Showing papers in "Studies in Family Planning in 2001"

The Effect of Power in Sexual Relationships on Sexual and Reproductive Health: An Examination of the Evidence

Abstract: This article reviews what has been learned to date about the role of gender-based power in sexual relationships in determining sexual and reproductive health outcomes. A framework for assessing the relationship between power relations and reproductive health is outlined and measurement issues are critically discussed. A summary is included of the main types of intervention approaches that have been implemented, as are a discussion of the programmatic, methodological, and ethical implications of the findings and recommendations for further experimentation and research. Although many challenges remain, results to date suggest that when the role of gender-based power is made an integral feature of sexual and reproductive health programs, there is a considerable payoff for both women and men.

Researching domestic violence against women: methodological and ethical considerations.

Abstract: The results of three population-based studies on violence against women in Nicaragua are compared in this article. Two of the studies were regional in scope (Leon and Managua) and focused specifically on women's experiences of violence, whereas the third study was a Demographic and Health Survey (DHS) conducted with a nationally representative sample of women. The lifetime prevalence estimates for women's undergoing physical violence from a partner were significantly higher in the Leon study (52 percent) and Managua study (69 percent), compared with that given in the DHS (28 percent). Possible explanations for the differences are examined through pooled multivariate logistic regression analysis, as well as analysis of six focus-group discussions carried out with field-workers and staff from the three studies. The most important differences that were found concerned ethical and safety procedures and the interview setting. The results indicate that prevalence estimates for violence are highly sensitive to methodological factors, and that underreporting is a significant threat to validity.

Bargaining Power Within Couples and Use of Prenatal and Delivery Care in Indonesia

Abstract: Indonesian women's power relative to that of their husbands is examined to determine how it affects use of prenatal and delivery care Holding household resources constant, a woman's control over economic resources affects the couple's decision-making Compared with a woman with no assets that she perceives as being her own, a woman with some share of household assets influences reproductive health decisions Evidence suggests that her influence on service use also varies if a woman is better educated than her husband, comes from a background of higher social status than her husband's, or if her father is better educated than her father-in-law Therefore, both economic and social dimensions of the distribution of power between spouses influence use of services, and conceptualizing power as multidimensional is useful for understanding couples' behavior

Obstacles to contraceptive use in Pakistan: A study in Punjab

Abstract: The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Survey data are analyzed that were collected in Punjab province in 1996 and that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband's preferences and attitudes, health concerns, and perceived access to services. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future, in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman's perception that such behavior would conflict with her husband's fertility preferences and his attitudes toward family planning and her perception of the social or cultural unacceptability of contraception. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning.

Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya.

Abstract: Using data from nearly 600 adolescents aged 12-19 in combination with data collected from 33 primary schools that the adolescents attended this report explores whether certain aspects of the school environment affect the initiation of premarital sex among girls and boys in three districts of Kenya. The results suggest that although neither the school nor the home appears to influence whether boys engage in sex prior to marriage for girls a school characterized by a gender-neutral atmosphere appears to reduce the risk of their engaging in premarital sex. Furthermore although policy-makers in Kenya are clearly concerned with the problem of "schoolgirl pregnancy" the data indicate that in this sample pregnancy is not the primary reason that girls leave school. (authors)

Disobedient distributors: street-level bureaucrats and would-be patrons in community-based family planning programs in rural Kenya.

Abstract: The implementation of social welfare programs, including family planning programs, is strongly conditioned by the needs, desires, and agendas of those who carry them out, known as "street-level bureaucrats." In this study, the strategies of CBD agents in western Kenya are examined in order to understand how they use their job as a means to achieve their own personal goals. The concept of clientelism, borrowed from the field of political science, can help to explain what the CBD agents are trying to achieve for themselves in their communities, at the same time as they promote the use of contraceptive pills and injections. CBD agents are concerned with building up their own stocks of prestige and respect from their community members, while avoiding blame for any possible negative outcomes of family planning.

Husbands' and wives' reports of contraceptive use.

