 Hantamalala Rafalimanana is Population Affairs Officer, Population Division, United Nations, Two United Nations Plaza, New York, NY 10017. E-mail: rafalimanana@un.org. Charles F. Westoff is Professor Emeritus and Senior Research Demographer, Office of Population Research (OPR), Princeton University. At the time this research was conducted, the first author was a Mellon Fellow at OPR. Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women’s reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed. (Studies in Family Planning 2000; 31[2]: 99–110)
Cynthia Stanton
is Director, Monitoring, Evaluation and Research, Maternal and Neonatal Health Project, JHPIEGO, 1615 Thames Street, Baltimore, MD 21231. E-mail: cstanton@jhpiego.org. Noureddine Abderrahim is Data Processing Specialist, Demographic and Health Surveys Project, Macro International, Calverton, MD. Kenneth Hill is Professor, Department of Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore.This study presents an assessment of the quality of data relating to maternal mortality collected in 14 Demographic and Health Surveys (DHS) for 13 countries that included a complete sibling history. Four aspects of data quality are considered: completeness of the data for reported events, evidence of omission in the reporting of events, plausibility of the pattern of sibling deaths, and sampling errors of the maternal mortality estimates. Although the data relating to reported events are complete for most variables, comparisons of sibling-history-based estimates of adult mortality for both males and females with other independent estimates suggest that sibling estimates are more likely to be underestimates than overestimates. The downward bias is probably greater for female mortality than for male mortality. The sampling errors associated with maternal mortality ratios are substantially larger than those associated with other frequently used DHS indicators. This lack of precision precludes the use of these data for trend analysis and has led to the recommendation that this DHS module not be used more than once every ten years in the same country. (Studies in Family Planning 2000; 31[2]: 111–123) Brent Wolff is Lecturer, Centre for Population Studies, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. Ann K. Blanc is an independent consultant, formerly Coordinator for Demographic Analysis at the Demographic and Health Surveys Program. John Ssekamatte-Ssebuliba is Head, Department of Population Studies, Institute of Statistics and Applied Economics, Makerere University, Kampala, Uganda. This study uses survey and focus-group data from the 1995–96 Negotiating Reproductive Outcomes study in Uganda to describe the nature of the decision to stop childbearing and to question the simplifying assumption of consensus decisionmaking implicit in much demographic research on unmet need. Negotiation is characterized in four stages, from normative precedent for decisionmaking to communication, disagreement, and conflict resolution. Indirect forms of communication between partners predominate, contributing to the tendency of both men and women to overestimate each other’s demand for additional children. Partner opposition is found to cause a statistically significant increase in unmet need reported by women and a shift in contraceptive mix favoring use of traditional methods over modern methods. For women, partner opposition may account for as much as 20 percent of unmet need in urban areas, 12 percent in rural areas, and 15 percent overall. (Studies in Family Planning 2000; 31[2]: 124–137)
Reports Shally Awasthi is Professor, and V.K. Pande is Research Associate, Department of Pediatrics and Clinical Epidemiology Unit, King George’s Medical College, Lucknow University, Lucknow U.P. India. Mark Nichter is Professor, Department of Anthropology, University of Arizona, Emil Haury Building, P.O. Box 210030, Tucson, AZ 85721. E-mail: mnichter@u.arizona.edu. An intervention developed to teach young men in the urban slums of Lucknow, India, about sexually transmitted diseases is described in detail. This community-based intervention was designed to impart core educational messages and to address preexisting ideas about sexual health and STD-prevention practices among participants. Indicators of knowledge recorded before and after the intervention are presented and evaluated against the scores of a control group. Levels of sexual activity and factors associated with risky sex are discussed. The intervention was successful in raising the young men’s awareness of STDs significantly in all areas except for the length of time that symptoms take to manifest following risky sex and the ineffectiveness of washing one’s genitals after sex to avoid acquiring STDs. Lessons learned during the intervention are described as a means of informing future STD-education programs, and issues requiring prompt attention are identified. (Studies in Family Planning 2000; 31,2: 138–150)
Susannah H. Mayhew is Research Fellow, Reproductive and Sexual Health Programme, International Division, Nuffield Institute for Health, University of Leeds, 71–5 Clarendon Road, Leeds, LS2 9PL, UK. E-mail: s.h.mayhew@leeds.ac.uk. Louisiana Lush is Lecturer, Health and Population Policy; John Cleland is Professor, Medical Demography, Centre for Population Studies; and Gill Walt is Reader, Health Policy, Health Policy Unit, London School of Hygiene and Tropical Medicine. In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda—integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health–family planning services—has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed. (Studies in Family Planning 2000; 31[2]: 151–162)
Ilene S. Speizer is Assistant Professor, Tulane University School of Public Health, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112–2737. E-mail: ispeze@mailhost.tcs.tulane.edu. Kenneth A. Bollen is Zachary Smith Professor, Carolina Population Center and the Department of Sociology, University of North Carolina at Chapel Hill. This study examines the relationship between common objective measures of quality and perceptions of the quality of family planning facilities. Results of prior research indicate that such perceptions are an important determinant of contraceptive use in rural Tanzania. The data for this study are drawn from two surveys conducted in rural Tanzania. Three models are tested separately for women and for men. The important determinants of perceptions of quality among women and men are: perceived travel time to the facility, availability of immunizations, and availability of maternal and child health services. Additionally, the ratio of the number of staff to outpatients is important to men. The data explain a moderate amount of the variance in the quality measures, indicating that perceived quality is not fully predicted by common objective measures of quality. Future surveys of facility quality should develop objective measures to better predict the perceived quality, with the underlying goal of increasing contraceptive use. (Studies in Family Planning 2000; 31[2]: 163–177)
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