 Ronald Freedman, Roderick D. McKenzie Distinguished Professor Emeritus of Sociology, Population Studies Center, University of Michigan, 1225 South University Avenue, Ann Arbor, MI 48104–2590. A literature review finds few studies about whether family planning programs have reduced fertility preferences. The strong and surprising evidence from Matlab, Bangladesh, demonstrated that this intensive program did not decrease preferences; however, it did crystallize latent demand for fewer children, resulting in a demand for contraception. One cross-national multivariate study was consistent with this finding. A few intracountry multivariate studies found small program effects, decreasing the number of children that couples want. An intensive multimethod study in India found plausible larger effects. Most studies of program media effects are flawed by possible selection bias, but one longitudinal study avoids this pitfall and finds large effects for one country. Program feedback effects are plausible but not yet demonstrated empirically. The effects of a coercive program are plausible, at least in China, but not definitively demonstrated. Several promising unpublished studies may strengthen the case for program effects in reducing fertility preferences, now often based on plausible but not conclusive evidence. Stronger generalizations require better studies of a wider range of locations. (Studies in Family Planning 1997; 28,1:1–13)
Barbara Entwisle, Edward M. Bernstein Professor, University of North Carolina at Chapel Hill, Carolina Population Center, University Square, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516–3997. Polina Kozyreva, Head, Scientific Group, Institute of Sociology, Russian Academy of Sciences, Moscow. This article describes findings from a new source of data for estimating the incidence of induced abortion in the Russian Federation, the Russian Longitudinal Monitoring Survey (RLMS). According to RLMS data, the abortion rate in 1994 was 56 per 1,000 women aged 15–44, with a 95 percent confidence interval of plus or minus 12 per 1,000, an estimate that varies from that advanced by official sources and other studies. The sensitivity of this estimate to survey design, underreporting of abortion, and potential confusion about miniabortions is considered. Consistency of abortion estimates with patterns of contraceptive use is also evaluated. A significant advantage of RLMS data is the ability to estimate abortion rates specific to respondent characteristics. The article presents findings concerning socioeconomic differences. (Studies in Family Planning 1997; 28,1: 14–23).
Mihira V. Karra, Senior Advisor, Western Consortium for Public Health, Population Leadership Program, 210 High Street, Santa Cruz, CA 95060. Nancy N. Stark, Senior International Population Fellow, University of Michigan. Joyce Wolf, Consultant, Institute for International Research. Family planning program planners often view men as gatekeepers who, if involved in reproductive decisionmaking, will thwart women's efforts to regulate fertility. This study examines fertility decisions made by five generations of one South Indian family and the factors affecting its sudden observed fertility decline. Male involvement in family planning and use of male methods are associated with the fertility decline and resulted in long-term benefits for women. Traditional notions about gender roles and family, in addition to economic concerns, shaped fertility decisionmaking. Individual motivation rather than choice of methods was more important for positive male participation in family planning. (Studies in Family Planning 1997; 28,1: 24–34)
ReportsAyşen Bulut, Professor of Public Health, Institute of Child Health, Istanbul University, Milliet Cad., 34390 Capa, Istanbul, Turkey. Véronique Filippi, Research Fellow and Tom Marshall, Senior Lecturer, Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine. Hacer Nalbant, Research Fellow, Institute of Child Health, Istanbul University. Nuray Yolsal, M.D. specialist, Department of Public Health, Istanbul Faculty of Medicine. Wendy Graham, Director, Dugald Baird Centre for Research on Women's Health, Aberdeen University. A cross-sectional survey was conducted in Istanbul to investigate the relationship between contraceptive choice and reproductive morbidity. Altogether, 918 women who had ever used any means of avoiding pregnancy were interviewed at home, and, among these, 694 parous nonpregnant women were examined by three female physicians. The women were aware of bearing a considerable burden of ill health, with 81 percent reporting at least one episode of illness in the three months prior to the interview. Current users of the intrauterine device were significantly more likely than users of other methods to report menstrual disorders, but pelvic relaxation and reproductive and urinary tract infections, whether perceived or diagnosed, were not significantly related to any of the contraceptive methods. The relatively small amount of switching between methods suggests that most users tended to stay with the same method once chosen and that health concerns played an important part only in the initial choice of the method. (Studies in Family Planning 1997; 28,1: 35–43)
Jennifer A. Strickler, Assistant Professor and H. Gilman McCann, Associate Professor, Department of Sociology, University of Vermont, 31 South Prospect Street, Burlington, VT 05405. Robert J. Magnani, Associate Professor and Lisanne F. Brown, Research Assistant Professor, Department of International Health and Development, Tulane School of Public Health and Tropical Medicine. Janet C. Rice, Professor, Department of Biostatistics and Epidemiology, Tulane School of Public Health and Tropical Medicine. This report addresses the consistency of reporting in the contraceptive calendar in the 1992 and 1995 Morocco Demographic and Health Surveys. Because a panel design was used in these surveys, the same women were interviewed in both years, providing a unique opportunity to examine the reliability of responses. Measures of reliability for various aspects of contraceptive-use dynamics are computed, and the impact of reporting errors on contraceptive failure, discontinuation, and switching rates is estimated. Results suggest that reporting of contraceptive behavior in Moroccan DHS calendar data appears to be relatively reliable at the aggregate level. Individual respondents, particularly those whose contraceptive patterns have been complex, have a lower level of reliability. The observed inconsistencies do not appear to affect aggregate-level estimates of contraceptive prevalence; however, measures of contraceptive-use dynamics are less stable. (Studies in Family Planning 1997; 28,1: 44–53).
Michel Garenne, Director of Research, CEPED, 15 rue de l'Ecole de Médecine, 75270 Paris. Rainer Sauerborn and Jochen Diesfeld, Professors of Public Health, Heidelberg University. Adrien Nougtara, Physician, Projet Recherche-Action, Ministry of Health, Ouagadougou, Burkina Faso. Matthias Borchert and Justus Benzler, Physicians, Heidelberg University, with the German Volunteer Service, Nouna, Burkina Faso. A retrospective study of maternal mortality was conducted in Nouna, a rural area of Burkina Faso in 1992. Strong evidence was found of a major mortality decline among children and young adults over the 50 years preceding the study: The estimated life expectancy of 36 years in around 1945 rose to 58 years in 1991. Direct and indirect (using the sisterhood method) estimates of the maternal mortality ratio (MMR) were compared. Overall, the direct estimate of the MMR (389 deaths per 100,000 live births) for women aged 15 and older was slightly lower than the indirect estimate (428 deaths per 100,000). Taking into account the biases involved in the use of information obtained from sisters, the direct estimates indicated a marked decline in maternal mortality over time from 569 deaths per 100,000 around 1941 to 305 deaths around 1987. The validity of both data and approach, as well as the discrepancies between the direct and indirect methods, are discussed. (Studies in Family Planning 1997; 28,1: 54–61)
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