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STUDIES IN FAMILY PLANNING, March 1999, Vol. 30, N? 1
D?AZ, Margarita; SIMMONS, Ruth; D?AZ, Juan; GONZALEZ, Carlos; MAKUCH, Maria Yolanda; BOSSEMEYER, Debora.
Expanding contraceptive choice: Findings from Brazil.
This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.
(BRAZIL, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, CONTRACEPTIVE METHODS).
English ? pp. 1-16.
M. D?az, Department of Education, Training and Communication, CEMICAMP, Caixa Postal 6181, 13081?970, Cidade Universit?ria, Campinas, SP, Brazil; R. Simmons, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, U.S.A.; J. D?az, Population Council, Brazil; C. Gonzalez, Program for Integrated Assistance to Women's Health, Brazil; M. Y. Makuch, CEMICAMP, Campinas, SP, Brazil; D. Bossemeyer, Clinical Training Advisor for Latin America and the Caribbean Office, JHPIEGO Corporation.
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SOLO, Julie; BILLINGS, Deborah L.; ALOO-OBUNGA, Colette; OMINDE, Achola; MAKUMI, Margaret.
Creating linkages between incomplete abortion treatment and family planning services in Kenya.
Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health-care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model.
(KENYA, INDUCED ABORTION, POSTABORTAL PROGRAMMES, COMPLICATIONS, FAMILY PLANNING PROGRAMMES).
English ? pp. 17-27.
J. Solo, International Programs Division, Population Council, New York, NY 10017, U.S.A.; D. L. Billings and C. Aloo-Obunga, Ipas, Carrboro, NC, U.S.A.; A. Ominde and M. Makumi, Maternal and Child Health?Family Planning Program, Division of Primary Health Care, Kenya Ministry of Health, Kenya.
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STEELE, Fiona; CURTIS, Si?n L.; CHOE, Minja.
The impact of family planning service provision on contraceptive-use dynamics in Morocco.
This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.
(MOROCCO, FAMILY PLANNING PROGRAMMES, CONTRACEPTION CONTINUATION, CONTRACEPTIVE METHODS, CHOICE, CONTRACEPTION FAILURES).
English ? pp. 28-42.
F. Steele, Department of Statistics, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, U.K.; S. L. Curtis, Macro International, Beltsville, MD, U.S.A.; M. Choe, Population and Health Research Program, East-West Center, Honolulu, U.S.A.
***
GRAY, Alan; CHOWDHURY, Jamil H; CALDWELL, Bruce; AL-SABIR, Ahmed.
Coitus-dependent family planning methods: Observations from Bangladesh.
Some coitus-dependent methods of family planning, such as withdrawal, periodic abstinence, and the condom, require male involvement for their use, and using these methods in combination has proved to be sensible. An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about "traditional" methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish. In order to obtain reliable responses about these methods, a survey approach different from the long-established one is required.
(BANGLADESH, CONTRACEPTIVE METHODS, DATA COLLECTION, QUALITY OF DATA).
English ? pp. 43-53.
A. Gray, Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakom Pathom 73170, Thailand; J. H. Chowdhury, Associates for Community and Population Research, Dhaka, Bangladesh; B. Caldwell, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia; A. Al-Sabir, National Institute for Population Research and Training, Dhaka, Bangladesh.
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BAWAH, Ayaga Agula; AKWEONGO, Patricia; SIMMONS, Ruth; PHILLIPS, James F.
Women's fears and men's anxieties: The impact of family planning on gender relations in Northern Ghana.
The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.
(GHANA, FAMILY PLANNING PROGRAMMES, WOMEN?S STATUS, SEX ROLES, INTERSPOUSE RELATIONSHIPS).
English ? pp. 54-66.
A. A. Bawah, Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, U.S.A.; P. Akweongo, Navrongo Health Research Centre, Upper East Region, Ghana; R. Simmons, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, U.S.A.; J. F. Phillips, Policy Research Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, U.S.A.
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OKONOFUA, Friday E.; ODIMEGWU, Clifford; AJABOR, Helen; DARU, Patrick H.; JOHNSON, Agnes.
Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria.
This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15?45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20% of the women reported having had an unwanted pregnancy. Of these, 58% reported that they had successfully terminated the pregnancies; 32% continued the pregnancies; and nearly 9% stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11%. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.