Abstract: Many Demographic and Health Surveys (DHS) in the past decade have queried husbands and wives about their current contraceptive use. In this study, couples' concurrence on use and method used is compared by means of data from 23 countries, mostly in sub-Saharan Africa. Husbands report higher levels of use than do their wives in every country studied, with ranges from 2 percent higher (Brazil) to 150 percent higher (Mali). Many of the discrepancies are the result of husbands' sole reports of periodic abstinence and condom use. Couples with polygynous husbands show less concurrence than do monogamous couples, although the majority of these differences could result from a data-collection problem. Monogamous couples in which one or both spouses reported having extramarital sex partners show less concurrence than do monogamous couples reporting no other partners. Problems of validity of both husbands' and wives' reports are discerned, and in the few instances where a direct comparison is possible, wives' reports are shown to have greater validity. Logistic regression results show that spousal discussion about family planning and greater female education are consistent predictors of concurrence.

An Evaluation of the “Entre Nous Jeunes” Peer—educator Program for Adolescents in Cameroon

Abstract: A quasi-experimental design is used in this study to evaluate the "Entre Nous Jeunes" peer-educator program to promote STI/HIV-preventive behaviors in Nkongsamba, Cameroon. The main objective of the study is to assess whether the young people exposed to a peer educator gained greater knowledge and practiced more protective behaviors than did those in the control community and those who were not exposed. During the 18-month intervention period, the peer educators were able to reach a large number of young people, specifically those who were sexually experienced and in need of reproductive health information. Multivariate analyses indicate that contact with a peer educator is statistically significantly associated with greater spontaneous knowledge of modern contraception, the symptoms of sexually transmitted infections, and greater use of modern contraceptives, including the condom. In the absence of a peer-education program, current contraceptive use in the intervention community would have been significantly lower.

Husband-wife survey responses in Malawi.

Abstract: Previous efforts by demographers to describe and explain spousal differences in reporting about family planning behavior have focused on individual attributes that are assumed to be related to the practice of contraception. This study extends that research by documenting spousal disagreement on a range of issues--household items livestock children and spousal communication about fertility family planning and AIDS. Using data from a 1998 study of 585 monogamous couples in rural Malawi the analysis identifies a systematic gender component to reporting: For many of the survey questions considered when spouses disagree husbands are more likely to say "yes" and wives "no." The findings are interpreted in terms of gendered strategies in the interview process. (authors)

Correlates of sexual activity and condom use among secondary-school students in urban Peru.

Abstract: Recent data indicate that adolescent fertility rates in Peru remain high and that Peruvian adolescents and young adults account for a disproportionate share of new HIV infections. The present study was undertaken to identify key risk and protective factors for early sexual activity and unprotected sex among secondary-school students in 9 large cities in Peru. Survey data from 6962 students aged 13-18 are consistent with existing research in indicating that behaviors of Peruvian youth are influenced in important ways by many factors. In the present study these included region of residence family economic position family structure working for pay peer behaviors and self-esteem. Knowledge of pregnancy and of the risks of acquiring sexually transmitted diseases and of the means of avoiding both did not however differentiate risk-takers from non-risk-takers. The study findings suggest a need for adolescent health programs to broaden their focus beyond the immediate proximate determinants of behavior such as sexual and reproductive health knowledge and access to contraceptives and also to target some of the key contextual factors in influencing adolescent behavior. (authors)

Impact of an integrated adolescent reproductive health program in Brazil.

Abstract: An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project. (authors)

A client-centered approach to family planning: the Davao project.

Abstract: The reproductive health approach to family planning shifts the focus of service provision from macro-level demographic objectives to meeting clients' needs. Little field experience exists to date, however, to indicate how to implement this approach. This study describes a field project in Davao del Norte and Compostela Valley provinces in the Philippines that implemented the reproductive health approach on a quasi-experimental basis. The intervention was designed to address clients' self-defined reproductive needs by providing them with relevant and accurate information and services of good quality. It consisted of two components: Providers were trained in information exchange at fixed clinics, and supervisors were trained in facilitative supervision. The results presented here indicate that the client-centered intervention was successful in enhancing service providers' knowledge and improving the content of information exchange between providers and clients. One provincial health officer has expanded the intervention throughout his province, while other provinces are interested in duplicating the model.

Childbearing in five Arab countries.

