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Showing papers in "Studies in Family Planning in 1977"


Journal Article•DOI•
TL;DR: Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined and variations in duration relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions.
Abstract: Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined. Quite extensive periods of postpartum abstinence are still observed by most rural and poorer urban women to prolong breastfeeding and increase child survivorship. Differentials in duration of breastfeeding and abstinence relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions. Implications for family planning prospects and policies are noted.

40 citations


Journal Article•DOI•
TL;DR: Only vigorous and active follow-up, together with ample time to complete data collection, editing, coding, and key punching, is likely to reduce the proportion of women with incomplete observations and be likely to minimize the biases attendant upon incomplete or partial observations of acceptors in prospective clinical studies of IUDs.
Abstract: Two major prospective studies of copper-bearing IUDs showed substantial changes in termination rates when calculated at different dates. One of the studies employed the Tietze life-table method and showed progressive increases in termination rates with the passage of time. The other study used the Potter life-table method and showed sharply decreased termination rates at later assessments. In investigating the reasons for these changes, it was noted that the data collected for periodic analyses during the studies violated the assumptions underlying the life-table technique. It was discovered that as a result of these violations the Potter and the Tietze life-table calculations based on the same set of data produced markedly different estimates of IUD termination rates during the course of a study. Underlying these differences, and the reason for the apparent changes in termination rates, was a large set of incomplete observations. Neither of the two life-table methods was able to deal adequately with the biases arising from these incomplete observations. The "anniversary method," devised to overcome the perceived problems of the Potter and Tietze methods, also proved inadequate to deal with the incomplete observations. Only vigorous and active follow-up, together with ample time to complete data collection, editing, coding, and key punching, is likely to reduce the proportion of women with incomplete observations and is likely to minimize the biases attendant upon incomplete or partial observations of acceptors in prospective clinical studies of IUDs.

40 citations



Journal Article•DOI•
TL;DR: Findings for 35 patients who underwent religation showed that recanalization and the establishment of a fistulous opening caused the majority of failures, indicating that more effective methods of tubal occlusion in sterilization are needed.
Abstract: 10174 female sterilization procedures performed in the University Dept. of Obstetrics and Gynecology at Kandang Kerbau Hospital (Singapore) during 1970-1975 were reviewed with the objective of estimating the pregnancy rates for women undergoing various procedures. 7989 (79%) of the tubal ligation procedures were performed by minilaparotomy 1650 (16%) by culdoscopy 314 (3%) by the vaginal approach and 221 (2%) by laparoscopy. The crude failure rate was .12 for minilaparotomy 1.21 for culdoscopy 2.23 for the vaginal approach and 3.17 for laparoscopy. Cumulative failure rates at 24 months were .34 for minilaparotomy 1.67 for culdoscopy 3.12 for the vaginal approach and 4.49 for laparoscopy. 8 of the 51 pregnancies reported were ectopic. Most of the failures were attributable to the technique of tubal ligation employed and the site of ligation. Technical reasons for the failures are discussed.

35 citations


Journal Article•DOI•
TL;DR: To decrease the need for abortion, programs that change attitudes toward sexual behavior and that give women increasing economic opportunities are needed in addition to programs that make contraceptives more available.
Abstract: A study of 500 abortion-seeking women in the San Francisco Bay area, in California, revealed that, although a majority of them had used contraceptives previously, only a minority had consistently used effective contraceptives. This paper presents a theory of contraceptive risk taking and analyzes the decision making process described by 50 of the women during in-depth interviews. The decision not to contracept is shown to be the result of a rational process of "cost accounting." To decrease the need for abortion, it is argued, programs that change attitudes toward sexual behavior and that give women increasing economic opportunities are needed in addition to programs that make contraceptives more available.

34 citations


Journal Article•DOI•
TL;DR: An inquiry into methodological issues suggests two recommendations for improvement of research procedures: more attention must be paid to the reliability of the questionnaires by which attitudes and practices are measured, and questions on attitudes and Practices should refer to the same action or object and to theSame period of time.
Abstract: Results of many family planning surveys do not suggest that attitudes are strongly predictive of family planning practices. An inquiry into methodological issues suggests two recommendations for improvement of research procedures. First, more attention must be paid to the reliability of the questionnaires by which attitudes and practices are measured. Second, questions on attitudes and practices should refer to the same action or object and to the same period of time. The available evidence suggests that implementation of these procedures can lead to identification of stronger linkages between family planning attitudes and practices, and to survey results having greater practical utility.

