Back to home pageUnited States of America (New York) STUDIES IN FAMILY PLANNING JULY/AUGUST 1992 - VOLUME 23, NUMBER 4 93.18.01 - English - Alice ARMSTRONG, Regional Coordinator, Women and Law in Southern Africa Trust, P.O. Box UA 171, Union Avenue, Harare (Zimbabwe) Maintenance Payments for Child Support in Southern Africa: Using Law to Promote Family Planning (p. 217-228) This article presents some of the legal, social, cultural, and practical constraints facing women who attempt to enforce their right to maintenance (child support) payments in southern Africa. It is based on research by the Women and Law in Southern Africa Trust, a network of women who research women's legal rights in six countries: Botswana, Lesotho, Mozambique, Swaziland, Zambia, and Zimbabwe. Statutes in all countries in the region provide that a man must support his legitimate and illegitimate children; there are, however, weaknesses in the laws on the books. The social and cultural constraints that influence the enforcement of maintenance laws include women's lack of knowledge of the law, attitudes toward child support influenced by customary law, allegations of women's abuse of maintenance payments, financial and practical problems, and fear of physical violence or other forms of retribution. Maintenance laws are relevant to family planning in that if such laws were more effectively enforced, so that the financial burden of children were more equally shared between women and men, men would have a financial stake in controlling their fertility. (BOTSWANA, LESOTHO, MOZAMBIQUE, SWAZILAND, ZAMBIA, ALIMONY, FAMILY PLANNING) 93.18.02 - English - Mizanur RAHMAN, International Centre for Diarrhoeal Disease Research, G.P.O. Box 128, Dhaka 1000 (Bangladesh) et al. Contraceptive Use in Matlab, Bangladesh: The Role of Gender Preference (p. 229-242) Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh. (BANGLADESH, SEX PREFERENCE, FAMILY PLANNING) 93.18.03 - English - J. Ties BOERMA, Coordinator for Health Analysis, and George T. BICEGO, Demographic and Health Surveys, Institute for Resource Development/Macro International, 8850 Stanford Boulevard, Columbia, MD 21045 (U.S.A.) Preceding Birth Intervals and Child Survival: Searching for Pathways of Influence (p. 243-256) The importance of the length of preceding birth intervals for the survival chances of young children has been established, but the debate concerning the causal biomedical or behavioral mechanisms continues. This article uses data from 17 Demographic and Health Surveys to investigate the effect of birth intervals on child mortality: Anthropometry of children, recent morbidity of children, and use of health services are examined in addition to child survival data for children born in the five years before the survey. Various methodological approaches are used to investigate the relative importance of the postulated mechanisms linking birth intervals and child survival. Short preceding birth intervals are associated with increased mortality risks in the neonatal period and at 1-6 months of age, and, to a much lesser extent, at 7-23 months of age. The effects of short birth intervals on nutritional status are rather moderate, and there is a weak relationship with lower attendance at prenatal care services. No consistent relationship exists between the length of birth intervals and other health status or health-service utilization variables. The results indicate that prenatal mechanisms are more important than postnatal factors, such as sibling competition, in explaining the causal nature of the birth interval effect. (DEMOGRAPHIC SURVEYS, BIRTH INTERVALS, INFANT MORTALITY) 93.18.04 - English - Alan G. FERGUSON, GTZ Family Planning Support Unit, Division of Family Health, Ministry of Health, P.O. Box 41607, Nairobi (Kenya) Fertility and Contraceptive Adoption and Discontinuation in Rural Kenya (p. 257-267) After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed. (KENYA, FAMILY PLANNING) 93.18.05 - English - Eitan F. SABATELLO, Division of Population, Demography, Health and Immigrants Absorption, Central Bureau of Statistics, P.O. Box 13015, 91130 Jerusalem (Israel) Estimates of Demand for Abortion among Soviet Immigrants in Israel (p. 268-273) In 1990, more than 185,000 Soviet Jews emigrated to Israel, increasing Israel's population by 4%; 148,000 more arrived in 1991. Given the fertility and abortion patterns prevailing among Soviet women in their native country, this article inquires about the short-range expected increase in abortion demand in Israel engendered by this large migratory inflow. Estimation techniques based on the abortion experience of an earlier wave of Soviet-born immigrants in Israel reveal that the increase in requests for abortion brought about by the 1990 immigrants may reach up to 14%, and as high as 24% for the combined immigration waves of 1990 and 1991. The expanded demand for abortions in Israel engendered by the new Soviet immigrants necessitates an expansion of both family planning services and of the medical committees entitled to grant a legal abortion. A failure in these fields would benefit illegal abortion. (ISRAEL, USSR, INTERNATIONAL MIGRATION, ABORTION, FAMILY PLANNING) SEPTEMBER/OCTOBER 1992 - VOLUME 23, NUMBER 5 93.18.06 - English - The Prevention of Maternal Mortality Network, c/o Deborah Maine, Prevention of Maternal Mortality, Center for Population and Family Health, Columbia University, 60 Haven Avenue B-3, New York, NY 10032 (U.S.A.) Barriers to Treatment of Obstetric Emergencies in Rural Comunities of West Africa (p. 279-291) This article is the result of a collaborative effort among the researchers of the Prevention of Maternal Mortality Network. The network consists of 12 multidisciplinary teams, 11 in West Africa and one based at Columbia University in New York. This article summarizes exploratory research conducted by the African teams using focus- group discussions in rural communities in Nigeria, Ghana, and