STUDIES IN FAMILY PLANNING

United States of America (New York) 18

NOVEMBER-DECEMBER 1994 - VOLUME 25, NUMBER 6

96.18.1 - English - Ronald FREEDMAN, Population Studies Center, University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48104-2590 (U.S.A.), Ming-Cheng CHANG, Taiwan Provincial Institute of Family Planning, Taichung (Taiwan), and Te-Hsiung SUN, Research, Development and Evaluation Commission, Executive Yuan (China)

Taiwan's transition from high fertility to below-replacement levels (p. 317-331)

This article compares the fertility experience of Taiwanese in the eight years since the total fertility rate reached 2.1 with that before fertility reached replacement levels. During the earlier period, two-thirds of the fertility decline resulted from falling marital fertility and one-third from higher age at marriage. The changing age distribution retarded this decline. Since 1983, the further decline to 1.7-1.8 has been entirely the result of the trend toward later marriage. Older age distributions now facilitate the decline. Births postponed by those marrying later make the conventional TFR misleading. Computation based on parity-progression ratios raise TFRs from 1.7 to 2.0, a number less alarming to policymakers. Contraceptive prevalence is at saturation levels in all major population strata. The "KAP-CAP" has disappeared. What would have happened without Taiwan's effective family planning program is impossible to determine, but clearly, contraceptive services supplied by the program were the major proximate cause of Taiwan's fertility decline. (TAIWAN, FERTILITY DECLINE, FAMILY PLANNING PROGRAMMES)

96.18.2 - English - Paul W. STUPP, Behavioral Epidemiology and Demographic Research Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341 (U.S.A.), and Renee SAMARA, Population Studies Center, University of Pennsylvania, Philadelphia, PA (U.S.A.)

Using parity-progression ratios to estimate the effect of female sterilization on fertility (p. 332-341)

In this article, a new methodology that employs parity-progression ratios to estimate the effect of female sterilization on fertility is described, and results using data from Ecuador are compared to those obtained using a previously existing approach that classifies women by marital duration. The methods differ in how they disaggregate marital fertility and in the assumption they make about what the subsequent fertility of sterilized women would have been if they had not been sterilized. The analysis of the Ecuadoran data shows that the estimate of births averted by sterilization has diminished over time, even as sterilization prevalence has been increasing. This situation is attributed to a decline in the fertility of nonsterilized women resulting from increased use of reversible methods of contraception. (ECUADOR, FERTILITY DECLINE, STERILIZATION, PARITY PROGRESSION RATIO, METHODOLOGY)

96.18.3 - English - Daniel GOODKIND, Brown University, Department of Sociology, P.O. Box 1916, Providence, RI 029120 (U.S.A.) Abortion in Vietnam: Measurements, puzzles, and concerns (p. 342-352)

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve. (VIET NAM, INDUCED ABORTION, ABORTION POLICY, UNWANTED PREGNANCY)

96.18.4 - English - Chinyelu B. OKAFOR, Women's Health Unit, College of Medicine, University of Nigeria (Nigeria), and Rahna R. RIZZUTO, Family Care International, 588 Broadway, Suite 503, New York, NY 10012 (U.S.A.) Women's and health-care providers' views of maternal practices and services in rural Nigeria (p. 353-361)

Maternal mortality and morbidity estimates in Nigeria continue to be dramatically high largely because maternal services, especially in rural areas, are often deficient and inappropriate to women's situations. The Safe Motherhood Project in Zone A examined the pregnancy-related knowledge, attitudes, and practices of community members, and women's use of community maternal health services. Focus-group discussions and interviews confirmed a number of recent findings by other studies; they also documented extensive hostility between the two most commonly used health-care providers: traditional birth attendants and midwives. The hostility resulted in rumors, deliberate attempts to discourage women from seeking higher levels of care, and refusals to accept referrals or treat patients, which were found to be serious constraints to good maternal care in the targeted rural area. (NIGERIA, MATERNAL MORTALITY, MATERNAL AND CHILD HEALTH, PROJECT EVALUATION)

96.18.5 - English - Barbara JANOWITZ, David HUBACHER, Thomas PETRICK and Nootan DIGHE, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709 (U.S.A.) Should the recommended number of IUD revisits be reduced? (p. 362-367)

