urban Research, Morgan State University, Baltimore, MD (U.S.A.)

Women's credit programs and family planning in rural Bangladesh (p. 158-162)

In many developing countries, programs offering collateral-free credit have integrated economic improvements with consciousness-raising, family planning information and motivation, preventive health services and other activities that promote social welfare. A 1995 household survey of the program areas of five nongovernmental organizations in rural Bangladesh that offer such credit programs reveals that women who participate in them are more likely to use contraceptives, to want no additional children and to desire smaller families than women who do not participate or who live outside of program areas. Increased empowerment was associated with the desire for no more children among credit members. Nonmembers living in program areas also desired smaller families, suggesting a diffusion of norms established by credit members to other women in the community. (BANGLADESH, WOMEN'S EMANCIPATION, CREDIT, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION)

98.76.14 - English - David HUBACHER, Family Health International, Research Triangle Park, NC (U.S.A.), Margarita SUAZO, Asociación Hondureña de Planificación de Familia, Tegucigalpa (Honduras), Stanley TERRELL, USAID, Tegucigalpa (Honduras), and Marco PINEL, Ministerio de Salud Pública, Tegucigalpa (Honduras)

Examining the increasing prevalence of traditional contraceptive methods in Honduras (p. 163-168)

The use of traditional methods has risen sharply in Honduras, from 19% of all contraceptive use in 1987 to 26% of prevalence in 1991-1992. A multivariate analysis of data from two national probability sample surveys shows that contraceptive users interviewed in 1991-1992 were significantly more likely to use rhythm than were those interviewed in 1987; reliance on withdrawal was not significantly different between survey years. The following factors all significantly raised the probability that a woman would select rhythm over modern methods - being 40-44 years old, having 0-2 living children, being legally married, living in a rural area, needing to travel more than one hour to a health facility, wanting more children and recently hearing a family planning message over the radio. Those factors that significantly predicted the choice of withdrawal over modern methods included four of the same variables - marriage, residence, travel time and 0-2 living children - plus being younger than 25, having fewer years of education and having eight or more children. (HONDURAS, CONTRACEPTIVE METHODS, TRADITIONAL CONTRACEPTION, BASAL BODY TEMPERATURE METHOD, COITUS INTERRUPTUS)

98.76.15 - English - D. Lawrence KINCAID, Alice Payne MERRITT, Liza NICKERSON, Sandra DE CASTRO BUFFINGTON, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD (U.S.A.), Marcos Paulo P. DE CASTRO and Bernadete MARTIN DE CASTRO, Promoção da Paternidade Responsável, São Paulo (Brazil)

Impact of a mass media vasectomy promotion campaign in Brazil (p. 169-175)

A mass media campaign to promote vasectomy in three Brazilian cities (São Paulo, Fortaleza and Salvador) consisted of prime-time television and radio spots, the distribution of flyers, an electronic billboard and public relations activities. Clinic data indicate that the monthly mean number of vasectomies initially increased during the six-week campaign by 108% in Fortaleza, by 59% in Salvador and by 82% in São Paulo. An in-depth analysis of the São Paulo clinic data indicates that during the campaign, television replaced personal sources as the dominant source of referrals among men who made telephone inquiries to the clinics. A regression analysis based on São Paulo clinic records for 12 years confirmed that periodic mass media promotions helped alleviate but did not halt the general downward trend in clinic volume over time. Increases in the cost of vasectomy and in alternative sources for the operation contributed to the lower volume. (BRAZIL, CITIES, VASECTOMY, MEDIA, PROPAGANDA, PROGRAMME EVALUATION)

SEPTEMBER 1997 - VOLUME 23, NUMBER 3

98.76.16 - English - Susheela SINGH, Alan Guttmacher Institute, New York NY (U.S.A.), Josefina V. CABIGON, Population Institute, University of the Philippines, Manille (Philippines), Altaf HOSSAIN, Haidary KAMAL, Bangladesh Association for Prevention of Septic Abortion, Dhaka (Bangladesh), and Aurora E. PEREZ, Population Institute, University of the Philippines, Manille (Philippines)

