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STUDIES IN FAMILY PLANNING, March 2000, Vol. 31, N° 1
KOENIG, Michael A.; FOO, Gillian H.C.; JOSHI, Ketan.
Quality of care within the Indian Family Welfare Programme: A review of recent evidence.
India's family planning program represents one of the earliest and most ambitious efforts in a developing country to address the issue of high fertility. Despite its more than four decades of existence, little is known concerning how the program is implemented at the field level, especially in relation to the quality of services provided. In this article, empirical evidence on the accessibility and quality of services provided through the Indian family planning program is reviewed and synthesized. The review highlights the serious and systemic shortcomings in quality of care that characterize the Indian program in such areas as restricted method choice, limited information provided to clients, poor technical standards, and low levels of follow-up and continuity of care. The factors constraining higher service quality are subsequently reviewed, and the prospects for improving quality of care within the Indian program are assessed.
(INDIA, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION).
English - pp. 118.
M. A. Koenig, Department of Population and Family Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, U.S.A.; G. H. C. Foo, Independent Consultant, Baltimore, U.S.A.; K. Joshi, Center for Communication Programs, The Johns Hopkins University, Baltimore, MD 21205, U.S.A.
MKoenig@jhsph.edu.
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HOODFAR, Homa; ASSADPOUR, Samad.
The politics of population policy in the Islamic Republic of Iran.
The Islamic Republic of Iran arguably has one of the most successful family planning programs in the developing world. This success is all the more interesting for advocates of population programs because the political leaders of the Islamic regime were once strongly opposed to family planning. Indeed, after gaining power following the 1979 revolution, they were responsible for dismantling Iran's relatively new family planning program and introducing pronatalist policies. This article provides an account of the different phases of the population policy in Iran and examines the diverse elements that led politicoreligious leaders to revise their views about fertility control and to participate in creating a workable family planning program. The complex formal and informal strategies that the political experts, the media, the religious authorities, and the government of the Islamic Republic adopted in order to achieve this about-face are described. The analysis is based on data collected by the first author during anthropological field research in 199396, by means of informal interviews with officials, with medical personnel, with family planning clients, and with religious leaders.
(IRAN, FAMILY PLANNING PROGRAMMES, POPULATION POLICY, ISLAM).
English - pp. 1934.
H. Hoodfar, Department of Sociology and Anthropology, Concordia University, 1455, de Maisonneuve Boulevard, West, Montreal, Quebec, Canada H3G 1M8; S. Assadpour, Public Health Affairs, Population and Family Planning Program, Ministry of Health and Medical Education, Tehran, Iran.
Hhoodfar@aol.com.
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HULTON, Louise A.; CULLEN, Rachel; WAMALA KHALOKHO, Symons.
Perceptions of the risks of sexual activity and their consequences among Ugandan adolescents.
The principal aim of this study of adolescents in Mbale District, Uganda, is to provide program-related information about their behavior, motivations, and perceptions of risk with regard to pregnancy and HIV transmission. Twelve single-sex focus-group discussions were conducted, six with young people aged 1718 who were still attending school, and six with people of the same age who were not. The most important findings to emerge are that knowledge of safe-sex behavior and reported behavior have little in common and that the fundamental barriers to behavioral change lie within the economic and sociocultural context that molds the sexual politics of youth. Young males' lack of responsibility for the outcomes of their behavior is identified as an important barrier to improved sexual health. The imperative to explore ways by which young women might achieve status and identity and acquire material resources by means not related to their sexuality is highlighted.
(UGANDA, ADOLESCENTS, SEXUAL BEHAVIOUR, RISK EXPOSURE, AIDS, ADOLESCENT PREGNANCY, CULTURE, POVERTY).
English - pp. 3546.
L. A. Hulton, Department of Social Statistics, University of Southampton, Highfield, Southampton, SO 17, U.K.; R. Cullen, International Planned Parenthood Federation European Network; S. Wamala Khalokho, AIDS Relief Uganda, Mbale District, Uganda.
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GARENNE, Michel; Tollman, Stephen; KAHN, Kathleen.
Premarital fertility in rural South Africa: A challenge to existing population policy.
The age pattern of fertility in a rural area of South Africa under demographic surveillance (Agincourt subdistrict) was investigated over the 199297 period. The total fertility rate (TFR) averaged 3.3 births per woman of reproductive age over the period, a major drop from earlier estimates in the same area (6.0 births in 197074). Age-specific fertility rates showed an atypical bimodal pattern. They were decomposed into two components of similar magnitude: premarital fertility (among women aged 1226) and marital fertility (among women aged 1549). The decomposition revealed the two underlying modes: a mode of premarital fertility (among women aged 1820) and a mode of marital fertility (among women aged 2830). Premarital fertility accounted for 21 percent of all births and for 47 percent of births among women aged 1226. This pattern of high premarital fertility appears to reflect a low incidence of contraceptive use before the first birth, especially among adolescents, a low prevalence of abortion, and a high contraceptive prevalence thereafter. This finding calls for a reorientation of the family planning policy, which until now has targeted married women and women who have been pregnant once, but has failed to address the contraceptive needs of young women before their first pregnancy, especially adolescents.