(NIGERIA, INDUCED ABORTION, UNWANTED PREGNANCY, DATA COLLECTION, METHODOLOGY).
English ? pp. 67-77.
F. E. Okonofua and H. Ajabor, Women's Health and Action Research Centre, 4 Alofoje Street, Off Uwasota Street, Post Office Box 10231, Ugbowo, Benin City, Edo State, Nigeria; C. Odimegwu, Department of Demography, Obafemi Awolowo University, Ile-Ife, Nigeria; P. H. Daru, Department of Obstetrics and Gynaecology, University of Jos Teaching Hospital, and A. Johnson, Department of Sociology, University of Jos, Jos, Nigeria.
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STUDIES IN FAMILY PLANNING, June 1999, Vol. 30, N? 2
MENSCH, Barbara S.; CLARK, Wesley H.; BAGAH, Daniel; BINKA, Fred.
The changing nature of adolescence in the Kassena-Nankana District of northern Ghana.
This study reports the results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, an isolated rural area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus-group discussions with adolescents, parents, chiefs, traditional leaders, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The social environment that adolescent boys and girls in the Kassena-Nankana District encounter and its links to reproductive behavior are described. The principal question is whether even in this remote rural area, the social environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in girls' education and the beginning of a decline in the incidence of early marriage. The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives of adolescent boys and girls have eroded, leading to an apparent increase in premarital sexual activity.
(GHANA, RURAL AREAS, ADOLESCENCE, REPRODUCTIVE BEHAVIOUR, SOCIAL ENVIRONMENT, SOCIAL CHANGE).
English ? pp. 95-111.
B. S. Mensch and W. H. Clark, Policy Research Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, U.S.A.; D. Bagah and F. Binka, Ministry of Health, Navrongo Health Research Centre, Ghana.
bmensch@popcouncil.org.
***
MAGNANI, Robert J.; HOTCHKISS, David R.; FLORENCE, Curtis S.; SHAFER, Leigh Anne.
The impact of the family planning supply environment on contraceptive intentions and use in Morocco.
Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992?95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.
(MOROCCO, FAMILY PLANNING PROGRAMMES, SUPPLY, DEMAND, CONTRACEPTIVE PREVALENCE).
English ? pp. 120-132.
R. J. Magnani and D. R. Hotchkiss, Department of International Health and Development, C. S. Florence, Department of Health Systems Management, and L. A. Shafer, Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, U.S.A.
Magnani@mailhost.tcs.tulane.edu.
***
ALVARADO, Reynaldo; ZEPEDA, Ana; RIVERO, Soledad; RICO, Nieves; L?PEZ, Susana; D?AZ, Soledad.
Integrated maternal and infant health care in the postpartum period in a poor neighborhood in Santiago, Chile.
An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.
(CHILE, CAPITAL CITY, MATERNAL AND CHILD HEALTH, POVERTY, PROGRAMME EVALUATION, COMPARATIVE ANALYSIS).
English ? pp. 133-141.
R. Alvarado, A. Zepeda and S. D?az, Instituto Chileno de Medicina Reproductiva, Jos? Ram?n Guti?rrez 295, Dept. 3, Santiago, Chile; S. Rivero, Proyecto San Luis de Huechuraba, Santiago, Chile; S. L?pez, Consultora Colomba, Santiago, Chile.
icmer@huelen.reuna.cl.
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NGOM, Pierre; AKWEONGO, Patricia; ADONGO, Philip; BAWAH, Ayaga Agula; BINKA, Fred.
Maternal mortality among the Kassena-Nankana of northern Ghana.
This report presents key findings from a maternal mortality study conducted in the Kassena-Nankana District of northern Ghana in 1997?98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age-specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.
(GHANA, RURAL AREAS, ETHNIC GROUPS, MATERNAL MORTALITY, ESTIMATES, METHODOLOGY, MORTALITY DECLINE).
English ? pp. 142-147.
