STUDIES IN FAMILY PLANNING

United States of America (New York) 18

MARCH 1998 - VOLUME 29, NUMBER 1

99.18.1 - English - Dudley KIRK and Bernard PILLET, Food Research Institute, Stanford University, Stanford, CA 94305-6084 (U.S.A.)

Fertility levels, trends, and differentials in sub-Saharan Africa in the 1980s and 1990s (p. 1-22)

This study presents an assessment of fertility trends in 23 countries of sub-Saharan Africa. It examines trends and differentials in proximate determinants and fertility preferences. Findings from the Demographic and Health Surveys for these countries over a period of 15 years show that desired family size has decreased significantly. Two-thirds of the countries examined show evidence of fertility decline, a particularly rapid decline in the cases of Kenya and Zimbabwe. Areas with higher education for women and lower child mortality experienced larger reductions in fertility and desired family size. Contraceptive use far exceeds other proximate determinants in explaining these changes. The striking regularity in fertility reduction across all ages indicates that contraception is practiced mostly for birth spacing and that contraceptive methods have gained wide acceptance among younger cohorts. Good prospects are seen for further intensification of fertility declines in East Africa and urban West Africa. However, low levels of education and high child mortality make rapid changes unlikely in rural West Aftica. (AFRICA SOUTH OF SAHARA, FERTILITY DECLINE, FERTILITY DETERMINANTS, DESIRED FAMILY SIZE)

99.18.2 - English - Philip B. ADONGO, Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper East Region (Ghana), and James F. PHILLIPS, Population Council, Washington, DC (U.S.A.), and Fred N. BINKA, Navrongo Health Research Centre, Navrongo (Ghana)

The influence of traditional religion on fertility regulation among the Kassena-Nankana of Northern Ghana (p. 23-40)

This article presents findings from a study of the influence of traditional religion on reproductive preferences of Kassena-Nankana lineage heads in northern Ghana. Seven reproductive preference questions were administered to nine lineage heads who are primary practitioners of the cult of soothsaying. With the assistance of soothsayers, interviews were repeated in conjunction with the invocation of religious rites in order to determine the views of ancestral spirits on the seven questions. Pairs of lineage head and ancestral interviews are compared to determine the role of traditional religion in shaping male reproductive preferences. Interview pairs reflect a shared preference for sons, large compounds, and a growing lineage. Findings nonetheless show that some ancestral spirits want small families, some even wanting fewer children than corresponding lineage heads. Spiritual consultations are nondogmatic and open to external ideas and influences, suggesting that family planning introduction will not encounter systematic religious opposition among the Kassena-Nankana. (GHANA, RELIGION, RELIGIOUS PRACTICE, PATRIARCHY, FAMILY PLANNING, DESIRED FAMILY SIZE, SEX PREFERENCE)

99.18.3 - English - Sarah SALWAY, Centre for Population Studies, London School of Hygiene and Tropical Medicine, University of London, 99 Gower Street, London C1E 6AZ (U.K.) and Sufia NURANI, Maternal and Child Health-Family Planning Extension Project (Urban), International Centre for Diarrhoeal Disease Research (Bangladesh)

Postpartum contraceptive use in Bangladesh: Understanding user's perspectives (p. 41-57)

Qualitative and quantitative data are used to explore postpartum contraceptive use in two populations in Bangladesh. Findings from in-depth interviews with contraceptive users illustrate that women are primarily concerned with their own and their newborn child's health and well-being in the period following childbirth. In addition, women are aware of a diminished risk of pregnancy during the period of postpartum amenorrhea. These perceptions, plus a belief that modern methods of contraception are "strong" and potentially damaging to health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, despite a desire to avoid closely spaced pregnancies. Supplementation of the child's diet is also shown to be an important factor determining the timing of postpartum contraceptive initiation. The findings suggest that current policies promoting contraception to women in the immediate postpartum period are inappropriate for many Bangladeshi women. (BANGLADESH, CONTRACEPTIVE USAGE, ATTITUDE, MATERNAL AND CHILD HEALTH)

99.18.4 - English - John H. BRATT, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709 (U.S.A.), James FOREIT, Latin American Operations Research Project (INOPAL III), Population Council, Washington DC (U.S.A.), and Teresa DE VARGAS, Centros Médicos de Orientación y Planificación Familiar (CEMOPLAF), Quito (Ecuador)

Three strategies to promote sustainability of CEMOPLAF clinics in Ecuador (p. 58-68)

The continuing trend of donor attention and resources away from Latin America threatens the sustainability of nongovernmental family planning organizations in that region, Managers can improve sustainability through cost control, cost recovery, and income generation. The Population Council's INOPAL II and INOPAL III projects and Family Health International assisted CEMOPLAF, an Ecuadoran private voluntary organization, in carrying out operations research in each of these areas. Studies included cost-savings analysis from altering IUD revisit norms (cost control), an ability-to pay study that showed potential gains from increased prices for reproductive health services (cost recovery), and a feasibility study to estimate income from ultrasound services (income generation). Results indicate that any one intervention will probably have a limited impact, and that managers likely will need to undertake several initiatives simultaneously to make significant progress toward sustainability. (ECUADOR, NON-GOVERNMENTAL ORGANIZATIONS, FAMILY PLANNING CENTRES, OPERATIONS RESEARCH, MANAGEMENT, COST ANALYSIS, FINANCING)

99.18.5 - English - Rebecca MILES-DOAN and Karin L. BREWSTER, Center for the Study of Population, Florida State University, 654 Bellamy, Tallahassee, FL 32306-2240 (U.S.A.)

The impact of type of employment on women's use of prenatal-care services and family planning in urban Cebu, the Philippines (p. 69-78)

This study re-evaluates the relationship of urban women's employment to their health-service and contraceptive use, drawing on data from the Cebu Longitudinal Health and Nutrition Survey. Multivariate analyses reveal significant differences across types of work for the likelihood of both obtaining timely prenatal care and practicing contraception at one year postpartum. Wage workers in white-collar jobs are significantly more likely than those not employed for pay to have obtained prenatal care and are substantially more likely to have adopted a contraceptive method in the year following childbirth. Women who are self-employed also are significantly more likely than those not employed for pay to be using contraceptives. Blue-collar wage work and piecework employment have no relationship to either dependent variable. These findings suggest that work-related autonomy encourages women to exercise control in other areas of their lives. (PHILIPPINES, FEMALE EMPLOYMENT, JOB CLASSIFICATION, CONTRACEPTIVE USAGE, PRENATAL CARE)

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