Abstract: The life-table technique is used in this study to describe childbearing patterns in five Arab countries (Algeria, Egypt, Morocco, Sudan, and Yemen). Two summary measures are estimated: the cumulative proportion of women of a given parity having a subsequent birth within 60 months of the previous birth (quintum), and the median length of the interval between successive births. The analysis indicates that in Yemen (where the total fertility rate exceeds seven children per woman of reproductive age), women begin childbearing at a relatively early age and a large proportion of ever-married women reach high parity at a relatively fast pace. Morocco and Egypt (with TFRs of 3.3 and 3.8 children per woman, respectively) are characterized by delay in the onset of childbearing, a slow pace of childbearing, and a smaller proportion of ever-married women reaching high parity. In Algeria and Sudan (with TFRs of 4.4 and 4.6 children), delay in the onset of childbearing plays a larger role in fertility reduction than do the tempo or the quantum of childbearing.

The link between postnatal abstinence and extramarital sex in Côte d'Ivoire.

Abstract: Whether the link, found in Benin, between postnatal abstinence and husbands' extramarital contacts can be generalized to other West African countries is assessed in this study. Data from the 1994 Demographic and Health Survey, Cote d'Ivoire, obtained from monogamous husbands concerning their extramarital sexual behavior in the two months preceding the survey were linked to data reported by wives concerning postnatal abstinence over the same time period. Logistic regression was applied to assess the link between these two factors, net of the effects of possible confounders. A significant effect of postnatal abstinence on the probability that the husband reported at least one extramarital partner was found. Unprotected extramarital sex was two times more common among men who observed conjugal abstinence than it was among other men. Other predictors of extramarital sex were urban-rural residence, region, education, and whether or not husband and wife had the same religious affiliation. Because condom use is low in this population, the protective effect of marital abstinence is offset by an increased probability that husbands will seek extramarital partners during the postpartum period. The results confirm the earlier findings for Benin and can likely be generalized to most of West Africa.

The role of changes in contraceptive use in the decline of induced abortion in Turkey.

Abstract: Tlie induced abortion rate in Turkey declined from a peak of 4.5 abortions per 100 women in 1988 to 2.4 in 1998. This study examines the extent to which the decline in abortion in Turkey can be attributed to increased use of modern contraceptives. Trends in induced abortion rates and in contraceptive use are examined among Turkish women together with fertility preferences, changes in the contraceptive behavior associated with abortion, and changes in the propensity to abort unwanted pregnancies. The analysis includes a number of simulations that examine what abortion levels might be in different contraceptive-use scenarios. Results indicate that the decline in abortion is due to a decrease in the number of abortions associated with traditional method failure. This decrease is related to three factors: a shift from traditional method use to modern method use, a decline in the traditional method failure rate, and a decline in the proportion of pregnancies resulting from traditional method failures that are aborted.

An ecologic analysis of maternal mortality ratios.

Abstract: Ecological associations have provided the basis for numerous programs to reduce maternal mortality. The authors argue that indices ecologically associated with maternal mortality ratios are highly intercorrelated and do not necessarily indicate that improving one aspect of the health system such as the skills of delivery attendants will in fact reduce maternal deaths. In 1993 they conducted an ecologic analysis of the correlates of maternal mortality from the data published by UN Childrens Fund in 1999 from 84 countries in order to evaluate the potential of promising interventions. Variables such as receipt of antenatal care tetanus toxoid immunization contraceptive prevalence adult literacy skilled attendant at delivery and institutional delivery were included in the analysis. A backward stepwise linear and fitted regression analyses for contraceptive prevalence and institutional deliveries using these variables to predict the maternal mortality ratio (MMR) was conducted. Overall results noted that MMR was inversely proportional with the variables included in the analyses. With the exception of tetanus toxoid for immunization it is noted that all the remaining variables were positively associated with one another. Moreover the study indicated that lower national MMRs were associated with skilled attendant at delivery and high contraceptive prevalence rates. Based on the results the authors argue that ecological indices associated with MMR are highly intercorrelated and do not necessarily indicate that the improvement of one aspect of the health system can reduce maternal mortality.

Implications for evaluating the impact of family planning programs with a reproductive health orientation.

