 Margarita Díaz, Director, Department of Education, Training and Communication, CEMICAMP, Caixa Postal 6181, 13081970, Cidade Universitária, Campinas, SP, Brazil. Ruth Simmons, Professor, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Juan Díaz, Senior Program Associate, Population Council, Brazil. Carlos Gonzalez, Coordinator, Program for Integrated Assistance to Women's Health, Brazil. Maria Yolanda Makuch, Research Assistant, CEMICAMP, Brazil. Debora Bossemeyer, Clinical Training Advisor for Latin America and the Caribbean Office, JHPIEGO Corporation. This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved. (Studies in Family Planning 30[1]: 1–16)
Julie Solo, Staff Program Associate, International Programs Division, Population Council, New York; Deborah L. Billings, Research Associate, Ipas, Carrboro, NC; Colette Aloo-Obunga, Regional Representative for Eastern Africa, Ipas; Achola Ominde, is Manager and Margaret Makumi is Deputy Manager, Maternal and Child HealthFamily Planning Program, Division of Primary Health Care, Kenya Ministry of Health. Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health-care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model. (Studies in Family Planning 1999; 30[1]: 17–27)
Fiona Steele, Lecturer, Department of Statistics, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Siân L. Curtis, EVALUATION Analyst, Macro International, Beltsville, MD. Minja Choe, Fellow, Population and Health Research Program, East-West Center, Honolulu. This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth. (Studies in Family Planning 1999; 30[1]: 28–42)
ReportsAlan Gray, Foreign Expert, Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakom Pathom 73170, Thailand. Jamil H. Chowdhury, Director, Associates for Community and Population Research, Dhaka, Bangladesh. Bruce Caldwell, Research Fellow, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia. Ahmed Al-Sabir, Director (Research), National Institute for Population Research and Training, Dhaka. Some coitus-dependent methods of family planning, such as withdrawal, periodic abstinence, and the condom, require male involvement for their use, and using these methods in combination has proved to be sensible. An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about "traditional" methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish. In order to obtain reliable responses about these methods, a survey approach different from the long-established one is required. (Studies in Family Planning 1999; 30[1]: 43–53)
Ayaga Agula Bawah is Demographer and Patricia Akweongo is Research Assistant, Navrongo Health Research Centre, Upper East Region, Ghana. Ruth Simmons, Professor, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor. James F. Phillips, Senior Associate, Policy Research Division, Population Council. Correspondence should be addressed to Ayaga Agula Bawah, Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104. The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed. (Studies in Family Planning 1999; 30[1]: 54–66)
Friday E. Okonofua is Director and Helen Ajabor is Administrative Manager and Health Assistant, Women's Health and Action Research Centre, 4 Alofoje Street, Off Uwasota Street, Post Office Box 10231, Ugbowo, Benin City, Edo State, Nigeria. Clifford Odimegwu, Lecturer, Department of Demography, Obafemi Awolowo University, Ile-Ife, Nigeria. Patrick H. Daru, Lecturer, Department of Obstetrics and Gynaecology, University of Jos Teaching Hospital, Jos, Nigeria. Agnes Johnson, Lecturer, Department of Sociology, University of Jos. This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15–45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used. (Studies in Family Planning 1999; 30[1]: 67–77)
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