 Barbara Mensch, Associate, Research Division and Anrudh Jain, Senior Associate and Director of Programs, Program Division, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017. Mary Arends-Kuenning, Graduate Student in Economics at the Population Studies Center, University of Michigan. Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p=.053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed. (Studies in Family Planning 1996; 27,2: 59–75)
John G. Haaga, Director, Committee on Population, National Academy of Sciences/National Research Council, 2101 Constitution Avenue NW, Washington, DC 20418. From 1991 to 1993 he was Project Director, MCH–FP Extension Project, International Centre for Diarrhoeal Disease Research, Bangladesh. Rushikesh M. Maru, Associate, The Population Council, Dhaka, Bangladesh, at the time this article was written. From 1989 to 1994 he was Associate Director of the MCH–FP Extension Project. This article is based on the ten-year experience of an operations research project in Bangladesh. It assesses how, and under what circumstances, research-based advice and results of pilot projects contribute to change in large-scale public programs. It discusses project research on issues facing the national family planning program: recruitment and training of field-workers; delivery of injectable contraceptives; management information; field-workers’ use of service registers; field supervision; satellite clinics; and contraceptive user fees. These issues are used to illustrate the advantages and disadvantages of a long-term institutionalized project, and to describe the diversity of means for communication with policymakers. The analysis shows that research, policy decision, and implementation can occur in any sequence. Policy advice that disrupts long-standing power relationships and organizational culture takes a great deal of effort to implement. Operations research can produce useful changes in organizational behavior, even when large-scale problems remain. (Studies in Family Planning 1996; 27,2: 76–87)
ReportsAlbert I. Hermalin, Professor of Sociology and Research Scientist, Population Studies Center, University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48104–2590. Barbara Entwisle, Edward M. Bernstein Professor of Sociology and Fellow, Carolina Population Center, University of North Carolina at Chapel Hill. Zeinab Khadr, graduate student, Population Studies Center, University of Michigan. Information about health and family planning infrastructures is collected through the service availability module (SAM), an important feature of the Demographic and Health Surveys (DHS) conducted in many developing countries. The DHS samples were designed to provide a representative sample of households and women of reproductive age. Using the weights routinely provided with DHS data sets, service accessibility can be described straightforwardly at the individual and household levels. However, without further adjustment, SAM data do not provide a representative picture of service delivery at the community, or primary sampling unit, level, where the data are collected. This report proposes a methodology for reweighting the SAM data, using rural data from the Egypt DHS as an illustration, so that available family planning facilities at this level may be usefully characterized at little additional cost. (Studies in Family Planning 1996; 27,2: 88–97)
Mian Bazle Hossain, Assistant Scientist, Maternal and Child Health–Family Planning Extension Project, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka. James F. Phillips, Senior Associate, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017. In 1978, the Bangladesh family planning program launched a national program of outreach services that continues to the present. Young married women were hired and trained to visit women in their homes, offer contraceptive services, provide information, and support sustained use over time. This report uses data from two rural districts to assess the effect of the household visitation program on the continuity of contraceptive use. Results of a multivariate analysis show that household outreach has had a pronounced net effect on the continuity of contraceptive use throughout the study period and that the magnitude of this effect has increased with time. This finding suggests that sustained contraceptive use continues to benefit from home-based outreach even after a decade of service encounters. Policy implications of this finding are discussed. (Studies in Family Planning 1996; 27,2: 98–106)
Sharon Stash, doctoral candidate in Sociology and trainee, Population Studies Center of the University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48105–2590. This study tests the hypothesis that, in Nepal, measures of ideal family size mask an underlying preference for sons, making some people willing to have families larger than their ideal. Existing evidence suggests that men are likely to have stronger preferences for sons than are women. This research uses empirical evidence to examine the hypothesis that husbands are more willing than their wives to pursue the birth of sons at the cost of an increasingly large completed family size. A Multiple-response Fertility Preference Scale was developed to test these propositions among a sample of couples. The methodology was successful in demonstrating differential patterns of decisionmaking between husbands and wives that are otherwise obscured by more simplistic, single-response measures (for example, ideal family size). The results indicate that husbands are consistently more willing than their wives to pursue the birth of sons at the expense of larger family sizes, and that the birth of daughters is not pursued to a similar degree by wives or husbands. (Studies in Family Planning 1996; 27,2: 107–118)
Data- Indonesia 1994: Results from the Demographic and Health Survey
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