P. Ngom, Navrongo Demographic Surveillance System, Navrongo Health Research Centre (NHRC), P.O. Box 114, Navrongo-UER, Ghana; P. Akweongo and P. Adongo, Social Science Unit, NHRC, ghana; A. A. Bawah, Population Studies Center, University of Pennsylvania, Philadelphia, U.S.A.; F. Binka, Public Health Specialist, Ministry of Health, NHRC, Ghana.
navrongo@africaonline.com.gh.
***
STUDIES IN FAMILY PLANNING, September 1999, Vol. 30, N? 3
SANTOW, Gigi; BRACHER, Michael.
Explaining trends in teenage childbearing in Sweden.
The teenage fertility rate fell precipitately in Sweden after 1966 and is now one of the lowest in Europe. This decline can be seen in the context of major reforms enacted in 1975 whereby the school sex-education curriculum was revised, contraceptive services were improved, and abortion was provided free and on demand. By means of microsimulation, the possible roles of contraception and induced abortion in causing teenage fertility to fall are examined. Before 1975, the decline appears to have been caused primarily by an increase in the number of induced abortions. After that date, however, an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that, even though the proportion of teenagers who sought abortion increased, the abortion rate declined. Parallels are drawn with the experience of other European countries, and contrasts with that of the United States, where no such developments have occurred, are noted.
(SWEDEN, ADOLESCENT FERTILITY, FERTILITY DECLINE, FAMILY PLANNING, INDUCED ABORTION, FERTILITY DETERMINANTS).
English ? pp. 169-182
G. Santow and M. Bracher, Demography Unit, Stockholm University, Stockholm S-106 91, Sweden.
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ARENDS-KUENNING, Mary; BAZLE HOSSAIN, Mian; BARKAT-E-KHUDA.
The effects of family planning workers' contact on fertility preferences: Evidence from Bangladesh.
Should family planning programs put more effort into persuading couples to want smaller families or into helping women achieve their reproductive goals? Indeed, can family planning programs affect fertility preferences? Longitudinal data from Bangladesh collected from 1982 to 1993 show that women's desired family sizes have declined dramatically. This study examines how the decline in desired family size is related to visits from family planning workers for three intervals: 1982?85, 1985?90, and 1990?93. By use of logistic-regression analysis, the number of rounds during which women received visits from family planning workers is found to have no statistically significant effect on the probability that women altered their preference from wanting more children at the beginning of an interval to wanting no more at the end of the interval.
(BANGLADESH, FAMILY PLANNING PROGRAMMES, FAMILY PLANNING PERSONNEL, PREFERENCES, DESIRED FAMILY SIZE, HOME VISITS).
English ? pp. 183-192.
M. Arends-Kuenning, Department of Agriculture and Consumer Economics, University of Illinois, Urbana-Champaign, 408 Mumford Hall, MC?710, 1301 West Gregory Drive, Urbana, IL 61801?3681, U.S.A.; M. Bazle Hossain and Barkat-e-Khuda, Operations Research Project, Health and Population Extension Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh.
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ROGERS, Everett M.; VAUGHAN, Peter W.; SWALEHE, Ramadhan M. A.; RAO, Nagesh; SVENKERUD, Peer; SOOD, Suruchi.
Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania.
An entertainment-education radio soap opera introduced in Tanzania in 1993 was evaluated by means of a field experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.
(TANZANIA, FAMILY PLANNING EDUCATION, MASS COMMUNICATION, RADIO, PROGRAMME EVALUATION, CONTRACEPTION).
English ? pp. 193-211.
E. M. Rogers, P. W. Vaughan, R. M. A. Swalehe, N. Rao, P. Svenkerud and S. Sood, University of New Mexico, Albuquerque, NM 87131?1171, U.S.A.
ERogers@UNM.edu.
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GOODKIND, Daniel.
Do parents prefer sons in North Korea?
Son preference in South Korea is stronger than anywhere else in the world, yet little is known about such preference in North Korea. Simple indicators of son preference in North Korea are constructed from its 1993 population census and a 1998 survey of child nutrition (conducted in the wake of the recent famine). These indicators include sex ratio at birth, sex ratios of infant and child mortality, and sex ratios of child malnutrition. North Koreans do not evince prenatal discrimination against daughters, a finding that may indicate a lack of prenatal sex-testing technologies. Neither is evidence found of excess female mortality or malnutrition in the postnatal period, during which discrimination requires no special technology. The discrepancy in son preference across the Korean peninsula seems due largely to the socialist agenda pursued in the north following political partition after World War II. An important aspect of that agenda challenged the ancient Confucian ideology presumed to underlie son preference. Apparently, this challenge was more successful in North Korea than in other Asian societies instituting similar political changes, because son preference was not eliminated in China or in Vietnam.