26 citations


Journal Article•DOI•
TL;DR: Ever-use of modern contraceptives was shown to be very low and the desire for many children very strong, which suggests that a significant interest in family planning services exists in Ngwa Igbo.
Abstract: A survey was conducted in August 1974 in 16 Ngwa Igbo villages in the East Central State of Nigeria to determine the attitudes and practices of currently married women with regard to fertility and contraception. The results revealed that 50-60 percent of wives had ever used traditional contraceptives (abstinence, prolonged lactation, and rhythm), although data suggest that some of these methods may have been used for purposes other than contraception. Ever-use of modern contraceptives (pill, IUD, and tubal ligation) was shown to be very low and the desire for many children very strong. Nearly 80 percent of the women interviewed, however, expressed a willingness to attend a family planning clinic if one were accessible to them. This finding suggests that a significant interest in family planning services exists in Ngwa Igbo.

25 citations


Journal Article•DOI•
TL;DR: The safety of early vacuum aspiration performed as an outpatient procedure using local anesthesia was examined in a controlled study sponsored by the World Health Organization and undertaken in two centers in Yugoslavia and Singapore.
Abstract: The safety of early vacuum aspiration performed as an outpatient procedure using local anesthesia was examined in a controlled study sponsored by the World Health Organization and undertaken in two centers in Yugoslavia and Singapore. The sample consisted of healthy women whose pregnancies were between 7 and 12 weeks in duration. Follow-up four weeks after abortion was nearly 100 percent in both centers. No important differences in complication rates were found between the different types of services and anesthesia, even though overall complication rates differed markedly between centers. Overnight postabortion observation was not associated with any decrease in complications.

24 citations


Journal Article•DOI•
TL;DR: Analysis of consistency of responses shows that while overall reliability at both aggregate and individual levels is reasonably good, there is greater reliability for factual than for attitudinal data.
Abstract: A number of factual and attitudinal questions asked in the 1973 Taiwan KAP-4 survey were repeated in a postenumeration survey one month later in order to assess the reliability of responses of the 286 women reinterviewed. The level of reliability is found to vary depending on the measures used and on whether the focus is aggregate data or individual responses. Analysis of consistency of responses shows that while overall reliability at both aggregate and individual levels is reasonably good, there is greater reliability for factual than for attitudinal data. Nevertheless, consistency of responses on factual questions varies considerably depending on the salience of the topic to the respondent. Estimates of reliability are shown to depend on the measure used and on the skewness of the distributions of the responses.

20 citations


Journal Article•DOI•
TL;DR: The overall rate of repeat abortion is consistent with a high level of contraceptive effectiveness and was found to be more frequent among women aged 20-34 and among women with a greater number of pregnancies, live births, and induced abortions prior to the change in law.
Abstract: The abortion registration system maintained by the Danish government permits an analysis of abortion incidence by individual. Using computer techniques to sort all the abortion records for the 15-month period from October 1973, when the abortion law was liberalized, through December 1974, it has been possible to determine the rate of repeat abortion and some demographic variables associated with it. Of the women who experienced induced abortion in the period under study, 2.92 percent had more than one abortion. Repeat abortion was found to be more frequent among women aged 20-34 and among women with a greater number of pregnancies, live births, and induced abortions prior to the change in law. A higher rate of repeat abortion was observed in urban areas. The overall rate of repeat abortion is consistent with a high level of contraceptive effectiveness.

19 citations


Journal Article•DOI•
TL;DR: The results indicate that nonrandom reliability at the individual level ranged from quite high (for several straightforward, facual questions) to quite low (for most attitudinal questions) and there was considerable distributional stability, however, even for many of the variables with low individual-level reliability.
Abstract: The two rounds of the National Longitudinal Study in Thailand provide a useful opportunity to explore response reliability in a large-scale social and demographic survey in a developing country. The results indicate that nonrandom reliability at the individual level ranged from quite high (for several straightforward, facual questions) to quite low (for most attitudinal questions). There was considerable distributional stability, however, even for many of the variables with low individual-level reliability. In terms of its response reliability, the Thai study compares reasonably well with several leading US fertility surveys. However, in both countries response reliability at the individual level for attitudinal questions is distressingly low. This clearly should be a matter of major concern for social scientists using survey results.

