 Sharon Stash, Associate Program Officer, The David and Lucile Packard Foundation, 300 Second Street, Suite 200, Los Altos, CA 94022. E-mail: s.stash@packfound.org. This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use; poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey. (Studies in Family Planning 1999; 30 [4]: 267-287)
Minna Säävälä, Research Fellow, Department of Sociology/Social Anthropology, Post Office Box 59, SF-00014, University of Helsinki, Finland. By analyzing the practice of female sterilization in rural Andhra Pradesh, in southern India, this article examines the role culture plays in demographic research. The popularity of female sterilization in rural Andhra Pradesh is shown to be intelligible if the symbolic value of a young mother's reproductive capacity is understood in terms of familial power relations. Through sterilization, young mothers can symbolically push their influential mothers-in-law toward old age, thus increasing their own relative prestige, and they can strive to control the ambiguity surrounding their reproductive functions. This study is based on 14 months of participant observation in three rural villages, a survey of 396 households, and unstructured interviews with 42 women and two men. It shows how demography and anthropology can be mutually supportive in their efforts to clarify population phenomena. (Studies in Family Planning 1999; 30[4]: 288-301)
Dennis P. Hogan, Robert E. Turner Distinguished Professor of Population Studies. Betemariam Berhanu, Fellow, Population and Studies Training Center, Box 1916, Brown University, Providence, RI 02912. Assefa Hailemariam, Associate Professor, Demographic Training and Research Center, Addis Ababa University, Addis Ababa, Ethiopia. The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region. (Studies in Family Planning 1999; 30[4]: 302-314)
Reports Fiona Steele, Lecturer, Department of Statistics, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. E-mail: F.Steele@lse.ac.uk. Ian Diamond, Professor, Department of Social Statistics, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Bangladesh has experienced a substantial decline in fertility that has been achieved by means of a large increase in the use of modern methods of contraception. As contraceptive prevalence increases, aspects of contraceptive-use dynamics, including reasons for discontinuation and behavior after discontinuation, become important influences on fertility. This report uses calendar data from the 1993-94 Bangladesh Demographic and Health Survey to examine contraceptive behavior following discontinuation of modern-method use. The individual-level characteristics found to influence switching behavior include the method used, method-related difficulties with previous contraceptive use, and education. A large amount of unexplained variation in switching rates remains, however, largely at the individual level, but also at the community level for certain types of transition. (Studies in Family Planning 1999; 30[4]: 315-328)
Do Trong Hieu, Director, Center for Reproductive Health Research and Information, Hanoi, Vietnam. Robert Hanenberg, Senior Research Associate and David Sokal, Associate Medical Director, Clinical Research Department, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709. Trinh Huu Vach, Director, Research Center for Rural Population and Health, Thai Binh Medical College, Thai Binh, Vietnam. Dao Quang Vinh, Researcher, National Center for Social Sciences and the Humanities, Hanoi, Vietnam. E-mail correspondence may be addressed to Dr. Hanenberg at bob@sanfranmail.com. This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available. (Studies in Family Planning 1999; 30[4]: 329-338)
Judith A. Fortney, Epidemiologist, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709. E-mail: jfortney@fhi.org. Recall and understanding of information provided to contraceptive study participants in four sites were assessed. Analysis was completed of data for 70 women who were asked about their recollection of information and understanding of participation. Most women understood the purpose of the study. Their reasons for agreeing to participate varied by site and included wanting to try a new method, wanting to help others, and wishing to avoid pregnancy. Most women recalled correctly the burden of participation—number and frequency of visits, tests, and examinations. Most understood that they could withdraw from the study without jeopardizing their care. The women were also asked to recall the risks and benefits of the contraceptive they were testing. Only 23 percent recalled the pregnancy risk correctly; 40 percent underestimated and 19 percent overestimated it. Few women interpreted rates of risk correctly; some perceived high rates as low ones and the rates of the spermicide being studied as better than those of other contraceptives. This study confirms that risk is better recalled than understood. The participants surveyed remembered the information they were questioned about better than did participants in some other studies, a finding that supports earlier research results showing that younger, healthier patients (such as contraceptive users) recall better than older, less healthy ones. (Studies in Family Planning 1999; 30[4]: 339-346)
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