Estimating the level of abortion in the Philippines and Bangladesh (p. 100-107 and 144)

In countries where data on induced abortion are underreported or nonexistent - such as the Philippines and Bangladesh - indirect estimation techniques may be used to approximate the level of abortion. The collection of data about women hospitalized for abortion complications and the use of such indirect estimation techniques indicates that the abortion rate in the Philippines is within the range of 20-30 induced abortions per 1,000 women aged 15-49, and the rate in Bangladesh ranges between 26 and 30 per 1,000. About 400,000 abortions are estimated to occur each year in the Philippines, while the number in Bangladesh is calculated to be about 730,000. Some 80,000 women per year are estimated to be treated in hospitals in the Philippines for complications of induced abortion; in Bangladesh, about 52,000 women are treated for such complications, and another 19,000 are treated for complications resulting from menstrual regulation procedures. The probability that a woman will be hospitalized for abortion complications in the Philippines is twice that in Bangladesh, probably because menstrual regulation procedures by trained providers account for about two-thirds of all voluntary pregnancy terminations in Bangladesh. (PHILIPPINES, BANGLADESH, INDUCED ABORTION, ESTIMATES, COMPARATIVE ANALYSIS)

98.76.17 - English - Ann E. BIDDLECOM, John B. CASTERLINE, Policy Research Division, Population Council, New York, NY (U.S.A.), and Aurora E. PEREZ, University of the Philippines, Manille (Philippines)

Spouses' view of contraception in the Philippines (p. 108-115)

Data from a 1993 survey in the Philippines indicate that, in the aggregate, men and women have similar views of contraception. For example, 72% of husbands and 77% of wives strongly approved of contraception, and at least half believed that relatives and friends approved (although men were less likely than women to think so). At the couple level, however, men's perceptions about contraception often differ from those of their wives. A relatively large amount of disagreement exists about the importance of certain contraceptive attributes and the extent to which these attributes apply to specific methods. This disagreement is associated both with lower levels of contraceptive use and with greater conflict over intentions to use contraceptives in the future. For example, when both spouses approve of family planning in general, 81% of couples share the same intentions to practice contraception in the future; but among couples who disagree over approval of contraception, just 43% share intentions about future use. (PHILIPPINES, SPOUSES, ATTITUDE, CONTRACEPTION)

98.76.18 - English - Barbara JANOWITZ, Matthew HOLTMAN, David HUBACHER, Family Health International, Durham, NC (U.S.A.), and Kanta JAMIL, Department of Population Dynamics, Johns Hopkins University, Baltimore, MD (U.S.A.)

Can the Bangladeshi family planning program meet rising needs without raising costs? (p. 116-121 and 145)

Efforts to expand Bangladesh's government-sponsored family planning program to meet the needs of more women while raising overall contraceptive prevalence may increase costs to unacceptably high levels. A 1993-1994 study examined this problem using data for both clinics and home visits. Results show that costs per couple-year of protection are affected by the overlap between the home service delivery and clinic systems, since fieldworkers visit couples of reproductive age in their homes, regardless of couples' method choice or source of supply. For example, in the case of IUDS, 39% of costs per couple-year of protection are accounted for by follow-up home visits, yet some users receiving these visits go to clinics for follow-up services. Furthermore, costs could be reduced if worker productivity improved. For instance, if fieldworkers eliminated unauthorized leave and increased the time they spent working each day from four to five hours, the labor cost per couple-year of protection for the pill would decline by about one-third, from $3.05 to $1.97; similarly, if clinic workers reduced their unused time, the clinic costs associated with IUD use would fall by one-third, from $1.94 to $1.32 per couple-year of protection. Moreover, increased productivity would enable the existing systems to meet the projected demand in 2004. (BANGLADESH, FAMILY PLANNING PROGRAMMES, COST ANALYSIS)

98.76.19 - English - Naushin MAHMOOD, Pakistan Institute of Development Economics, Islamabad (Pakistan), and Karim RINGHEIM, Office of Population, U.S. Agency for International Development, Washington, DC (U.S.A.)