Journal Article•DOI•
TL;DR: A set of guidelines for ethical evaluation of incentive schemes is proposed and it is argued that, in a just scheme, a progressive, negative incentive or fee, calculated as a surtax on a modified income tax or an equivalent standard, would distribute burdens equally.
Abstract: A range of various incentive programs is presented and ethical implications of each considered 3 studies in India show that family planning acceptors prefer immediate incentives Group incentives exert a definite pressure on the individual Some pay a flat rate and some a variable rate and others pay the finder of an acceptor The most just incentives are sliding scale incentives which will not put undue pressure on the poor It seems impossible to do this with a positive incentive Instead a progressive negative incentive or fee is proposed calculated as a surtax on a modified income tax or an equivalent standard that would distribute burdens equally To be judged ethically acceptable an incentive should: avoid coercion avoid harming children (denying health or welfare services) minimize the monetizing of childbearing decisions avoid promoting population-related decision for immediate financial gain avoid deception distribute the burden of change in population-related behavior equally and apply to all childbearing decisions equally rather than being limited to decisions after the Nth child


Journal Article•DOI•
TL;DR: Women in their first pregnancies and those who had experienced an induced or spontaneous abortion in their previous pregnancy had a higher rate of complications following the current induced abortion.
Abstract: Patient characteristics such as age and parity, the timing of abortion, and the technique and procedures are all factors that may affect the risk of complications following induced abortion. With respect to the last two factors, Andolsek (1974) found fewer short-term complications associated with vacuum aspiration than with dilatation and curettage. However, in another study, based on the same sample used here, she found no higher risk of complications after induced abortion performed under local anesthesia than under general anesthesia (see the preceding article in this issue). This study tests the relationship between complication rates following vacuum-aspiration abortion and several patient and method characteristics: age, marital status, parity, duration of pregnancy, outcome of last pregnancy, interval since last pregnancy, and amount of cervical dilatation achieved. It also compares findings with those of earlier studies. The data derive from a controlled study conducted in Yugoslavia and Singapore comparing the risk of complications following induced abortion by vacuum aspiration using (1) local versus general anesthesia and (2) outpatient services versus overnight postoperative hospitalization. The sample consists of a group of healthy women pregnant 7-12 weeks. The study was conducted in 1973-74 at the World Health Organization (WHO) Collaborating Centers for Clinical Research on Human Reproduction at the Family Planning Institute and the Clinic of Obstetrics and Gynecology, Ljubljana, Yugoslavia,

Journal Article•DOI•
TL;DR: The present analysis indicates that the use of oral contraceptives, in the absence of smoking, is considerably safer than no fertility control for all ages, including the group aged 40-44.
Abstract: Recent studies in Great Britain and the United States have raised serious concern about the safety of oral contraceptives for women aged 40 and over. This article reanalyzes the data published in these studies and shows that a clear understanding of the synergistic effects of smoking and pill use is essential for proper assessment of the safety of oral contraceptives. The present analysis indicates that (1) the use of oral contraceptives, in the absence of smoking, is considerably safer than no fertility control for all ages, including the group aged 40-44; (2) the use of oral contraceptives among smokers aged 40 and over is substantially more hazardous than no fertility control, although there is little difference for light smokers; (3) the use of oral contraceptives among heavy smokers in the group aged 30-39 may be more hazardous than no fertility control; and (4) the use of oral contraceptives among heavy smokers in the group aged 15-29 may be more hazardous than any other method of fertility regulation.

