Showing papers in "Studies in Family Planning in 1999"
TL;DR: Evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations, and focus-group discussions with men and women highlight the strains on gender relations resulting from contraceptive use.
Abstract: The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment ofbridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.
306 citations
TL;DR: The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regardingFamily planning adoption and influenced listeners to talk with their spouses and peers about contraception.
Abstract: An entertainment-education radio soap opera introduced in Tanzania in 1993 was evaluated by means of a field experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.
273 citations
TL;DR: Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior, and women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region.
Abstract: The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region.
182 citations
TL;DR: Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.
Abstract: Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.
152 citations
TL;DR: The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.
Abstract: This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.
141 citations
TL;DR: In this article, the authors describe a study that was conducted in Kenya to test three different models of ways to provide post-abortion family planning, and they found that the provision of postabortion counseling and methods on the gynecological ward by ward staff was the preferred and most effective model.
Abstract: Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health-care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model.
107 citations
TL;DR: The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the existence of a pharmacy isassociated with lower discontinuation due to side effects or health concerns.
Abstract: This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.
102 citations
TL;DR: By the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quantity and efficiency of their work activities, and contraception appears to be a valuable resource, permitting women to improve their economic and social status.
Abstract: This study examines the social and economic impact of family planning on womens lives in the district of Bamako Mali Africa. Longitudinal data collected by interview in October 1996 from 55 first-time users of clandestine contraceptives were used in this study. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth-control method from their husbands. After collecting all the data it was found out that substantial collusion have occurred between sister-in-law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. Evidences also suggest that clandestine users have higher rates of discontinuation than overt users. This discontinuation is often associated with the menstrual disruption which they feared would make their husbands aware of their contraceptive use. At the end of the study women were aware that their use of contraceptives had increased their mobility and available time enabling them to enhance the quality and efficiency of their work activities. Therefore contraception appears to be a valuable resource permitting women to improve their economic and social status.
83 citations
Journal Article•
80 citations
TL;DR: The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives of adolescent boys and girls have eroded, leading to an apparent increase in premarital sexual activity.
Abstract: Results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District in northern Ghana were reported. The apparent unwillingness or inability of young men to support their offspring and the emergence of HIV/AIDS has changed adolescent reproductive behavior in a particularly worrisome way. The data included 43 in-depth interviews and focus-group discussions with adolescents parents chiefs traditional leaders youth leaders and health workers supplemented by quantitative data from the 1996 panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The links between social environment and the reproductive behavior of adolescents in the Kassena-Nankana District were described. Relevant data from large-scale demographic surveillance and survey initiatives in the district were used to set qualitative findings in the study. The principal question addressed is whether the social and economic landscape has shifted in ways that undermine traditional sexual and reproductive behavior. Results indicated an increase in girls education and the beginning of a decline in the incidence of early marriage. Thus social institutions systems and practices such as female circumcision that previously structured the lives of adolescents have eroded leading to an apparent increase in premarital sexual activity.
71 citations
TL;DR: Evidence of a significant enabling or facilitating role of family planning services is found, and the results suggest that family planning program factors influence contraceptive intentions in important ways.
Abstract: Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.
TL;DR: This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory and strategies employed to lower contraceptive risk.
Abstract: This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use; poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey.
TL;DR: The popularity of female sterilization in rural Andhra Pradesh is shown to be intelligible if the symbolic value of a young mother's reproductive capacity is understood in terms of familial power relations.
Abstract: By analyzing the practice of female sterilization in rural Andhra Pradesh, in southern India, this article examines the role culture plays in demographic research. The popularity of female sterilization in rural Andhra Pradesh is shown to be intelligible if the symbolic value of a young mother's reproductive capacity is understood in terms of familial power relations. Through sterilization, young mothers can symbolically push their influential mothers-in-law toward old age, thus increasing their own relative prestige, and they can strive to control the ambiguity surrounding their reproductive functions. This study is based on 14 months of participant observation in three rural villages, a survey of 396 households, and unstructured interviews with 42 women and two men. It shows how demography and anthropology can be mutually supportive in their efforts to clarify population phenomena.
TL;DR: Findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices are presented, showing its considerable impact in broadening reproductive options.
Abstract: This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.
TL;DR: In this article, the authors examined the possible roles of contraception and induced abortion in causing teenage fertility to fall and found that an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that even though the proportion of teenagers who sought abortion increased, the abortion rate declined.