This study uses data from clinical trials of intrauterine devices to examine the effect of reducing the recommended number of IUD follow-up visits. Over 11,000 follow-up forms were analysed to estimate the number of health problems that would have escaped detection if women with no or mild symptoms had not made recommended revisits. Less than 1% of woman-visits with no or only mild symptoms had an underlying health risk that could have gone undetected if the follow-up visits that were made in the clinic trial setting had not been made. The results from this analysis suggest that a reduction in the number of recommended follow-up visits is safe, when measured according to selected conditions. Additional research is necessary to determine whether any revisits should be recommended in the absence of signs or symptoms. (IUD, COMPLICATIONS, SANITARY CONTROL, METHODOLOGY)

JANUARY-FEBRUARY 1995 - VOLUME 26, NUMBER 1

96.18.6 - English - Rezina MITA, International Centre for Diarrhoeal Disease Research (Bangladesh), and Ruth SIMMONS, Departments of Population Planning and International Health, and Public Health Policy and Administration, University of Michigan School of Public Health, Thomas Francis Building, Ann Arbor, MI 48109-2029 (U.S.A.) Diffusion of the culture of contraception: Program effects on young women in rural Bangladesh (p. 1-13)

This article describes a process of diffusion of family planning information, ideas, and technology among an unanticipated audience of young, unmarried women in rural Bangladesh. The data are derived from a focus-group study conducted in 1987-88 in the Maternal Child Health and Family Planning Project in Matlab, Bangladesh. A discussion with a staff member revealed her vivid memory of the arrival of the community-based family planning worker in her village 10 years earlier, before she was married. Based on this research lead, four focus-group sessions were held with newly married young women, and a set of questions about young women were incorporated into the sessions with other community women. The discussions showed that many young, unmarried women learn about family planning from an early age from the community-based family planning worker, from female relatives, peers, and the media. The findings of this exploratory study suggest that greater attention be paid to the contraceptive needs of young women and that continued research be conducted with this population of women. (BANGLADESH, CONTRACEPTION, FAMILY PLANNING PROGRAMMES, RURAL WOMEN)

96.18.7 - English - Huda ZURAYK, The Population Council, P.O. Box 115, Dokki, Gizeh (Egypt), Hind KHATTAB, Social Research, Delta Consultants, Cairo (Egypt), Nabil YOUNIS, Obstetrics and Gynecology, Al-Azhar University, Cairo (Egypt), Olfia KAMAL, Social Research, Delta Consultants, Cairo (Egypt), and Mahinaz EL-HELW, The Population Council Regional Office for West Asia and North Africa, Cairo (Egypt)

Comparing women's reports with medical diagnoses of reproductive morbidity conditions in rural Egypt (p. 14-21)

This article is based on a survey of a random sample of 509 ever-married nonpregnant women residing in two villages in the Giza Governorate of Egypt, each of whom responded to a questionnaire on symptoms of gynecological conditions and then was accompanied to the village health center for a gynecological exam. A response rate of 91% was achieved. The article focuses on reproductive tract infections and genital prolapse, highly prevalent conditions in the community, The women's reports of symptoms are compared with the medical diagnoses, using indicators of sensitivity, specificity, positive and negative predictive values, and percentage of agreement. The findings show that women's reports of vaginal discharge agree moderately well with the physicians' observations but are not good predictors of the occurrence of reproductive tract infections. Women's reports of the symptoms of prolapse do not agree well with medical diagnoses of the condition. The findings are analyzed, taking into account the social context of the lives of the women surveyed to arrive at conclusions as to how to improve ways of learning from women themselves about gynecological problems in the community. (EGYPT, GYNAECOLOGIC DISEASES, HEALTH SURVEYS, RURAL WOMEN)

96.18.8 - English - Elizabeth A. GOODBURN, United Nations Population Fund in Cambodia, UNFPA, 53, rue Pasteur, Boeung Weng Kang, Phnom Penh (Cambodia), Rukhsana GAZI and Mushtaque CHOWDHURY, Research and Evaluation Division, Bangladesh Rural Advancement Committee (Bangladesh) Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh (p. 22-32)

Most maternal deaths occur in the puerperium and most maternal morbidities probably also arise at that time. Maternal morbidities occur much more frequently than maternal deaths, but very little is known about their magnitude or causes. This study uses focus-group discussions to explore the experiences of childbirth and postpartum illness among rural Bangladeshi women. The women's beliefs about disease causation, and their use of traditional health care, are explored. The significance of the findings for the training of traditional birth attendants and for programs of postpartum care is discussed. (BANGLADESH, MATERNAL MORTALITY, MORBIDITY, RURAL WOMEN)