Knowledge, approval and communication about family planning as correlates of desired fertility among spouses in Pakistan (p. 122-129 and 145)

The responses of a matched sample of husbands and wives who participated in the 1990-1991 Pakistan Demographic and Health Survey are used to identify the factors associated with desired fertility in Pakistan. In urban areas, 40% of men and 50% of women do not want more children, compared with 26% of men and 37% of women in rural areas. Urban men and women are equally likely to approve of family planning, whereas among rural residents, men are significantly more likely than women to approve. In both settings, men are more likely than women to know of a source of supply. Multivariate analyses indicate that a couple's approval of family planning, knowledge of a source of family planning and discussion about family planning are correlated with the desire to have no additional children, and the relationship is particularly strong among rural residents. The influence of the spouse's fertility desire and of communication about family planning suggest that concerted efforts to educate men about reproductive and child health and to facilitate communication between husbands and wives would assist couples in agreeing upon and meeting their reproductive goals. (PAKISTAN, COUPLE, DESIRED FAMILY SIZE, FAMILY PLANNING, COMMUNICATION)

DECEMBER 1997 - VOLUME 23, NUMBER 4

98.76.20 - English - John ROSS and Laura HEATON, The Futures Group International, Glastonbury, CT (U.S.A.)

Intended contraceptive use among women without an unmet need (p. 148-154)

Many women with an unmet need for contraception report that they do not intend to use a method, while others, not classified as having an unmet need, say they do intend to use. Contraceptive outreach programs have not sought out the latter group of women, who constitute a large reservoir of potential users. Demographic and Health Survey data from 25 countries show that in 15 countries, those without an unmet need who intend to practice contraception outnumber women with an unmet need who do not intend to do so; in Colombia and Zimbabwe, for example, they are four times as numerous. Among women who intend to use a method, those who have an unmet need for contraception to space the next birth are similar to those without an apparent unmet need in age and family size, and they have a similar record of past contraceptive use; however, those without an unmet need are more likely to be pregnant (34% vs. 28%) and to say they wish to defer use for at least one year (34% vs. 23%). Women with no unmet need who plan to use a method are also generally similar to current users in family size, though they are a little younger and are considerably more likely to have had a recent birth. (FAMILY PLANNING PROGRAMMES, CONTRACEPTIVE PREVALENCE, NEEDS)

98.76.21 - English - Paulina MAKINWA-ADEBUSOYE, Population Research Unit, Nigerian Institute of Social and Economic Research, Ibadan (Nigeria), Susheela SINGH and Suzette AUDAM, The Alan Guttmacher Institute, New York, NY (U.S.A.)

Nigerian health professionals' perceptions about abortion practice (p. 155-161)

Although the provision of abortion is highly restricted in Nigeria, findings from a 1996 survey of 67 health professionals from two-thirds of the country's states indicate that women of all socioeconomic levels obtain induced abortions, albeit under a wide range of conditions. Nationally, about one-third of women seeking an abortion are thought to obtain it from a physician, and almost one-quarter are believed to go to a nurse or midwife; nearly half are thought to either use traditional providers who have no formal medical training, take drugs they purchase over the counter or employ other means to induce the abortion themselves. Because such a high proportion of abortions are likely performed by unskilled providers or are self-induced, about two-fifths of all women who have an abortion are believed to suffer a medical complication, and nearly one-fifth are expected to be hospitalized for treatment of health consequences. Urban women and those who are relatively well-off are more likely than their rural and poor counterparts to have access to safe abortion services and hospital treatment for medical complications. (NIGERIA, INDUCED ABORTION, MEDICAL PERSONNEL, SOCIO-ECONOMIC DIFFERENTIALS)

98.76.22 - English - Linda LACEY, Carolina Population Center, University of North Carolina at Chapel Hill, NC (U.S.A.), Victoria ADEYEMI, Federal Office of Statistics, Lagos (Nigeria), and Alfred ADEWUYI, Obafemi Awolowo University, Ile-Ife (Nigeria)

