 Barbara S. Mensch, Senior Associate and Wesley H. Clark, Staff Research Associate, Policy Research Division, Population Council. E-mail: bmensch@popcouncil.org. At the time this research was conducted, Daniel Bagah was Mellon/Ghana Postdoctoral Fellow, Navrongo Health Research Centre, Navrongo, Ghana. Fred Binka, Public Health Specialist, Ministry of Health, Navrongo Health Research Centre, Ghana. This study reports the results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, an isolated rural area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus-group discussions with adolescents, parents, chiefs, traditional leaders, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The social environment that adolescent boys and girls in the Kassena-Nankana District encounter and its links to reproductive behavior are described. The principal question is whether even in this remote rural area, the social environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in girls' education and the beginning of a decline in the incidence of early marriage. The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives of adolescent boys and girls have eroded, leading to an apparent increase in premarital sexual activity. (Studies in Family Planning 1999; 30[2]: 95–111)
Joan Kaufman, Program Officer, The Ford Foundation, International Club Office Building, Suite 501, 21 Jianguomenwai Dajie, Beijing, China, 100020. E-mail: jkaufman@fordfound.org. Yan Liqin and Wang Tongyin, Professors, Department of Tropical Medicine, Kunming Medical College. At the time of the study, Anne Faulkner was Senior Analyst, Abt Associates. Reproductive tract infections are a significant cause of poor health among rural Chinese women. This study assesses the accuracy of simple, field-based methods of diagnosing five reproductive tract infections (trichomonas, candida, bacterial vaginosis, gonorrhea, and chlamydia) in two rural Chinese counties, using "gold standard" laboratory diagnosis as the reference. Self-reported symptoms and clinical examination proved inadequate for making accurate diagnoses, because many infected women show no symptoms or are infected with two or more conditions. The use of simple tests such as KOH staining, wet mount, Gram's stain, and pH of discharge greatly improved diagnostic accuracy, especially for candida and trichomonas, the two most common infections. Promoting the use of such diagnostic approaches by rural Chinese medical and family planning health providers would reduce the prevalence and severity of these preventable and easily treated infections. (Studies in Family Planning 1999; 30[2]: 112–119)
Reports Robert J. Magnani, Associate Professor and David R. Hotchkiss, Assistant Professor, Department of International Health and Development; Curtis S. Florence, Assistant Professor, Department of Health Systems Management; and Leigh Anne Shafer, doctoral candidate, Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine. Correspondence should be addressed to Robert J. Magnani, Tulane University Medical Center, School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112. E-mail: Magnani@mailhost.tcs.tulane.edu Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992–95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways. (Studies in Family Planning 1999; 30[2]: 120–132)
Reynaldo Alvarado, Medical Director and Soledad Rivero, Research Midwife, Proyecto San Luis de Huechuraba, Santiago, Chile. Ana Zepeda, Statistician and Soledad Díaz, Senior Researcher, Instituto Chileno de Medicina Reproductiva, Santiago. Nieves Rico, Sociologist and Susana López, Psychiatrist, Consultora Colomba, Santiago. Correspondence should be addressed to Reynaldo Alvarado, Instituto Chileno de Medicina Reproductiva, José Ramón Gutiérrez 295, Dept. 3, Santiago, Chile. E-mail: icmer@huelen.reuna.cl An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children. (Studies in Family Planning 1999; 30[2]: 133–141)
Pierre Ngom, Senior Research Scientist and Population Council/Rockefeller Fellow in charge of the Navrongo Demographic Surveillance System, Navrongo Health Research Centre (NHRC), P.O. Box 114, Navrongo-UER, Ghana. Email: navrongo@africaonline.com.gh. Patricia Akweongo, Social Scientist, Social Science Unit, and Philip Adongo, Social Scientist and Head of the Social Science Unit, NHRC. Ayaga Agula Bawah, formerly Demographer, Community Health and Family Planning Project, NHRC, is currently a graduate student at the University of Pennsylvania Population Studies Center, Philadelphia. Fred Binka, Public Health Specialist, Ministry of Health, NHRC, Ghana. This report presents key findings from a maternal mortality study conducted in the Kassena-Nankana District of northern Ghana in 1997–98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age-specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years. (Studies in Family Planning 1999; 30[2]: 142–147)
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