96.18.9 - English - Guy STECKLOV, Department of Demography, University of California at Berkeley, 2232 Piedmont Avenue, Berkeley, CA 94720 (U.S.A.) Maternal mortality estimation: Separating pregnancy-related and non-pregnancy-related risks (p. 33-38)

The increased availability of survey data and improved estimation techniques have furthered our understanding of maternal mortality in developing countries. Both the indirect and direct sisterhood methods of estimation depend on time-of-death information from surveys. This report proposes a method for calculating two rates, one during the pregnancy period and one outside of it. Analysis of both rates provides more information about mortality associated with pregnancy than do methods that only produce one rate. The pregnancy-related mortality rate can be estimated by assuming that non-pregnancy-related risks are constant, irrespective of whether women are pregnant or not. An estimated 69% of deaths in Bolivia during pregnancy may be pregnancy related; this result is significantly lower than that obtained using the traditional sisterhood method. In certain cases, this result may be viewed as a plausible lower bound. A variety of estimates should probably be used for policy purposes. (DEVELOPING COUNTRIES, BOLIVIA, MORTALITY RATE, MATERNAL MORTALITY, PREGNANCY)

96.18.10 - English - Edilberto LOAIZA, Macro International Inc./DHS Program, 11785 Beltsville Drive, Calverton, MD 20705 (U.S.A.) Sterilization regret in the Dominican Republic: Looking for quality-of-care issues (p. 39-48)

This report approaches the concept of quality of care by looking at the covariates of sterilization regret in the Dominican Republic according to the results from the 1991 Demographic and Health Survey. The main variables observed are the women's satisfaction with sterilization, their decisionmaking process, sterilization experience, use of family planning, and socioeconomic characteristics. The more detailed measurement and analysis of the outcomes of care point to a need for improvement in the public program effort with regard to sterilization. Substantial proportions of women were sterilized who were younger than 30, who had three or fewer living children, and who had the operation before they had used any other method of contraception. Because a greater proportion of sterilization regret is observed among these groups, women must be enabled to make a free and informed decision about sterilization by means of programs that offer a more balanced choice of methods, as well as better counseling, education, and access to high-quality services. (DOMINICAN REPUBLIC, FEMALE STERILIZATION, FAMILY PLANNING)

MARCH-APRIL 1995 - VOLUME 26, NUMBER 2

96.18.11 - English - John BONGAARTS and Judith BRUCE, The Population Council, New York (U.S.A.) The causes of unmet need for contraception and the social content of services (p. 57-75)

Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. This study analyzes survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use. (CONTRACEPTIVE USAGE, SUPPLY AND DEMAND, PROGRAMME EVALUATION)

96.18.12 - English - Florina SERBANESCU, WHO Collaborating Center in Perinatal Care Health Research, Mailstop K-35, DRH/CDC, 4770 Buford Highway, Atlanta, GA 30341-3724 (U.S.A.), Leo MORRIS, Paul STUPP, Behavioral Epidemiology and Demographic Research Branch, DRH/CDC, Atlanta (U.S.A.), and Alin STANESCU, Institute for Mother and Child Care, Bucarest (Romania)

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania (p. 76-87)

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20%, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70% of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy. (ROMANIA, LEGISLATION, INDUCED ABORTION, CONTRACEPTION, FERTILITY DECLINE, FAMILY PLANNING PROGRAMMES)

96.18.13 - English - Aysen BULUT, Family Health Division of the Institute of Child Health, Istanbul University, Children's Hospital, Millet Cad., 34390, �apa, Istanbul (Turkey), and Janet MOLZAN TURAN, Department of Population Dynamics of the Johns Hopkins University School of Hygiene and Public Health (U.S.A.)