Abstract: The teenage fertility rate fell precipitately in Sweden after 1966 and is now one of the lowest in Europe. This decline can be seen in the context of major reforms enacted in 1975 whereby the school sex-education curriculum was revised, contraceptive services were improved, and abortion was provided free and on demand. By means of microsimulation, the possible roles of contraception and induced abortion in causing teenage fertility to fall are examined. Before 1975, the decline appears to have been caused primarily by an increase in the number of induced abortions. After that date, however, an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that, even though the proportion of teenagers who sought abortion increased, the abortion rate declined. Parallels are drawn with the experience of other European countries, and contrasts with that of the United States, where no such developments have occurred, are noted.
TL;DR: The individual-level characteristics found to influence switching behavior include the method used, method-related difficulties with previous contraceptive use, and education, and the community level for certain types of transition.
Abstract: The major focus of the study was to examine the individual community and district factors influencing women to continue or discontinue the use of a contraceptive method. The data came from the BDHS conducted between 1993 and 1994. In the selected households a total of 9640 ever-married women 15-49 years old were interviewed. Retrospective data on contraceptive use were collected for a period of 6 years from April 1988 to the month of the interview. The final sample consisted of 3826 intervals of pill use 2345 intervals of other modern method use and 1490 traditional contraceptive use intervals. The method changes made by a cohort of Bangladeshi women younger than 25 were examined. In the country the impressive contraceptive prevalence was matched by an equally notable rate of discontinuation. Only 13% of the women were still using the pill at the end of the period and 65% of those who discontinued had an unplanned pregnancy. Among women who used traditional methods only around one-quarter were still using contraception at the end of the 24-month period. Women 30 or older were much less likely to discontinue use to become pregnant or because of contraceptive failure. Teenage women were less likely than those in their 20s and 30s to switch to a modern method. Women with few children were less motivated to continue. Pill user who had at least secondary-level education had an increased chance of switching to a traditional method. For pill users the risk of discontinuing in order to become pregnant or because of contraceptive failure was the highest in Chittagong division. The rate of switching to nonuse while still in need of contraception was greater for Muslims than for Hindus for any type of modern method. Condom users were most likely to switch to nonuse in most cases because they wished to become pregnant.
TL;DR: The discrepancy in son preference across the Korean peninsula seems due largely to the socialist agenda pursued in the north following political partition after World War II, and an important aspect of that agenda challenged the ancient Confucian ideology presumed to underlie son preference.
Abstract: Son preference in South Korea is stronger than anywhere else in the world, yet little is known about such preference in North Korea. Simple indicators of son preference in North Korea are constructed from its 1993 population census and a 1998 survey of child nutrition (conducted in the wake of the recent famine). These indicators include sex ratio at birth, sex ratios of infant and child mortality, and sex ratios of child malnutrition. North Koreans do not evince prenatal discrimination against daughters, a finding that may indicate a lack of prenatal sex-testing technologies. Neither is evidence found of excess female mortality or malnutrition in the postnatal period, during which discrimination requires no special technology. The discrepancy in son preference across the Korean peninsula seems due largely to the socialist agenda pursued in the north following political partition after World War II. An important aspect of that agenda challenged the ancient Confucian ideology presumed to underlie son preference. Apparently, this challenge was more successful in North Korea than in other Asian societies instituting similar political changes, because son preference was not eliminated in China or in Vietnam.
TL;DR: Promoting the use of simple, field-based methods of diagnosing five reproductive tract infections in two rural Chinese counties using "gold standard" laboratory diagnosis as the reference would reduce the prevalence and severity of these preventable and easily treated infections.
Abstract: This study assessed the accuracy of simple field-based methods for diagnosing reproductive tract infections (RTIs) in rural Yunnan Province China RTIs have been recognized as a significant cause of poor health among Chinese women Two rural counties--Chengjiang and Luliang--were surveyed by a population-based method 2020 married women aged 15-49 years were included in the sample survey Simple field-based tests were conducted for Trichomonas Candida and bacterial vaginosis using wet-mount microscopy and biochemical tests The analysis showed that self-reported symptoms and clinical examination were ineffective in RTI differential diagnosis because many infected women showed no symptoms or were infected with two or more conditions Simple tests greatly improved diagnostic accuracy particularly for Candida and Trichomonas The wet mount and vaginal pH test combination were preferable for diagnosing Candida However the diagnostic approach for Trichomonas should be reassessed because this method requires substantial investment Other simple tests do not work well for diagnosing bacterial vaginosis and chlamydial and gonorrheal infections Thus this study demonstrates the feasibility and limitations of RTI management at the local level in rural China
TL;DR: The participants surveyed remembered the information they were questioned about better than did participants in some other studies a finding that supports earlier research results showing that younger healthier patients (such as contraceptive users) recall better than older less healthy ones.