(KOREA, SEX PREFERENCE, ESTIMATES, TRENDS, POLITICAL SYSTEMS).
English ? pp. 212-218.
D. Goodkind, U.S. Bureau of the Census, International Programs Center, Room 117, Washington Plaza II, Washington, DC 20233?8860, U.S.A.
Daniel.M.Goodkind@ccmail.census.gov.
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JONES, Heidi; DIOP, Nafissatou; ASKEW, Ian; KABOR?, Inoussa.
Female genital cutting practices in Burkina Faso and Mali and their negative health outcomes.
Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94% of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56%), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74%); 5% of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.
(BURKINA FASO, MALI, FEMALE CIRCUMCISION, FEMALE GENITALIA, COMPLICATIONS).
English ? pp. 219-230.
H. Jones, N. Diop and I. Askew, Frontiers in Reproductive Health Project, Population Council; I. Kabor?, Burkina Faso Office, Population Council.
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CASTLE, Sarah; KANI KONAT?, Mamadou; ULIN, Priscilla R.; MARTIN, Sarah.
A qualitative study of clandestine contraceptive use in urban Mali.
This prospective study uses qualitative methods to examine the social and economic impact of family planning on women's lives in the district of Bamako, Mali. Fifty-five first-time users of contraceptives were interviewed in October 1996. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth-control method from their husbands. Substantial collusion is found to have occurred between sisters-in-law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. The main reason for discontinuation among the clandestine users was menstrual disruption, which they feared would make their husbands aware of their contraceptive use. By the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quantity and efficiency of their work activities. Contraception, therefore, appears to be a valuable resource, permitting women to improve their economic and social status. In settings where clandestine use is prevalent, at least in the short term involving men in family planning programs may not always be beneficial, nor may considering the couple as the unit of intervention and analysis always be appropriate. In the long term, however, the underlying causes of men's objections to contraceptive use need to be addressed so as to facilitate communication and joint decisionmaking about family planning.
(MALI, CAPITAL CITY, CONTRACEPTIVE USERS, INTERSPOUSE RELATIONSHIPS, WOMEN?S STATUS).
English ? pp. 231-248.
S. Castle, Centre for Population Studies, London School of Hygiene and Tropical Medicine, 49?51 Bedford Square, London WC1B 3DP, U.K.; M. Kani Konat?, Women, Families, and Development Program, Centre d'Etudes et de Recherche sur la Population pour le D?veloppement, Bamako, Mali.
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STUDIES IN FAMILY PLANNING, December 1999, Vol. 30, N? 4
STASH, Sharon.
Explanations of unmet need for contraception in Chitwan, Nepal.
This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use; poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey.
(NEPAL, RURAL AREAS, DESIRED FAMILY SIZE, PREFERENCES, CONTRACEPTIVE USAGE, CONTRACEPTIVE METHODS, CHOICE).
English ? pp. 267-287.
S. Stash, The David and Lucile Packard Foundation, 300 Second Street, Suite 200, Los Altos, CA 94022, U.S.A.
s.stash@packfound.org.
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S??V?L?, Minna.
Understanding the prevalence of female sterilization in rural south India.
By analyzing the practice of female sterilization in rural Andhra Pradesh, in southern India, this article examines the role culture plays in demographic research. The popularity of female sterilization in rural Andhra Pradesh is shown to be intelligible if the symbolic value of a young mother's reproductive capacity is understood in terms of familial power relations. Through sterilization, young mothers can symbolically push their influential mothers-in-law toward old age, thus increasing their own relative prestige, and they can strive to control the ambiguity surrounding their reproductive functions. This study is based on 14 months of participant observation in three rural villages, a survey of 396 households, and unstructured interviews with 42 women and two men. It shows how demography and anthropology can be mutually supportive in their efforts to clarify population phenomena.
(INDIA, RURAL AREAS, FEMALE STERILIZATION, SOCIAL CONTROL, ANTHROPOLOGY).