Abstract: In 1994 Jain and Bruce proposed an index--HARI an acronym for Helping Individuals Achieve their Reproductive Intentions--to measure success or failure of family planning (FP) programs with a reproductive health orientation. HARI applies the principle of individual rights and well-being to the assessment of these programs. The index measures two components: the achievement of an individuals reproductive intentions and the avoidance of severe reproductive health (RH) problems associated with an individuals efforts to achieve her stated reproductive intentions. A FP program can be deemed successful if an individual is able to avoid having an unintended pregnancy (or is able to have a wanted child) within the stipulated period and if she experiences no severe RH problems in the process. If these conditions are not met the program could be deemed a failure. The HARI index has not yet been applied in field conditions. This report illustrates the procedure for estimating HARI by using data from a panel survey conducted in Peru. It discusses the usefulness and limitations of the index in assessing the success or failure of a FP program with a RH orientation. (authors)

Changes in contraceptive use in Bulgaria, 1995-2000.

Abstract: Comparison of results from national surveys conducted in Bulgaria in 1995 and 2000 reveal little overall change in use of modern contraceptives. Dramatic increases occurred, however, among women younger than 25 who entered their reproductive period after the end of the state socialist period. This finding suggests that contraceptive gains in the country will come largely as a cohort-replacement process. From these data, no separate program impact appears for special clinics established to provide direct, subsidized delivery of modern contraceptives to women in selected cities. The special clinics opened in cities where contraceptive use was already above the national average. During these five years, other cities lacking special clinics managed to gain in prevalence of modern contraceptive use, leaving a relatively homogenous urban-rural difference in levels of use throughout the country.

Consistency between survey and interview data concerning pregnancy wantedness in the Philippines.

Abstract: Through a comparison of survey and in-depth interview data reported by a small sample of Filipino women and men, standard survey questions and the standard conceptualizations of pregnancy wantedness are assessed to determine whether they capture respondents' attitudes toward pregnancies and their timing in two areas in the Philippines. The study reveals that more than two-thirds of respondents were completely consistent in their survey and interview responses. Consistency was higher for women than for men, and it improved when a dichotomous measure (intended/unintended) was used rather than a more detailed variable that distinguished between intended, mistimed, and unwanted pregnancies. To the extent that the two data sources disagree, the interview transcripts suggest two possible reasons for inconsistent reports: deference to a spouse's perceived attitude or the respondent's ambivalence toward or ready acceptance of an unintended pregnancy.

Organizing a Public‐sector Vasectomy Program in Brazil

Abstract: Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service

Is fertility declining in Benin

Abstract: This study analyzes reproductive changes in Benin, a West African country with high fertility and low prevalence of use of modern contraceptive methods, using a combination of quantitative and qualitative approaches. Findings indicate that an irreversible fertility transition has started as the result of an emerging pattern of birth limitation and continued desire for the traditional long birth intervals. The data suggest that changes in childhood mortality in combination with an increase in women's education, although modest, have created a demand for fertility control among women; that induced abortion may be one of the means through which such demand is being met, particularly in urban areas; and that the economic crisis of the 1980s was the main catalyst that precipitated the onset of transition. Changes in reproductive preferences and practice suggest a diffusion process, from urban and more educated women to rural and less-educated ones.

Sterilization and financial penalties imposed on registered peasant couples, Hebei Province, China.

Abstract: Using fertility survey data from the 1980s for registered Han peasant couples in Hebei Province, this study examines whether China's family planning policy reflects couples' voluntary compliance with policy regulations, their coercion by means of government sanctions, or a combination of both. Three family planning regulations are considered: birth-quota status, contraceptive use, and length of prior birth interval. The results of the study provide support for both compliance and sanction perspectives and suggest that by the late 1980s, the state was less willing than it had been previously to negotiate with couples who had had three children. Evidence is found of cooperation between couples and the state to ensure that each family had at least one son.

Nigeria 1999: results from the Demographic and Health Survey.

Abstract: With the technical assistance from ORC/Macro the National Population Commission in Abuja Nigeria conducted the Nigeria Demographic and Health Survey during March 29-May 29 1999. Data for the nationally representative population were gathered from 7647 households. Moreover complete interviews with 8199 women aged 15-49 and 2680 men aged 15-64 were conducted. This paper presents tables and graphs on the statistical results of the survey. It presents data on the general characteristics and percentage distribution of women surveyed according to educational level and residence. In addition the statistics on fertility fertility preferences contraceptive use contraception marital and contraceptive status postpartum variables infant mortality disease prevention and treatment and anthropometric measures of nutritional status are shown.