 John B. Casterline, Senior Associate and Ann E. Biddlecom, Research Associate, Policy Research Division, Population Council. Aurora E. Perez, Professor, University of the Philippines. The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed “unmet need“ is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need. (Studies in Family Planning 1997; 28,3: 173–191)
Pierre Ngom, Population Council/Rockefeller Research Fellow in charge of the Demographic Surveillance System, Navrongo Health Research Centre. P.O. Box 114, Navrongo-UER, Ghana. This article introduces the concept of men's unmet need for family planning and explains its programmatic relevance. Using data from Demographic and Health Surveys (DHS) of Ghana (1988, 1993) and Kenya (1989, 1993), married men are found to have high levels of unmet need for family planning that are comparable to, although slightly lower than, those for women. The importance of men's unmet need is demonstrated when the analysis is restricted to marital pairs in the DHS samples; trends in the joint unmet need of husbands and wives are shown to be closely associated with the nature of the fertility transitions occurring in Ghana and Kenya. Because of wide discrepancies found between husbands' and wives' unmet need statuses, family planning programs that foster spousal communication are likely to facilitate the transition to lower fertility. (Studies in Family Planning 1997; 28,3: 192–202)
Carine Ronsmans, Lecturer, Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England. Endang Achadi, Director, Surekha Cohen Program Manager, and Ali Zazri Research Coordinator, MotherCare Project, John Snow, Inc., Indonesia. The search for indicators for monitoring progress toward safe motherhood has prompted research into population-based measures of obstetric morbidity. One possible such measure is based on women's reports of their past childbirth experiences. In this prospective study in three hospitals in South Kalimantan, Indonesia, the accuracy of women's reporting of severe birth-related complications was examined. The findings of this study suggest that poor agreement exists between the way women report their experience of childbirth and the way doctors diagnose obstetric problems, although the degree of agreement varies with the type of complication. Questionnaires relying on women's experience of childbirth will tend to overestimate the prevalence of medically diagnosed obstetric problems such as those associated with excessive vaginal bleeding or dysfunctional labor. Questions suggestive of eclampsia may be more promising, although the small number of eclamptic women in this study precludes firm conclusions. (Studies in Family Planning 1997; 28,3: 203–214)
ReportsBarbara S. Okun, Lecturer, Department of Population Studies, Faculty of Social Sciences, Hebrew University of Jerusalem, Mount Scopus Campus, 91905, Jerusalem, Israel. This report describes trends and differentials in contraceptive practices among Israeli Jews. Data from two fertility surveys show a heavy reliance on the IUD, little use of sterilization, and declining, but still significant use of withdrawal. The factors associated with the practice of withdrawal are explored. Evidence is found in support of Santow's hypotheses that the degree of sex-role differentiation within marriage and the belief that men hold the authority in reproductive decisionmaking are both positively related to the practice of withdrawal. Fear of oral contraceptives, a dislike of sterilization, and a reliance on the IUD only at greater parities imply a continuing role for withdrawal, especially among Israeli Jewish couples in which wives are less educated and have more traditional sex roles than the wives in other couples. (Studies in Family Planning 1997: 28,3: 215–227)
Rachel K. Jewkes, Coordinator, CERSA_Women's Health, Centre for Epidemiological Research in Southern Africa, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa. Susan Fawcus, Specialist Obstetrician, Department of Obstetrics and Gynaecology, Mowbray Hospital, Cape Town. Helen Rees, Director, Reproductive Research Unit, Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg. Carl J. Lombard, Chief Statistician, Medical Research Council, Cape Town. Judy Katzenellenbogen, researcher, Midland, New Zealand. In 1994, a national hospital-based study was undertaken of cases of incomplete abortion presenting to public hospitals in South Africa. Data were collected for all women admitted to a random sample of hospitals with incomplete abortion during a two-week period. The WHO protocol for such studies was used as a basis for developing the methods to describe the epidemiology of incomplete abortion and hospital management of cases. Attempts were made to estimate the proportion of cases that might have been induced. This report focuses on methodological issues arising from the study that have implications for future research. The findings demonstrate that only a small proportion of the women acknowledged having had an induced abortion and that only a few of those who did showed evidence of interference with pregnancy. Clinical opinion of sepsis and the likelihood of induction were found to be highly unreliable. These findings considerably reduce the usefulness of the WHO-protocol method of estimating the likely origin of incomplete abortions. Results presented in terms of three partially overlapping descriptive categories are judged to better reflect the limitations of the data collected. (Studies in Family Planning 1997; 28,3: 228–234)
Carla Makhlouf Obermeyer, Associate Professor of Population and Anthropology, Harvard School of Public Health, Department of Population and International Health, 665 Huntington Avenue, Boston, MA 02115. Rosario C‡rdenas, Researcher, General Directorate of Statistics and Informatics, Ministry of Health, Mexico. This report investigates the links between son preference and differential treatment of children by analyzing data from the Demographic and Health Surveys of Morocco and Tunisia, two countries that are thought to vary considerably regarding indicators of gender. The analyses find no significant differences in either country in the duration and intensity of breastfeeding and small differences in favor of boys in Tunisia regarding immunization and the treatment of diarrhea. These findings, which are, to some degree, unexpected, are discussed in light of other research relevant to son preference in the two countries. (Studies in Family Planning 1997; 28, 3: 235–244)
Commentary Menstruation Requirements as a Barrier to Access
John Stanback, Andy Thompson, Karen Hardee, Barbara Janowitz
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