Postpartum family planning and health needs of women of low income in Istanbul (p. 88-100)

This study was designed to learn what types of postpartum health and family planning services are most appropriate for couples with low incomes living in Istanbul, Turkey. The methods used included focus groups, site visits, questionnaires for postpartum women, and a self-administered questionnaire for health-care providers. By five months postpartum, 86% of the women surveyed were using some method of family planning. Many couples used withdrawal, starting immediately upon resumption of intercourse after childbirth, intending to use a medical method after menses resumed. However, only 34% of users had begun to use a medical method by five months after childbirth. The health facilities visited provide little information and counseling about the postpartum period. Women said that they wanted information on infant care, breastfeeding, and family planning, either before becoming pregnant or while they are pregnant. Most women prefer that postpartum services address the needs of the whole family, not only those of the baby or the mother. Recommendations for the timing, mode, and content of postpartum health and family planning services are made based on the study's findings. (TURKEY, FAMILY PLANNING PROGRAMMES, POSTPARTUM PROGRAMMES, POVERTY)

96.18.14 - English - Mohammed SHAHIDULLAH, Maternal and Child Health-Family Planning Extension Project (Rural), International Centre for Diarrhoeal Disease Research, G.P.O. Box 128, Dhaka (Bangladesh) The sisterhood method of estimating maternal mortality: The Matlab experience (p. 101-106)

This study reports the results of a test of validation of the sisterhood method of measuring the level of maternal mortality using data from a Demographic Surveillance System (DSS) operating since 1966 in Matlab, Bangladesh. The records of maternal deaths that occurred during 1976-90 in the Matlab DSS area were used. One of the deceased woman's surviving brothers or sisters, aged 15 or older and born to the same mother, was asked if the deceased sister had died of maternity-related causes. Of the 384 maternal deaths for which siblings were interviewed, 305 deaths were correctly reported, 16 deaths were underreported, and the remaining 63 were misreported as nonmaternal deaths. Information on maternity-related deaths obtained in a sisterhood survey conducted in the Matlab DSS area was compared with the information recorded in the DSS. Results suggest that in places similar to Matlab, the sisterhood method can be used to provide an indication of the level of maternal mortality if no other data exist, though the method will produce negative bias in maternal mortality estimates. (BANGLADESH, MATERNAL MORTALITY, METHODOLOGY)

96.18.15 - English - Kathy I. KENNEDY, Contraceptive Use and Epidemiology Division, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709 (U.S.A.), Barbara A. GROSS, Department of Clinical Endocrinology, Westmead Hospital, Westmead, NSW (Australia), Suzanne PARENTEAU-CARREAU, "Serena Canada", Montr�al (Canada), Anna M. FLYNN, Natural Family Planning Centre, Department of Obstetrics and Gynecology, Birmingham Maternity Hospital, Birmingham (U.K.), James B. BROWN, Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, VIC (Australia), and Cynthia M. VISNESS, Contraceptive Use and Epidemiology Division, Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709 (U.S.A.)

Breastfeeding and the symptothermal method (p. 107-115)

This prospective study was conducted among experienced users of periodic abstinence methods in Sydney, Montreal, and Birmingham (England) in order to describe the relationship between a laboratory measurement of ovulation and the natural symptoms of fertility during breastfeeding. Daily urinary estrogen and pregnanediol glucuronide assays were used to estimate the date of ovulation and to determine potentially fertile days. A standard set of Symptothermal Method (STM) rules was applied to daily STM records to assess the correspondence of the natural symptoms of fertility to the underlying hormonal profile. The STM symptoms and rules accurately identified 77-94% of the women's potentially fertile days, but abstinence was also recommended on about half of the days when the women were not fertile. An integrated set of common rules for STM use during breastfeeding is highly sensitive but not specific in its ability to screen for ovulation. (BREAST FEEDING, OVULATION DETECTION, BASAL BODY TEMPERATURE METHOD)

MAY-JUNE 1995 - VOLUME 26, NUMBER 3

96.18.16 - English - Fred N. BINKA, Alex NAZZAR and James F. PHILLIPS The Navrongo community health and family planning project (p. 121-139)

In 1994, an experiment was launched by the Navrongo Health Research Centre that will test the demographic impact of community health and family planning services in a rural, traditional area of northern Ghana. While exhaustive social research has been directed to clarifying societal constraints to reproductive change, relatively little is known about how African cultural characteristics can be a resource to family planning programs. This study will clarify ways in which cultural resources of a traditional African society can be used in efforts to foster reproductive change. This article reviews characteristics of the study population, the design of the Navrongo experiment, and the research plan. The Navrongo Project will be the first African experimental trial of the demographic impact of family planning. (GHANA, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, CULTURE)

