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18 STUDIES IN FAMILY PLANNING
June 1998, Vol. 29, N° 2
"Adolescent Reproductive Behavior in the Developing World"
Editors: John Bongaarts and Barney Cohen
99.18.6 - BLANC, Ann K.; WAY, Ann A.
Sexual behavior and contraceptive knowledge and use among adolescents in developing countries.
This article offers an overview of sexual behavior and contraceptive knowledge and use among adolescent women across a large number of developing countries. The results demonstrate that almost universally in sub-Saharan Africa and in the majority of countries in other regions, the gap between age at first sexual intercourse and age at first marriage has increased across age cohorts. The predominant pattern is one in which both age at marriage and age at first intercourse have risen, but the increase in age at marriage is greater, resulting in a widening gap. In most countries in sub-Saharan Africa, current contraceptive use is higher among sexually active, unmarried teens than it is among married teens, whereas in Latin America and the Caribbean, current-use levels are higher among married teens. The results also show that adolescents are unlikely to use a contraceptive the first time they have sex and are more likely than older women to experience a contraceptive failure.
English - pp. 106-116.
A. K. Blanc et A. A. Way, Macro International, Inc., 11785 Beltsville Drive, Calverton, MD 20705, U.S.A.
(DEVELOPING COUNTRIES, ADOLESCENT FERTILITY, SEXUAL BEHAVIOUR, CONTRACEPTIVE USAGE)
Adolescent childbearing in developing countries: A global review.
This article discusses the current levels and recent trends in the rate of adolescent childbearing, the timing of the first birth, and births to unmarried women for 43 developing countries. Differences in rates of adolescent childbearing by residence and level of education are also examined. The analysis is based on nationally representative fertility surveys. Substantial declines in adolescent fertility have occurred in North Africa and Asia, but levels are still high in some countries. Declines are beginning to occur in sub-Saharan Africa, but current levels are still high in most countries of this region, and the proportion of births to unmarried adolescents is increasing in some countries. In Latin America, where the level of teenage childbearing is moderate, declines are less prevalent and some small increases have occurred. Higher education is associated with lower rates of adolescent childbearing, but other socioeconomic changes cancel or reduce this effect in several countries.
English - pp. 117-136.
S. Singh, Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, U.S.A.
(DEVELOPING COUNTRIES, ADOLESCENT FERTILITY, FERTILITY DETERMINANTS)
99.18.8 - CALDWELL, John C.; CALDWELL, Pat; CALDWELL, Bruce K.; PIERIS, Indrani.
The construction of adolescence in a changing world: Implications for sexuality, reproduction, and marriage.
This article aims to show how the period now known as adolescence came into being and how it was shaped by international economic, institutional, and social influences. It considers premodern societies and argues that traditional culture has shaped contemporary adolescence even more than has global society. Explanations are offered for the enormous differences across the world in adolescent sexuality, reproduction, and marriage. The data are drawn mainly from research programs in Nigeria, Sri Lanka, India, and Bangladesh, and comparisons are made with other countries.
English - pp. 137-153.
J. C. Caldwell, Health Transition Centre, Australian National University, Canberra, ACT 0200, Australia.
(ADOLESCENCE, SEXUALITY, REPRODUCTION, MARRIAGE, LIFE CYCLE, ANTHROPOLOGY)
Sexual activity and contraceptive use: The components of the decisionmaking process.
In light of the social consequences of early childbearing, unplanned pregnancy, and the transmission of AIDS, a great need exists to understand how adolescents make sexual and reproductive decisions. Drawing primarily on literature from sub-Saharan Africa, this article focuses on three behavioral outcomes: nonmarital sexual activity, contraceptive use, and condom use. It explores adolescents' perceptions of the costs and benefits of engaging in these behaviors, their assessment of their susceptibility to the potential consequences of their actions, and the role of family, peer, and dyadic factors in shaping their reproductive decisions. The literature reveals that cultural values regarding sexuality and gender roles, the power dimensions of adolescents' lives, and economic disadvantage exert powerful influences on the decisionmaking process. Decisions to engage in unprotected sex may also be based on insufficient knowledge and distorted judgments of the risks of becoming pregnant and acquiring sexually transmitted infections. Nondecisionmaking is found to be fairly common in some contexts.
English - pp. 154-166.
A. J. Gage, Population Leadership Program, Western Consortium for Public Health, USAID, G/PHN/POP/P&E, Room 3.06-046, Washington, DC 20523-3601, U.S.A.