A tool for monitoring the performance of family planning programs in the public and private sectors: An application in Nigeria (p. 162-167)

A one-page family planning questionnaire developed by Nigeria's Federal Office of Statistics can be attached to nationally representative surveys that are routinely conducted to monitor development activities. The module collects data on household composition, source of family planning information, current use of family planning methods and the source of services and supplies. A comparison of data from two of these family planning modules, fielded in December 1992 and December 1993, with results from two earlier national surveys reveals that modern method use among women aged 15-49 went from 4% in 1990 to 9% in 1992, and then rose to 11% in 1993. Such a tool allows program managers to document the expansion of family planning practice between infrequently conducted national fertility surveys. (NIGERIA, FAMILY PLANNING PROGRAMMES, CONTRACEPTIVE PREVALENCE, MEASUREMENT, SURVEYS)

98.76.23 - English - Romel Saulog LACSON, South Carolina Department of Health and Environmental Control, STD/HIV Division, Columbia, SC (U.S.A.), Theocharis R. THEOCHARIS, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (U.S.A.), Robert STRACK, Prevention Center, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD (U.S.A.), Francisco S. SY, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC (U.S.A.), Murray L. VINCENT, Department of Health Promotion and Education, School of Public Health, University of South Carolina, Columbia, SC (U.S.A.), Trinidad S. OSTERIA and Pilar Ramos JIMENEZ, Behavioral Sciences Department, De La Salle University, Manille (Philippines)

Correlates of sexual abstinence among urban university students in the Philippines (p. 168-172)

The majority of members of a convenience sample of 1,355 urban university students in metropolitan Manila, the Philippines, were sexually abstinent (83%). Most were knowledgeable about AIDS, about pregnancy risk and about contraception in general (60-88%), but only 20% had adequate knowledge about condoms. Approximately 90% of all students held nonaccepting attitudes toward premarital and recreational sex. Males were more likely than females to have ever had sexual intercourse (30% vs. 7%), and they were better informed about condoms and about contraception in general. Sexually abstinent students were more likely than sexually active students to attend church regularly (76% vs. 64%) and to feel that premarital sex was unacceptable (92% vs. 67%). Males who disapproved of premarital sex were nearly three times as likely, and females who did so were nearly seven times as likely, to abstain from sex as were their peers who held more accepting views. Young women who did not have a sister who had experienced an adolescent pregnancy were nearly six times more likely than those with such a sibling to abstain from intercourse. (PHILIPPINES, STUDENTS, URBAN ENVIRONMENT, SEXUAL ABSTINENCE)

98.76.24 - English - Eugênio TELES, School Maternity Hospital Assis Chateaubriand, Federal University of Ceará, Fortaleza (Brazil), Ellen HARDY, Department of Obstetrics and Gynecology, Medical Sciences Faculty, State University of Campinas, Campinas, SP (Brazil), U. M. OLIVEIRA, Department of Clinical Pathology, Medical Sciences Faculty, State University of Campinas, Campinas, SP (Brazil), Christopher J. ELIS, Population Council, Bangkok (Thailand), and Anibal FAÚNDES, Department of Obstetrics and Gynecology, Medical Sciences Faculty, State University of Campinas, Campinas, SP (Brazil)

Reassessing risk assessment: Limits to predicting reproductive tract infection in new contraceptive users (p. 179-182)

The high costs and technical complexity of testing for reproductive tract infection make routine screening difficult in resource-poor reproductive health service environments. An analysis of 407 women visiting a Brazilian family planning clinic to initiate contraceptive use finds that 35% had reproductive tract infections, with bacterial vaginosis (26%) and chlamydia (7%) the most common types of infection. Only a history of sexually transmitted diseases and fewer years of education were significantly associated with having an infection of the reproductive tract. However, 95% of infections occurred among women who met neither of these risk criteria. The findings highlight the need for further research on cost-effective strategies for identifying women at risk for reproductive tract infection. (BRAZIL, INFECTION, FEMALE GENITALIA, RISK)

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