Sierra Leone. The objective was to identify barriers to the use of health-care facilities when obstetric problems arise. The findings illustrate how sociocultural factors, such as societal expectations and the role of women, affect the use of health services. Physical and social distance between communities and facilities, as well as transportation problems, were found to be obstacles to care. Health-service factors were also found to pose barriers to prompt treatment. This article also provides an example of how qualitative methodology can be used to obtain substantive information about a community's frustrations and needs with respect to health care. (WESTERN AFRICA, OBSTETRICS, HEALTH FACILITIES, MEDICAL CARE) 93.18.07 - English - John C. CALDWELL, Health Transition Centre, Australian National University, Canberra, ACT 2601 (Australia) What Does the Matlab Fertility Experience Really Show? (p. 292- 310) The family planning program in the Matlab Dirstrict of Bangladesh has been described in unique detail for more than 25 years and is regarded as a model for equally poor parts of the world. Its experience has been reported as showing the ineffectiveness of contraceptive saturation approaches and the prime importance of program management and especially of the selection of a special type of family planning household visitor, criteria that render family planning programs relatively expensive. This reanalysis of the Matlab experience suggests that there is inadequate evidence from which to judge the record of the saturation experiment and of family planning workers from less highly selected backgrounds. It is also argued here that the role of contraceptive choice and of access to different types of contraceptives, especially injectables, delivered to the door in this society of secluded women has been underestimated, and that too little importance has been attributed to demand in contrast to supply. While it is agreed that the Matlab demonstration has been of central importance in showing that fertility can be reduced in Bangladesh, it is argued that many developing countries can draw on this experience to provide less costly family planning programs with less emphasis on the managerial, top-down approach. (BANGLADESH, FAMILY PLANNING PROGRAMMES, MANAGEMENT) 93.18.08 - English - Prem J. THAPA, Neera SHRESTHA, Integrated Development Systems, Kathmandu (Nepal), and Shyam THAPA, Family Health International, Research Triangle Park, NC 27709-3950 (U.S.A.) A Hospital-Based Study of Abortion in Nepal (p. 311-318) This report presents the major findings of a study of induced abortion in Nepal, based on 165 cases out of the 1,576 female patients identified as having abortion-related complications who were admitted to five major hospitals in urban Nepal during a one- year study period. Traditional birth attendants had been the service providers for two-fifths of the women. A longer delay in hospital referrals and lengthier hospital stays occurred for cases of induced abortion than for those of spontaneous abortion. Twelve of the 165 women in the study died in the hospital, most of them from tetanus. Deaths resulting from abortion-related complications represented more than half of all maternity-related deaths in the hospitals studied. The authors suggest that health risks could be reduced considerably by strengthening the hospital-referral system and by taking some preventive steps, such as educating the traditional birth attendants and other paramedical providers about the consequences of unsafe abortion practices; increasing the availability of contraceptive methods; and promoting the use of menstrual regulation, which has recently become available in Nepal on a limited scale, mostly in private clinics. (NEPAL, INDUCED ABORTION, HOSPITALIZATION) 93.18.09 - English - Friday E. OKONOFUA, A. ABEJIDE, and Roger A. MAKANJUOLA, College of Medical Sciences, Obafemi Awolowo University Hospital, Ile-Ife (Nigeria) Maternal Mortality in Ile-Ife, Nigeria: A Study of Risk Factors (p. 319-324) The objective of this study was to determine which background factors predispose women to maternal mortality at the Obafemi Awolowo University Hospital in Nigeria. The study exmined 35 cases of maternal death occurring in the hospital during the period October 1989 to 30 April 1991. The control group comprised 35 women who were admitted to the hospital with similar complications during the same period, but who survived. Both cases and controls were investigated for their sociodemographic characteristics, their use of prenatal care, and the incidence of delay in clinical management. The results showed that the maternal deaths involved women who were younger and of poorer socioeconomic status than the women in the control group. Both groups showed an equal lack of prenatal care. However, a higher incidence of delayed treatment was found in the management of the cases of maternal deaths. Maternal mortality in the study population can be reduced through improved transportation and institutional management, and, on a long-term basis, through the adoption of measures to improve the socioeconomic status of women. (NIGERIA, MATERNAL MORTALITY, SOCIO-ECONOMIC STATUTS) 93.18.10 - English - Aafke JUSTESEN, Department of Obstetrics and Gynaecology, Muhimbili Medical Centre, Saidi H. KAPIGA, Department of Community Health, University of Dar es-Salam, Dar es-Salam (Tanzania), and Henri A.G.A. van ASTEN, WHO Coordinator, Tanzania Global Project for AIDS Abortions in a Hospital Setting: Hidden Realities in Dar es-Salam, Tanzania (p. 325-329) This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es-Salam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life). A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es-Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies - precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics. (TANZANIA, INDUCED ABORTION, HOSPITALS)
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