English ? pp. 288-301.
M. S??v?l?, Department of Sociology/Social Anthropology, Post Office Box 59, University of Helsinki, Helsinki, Finland.
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HOGAN, Dennis P.; BERHANU, Betemariam; HAILEMARIAM, Assefa.
Household organization, women's autonomy, and contraceptive behavior in southern Ethiopia.
The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region.
(ETHIOPIA, KNOWLEDGE OF CONTRACEPTIVES, CONTRACEPTIVE PREVALENCE, COMMUNICATION, WOMEN?S STATUS, HOUSEHOLD, SOCIAL ORGANIZATION).
English ? pp. 302-314.
D. P. Hogan and B. Berhanu, Population and Studies Training Center, Brown University, Box 1916, Providence, RI 02912, U.S.A.; A. Hailemariam, Demographic Training and Research Center, Addis Ababa University, Addis Ababa, Ethiopia.
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STEELE, Fiona; DIAMOND, Ian.
Contraceptive switching in Bangladesh.
Bangladesh has experienced a substantial decline in fertility that has been achieved by means of a large increase in the use of modern methods of contraception. As contraceptive prevalence increases, aspects of contraceptive-use dynamics, including reasons for discontinuation and behavior after discontinuation, become important influences on fertility. This report uses calendar data from the 1993-94 Bangladesh Demographic and Health Survey to examine contraceptive behavior following discontinuation of modern-method use. The individual-level characteristics found to influence switching behavior include the method used, method-related difficulties with previous contraceptive use, and education. A large amount of unexplained variation in switching rates remains, however, largely at the individual level, but also at the community level for certain types of transition.
(BANGLADESH, CONTRACEPTIVE USAGE, CONTRACEPTIVE METHODS, CHOICE, CONTRACEPTION CONTINUATION).
English ? pp. 315-328.
F. Steele, Department of Statistics, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, U.K.; I. Diamond, Department of Social Statistics, University of Southampton, Highfield, Southampton SO17 1BJ, U.K.
F.Steele@les.ac.uk.
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HIEU, Do Trong; HANENBERG, Robert; VACH, Trinh Huu; VINH, Dao Quang; SOKAL, David.
Maternal mortality in Vietnam in 1994-95.
This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available.
(VIET NAM, MATERNAL MORTALITY, ESTIMATES, COMPARATIVE ANALYSIS).
English ? pp. 329-338.
Do Trong Hieu, Center for Reproductive Health Research and Information, Hanoi, Vietnam; R. Hanenberg and D. Sokal, Clinical Research Department, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709, U.S.A.; Trinh Huu Vach, Research Center for Rural Population and Health, Thai Binh Medical College, Thai Binh, Vietnam; Dao Quang Vinh, National Center for Social Sciences and the Humanities, Hanoi, Vietnam.
bob@sanfranmail.com.
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FORTNEY, Judith A.
Assessing recall and understanding of informed consent in a contraceptive clinical trial.
Recall and understanding of information provided to contraceptive study participants in four sites were assessed. Analysis was completed of data for 70 women who were asked about their recollection of information and understanding of participation. Most women understood the purpose of the study. Their reasons for agreeing to participate varied by site and included wanting to try a new method, wanting to help others, and wishing to avoid pregnancy. Most women recalled correctly the burden of participation--number and frequency of visits, tests, and examinations. Most understood that they could withdraw from the study without jeopardizing their care. The women were also asked to recall the risks and benefits of the contraceptive they were testing. Only 23% recalled the pregnancy risk correctly; 40% underestimated and 19% overestimated it. Few women interpreted rates of risk correctly; some perceived high rates as low ones and the rates of the spermicide being studied as better than those of other contraceptives. This study confirms that risk is better recalled than understood. The participants surveyed remembered the information they were questioned about better than did participants in some other studies, a finding that supports earlier research results showing that younger, healthier patients (such as contraceptive users) recall better than older, less healthy ones.
(FAMILY PLANNING EDUCATION, RECALL ERRORS, MESSAGE, COMMUNICATION, IEC, EVALUATION).
English ? pp. 339-346.
J. A. Fortney, Department of Epidemiology, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709, U.S.A.
jfortney@fhi.org.
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