(AFRICA SOUTH OF SAHARA, ADOLESCENTS, DECISION MAKING, SEXUALITY, REPRODUCTION, CONTRACEPTIVE USAGE)
99.18.10 - MENSCH, Barbara S.; LLOYD, Cynthia B.
Gender differences in the schooling experiences of adolescents in low-income countries: The case of Kenya.
Although a growing proportion of young people is spending some time in school between puberty and marriage, little research on education in developing countries has been focused on adolescent issues. This article examines the school environment in Kenya and the ways it can help or hinder adolescents. Gender differences are considered with a view toward illuminating some factors that may present particular obstacles or opportunities for girls. Using both qualitative and quantitative data, 36 primary schools in rural areas in three districts of Kenya are studied. These schools are chosen to reflect the spectrum of school quality in the country. The focus in this study is on primary schools because the majority of adolescents in school attend primary school. In these schools, where considerable variation in performance and parental educational status is found, disorganization coexists with strict punishment, minimal comforts are lacking, learning materials are scarce, learning is by rote, and sex education is not provided. In the primary-school-leaving exam, girls' performance is poorer than that of boys. Teachers' attitudes and behavior reveal lower expectations for adolescent girls, traditional assumptions about gender roles, and a double standard about sexual activity.
English - pp. 167-184.
B. S. Mensch and C. B. Lloyd, Social Science Research, Policy Research Division, Population Council, New York, U.S.A.
(KENYA, ADOLESCENTS, PRIMARY SCHOOLS, EDUCATIONAL SYSTEMS, SEX DIFFERENTIALS)
99.18.11 - AMIN, Sajeda; DIAMOND, Ian; NAVED, Ruchira T.; NEWBY, Margaret.
Transition to adulthood of female garment-factory workers in Bangladesh.
This article examines data from a study on garment-factory workers in Bangladesh to explore the implications of work for the early socialization of young women. For the first time, large numbers of young Bangladeshi women are being given an alternative to lives in which they move directly from childhood to adulthood through early marriage and childbearing. Employment creates a period of transition in contrast to the abrupt assumption of adult roles at very young ages that marriage and childbearing mandate. This longer transition creates a period of adolescence for young women working in the garment sector that is shown to have strong implications for the women's long-term reproductive health.
English - pp. 185-200.
S. Amin, Policy Research Division, Population Council, New York, U.S.A.
(BANGLADESH, ADOLESCENCE, INDUSTRIAL WORKERS, FEMALE EMPLOYMENT, SOCIALIZATION)
The costs of adolescent childbearing: Evidence from Chile, Barbados, Guatemala, and Mexico.
Findings from Chile, Barbados, Guatemala, and Mexico are reviewed in this article to shed light on the consequences of adolescent childbearing for mothers' economic and social opportunities and the well-being of their first-born children. The studies include retrospective information and a comparison group of adult childbearers to account for the effects of background factors (poverty) and the timing of observations. The findings show that early childbearing is associated with negative economic rather than social effects, occurring for poor rather than for all mothers. Among the poor, adolescent childbearing is associated with lower monthly earnings for mothers and lower nutritional status of children. Also, among this group of women only, improvements in the child's well-being are associated with mother's education and her contribution to household income. These findings suggest that social policy that expands the educational and income-earning opportunities of poor women could help to contain the intergenerational poverty associated with early childbearing among the poor.
English - pp. 201-209.
M. Buvinic, Social Development Division, Inter-American Development Bank, 1300 New York Avenue, NW, Washington, DC 20577, U.S.A.
(LATIN AMERICA, ADOLESCENT FERTILITY, POVERTY, MOTHER, CHILDREN, ECONOMIC CONDITIONS)
99.18.13 - ZABIN, Laurie Schwab; KIRAGU, Karungari.
The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa.
This article reviews the literature on health consequences of adolescent sexual behavior and childbearing in sub-Saharan Africa, and the social and cultural context in which they occur. It suggests that, in addressing the most serious health sequelae, sexual intercourse that occurs in early marriage and premaritally must both be considered. Some limitations of the data are noted. Despite the excess risk to which adolescents are exposed, due both to custom and age-related vulnerability, differences between health effects among adult and adolescent women are often differences in degree. They are attributable to behavioral, social, and biological causes, exist in traditional and nontraditional settings, in union and out of union, and are exacerbated by declining ages at menarche, pressures of HIV/AIDS and STDs, and a dearth of appropriate services-especially for young people. Some current interventions are discussed, and the need for policy as well as medical intervention is stressed.
