 John Bongaarts, Vice President, Policy Research Division, Population Council, One Dag Hammarskjold Plaza, New York. This study analyzes trends in unwanted fertility in 20 developing countries, based on data from the World Fertility Surveys and the Demographic and Health Surveys. Although wanted childbearing almost invariably declines as countries move through the fertility transition, the trend in unwanted fertility was found to have an inverted U shape. During the first half of the transition, unwanted fertility tends to rise, and it does not decline until near the end of the transition. This pattern is attributed to the combined effects of an increase in the duration of exposure to the risk of unwanted pregnancy and a rise in contraceptive use as desired family size declines. The substantial variation in unwanted fertility among countries at the same transition stage is caused by variation in the degree of implementation of preferences, the effectiveness of contraceptive use, the rate of induced abortion, and other proximate determinants, such as age at marriage, duration of breastfeeding, and frequency of sexual relations. The principal policy implication from this analysis is that vigorous efforts to reduce unwanted pregnancies through family planning programs and other measures are needed early in the fertility transition because, in their absence, unwanted fertility and abortion rates are likely to rise to high levels. (Studies in Family Planning 1997; 28,4: 267–277)
Michael A. Koenig Program Officer, The Ford Foundation, New Delhi. Mian Bazle Hossain, Demographer, Maternal and Child Health–Family Planning Extension Project, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. Maxine Whittaker, Senior Lecturer, Australian Centre for International and Tropical Health and Nutrition, Brisbane. Efforts to develop quantitative indicators of quality of care for family planning services, and to evaluate its role in contraceptive behavior, remain at an early stage. The present study, based upon an analysis of prospective data from a sample of 7,800 reproductive–aged rural Bangladeshi women, provides empirical evidence on the importance of quality of care for contraceptive practice. The results demonstrate that the perceptions of women regarding the quality of field–worker care were significantly related to the probability of subsequent adoption of a family planning method. Women who were not using a method and who scored high on an index of perceived quality of care were 27 percent more likely to adopt a method subsequently, compared with women with a low score. Effects were even more pronounced for contraceptive continuation; high quality of care was associated with a 72 percent greater likelihood of continued use of any method of contraception. (Studies in Family Planning 1997; 28,4: 278–289)
Naomi Rutenberg , Program Associate, Population Council, East and Southern Africa Regional Office, P.O. Box 17643, Multichoice Towers, Nairobi, Kenya. Susan Cotts Watkins, Professor, Department of Sociology, University of Pennsylvania, Philadelphia. When women talk with each other about family planning outside the clinic, are they really only spreading myths and rumors? If nurses give good information about family planning, why do women go and talk with other women? Why would a woman instructed by a nurse at a workshop want to talk to the workshop cleaner as well? To answer these questions, findings are used from a household survey and in-depth interviews that examine the role of informal social interaction in influencing the use of contraceptives in rural Kenya. The women in the study area are found to be ambivalent about family planning, and they supplement providers’ instructions with the experiences of women whose bodies and circumstances are similar to their own. Family planning programs could improve their effectiveness by viewing clients and providers not only as individuals but also as members of informal networks that are meaningful to them. (Studies in Family Planning 1997; 28,4: 290–307)
ReportsAndrew A. Fisher, Senior Associate and Director, HIV/AIDS Horizons Project, Population Council, 4201 Connecticut Avenue, NW, Suite 408, Washington, DC. Joedo Prihartono, Professor, Department of Community Medicine, Medical School, University of Indonesia, Jakarta. Jayanti Tuladhar, Program Associate, Population Council, Asia and Near East Operations Research and Technical Assistance Project, New Delhi, India. R. Hasan M. Hoesni, Chief, BKKBN Center for Biomedical and Human Reproduction Research, Jakarta. From 1987 to 1997, approximately four million Indonesian women had a Norplant® insertion. Concerns have been raised about the timely removal of the implant within a few days of the user’s request or at the end of the recommended five years of use and about the possibility of a large and rapidly increasing backlog of removal cases developing. This study of 2,979 Indonesian women in 14 provinces, all of whom had had Norplant inserted five or more years before they were interviewed, reveals that 66 percent had obtained removal by the end of the fifth year of use and 90 percent had done so by the end of the sixth year of use. The data from this study strongly suggest that no large backlog of removal cases exists, particularly after the sixth year of use. The major reason for the underreporting of removals is probably clients’ use of nurse/midwives, of caregivers in the private sector, and of mass safari camps, because records from each of these sources are poor or nonexistent. (Studies in Family Planning 1997; 28,4: 308–316)
Victor Agadjanian and Zhenchao Qian, Assistant Professors, Department of Sociology, Arizona State University, Tempe, AZ 85287–2101. This study analyzes ethnic differences in induced abortion among ever-married women in Kazakstan, drawing on data from the 1995 Kazakstan Demographic and Health Survey. Instead of conventional ethnic markers, such as “Kazak” or “Russian,” it focuses on more complex ethnocultural identities that combine ascribed ethnicity with language use. Because of the history of russification in Kazakstan, three ethnocultural groups are defined and compared–Kazak women who chose to be interviewed in Kazak, Kazak women who chose to be interviewed in Russian, and women of European background interviewed in Russian. Whereas women of European origin were the most likely to undergo induced abortion, the Russian-interviewed Kazaks had higher abortion ratios and were more likely to terminate their pregnancies than were the Kazak-interviewed Kazaks, net of other characteristics. The implications of the results for induced abortion trends and family planning policy in Kazakstan are discussed in addition to other findings. (Studies in Family Planning 1997: 28,4: 317–329)
At the time this report was written, Murat Z. Akalin, 19 Sunset Street, Roxbury, MA 02120, was Project Coordinator, Prevention of Maternal Mortality Program, Center for Population and Family Health, Columbia University School of Public Health. He is now a student at Harvard Medical School. Deborah Maine, Research Scientist, Center for Population and Family Health, Columbia University School of Public Health. Andres de Francisco, Director, Maternal and Child Health–Family Planning Programme, International Centre for Diarrhoeal Disease Research, Bangladesh. Roger Vaughan, Assistant Professor of Clinical Public Health, Columbia University School of Public Health. In recent years, the perinatal mortality rate (PNMR) has been proposed as a proxy measure of maternal mortality, because perinatal deaths are more frequent and potentially more easily measured. This report assesses evidence for an association between these two statistics. This study, based upon data from Matlab, Bangladesh, shows that the maternal mortality ratio (MMR) and the PNMR do not vary together over time, and that the PNMR does not reliably indicate either the magnitude or the direction of change in the MMR from year to year. Statistical analysis shows that the correlation between the PNMR and the MMR is not significantly different from zero. An examination of the major causes of maternal and perinatal deaths indicates that the two measures cannot be expected to vary together. Almost half of perinatal deaths result from causes that do not pose a threat to the mother's life, and almost half of maternal deaths result from causes that do not lead to perinatal death. Monitoring of the PNMR can give an inaccurate picture of maternal mortality and should not be used as a proxy. (Studies in Family Planning 1997; 28,4: 330–335)
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