 Stan Becker, Associate Professor, Population Dynamics Department, School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205–2179. Traditionally, fertility and family planning research and programs have focused on women. With the expansion of the field to include reproductive health following the 1994 International Conference on Population in Cairo, the more appropriate focus for most reproductive health components appears to be the sexually active couple. This review of studies of couples and reproductive health outcomes examines reports of objective reproductive events, of attitudes and reproductive intentions, of the effect of each partner´ attitudes and intentions, of reproductive outcomes, and of the effectiveness of interventions that target couples compared with those that target one partner or the other. For couples´ statements about reproductive events, studies throughout the world typically show identical reports less than 90 percent of the time. Concordance between partners on subjective matters is in the range of 60 to 70 percent. Data based on reports of reproductive intentions from both partners have been shown to lead to better predictions of behavior than have data from only one partner. Finally, reproductive health interventions that target couples are found to be more effective than those directed to only one sex. The evidence clearly justifies a focus on couples. (Studies in Family Planning 1996; 27,6: 291–306)
John Knodel, Professor of Sociology, Population Studies Center, University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48104. Vipan Prachuabmoh Ruffolo, Assistant Professor and Kua Wongboonsin, Associate Professor, Institute of Population Studies, Chulalongkorn University, Bangkok, Thailand. Pakamas Ratanalangkarn, Statistician, Social Statistics Division, National Statistical Office, Bangkok, Thailand. Two large national surveys in 1988 and 1993 provide new evidence on trends in family-size preferences in Thailand at a time when the Thai fertility transition is reaching its conclusion. Although the average preferred number of children has continued to decline, a resistant lower bound of two children is found for the vast majority of respondents, stemming, apparently, from a pervasive, although not inflexible, desire to have one child of each sex. Moreover, new evidence from birth-registration data indicates that the decline in the total fertility rate appears to have leveled off at about replacement level. These findings challenge the view that fertility in Thailand will continue to fall well below replacement level, and contradict recently expressed alarmist predictions of population decline in the foreseeable future. (Studies in Family Planning 1996; 27,6: 307–318)
ReportsSusan Fawcus, Senior Specialist, Department of Obstetrics and Gynaecology, Grooteschuur Hospital, Observatory 7925, Cape Town, South Africa. Michael Mbizvo, Senior Lecturer, Department of Obstetrics and Gynaecology, University of Zimbabwe. Gunilla Lindmark, Associate Professor, Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden. Lennarth Nyström, Senior Lecturer, Department of Epidemiology and Public Health, Umeå University, Umeå, Sweden. A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability. Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of the 61 urban deaths. Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively. Lack of transportation delayed or prevented access to health facilities in the rural area, a major problem in 28 percent of the cases studied. Suboptimal clinic and hospital management was identified in 67 percent and 70 percent of rural and urban deaths, respectively. Lack of appropriately trained personnel contributed to suboptimal care. In both settings, the severity of patients´ conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment. Appropriate community and health-service interventions to reduce maternal mortality are discussed. (Studies in Family Planning 1996; 27,6: 319–327)
Pavalavalli Govindasamy, Demographic Specialist, Demographic and Health Surveys, Macro International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705. Anju Malhotra, Assistant Professor, Center on Population, Gender and Social Inequality, University of Maryland. In this report, data from the 1988 Egypt Demographic and Health Survey are used to address some of the most frequently raised questions about the relationship between gender inequality and reproductive behavior. The findings from binomial and multinomial logit models show that while the relationship between women’s position and fertility control in Egypt is complex, some clear, broad patterns exist that have important theoretical and policy implications. First, although women’s status in Egypt is clearly multidimensional, the reproductive aspect of women’s position has a strong connection with the nonreproductive dimensions. Second, the case for the continued use of education and employment as proxies of women’s position, especially in relationship to fertility control, is considerably discredited by the results. Finally, the findings indicate that Egyptian culture supports gender equality in the form of interaction and negotiation rather than women’s autonomy. (Studies in Family Planning 27,6: 328–340)
Commentary - Lessons from the Dutch Abortion Experience
Data - Morocco 1995: Results from the Demographic and Health Survey
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