Abstract: Recall and understanding of information provided to contraceptive study participants in four sites were assessed. Analysis was completed of data for 70 women who were asked about their recollection of information and understanding of participation. Most women understood the purpose of the study. Their reasons for agreeing to participate varied by site and included wanting to try a new method wanting to help others and wishing to avoid pregnancy. Most women recalled correctly the burden of participation—number and frequency of visits tests and examinations. Most understood that they could withdraw from the study without jeopardizing their care. The women were also asked to recall the risks and benefits of the contraceptive they were testing. Only 23% recalled the pregnancy risk correctly; 40% underestimated and 19% overestimated it. Few women interpreted rates of risk correctly; some perceived high rates as low ones and the rates of the spermicide being studied as better than those of other contraceptives. This study confirms that risk is better recalled than understood. The participants surveyed remembered the information they were questioned about better than did participants in some other studies a finding that supports earlier research results showing that younger healthier patients (such as contraceptive users) recall better than older less healthy ones. (authors)
TL;DR: This study demonstrates that integrated postpartum health-care interventions are possible for poor communities, providing significant advantages for women and children.
Abstract: An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.
TL;DR: Direct and indirect estimates suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.
Abstract: Key findings from a maternal mortality study conducted in the Kassena-Nankana district of northern Ghana in 1997-98 are presented. The factors influencing the high maternal mortality rate included high disease burden during pregnancy substantial delays in seeking care for pregnant women and inadequate health facilities for serious obstetric cases. Sibling history data randomly sampled from 8399 women aged 15-49 and longitudinal data collected from the 1997 Maternal Mortality Survey and Navrongo Demographic Surveillance System (NDSS) were analyzed. A comparison between mortality data from these two sources indicated accurate estimates of age-specific death rates using the sisterhood method. Results showed a good fit between direct maternal mortality estimated from the sibling histories and those from longitudinal demographic surveillance data. Great consistency between direct and indirect estimates of maternal mortality ratios collected from the sibling history data was indicated. The results of the study using estimates from these two methods suggested a decline in the maternal mortality rate for the Kassena-Nankana District from about 800 to 600 maternal deaths per 100000 live births over the past 14 years.
TL;DR: Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth and because the procedure is legal and easily available.
Abstract: This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100000 live births. This ratio compares with the World Health Organization’s estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries takes place in clinics and hospitals where few women die in childbirth. Also few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available. (authors)
TL;DR: An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about "traditional" methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish.
Abstract: In-depth interviews conducted with 150 women and 141 men (128 matched couples) from rural Bangladesh as part of a survey of contraceptive use patterns revealed many inconsistencies between partners especially in terms of use of condoms the safe period and withdrawal. In general respondents who used coitus-dependent methods had difficulties answering survey questions on method use. Although many couples are known to use a combination of coitus-dependent methods (e.g. condoms during the fertile period of the cycle and coitus interruptus on days considered to be associated with a lower probability of conception) the interviews did not reflect this pattern. If one coitus-dependent method was mentioned by the woman and another by the man investigation showed that in most cases the couple was using a combination of all the coitus-dependent methods they had mentioned. In some cases the method mix employed by a couple changed from month to month. As a result different aspects of a couples regular sexual practice might be reported by each partner. Occasional unavailability of condoms was another reason for multiple method use. Overall these findings indicate that inconsistencies in reported use of coitus-dependent methods of family planning are not due to careless or misleading responses to survey questions. These methods are so often used in combination in order to enhance contraceptive effectiveness that the combination itself is really the method being used. More accurate assessment methods are needed to capture use of coitus-dependent methods.
TL;DR: The number of rounds during which women received visits from family planning workers is found to have no statistically significant effect on the probability that women altered their preference from wanting more children at the beginning of an interval to wanting no more at the end of the interval.
Abstract: This study examines the relationship between the decline in desired family size and visits from family planning workers within three intervals (1982-85 1985-90 and 1990-93) in Bangladesh. Data utilized were gathered from surveys conducted by the International Center for Diarrheal Disease Research Bangladesh Maternal and Child Health-Family Planning Extension Project. A logistic regression analysis was used to examine whether family planning workers visit received during an interval had an effect on the probability that altered womens fertility preference. Results revealed that a number of rounds during which women received visits from family planning workers has no statistical significant effect on the probability that women altered their preference from wanting more children at the beginning of an interval to wanting no more at the end of the interval.