(SOUTH AFRICA, RURAL AREAS, PREMARITAL BIRTHS, ADOLESCENT FERTILITY, CONTRACEPTIVE USAGE).
English - pp. 4754.
M. Garenne, CEPED, 15 rue de l'École de Médecine, F-75270 Paris Cedex 06, France; S. Tollman and K. Kahn, Witwatersrand University, Agincourt Health and Population Program, Department of Community Health, Johannesburg, Republic of South Africa.
garenne@ceped.ined.fr.
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BAUNI, Evasius K.; JARABI, Ben Obonyo.
Family planning and sexual behavior in the era of HIV/AIDS: The case of Nakuru District, Kenya.
Recently, the prevalence of contraceptive use has increased in Kenya. The twin risks of unwanted pregnancy and HIV/AIDS infection remain central concerns of reproductive health programs. However, we do not know how sexually active men and women perceive these risks, nor the strategies they consider appropriate to cope with these risks, nor the difficulties they face in trying to adopt appropriate sexual behaviors to minimize them. This study seeks to provide insights into perceptions, coping strategies, and constraints in the changing behavior of sexually active people in Nakuru District, Kenya. Twelve focus-group discussions were conducted, the results of which show that people in the study area consider the two risks to be serious problems, but that they neither use condoms within marriage nor refuse their partners sex even if they perceive a risk of acquiring HIV. These findings call for serious efforts toward fostering behavioral change in this area.
(KENYA, REGIONS, CONTRACEPTIVE USAGE, AIDS, FAMILY PLANNING PROGRAMMES, SEXUAL BEHAVIOUR, RISK, ATTITUDE).
English - pp. 6980.
E. K. Bauni and B. O. Jarabi, African Population and Health Research Centre, Population Council, Post Office Box 17643, Nairobi, Kenya.
ebauni@popcouncil.or.ke.
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STUDIES IN FAMILY PLANNING, June 2000, Vol. 31, N° 2
RAFALIMANANA, Hantamalala; WESTOFF, Charles F.
Potential effects on fertility and child health and survival of birth-spacing preferences in sub-Saharan Africa.
Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women's reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed.
(AFRICA SOUTH OF SAHARA, BIRTH INTERVALS, BIRTH SPACING, MATERNAL AND CHILD HEALTH, FERTILITY DECLINE, FERTILITY DETERMINANTS, PREFERENCES).
English - pp. 99-110.
H. Rafalimanana, Population Division, United Nations, Two United Nations Plaza, New York, NY 10017, U.S.A.; C. F. Westoff, Office of Population Research (OPR), Princeton University, Princeton, U.S.A.
rafalimanana@un.org.
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STANTON, Cynthia; ABDERRAHIM, Noureddine; Hill, Kenneth.
An assessment of DHS maternal mortality indicators.
This study presents an assessment of the quality of data relating to maternal mortality collected in 14 Demographic and Health Surveys (DHS) for 13 countries that included a complete sibling history. Four aspects of data quality are considered: completeness of the data for reported events, evidence of omission in the reporting of events, plausibility of the pattern of sibling deaths, and sampling errors of the maternal mortality estimates. Although the data relating to reported events are complete for most variables, comparisons of sibling-history-based estimates of adult mortality for both males and females with other independent estimates suggest that sibling estimates are more likely to be underestimates than overestimates. The downward bias is probably greater for female mortality than for male mortality. The sampling errors associated with maternal mortality ratios are substantially larger than those associated with other frequently used DHS indicators. This lack of precision precludes the use of these data for trend analysis and has led to the recommendation that this DHS module not be used more than once every ten years in the same country.
(DEMOGRAPHIC AND HEALTH SURVEYS, MATERNAL MORTALITY, QUALITY OF DATA, MORTALITY MEASUREMENT, ESTIMATES, UNDERESTIMATION).
English - pp. 111-123.
C. Stanton, Monitoring, Evaluation and Research, Maternal and Neonatal Health Project, JHPIEGO, 1615 Thames Street, Baltimore, MD 21231, U.S.A.; N. Abderrahim, Demographic and Health Surveys Project, Macro International, Calverton, MD, U.S.A.; K. Hill, Department of Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, U.S.A.
cstanton@jhpiego.org.
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WOLFF, Brent; BLANC, Ann K.; SSEKAMATTE-SSEBULIBA, John.
The role of couple negotiation in unmet need for contraception and the decision to stop childbearing in Uganda.