96.18.17 - English - Deborah ROGOW and Sonya HOROWITZ

Withdrawal: A review of the literature and an agenda for research (p. 140-153)

A review to evaluate available literature about withdrawal (coitus interruptus) reveals a dearth of research on the current prevalence, acceptability, use-effectiveness, service-delivery issues, and safety of this ancient and widely used temporary contraceptive method. Population and family planning professionals are shown to have neglected withdrawal in favor of modern, female controlled methods. This neglect is founded largely upon the popular belief that fertile levels of viable sperm are present in pre-ejaculatory fluid, despite data to the contrary. The validity of existing data on the prevalence of withdrawal is questioned because of the methodological bias inherent in most studies. The use-effectiveness of the practice and its relationship to sexually transmitted diseases have not been adequately investigated. A detailed research agenda on numerous topics concerning withdrawal is proposed. (COITUS INTERRUPTUS, DATA EVALUATION, STUDY DESIGN)

96.18.18 - English - Lisanne BROWN, Mostafa TYANE, Jane BERTRAND, Don LAURO, Mohamed ABOU-OUAKIL and Lisa DEMARIA Quality of care in family planning services in Morocco (p. 154-168)

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program. (MOROCCO, POSTPARTUM PROGRAMMES, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION)

96.18.19 - English - Tu PING IUD discontinuation patterns and correlates in four counties in North China (p. 169-179)

This study presents an in-depth analysis of IUD discontinuation patterns and correlates in four counties in North China for the years following the introduction of provincial family planning regulations and the family planning target responsibility system. It is based on contraceptive-use data from 8,630 rural married women younger than 35. The gross IUD discontinuation rate was low among women with one child. The pattern of discontinuation was determined mainly by individual demographic profile and institutional variables. IUD users with two or more children tended to undergo sterilization after the introduction of the regulations of the late 1980s. These counties appear to have been successful in shaping couples' contraceptive behavior, but at the expense of individual choice. The effect of introducing copper IUDs may be smaller than expected unless providers' training is substantially improved and couples' fertility preferences altered. (CHINA, IUD REMOVAL, FEMALE STERILIZATION, FAMILY PLANNING POLICY)

JULY-AUGUST 1995 - VOLUME 26, NUMBER 4

96.18.20 - English - Teresa CASTRO MART�N Women's education and fertility: Results from 26 Demographic and Health Surveys (p. 187-202)

This article presents an updated overview of the relationship between women's education and fertility. Data from the Demographic and Health Surveys for 26 countries are examined. The analysis confirms that higher education is consistently associated with lower fertility. However, a considerable diversity exists in the magnitude of the gap between upper and lower educational strata and in the strength of the association. In some of the least-developed countries, education might have a positive impact on fertility at the lower end of the educational range. Yet, compared with patterns documented a decade ago, the fertility-enhancing impact of schooling has become increasingly rare. The study also examines the impact of female education on age at marriage, family-size preference, and contraceptive use. It confirms that education enhances women's ability to make reproductive choices. (DEMOGRAPHIC AND HEALTH SURVEYS, EDUCATION OF WOMEN, FERTILITY)

96.18.21 - English - Jagdish C. BHATIA and John CLELAND Self-reported symptoms of gynecological morbidity and their treatment in South India (p. 203-216)

This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications. (INDIA, MORBIDITY, GYNAECOLOGIC DISEASES)

96.18.22 - English - P.N. MARI BHAT, K. NAVANEETHAM and S. IRUDAYA RAJAN Maternal morbidity in India: Estimates from a regression model (p. 217-232)

This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5% of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India. (INDIA, MATERNAL MORTALITY, MORTALITY MEASUREMENT, MORTALITY DECLINE, METHODOLOGY)

96.18.23 - English - Stan BECKER, Kale FEYISETAN and Paulina MAKINWA-ADEBUSOYE The effect of the sex of interviewers on the quality of data in a Nigerian family planning questionnaire (p. 233-240)