English - pp. 210-232.
L. S. Zabin, Department of Population Dynamics, Johns Hopkins School of Hygiene and Public Health, 4503 Hygiene, 615 North Wolfe Street, Baltimore, MD 21205, U.S.A.
(AFRICA SOUTH OF SAHARA, ADOLESCENT FERTILITY, SEXUALITY, PUBLIC HEALTH)
99.18.14 - HUGHES, Jane; McCAULEY, Ann P.
Improving the fit: Adolescents' needs and future programs for sexual and reproductive health in developing countries.
Demand is growing in developing countries for sexual and reproductive health programs for young people. However, little scientifically based evidence exists about which program approaches are most effective in shaping healthy behaviors. Careful evaluation and research must be increased, but meanwhile, planners need guidance as they expand programming. Research indicates that current programs often do not match the needs and health-seeking behaviors of young people. Behavioral theories and expert opinion agree that adolescents must be taught generic and health-specific skills necessary for adopting healthy behaviors. Constraints on financial and human resources, coupled with the great size of the youth population, highlight the need to find less costly ways to reach young people. These observations generate six programming principles to help planners and communities experiment with a wide variety of programming approaches.
English - pp. 233-245.
J. Hughes, Population Services, The Rockefeller Foundation, 420 Fifth Avenue, New York, NY 10018-2702, U.S.A.
(DEVELOPING COUNTRIES, PUBLIC HEALTH, SEXUALITY, ADOLESCENTS, HEALTH SERVICES, PROGRAMME PLANNING, METHODOLOGY)
99.18.15 - FURSTENBERG, Frank F., Jr.
When will teenage childbearing become a problem? The implications of Western experience for developing countries.
This article reflects on the process that leads to perceptions of teenage childbearing as a social problem and examines whether that process will occur in developing countries as it has in the United States. In postindustrial Western economies, family and adult control over young peoples' sexual behavior has loosened, while marriage rates have declined. In the United States, nonmarital births to adolescents, particularly among poor minorities who have few opportunities and reasons to delay childbearing, have become a cause for public concern. However, the economic, educational, and nuptial changes that have occurred in other postindustrial countries have not necessarily led to fertility problems among teenagers, because of a greater willingness to acknowledge their sexual activity and to provide the resources to prevent their childbearing. Although developing nations may undergo changes that result in more schooling and greater autonomy for adolescents, whether nonmarital births will come to constitute a problem will depend on many different factors; the United States provides an example of the conditions they may wish to avoid.
English - pp. 246-253.
F. F. Furstenberg, Jr., Department of Sociology, University of Pennsylvania, 277 McNeil, 3718 Locust Walk, Philadelphia, PA 19104-6299, U.S.A.
(DEVELOPING COUNTRIES, UNITED STATES, ADOLESCENT FERTILITY, SOCIAL PROBLEMS, SOCIAL CHANGE)
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18 STUDIES IN FAMILY PLANNING
December 1998, Vol. 29, N° 4
Dead mothers and injured wives: The social context of maternal morbidity and mortality among the Hausa of Northern Nigeria.
Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.
English - pp. 341-359.
L. L. Wall, Department of Obstetrics and Gynecology, Louisiana State University Medical Center, 1542 Tulane Avenue, La Nouvelle Orléans, LA 70112, U.S.A.
(NIGERIA, ETHNIC GROUPS, MATERNAL MORTALITY, MORBIDITY, MORTALITY TRENDS)
99.18.17 - BIDDLECOM, Ann E.; FAPOHUNDA, Bolaji M.
Covert contraceptive use: Prevalence, motivations, and consequences.
This article examines women's covert use of contraceptives, that is, their use of a method without their husbands' knowledge. Three questions are addressed: (1) How is covert use measured? (2) How prevalent is it? and (3) What are the factors underlying covert use? Existing studies are used together with survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and their husbands. Women's covert use of contraceptives is estimated to account for 6 to 20 percent of all current contraceptive use, and it is more widespread when contraceptive prevalence is low. The multivariate analysis indicates that difficult spousal communication about contraception is the strongest determinant of covert use. Husbands' disapproval of contraception works through spousal communication rather than as a direct influence on covert use. Husbands' pronatalism had no significant effect. The article concludes with implications of covert use for reproductive health and family planning programs, especially women's (and men's) needs for confidential services.
