 Jagdish Bhatia is Professor (Emeritus), Indian Institute of Management, Bangalore India. John Cleland is Professor of Medical Demography, Centre for Population Studies, London School of Hygiene & Tropical Medicine, 50 Bedford Square, London WC1B 3DP, United Kingdom. E-mail: j.cleland@lshtm.ac.uk. This report describes the lessons learned from a series of community-based studies of gynecological morbidity among young married women in Karnataka State, India. Women's self-reports of symptoms of illness were found to be responsive to the context of the interview and the nature of questioning. In particular, women appeared much readier to report symptoms to lay interviewers after being invited to undergo a clinical examination in the near future than they were if no examination were offered. Little consistency was found in the results obtained from interviews, clinical examinations, and laboratory tests. Apparently, no alternative exists to the collection of biological specimens for laboratory analysis when estimates of disease prevalence are needed. Use of generic health-related quality-of-life assessments is recommended for future surveys. Prospective studies will yield more valuable data on these topics than will cross-sectional surveys. (Studies in Family Planning 2000; 31[4]: 267–273)
Jeremy Shiffman is Assistant Professor, Department of Public Administration, Maxwell School, Syracuse University, 306 Eggers Hall, Syracuse, NY 132441090. Email: jrshiffm@maxwell.syr.edu. Does poverty bind developing countries to high levels of maternal death in childbirth? Or, as safe-motherhood advocates claim, do public health and social policy interventions have the potential to accelerate maternal mortality transitions? Globally, almost one in 200 live births leads to the death of the mother, making maternal mortality an issue of critical international import. This article presents an analysis of the determinants of national maternal mortality levels with a view to shedding light on these questions. A cross-national regression of 64 countries shows that wealth indicators explain only a portion of the variance in national maternal mortality levels. Other determinants, including women's educational levels and the proportion of deliveries attended by trained health personnel, are an are measures of wealth. The results offer grounds for optimism concerning the potential for global safe-motherhood efforts to induce maternal mortality transitions. (Studies in Family Planning 2000; 31[4]: 274–289)
Kathryn M. Yount is Assistant Professor, Departments of International Health and Sociology, The Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322. Ray Langsten is Research Associate Professor, Social Research Center, American University in Cairo. Kenneth Hill is Professor, Department of Population and Family Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, Baltimore. Data are used from two surveys of currently married women aged 1544 conducted in 197980 and 199091 to explore the changing impact of gender preference on modern contraceptive use and on fertility in rural Menoufia, Egypt. The significantly positive effects on contraceptive use of having one or more sons in 1979 remained constant in 1990. Families without living sons had higher odds of having a birth than did families with two or more sons during 197980, and these relative odds were even higher in 199091 among families with three or more living children. The implications of these findings for subsequent declines in aggregate fertility are discussed. (Studies in Family Planning 2000; 31[4]: 290–300)
ReportsAya Goto is Public Health Fellow, Population Council. Akira Fukao is Professor, Yamagata University School of Medicine, Department of Public Health. Chihaya Fujiyama-Koriyama is Lecturer, Kagoshima University School of Medicine, Department of Public Health. Michael R. Reich is Chair, Harvard School of Public Health, Department of Population and International Health. Correspondence should be addressed to Dr. Goto at Tu Du Obstetrical and Gynecological Hospital, 284 Cong Quynh Street, Ho Chi Minh City, Vietnam. Email: agoto@hcm.vnn.vn. In this study, recent trends in the incidence of induced abortion are analyzed in order to identify the target population and its requirements for family planning policy in Japan. Abortion statistics from 1975 to 1995 from the Ministry of Health and Welfare are reviewed. The abortion rate (the number of cases of induced abortion per 1,000 women per year) for women younger than 20 increased during the study period. The abortion ratio (number of cases per 1,000 live births) remained the highest among women aged 4044. An increase in the abortion ratio was seen in the two youngest groups (younger than 20 and 2024), especially among those who were born after 1955. The proportion of abortions experienced by women younger than 25 increased from 18 percent between 1976 and 1980 to 30 percent between 1991 and 1995, and a slight increase was also observed among women aged 4044. The proportion of abortions performed after eight weeks of a pregnancy for the two youngest groups remained higher than that for older age groups during 197595. The analysis demonstrates that women younger than 25 should be the principal concern of family planning policy in Japan. Further investigations on unintended pregnancy are recommended. (Studies in Family Planning 2000; 31[4]: 301–308)
Véronique Filippi is Lecturer and Carine Ronsmans is Senior Lecturer, London School of Hygiene and Tropical Medicine, Maternal Health Programme, Keppel Street, London, WC1E 7HT, UK. Timothée Gandaho is Regional Director for West and Central Africa, Population Council, Dakar, Senegal (formerly Research Coordinator, Centre de Recherche en Reproduction Humaine et en Démographie, Benin). Wendy Graham is Director, Dugald Baird Centre for Research on Women's Health, Aberdeen, UK. Eusèbe Alihonou is Director, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin. Paul Santos is Obstetrician, Clinique Universitaire de Gynécologie et d'Obstétrique, Cotonou, Benin. This study examines the validity of a survey instrument on near-miss obstetric complications. Three groups of women with severe complications, with mild complications, and with a normal delivery were identified retrospectively in three hospitals in South Benin and interviewed at home. The concept of "near-miss" was used to identify women with severe episodes of morbidity. The questionnaire was able to detect, with some accuracy, eclamptic fits, abnormal bleeding in the third trimester for a recall period of at least three to four years, and all episodes of bleeding independent of timing within a period of two years. Questions concerning dystocia and infections of the genital tract generated disappointing results except when information on treatment was included. Overall, better results were achieved for antepartum and acute events. Severity made a positive difference only in the case of eclampsia, with an increase in sensitivity. The implications of the results for using women's recall of obstetric complications in surveys are discussed. (Studies in Family Planning 2000; 31[4]: 309–324)
Margaret Luck is Researcher, Centro de Malária e Outras Doenças Tropicais and Health Systems Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, P-1300 Lisbon, Portugal. At the time this study was conducted, Ebrima Jarju was Health Coordinator and M. Diane Nell was Field Office Director, The Gambia Field Office, Save the Children/US, and Melville O. George was Director of Medical Services, Ministry of Health, The Gambia. A community trial was conducted in rural Gambia in order to determine whether a community-based intervention designed to mobilize latent demand for contraception would increase use of modern contraceptives, even in the absence of improved availability of family planning services. Analysis of trial data indicates that the demand-mobilization intervention had a statistically significant positive effect on nonusers' adoption of modern contraception and that coterminous implementation of an intervention designed to improve access to services offered no additional benefit. The program component found to have the greatest impact was the "kabilo approach," in which village women provide basic health and family planning counseling to other women in their extended families. These results suggest that the principal barriers to increased contraceptive use in rural Gambia are psychosocial and that these barriers can be overcome through village-based interventions designed to provide socially appropriate counseling to potential contraceptive users. (Studies in Family Planning 2000; 31[4]: 325–335)
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