Traditionally, female interviewers have been preferred to men for conducting fertility and family planning surveys. However, in West Africa, evidence for their superiority over male interviewers is mixed. In Nigeria, as part of a four-state pretest of the national family planning questionnaire, an experimental design was incorporated to quantify effects of the sex of the interviewer. In one state, reinterviews were also performed to measure the reliability of responses. In the conservative northern state of Kano, the use of male interviewers was problematic. However, in the other three states, only weak evidence was found to mitigate against the use of male interviewers. In fact, in two states, the proportion of respondents reporting knowledge of several contraceptive methods was significantly higher when male interviewers conducted the survey. Respondents' reports of contraceptive use were very unreliable for interviewers of both sexes. (NIGERIA, FERTILITY SURVEYS, FAMILY PLANNING, INTERVIEWER BIAIS)

SEPTEMBER-OCTOBER 1995 - VOLUME 26, NUMBER 5

96.18.24 - English - Charlotte ELLERTSON, Beverly WINIKOFF, Elizabeth ARMSTRONG, Sharon CAMP and Pramilla SENANAYAKE Expanding access to emergency contraception in developing countries (p. 251-263)

Emergency contraception has been called the best-kept contraceptive secret. Previous research shows that several regimens of postcoital contraception offer safe and effective ways for women to avoid pregnancy. Yet the methods are typically unavailable to women in developing countries. In this article, the authors review the main methods of emergency contraception and describe experience with them to date. The prevalence and urgency of the need for making these methods available to women in developing countries are assessed. The necessary elements for creating such access are described. In several developing countries, conditions for introducing the methods may be more favorable than in industrialized countries. These advantages are reviewed. Finally, the authors describe the challenges anticipated for broadening the availability of postcoital methods in the developing world. They conclude with a brief series of recommendations for policymakers. (DEVELOPING COUNTRIES, POSTCOITAL CONTRACEPTION)

96.18.25 - English - Anastasia J. GAGE Women's socioeconomic position and contaceptive behavior in Togo (p. 264-277)

Few studies have examined empirically the influence of women's position on contraceptive behavior in sub-Saharan Africa. Using data from the 1988 Togo Demographic and Health Survey, this article explores the linkages between various indicators of women's position and spousal communication about family planning and contraceptive use. The results highlight the importance to their contraceptive behavior of women's economic power and individual control over choice of partner. The likelihood of spousal communication about family planning and modern contraceptive use is significantly higher among women who exercised complete control over selection of partner than among those with arranged marriages. Women who work for cash are significantly more likely than those who do not to communicate with their spouses about family planning, particularly if they participate in rotating credit or savings schemes. Such participation also increases significantly the likelihood of ever using traditional and modern methods of contraception. (TOGO, CONTRACEPTIVE USAGE, WOMEN'S STATUS, SOCIO-ECONOMIC CONDITIONS)

96.18.26 - English - Tu PING and Herbert L. SMITH Determinants of induced abortion and their policy implications in four counties in North China (p. 278-286)

A retrospective survey conducted in four counties in North China in 1991-92 shows that the probability of aborting a pregnancy is strongly related to parity. No induced abortions are found prior to the first live birth, and almost universal abortion is shown after the second. Women had a high risk of undergoing abortion after their first live birth because most (82%) had become pregnant again without meeting official requirements for late second births with long spacing between births. The likelihood that a pregnancy will be aborted is strongly determined by official family planning policy and regulations. Individual and household socioeconomic status plays a relatively insignificant role. Great variation in the prevalence of induced abortion exists at the county and village levels. In recent years, the incidence of induced abortion has increased among women with one living child. Even a two-child policy, with late childbearing and spacing, can have high social and health costs in a country where childbearing is universal and begins relatively early. (CHINA, INDUCED ABORTION, BIRTH SPACING, ANTINATALIST POLICY)

96.18.27 - English - W. PARKER MAULDIN, John A. ROSS, John KEKOVOLE, BARKAT-E-KHUDA and Abul BARKAT Direct and judgmental measures of family planning program inputs (p. 287-295)

This report compares two different approaches to measuring the strength of family planning programs in Bangladesh and Kenya. The first approach, the judgmental approach, has been used in a number of studies during the past two decades; scores on the characteristics of family planning programs are derived from the responses knowledgeable persons give to a series of questions. The second approach is to obtain direct measures of each item being considered. In Bangladesh, the total score varied trivially between the direct and the judgmental approaches. In Kenya, the total direct score was substantially higher than the judgmental score. The primary advantage of the judgmental approach is that comparative scores can be obtained for a larger number of countries for the same time period at a much lower cost than would be required by the direct approach. (BANGLADESH, KENYA, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, METHODOLOGY)

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