This study uses survey and focus-group data from the 1995-96 Negotiating Reproductive Outcomes study in Uganda to describe the nature of the decision to stop childbearing and to question the simplifying assumption of consensus decisionmaking implicit in much demographic research on unmet need. Negotiation is characterized in four stages, from normative precedent for decisionmaking to communication, disagreement, and conflict resolution. Indirect forms of communication between partners predominate, contributing to the tendency of both men and women to overestimate each other's demand for additional children. Partner opposition is found to cause a statistically significant increase in unmet need reported by women and a shift in contraceptive mix favoring use of traditional methods over modern methods. For women, partner opposition may account for as much as 20 percent of unmet need in urban areas, 12 percent in rural areas, and 15 percent overall.
(UGANDA, FAMILY PLANNING, DECISION MAKING, COUPLE, INTERPERSONAL COMMUNICATION, NEEDS).
English - pp. 124-137.
B. Wolff, Centre for Population Studies, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, U.K.; A. K. Blanc, Blancroft Research International, 11718 Lightfall Court, Columbia, MD 21044, U.S.A.; J. Ssekamatte-Ssebuliba, Department of Population Studies, Institute of Statistics and Applied Economics, Makerere University, Kampala, Uganda.
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AWASTHI, Shally; PANDE, V. K.; NICHTER, Mark.
Developing an interactive STD-prevention program for youth: Lessons from a north Indian slum.
An intervention developed to teach young men in the urban slums of Lucknow, India, about sexually transmitted diseases is described in detail. This community-based intervention was designed to impart core educational messages and to address preexisting ideas about sexual health and STD-prevention practices among participants. Indicators of knowledge recorded before and after the intervention are presented and evaluated against the scores of a control group. Levels of sexual activity and factors associated with risky sex are discussed. The intervention was successful in raising the young men's awareness of STDs significantly in all areas except for the length of time that symptoms take to manifest following risky sex and the ineffectiveness of washing one's genitals after sex to avoid acquiring STDs. Lessons learned during the intervention are described as a means of informing future STD-education programs, and issues requiring prompt attention are identified.
(INDIA, CITIES, SLUMS, SEXUALLY TRANSMITTED DISEASES, PREVENTIVE MEDICINE, HEALTH EDUCATION, PROGRAMME EVALUATION).
English - pp. 138-150.
S. Awasthi and V. K. Pande, Department of Pediatrics and Clinical Epidemiology Unit, King George's Medical College, Lucknow University, Lucknow U.P., India; M. Nichter, Department of Anthropology, University of Arizona, Emil Haury Building, P.O. Box 210030, Tucson, AZ 85721, U.S.A.
mnichter@u.arizona.edu.
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MAYHEW, Susannah H.; LUSH, Louisiana; CLELAND, John; WALT, Gill.
Implementing the integration of component services for reproductive health.
In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda-integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services-has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed.
(AFRICA SOUTH OF SAHARA, SEXUALLY TRANSMITTED DISEASES, MATERNAL AND CHILD HEALTH, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION).
English - pp. 151-162.
S. H. Mayhew, Reproductive and Sexual Health Programme, International Division, Nuffield Institute for Health, University of Leeds, 71-5 Clarendon Road, Leeds, LS2 9PL, U.K.; L. Lush, Health and Population Policy, J. Cleland, Medical Demography, Centre for Population Studies, G. Walt, Health Policy Unit, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, U.K.
s.h.mayhew@leeds.ac.uk.
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SPEIZER, Ilene S.; BOLLEN, Kenneth A.
How well do perceptions of family planning service quality correspond to objective measures? Evidence from Tanzania.
This study examines the relationship between common objective measures of quality and perceptions of the quality of family planning facilities. Results of prior research indicate that such perceptions are an important determinant of contraceptive use in rural Tanzania. The data for this study are drawn from two surveys conducted in rural Tanzania. Three models are tested separately for women and for men. The important determinants of perceptions of quality among women and men are: perceived travel time to the facility, availability of immunizations, and availability of maternal and child health services. Additionally, the ratio of the number of staff to outpatients is important to men. The data explain a moderate amount of the variance in the quality measures, indicating that perceived quality is not fully predicted by common objective measures of quality. Future surveys of facility quality should develop objective measures to better predict the perceived quality, with the underlying goal of increasing contraceptive use.
(TANZANIA, FAMILY PLANNING PROGRAMMES, PROGRAMME EVALUATION, MEASUREMENT).
English - pp. 163-177.
I. S. Speizer, Tulane University School of Public Health, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112-2737, U.S.A.; K. A. Bollen, Carolina Population Center and the Department of Sociology, University of North Carolina at Chapel Hill, U.S.A.
ispeizer@mailhost.tcs.tulane.edu.
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