Journal Article•DOI•
TL;DR: Programmatic evidence suggests that using nurse-midwives more extensively for Copper T insertion would increase IUD acceptance at no cost to the existing loop program.
Abstract: In 1972-1973 a study involving 40 midwives from Thailand rural health centers with no physician or only a part-time physician and from a few intermediate-size health centers was made to see if IUD insertion could be accomplished by paramedical personnel. Training was both theoretical and practical and took 6 weeks. Nurse-midwives were especially trained to note pelvic abnormalities and do routine follow-up. After the training course the group inserted over 3700 Copper-T IUDs. In 1974 a systematic 1-in-3 sample of these insertions was evaluated; of this initial sample of 1035 women 80% or 816 were available for follow-up. In addition clinic records were recovered for 154. Continuation rates were 86.8% for the midwife insertions compared with 81.9% for a control group of physician insertions. Expulsion rate was 2.9% compared with 6.7% for physician insertions. Removals for medical reasons were 6.4% compared with 5.2% for the controls. The higher expulsion rate for physicians could be due to the lower parity of the urban physician sample. Also in more difficult cases the midwife might have referred the case to a physician or not made an insertion. More of the women who had nurse-midwife insertions reported pain at insertion and heavy bleeding the 1st week after insertion. Most of these complaints were either self-treated or treated by the nurse-midwife. Most acceptors felt the side effects had been explained to them well and they left the clinic with a satisfactory understanding of the method. They also reported they had spoken favorably of the clinic to friends and neighbors. Since 1972 sterilizations have increased in Thailands clinics while oral contraceptive use has fallen. Use of nurse-midwives has expanded IUD insertions and seems to be increasing contraceptive use especially in rural clinics. It is felt that the addition of the Copper-T device would not be at the expense of the Lippes Loop program.

Journal Article•DOI•
TL;DR: The Preethi marketing program resulted in sales of more than 11 million condoms during its first 33 months, multiplying Sri Lanka's annual per capita condom use by a factor of five, and suggests that a social marketing approach can advance family planning at a relatively low cost.
Abstract: The Preethi marketing program resulted in sales of more than 11 million condoms during its first 33 months, multiplying Sri Lanka's annual per capita condom use by a factor of five. Estimates for 1974 show 144,000 new acceptors (8% of married women of reproductive age), totaling 50,000 couple-years of protection. It is also estimated that more than half of the nation's 1.8 million couples of childbearing age were educated about the function of a condom. Unit costs were low for this new, nationwide program: about US $2.00 for each new acceptor; 6.00 dollars for each couple-year of protection; and 0.09 dollars for each couple educated. The program's success suggests that a social marketing approach can advance family planning at a relatively low cost.

Journal Article•DOI•
TL;DR: Menstrual regulation is the induction of uterine bleeding that has been delayed up to 14 days from its anticipated date of onset and can be accomplished mechanically and through the administration of drugs.
Abstract: Menstrual regulation is the induction of uterine bleeding that has been delayed up to 14 days from its anticipated date of onset. MR can be accomplished mechanically and through the administration of drugs. By far the most common method of performing menstrual regulation is by mini-vacuum aspiration. Induction of delayed menstruation through prostaglandin compounds initially appeared promising but was associated with a high and unacceptable incidence of gastrointestinal side effects. Although the use of estrogens and progesterones to induce delayed menstruation has been a common practice, these drugs not only are ineffective, but they are also potentially dangerous to both the woman and her offspring (Vengadasalam et al., 1976, 1977). New analogs are constantly under investigation, especially those having the potential for self-administration, but at this time they offer no advantages over vacuum aspiration. Menstrual regulation by vacuum aspiration is generally performed as an outpatient procedure, without anesthesia, using relatively simple and inexpensive equipment. It is frequently performed without a positive pregnancy test during the interval before conventional pregnancy testing is reliable (the first two weeks after a missed menstrual period). This technique has achieved international acceptance as an uncomplicated, safe, and effective method of inducing uterine bleeding irrespective of the cause of the delay.

Journal Article•DOI•
TL;DR: The acceptability of family planning services was studied at 12 federally funded clinics in the poor, inner-city area of Detroit by means of a questionnaire given to 535 patients selected at random.
Abstract: In order to determine whether patients were satisfied with the care provided by the Detroit Michigan public family planning services the acceptability of family planning services was measured through the subjective reactions of the women patients at 12 clinics to the interpersonal and physical aspects of the services in the clinic setting. All patients were black; 92% had a monthly income of less than $500; 94% were age 34 or younger; and 81% used oral contraceptives. "Acceptability" was defined as the extent to which clinic service is considered by patients to be attractive or popular. About 45 patients who had seen the doctor and nurse at each of the 12 clinics were selected randomly from those attending during the 1st and 2nd weeks of March 1974. 5 factors accounting for 85% of the total variance were used as the acceptability criteria - nurses care doctors care waiting time accessibility and comfortableness of the clinic. Community clinics were evaluated more favorably than hospital clinics and clinics providing family planning services only were rated more favorably than those providing other services as well. Analysis of variance results showed that the between-clinic variation is significantly greater than the within-clinic variance (p < .001) suggesting that acceptability scores reflect differences among clinics rather than reactions of individual patients. Pearsonian correlations among the 5 criteria were found to be all positive and statistically significant at the .01 level. The strongest correlation existed between doctors care and nurses care suggesting that in general a patient who views the doctors care as highly acceptable will consider the nurses care highly acceptable also. The 2 items rated least acceptable were time spent waiting for the doctor and time the doctor spent with the patient. Contrary to the critical opinions expressed about family planning services for the poor in Detroit 72% of the women in this study judged the services to be acceptable. There were differences however in ratings when various subgroups of patients and clinics were reviewed separately.

