 Deborah Maine, Program Director, Murat Z. Akalin, Project Coordinator, Prevention of Maternal Mortality Program, Center for Population and Family Health, Columbia University School of Public Health, 60 Haven Avenue, B-3, New York, NY 10032. Jyosnamoy Chakraborty, Manager and Andres de Francisco, Project Director, Matlab Maternal and Child Health–Family Planning Programme. Michael Strong, Population Advisor, National Office of Population, Addis Ababa, Ethiopia. In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the physicians at the Matlab maternity clinic. Their ability to refer patients to higher levels of care was important. The data further indicate that the decline in deaths depended upon the functioning of the government hospital in Chandpur, where cesarean sections and blood transfusions were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangladesh. (Studies in Family Planning 1996; 27,4: 179–187)
P. Stanley Yoder, Researcher and Public Health Consultant and Robert Hornik, Professor of Communications, Annenberg School for Communications, 3620 Walnut Street, University of Pennsylvania, Philadelphia, PA 19104–6220. Ben C. Chirwa, Director, Health Education Unit, Ministry of Health, Zambia, at the time of this project. This study describes an approach to the analysis of data that is designed to isolate program effects for evaluations and applies that approach to a program in Zambia designed to disseminate AIDS information. Evidence is considered that a radio drama broadcast for nine months had an impact on knowledge and behavior related to AIDS among Bemba speakers in northern Zambia. Using results from large sample surveys (1,600 men and women), conducted before and after the drama was broadcast, the analyses compare changes in knowledge and behavior in those most likely and least likely to have listened to the broadcast. While the population as a whole had improved its knowledge substantially, and some people reported having reduced risky behavior, attributing these changes to the program itself was not possible. (Studies in Family Planning 1996; 27,4: 188–203)
James F. Phillips, Senior Associate, Research Division, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017. Mian Bazle Hossain, Assistant Scientist, Maternal and Child Health and Family Planning Extension Project, International Centre for Diarrhoeal Disease Research, Bangladesh. Mary Arends-Kuenning, Graduate Fellow, Department of Economics, University of Michigan. Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh—where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive-use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed. (Studies in Family Planning 1996; 27,4: 204–219)
ReportJames A. Hanley, Professor, Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Avenue West, Montreal, H3A 1A2, Canada. Catherine A. Hagen is Clinical Instructor, Department of Family Practice, University of British Columbia, Prince George, British Columbia, Canada. Tesfaye Shiferaw, Associate Professor, Department of Community Health, Jimma Institute for Health Sciences, Jimma, Ethiopia. The sisterhood method is an indirect method of estimating maternal mortality that has, in comparison with conventional direct methods, the dual advantages of ease of use in the field and smaller sample-size requirements. This report describes how to calculate a standard error to quantify the sampling variability for this method. This standard error can be used to construct confidence intervals and statistical tests and to plan the size of a sample survey that employs the sisterhood method. Statistical assumptions are discussed, particularly in relation to the effective sample size and to effects of extrabinomial variation. In a worked example of data from urban Pakistan, a maternal mortality ratio of 153 (95 percent confidence interval between 96 and 212) deaths per 100,000 live births is estimated. (Studies in Family Planning 1996; 27,4: 220–227)
Commentary DataHaiti 1994–95: Results from the Demographic and Health Survey
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