English - pp. 360-372.
A. E. Biddlecom, Institute for Social Research, University of Michigan, U.S.A.
(ZAMBIA, URBAN AREAS, CONTRACEPTIVE USAGE, COUPLE, INTERPERSONAL COMMUNICATION)
99.18.18 - SHORT, Susan E.; FENGYING, Zhai.
Looking locally at China's one-child policy.
Of all the reforms and policies set in motion in the early 1980s in China, the one-child policy has been called the most far-reaching in its implications for China's population and economic development. Almost two decades later, little is known about what the policy looks like across local neighborhoods and villages. To sketch a more general picture of the one-child policy, this article presents panel data from three waves of the China Health and Nutrition Survey (1989, 1991, and 1993) collected in 167 communities in eight provinces. Local policy, including policy strength and policy incentives and disincentives, is detailed separately for urban and rural areas. These data confirm that no single one-child policy exists; policy varied considerably from place to place and within individual communities during the 198993 period.
English - pp. 373-387.
S. E. Short, Department of Sociology, Brown University, Maxcy Hall, Box 1916, Providence, RI 02912, U.S.A.
(CHINA, LOCAL COMMUNITIES, ANTINATALIST POLICY)
99.18.19 - SINGH, Kaushalendra K.; BLOOM, Shelah S.; ONG TSUI, Amy.
Husbands' reproductive health knowledge, attitudes, and behavior in Uttar Pradesh, India.
To enhance the reproductive health status of couples in developing countries, the knowledge, attitudes, and behavior of both women and men must be investigated, especially where women depend on men for the decision to seek care. This study analyzes data from a survey of 6,727 husbands from five districts in the northern state of Uttar Pradesh, India. Data are presented on men's knowledge of women's health and on their own sexual behavior outside the context of marriage, on their perceptions of sexual morbidity and their attempts at treatment for specific conditions, and on their opinions concerning the social role of wives. Findings indicate that men know little about maternal morbidity or sexual morbidity conditions. Few husbands reported that they had had sexual experience outside of marriage and the majority of these few said they had had such a relationship with more than one partner. Of men who said they had had reproductive morbidity symptoms, many said they had not sought treatment. Men's views concerning the role of wives indicate a low level of women's autonomy in this region of India. Results indicate a pressing need for reproductive health education that targets both women and men in Uttar Pradesh.
English - pp. 388-399.
K. K. Singh, Department of Statistics, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
(INDIA, STATE, MATERNAL AND CHILD HEALTH, MARRIED MEN, KAP SURVEYS, WOMEN'S STATUS)
99.18.20 - JOHANSSON, Annika; THU NGA, Nguyen; QUANG HUY, Tran; DU DAT, Doan; HOLMGREN, Kristina.
Husbands' involvement in abortion in Vietnam.
This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion.
English - pp. 400-413.
A. Johansson, Unit for International Health Care Research, IHCAR, Division of Public Health Sciences, Karolinska Institutet, 17176 Stockholm, Sweden.
(VIET NAM, INDUCED ABORTION, MARRIED MEN, DECISION MAKING, ETHICS)
99.18.21 - CHANDRAMOHAN, Daniel; RODRIGUES, Laura C.; MAUDE, Gillian H.; HAYES, Richard J.
The validity of verbal autopsies for assessing the causes of institutional maternal death.
This report presents data from a study carried out in three African countries to assess the validity of verbal autopsiesbased on information about symptoms and signs observed antemortem by relatives or associates of deceased individualsfor determining the causes of institutional maternal death. The validity of the verbal autopsy was assessed for each cause of death, and for groups of "direct" and "indirect" maternal causes, by comparing the verbal autopsy diagnoses with the reference diagnoses and calculating their sensitivity, specificity, and positive predictive value. Verbal autopsies were found to be highly specific (98 percent specificity for all causes of maternal death) but not very sensitive (60 percent sensitivity for all causes except ante/postpartum hemorrhage). Verbal autopsy estimates of cause-specific mortality were comparable to expected values for most of the causes. The study shows that certain direct causes of hospital-based maternal mortality can be determined by means of verbal autopsies with a reasonable level of confidence.
English - pp. 414-422.
D. Chandramohan, L. C. Rodrigues, G. H. Maude and R. J. Hayes, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, U.K.
(AFRICA, MATERNAL MORTALITY, CAUSES OF DEATH, DIAGNOSIS, QUALITY OF DATA, METHODOLOGY,
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