Journal Article•DOI•
TL;DR: The preliminary test showed that household distribution was culturally acceptable and administratively feasible and that it did increase contraceptive use, and cost-effectiveness was considered to be within the range of the national program.
Abstract: A major 4-phase experiment was conducted in Euiryong about 150 km northwest of Pusan City Korea to test 3 alternative delivery systems of family planning determine which is most feasible for Korean rural areas to investigate possible conflicts between the new systems and the government health network and to devise a suitable information system for a later large study. Distribution in addition to the government program seems advisable because of the inconvenience of walking or traveling to government clinics the inability of mass clinics to give personal help and reassurance and the reluctance of women to go to government clinics. The 1st delivery system was called the 100% method; all households with 1 or more eligible women were canvassed and the eligible women were offered contraceptives. The 2nd system involved group meetings with partial canvas of households not represented at the meeting. The 3rd method called the 10% method divided the households into groups of 10 and a woman from each group recruited to be responsible for family planning supplies. All 3 systems were successful in that they increased contraceptive use considerably during the 4-month trial they were culturally acceptable and they were cost-effective. The group meetings proved least effective and the leaders ended up canvassing each household by the end of the trial. The 10% method proved to be a nightmare for crew leaders who were continually recruiting new canvassers. Therefore the 100% method was chosen for the larger trial. All 3 methods increased contraceptive use about 20-25% during the 4 months. The larger study began in 1976 in Cheju province.

Journal Article•DOI•
TL;DR: This paper examines the problems of language usage and of translation, in KAP surveys in particular, using examples from African and other research experience to emphasize that language pervades all stages of family planning surveys.
Abstract: Language is an important but often neglected source of non-sampling error in family planning surveys. This paper examines the problems of language usage and of translation, in KAP surveys in particular, using examples from African and other research experience. The authors emphasize that language pervades all stages of family planning surveys, pointing out that interpretations of survey results should take into account the possibility of the influence of language differences. Various measures are suggested that can contribute to minimizing this source of response error.


Journal Article•DOI•
TL;DR: The data suggest that in Jordan, as in many other developing countries, the fertility rate is extremely high, and that, while rural/urban residence and socio-economic status have no significant influence on fertility, educational attainment of wives does have a marked effect on fertility.
Abstract: A national fertility sample survey conducted in 1972 on the East Bank of the Hashemite Kingdom of Jordan collected information on fertility levels, desire for additional children, and knowledge and practice of family planning. The data suggest that in Jordan, as in many other developing countries, the fertility rate is extremely high, and that, while rural/urban residence and socio-economic status have no significant influence on fertility, educational attainment of wives does have a marked effect on fertility. The survey results also indicate that, while knowledge of contraception is not lacking, its practice is limited, and that the average ideal family size is lower than the actual size among almost all socioeconomic groups.

Monograph•DOI•
TL;DR: In this paper, the authors present the results of a study on the development of children in the context of the Ford Foudation, New York, India office. Department of Child Development, University of Baroda, Gujarat, India.
Abstract: Ford Foudation, New York, India office. Department of Child Development, University of Baroda, Gujarat, India.

Journal Article•DOI•
TL;DR: In this paper, the influence of women's birth parity and accumulated market skills on their current labor force participation and birth expectations was examined within a sequential choice framework, showing that women who have accumulated larger families work less in the current period and anticipate fewer additional births.
Abstract: The influence of women's birth parity and accumulated market skills on their current labor force participation and birth expectations is examined within a sequential choice framework. Analysis of household data from the 1973 Philippines National Demographic Survey suggests these patterns: (a) women who have accumulated larger families work less in the current period and anticipate fewer additional births; (b) women with more past work experience tend to work more hours in the current period; and (c) work experience appears to have only a weak negative effect on birth expectations among older women.

