 John Bongaarts is Vice President, Policy Research Division, Population Council, New York. Charles F. Westoff is Professor Emeritus and Senior Research Demographer, Princeton University. This study examines the potential role of further increases in contraceptive prevalence and effectiveness in reducing abortion rates. The model used in this analysis links the abortion rate to its direct determinants, including couples' reproductive preferences, the prevalence and effectiveness of contraceptive practice to implement these preferences, and the probability of undergoing an abortion to avoid an unintended birth when a contraceptive fails or is not used. An assessment of the tradeoff between contraception and abortion yields estimates of the decline in the total abortion rate that would result from an illustrative increase of 10 percentage points in prevalence. This effect varies among societies, primarily because the tendency to obtain an abortion after an unintended pregnancy varies. For example, in a population with an abortion probability of 0.5, a 10 percentage-point increase in prevalence would avert approximately 0.45 abortions per woman, assuming contraception is 95 percent effective. If all unintended pregnancies were aborted, this effect would be three times larger. Eliminating all unintended pregnancies and subsequent abortions would require a rise in contraceptive prevalence to the level at which all fecund women who do not wish to become pregnant practice contraception that is 100 percent effective. A procedure is provided for estimating this "perfect" level of contraceptive prevalence. (Studies in Family Planning 2000; 31[3]: 193–202)
Lisa J. Messersmith is Program Officer, The Ford Foundation, Hanoi. Mailing address: 320 East 43rd Street, New York, NY 10017. E-mail: L.Messersmith@fordfound.org. Thomas T. Kane is Adjunct Faculty Member, Department of Population and Family Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD. Adetanwa I. Odebiyi is Professor, Department of Sociology and Anthropology and Alfred A. Adewuyi is Professor, Department of Demography, Obafemi Awolowo University, Ile-Ife, Nigeria. Many STD/HIV-prevention programs worldwide assume that individuals' risk of acquiring sexually transmitted diseases, including HIV infection, is highest in the context of commercial sex. To address this assumption, research conducted in urban Southwest Nigeria combined qualitative and quantitative methods to examine men's sexual behavior, condom use, and STD experience in different types of sexual relationships (marital, casual, and commercial). Logistic regression analysis of survey data indicates that number of sexual partners and sex with sex workers are positively and significantly related to STD experience. Follow-up in-depth interviews with clients of sex workers indicate, however, that these men are actually more likely to report having contracted an STD from a casual sex partner than from a sex worker. Men are most uncertain about their vulnerability to STDs with casual partners. Men's condom use is highest in commercial sex, inconsistent in casual relationships, and lowest in marriage. STD/HIV-prevention programs need to address the range of sexual relationships and the meanings and behaviors associated with them. (Studies in Family Planning 2000; 31[3]: 203–216)
Thomas Lutalo and Medi Kidugavu are Researchers, Rakai Project Team, Uganda Virus Research Institute, Entebbe. Maria Wawer is Professor, Center for Population and Family Health, the Joseph L. Mailman School of Public Health, Columbia University, New York. David Serwadda is Associate Professor, Institute of Public Health, Makerere University, Kampala. Laurie Zabin and Ronald Gray are Professors, Department of Population and Family Health Sciences, Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail: rgray@jhsph.edu. Correspondence should be directed to Dr. Gray. A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15–49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20–39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary. (Studies in Family Planning 2000; 31[3]: 217–227)
ReportsNeeru Gupta is Demographer, Macro International, 11785 Beltsville Drive, Calverton, MD 20705. E-mail: ngupta@macroint.com. To estimate trends and determinants of sexual initiation and contraceptive use among adolescent women in Northeast Brazil, multivariate logistic hazard models are used that draw on data from three Demographic and Health Surveys conducted there between 1986 and 1996. Educational attainment is among the variables found to be associated most consistently with differential risk of engaging in first intercourse during adolescence, including premarital intercourse, and of contraceptive use during sexual initiation. Greater frequency of attending religious services and greater exposure to television are also associated with lower rates of sexual initiation and higher use of contraceptives. Seemingly diminishing returns of education on delayed sexual activity may help explain, in part, observed increases in the absolute level of adolescent sexual experience across survey periods, however. Multilevel modeling techniques pointing to the existence of cluster-level random variances underline the need for further research into community influences on individual sexual activity. (Studies in Family Planning 2000; 31[3]: 228–238)
Bruce Caldwell is Research Fellow, National Centre for Epidemiology and Population Health, The Australian National University, Canberra ACT 0200, Australia. Barkat-e-Khuda is Chief of Party, Operations Research Project, and Division Director, Health and Population Extension Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Centre for Health and Population Research, Dhaka. In Bangladesh, the total fertility rate declined from more than six children per woman of reproductive age in 1980 to 3.3 children per woman in 1996. Much discussion has ensued about the circumstances responsible for this decline and, in particular, about the contribution made by the national family planning program. For this study, qualitative interviews were conducted with 67 women concerning the factors influencing their reproductive behavior. The participants, residents of a rural area in southwestern Bangladesh, consisted of two groups: women who were currently practicing family planning and women who had never practiced or had not done so for at least four years. The findings suggest that the family planning program has played an important role in reducing family size, but also indicate that economic and social changes, and especially growing aspirations (particularly for a life outside agriculture) have combined with changes in the nature of family decisionmaking to make couples more receptive to the idea of family planning. (Studies in Family Planning 2000; 31[3]: 239–251)
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