Journal Article•DOI•
TL;DR: Analysis of 8,073 abortions performed in the state of Karnataka between April 1972 and March 1975 indicates that abortions have increased rapidly since legalization, with proportions of women with less than primary education obtaining abortions and number of new contraceptors after abortion increased.
Abstract: Induced abortion in India was liberalized by the Medical Termination of Pregnancy Act, which became effective in April 1972. Analysis of 8,073 abortions performed in the state of Karnataka between April 1972 and March 1975 indicates that abortions have increased rapidly since legalization. Age of women obtaining abortions, their family size, duration of pregnancy, and age of new contraceptors after abortion have declined, while proportions of women with less than primary education obtaining abortions and number of new contraceptors after abortion have increased. Data suggest that if there were more approved rural hospitals and a greater diffusion of information, the number of legal abortions would increase further.

Journal Article•DOI•
TL;DR: While about the same number of couples were served by the private programs in 1976 as in 1976, the commercial sector grew at over 10 percent per year and official coverage expanded around fivefold, and the proportion of eligible women protected by contraception doubled.
Abstract: This study analyzes changes in levels of contraceptive protection that had occurred as of June 1976 in response to the efforts and resources expended since 1973. It also presents results of major follow-up studies carried out in the two largest family planning programs-those of SSA and IMSS. To calculate levels of contraceptive practice the following sources of information were utilized: the official statistics of the family planning programs of APSM FEPAC SSA IMSS and ISSSTE; an unpublished study of the commercial distribution of contraceptives conducted at the request of SSA in 1974; and figures on commercial distribution of contraceptives during 1974 1975 and 1976 gathered by the International Marketing Survey and compared with those offered extraofficially by the leading drug distributors. The analysis also uses data from studies carried out by FEPAC SSA and IMSS of the continuation rates of their acceptors. (excerpt)


Journal Article•DOI•
TL;DR: Fertility has declined especially rapidly among the more poorly educated strata since these are a large if diminishing part of the Taiwan population and this pattern is consistent within all educational strata but especially among the poorly educated.
Abstract: In this report Taiwans continuing fertility decline is brought up to date through 1974 and attention is given to the role of changing educational distributions in the fertility decline from 1966 to 1974. Between 1961-1974 Taiwans crude birthrate decreased from 37.7 to 23.4 a decline of 38%. The major cause of this decline was the decline in marital fertility. In comparing the 3 broad periods 1961-1965 1965-1970 and 1970-1974 the following trends become evident: 1) fertility decline was greatest in the most recent period as measured either by per annum decline in the standardized birthrate or by the total fertility rate; and 2) the fertility decline has shifted into younger ages. Education has been shown to have a strong relation to fertility marital status and other aspects of reproduction in Taiwan in the past. Although data is not available for the entire 1961 through 1974 period data are available on age-education specific fertility rates for 1966 1971 and 1974. It is learned that the educational distribution has changed within reproductive age groups for the period under review. For example among women aged 25-29 the proportion with less than primary education decreased from 48% to 21% while the percentage with senior high school education increased from 6% to 18% in the 1966-1974 period. The most important general statement that can be made about education-fertility data is that while structural changes in educational levels have had a significant effect in producing lower fertility in Taiwan the major effects come from changes in fertility within educational strata. It is particularly important that fertility has declined especially rapidly among the more poorly educated strata since these are a large if diminishing part of the Taiwan population. Data from other sources indicate that this pattern is consistent within all educational strata but especially among the poorly educated.

Journal Article•DOI•
TL;DR: Decline in third and subsequent births was the most important factor in fertility decline after 1972, and the numbers of abortions and sterilizations undergone by higher parity women have increased substantially sin"e 1970.
Abstract: To aid in achieving demographic goals, since 1968 the government of Singapore has passed a series of laws designed to limit family size. Policies were instituted in 1968 to discourage couples from having more than three children; policies introduced in 1973 discouraged having more than two. Trends in fertility rates and in the numbers of abortions and sterilizations in recent years are consistent with the intent of these social policies. Decline in third and subsequent births was the most important factor in fertility decline after 1972, and the numbers of abortions and sterilizations undergone by higher parity women have increased substantially sin"e 1970. Although other factors have affected fertility in Singapore, the data suggest that the disincentives have played a role in continued fertility decline in recent years.