 Ann K. Blanc is Demographer, Blancroft Research International, 11718 Lightfall Court, Columbia, MD 21044. E-mail: ablanc@blancroft.com. This article reviews what has been learned to date about the role of gender-based power in sexual relationships in determining sexual and reproductive health outcomes. A framework for assessing the relationship between power relations and reproductive health is outlined and measurement issues are critically discussed. A summary is included of the main types of intervention approaches that have been implemented, as are a discussion of the programmatic, methodological, and ethical implications of the findings and recommendations for further experimentation and research. Although many challenges remain, results to date suggest that when the role of gender-based power is made an integral feature of sexual and reproductive health programs, there is a considerable payoff for both women and men. (Studies in Family Planning 2001; 32[3]: 189–213)
Mohamed M. Ali is Lecturer and John G. Cleland is Professor, London School of Hygiene & Tropical Medicine, Department of Epidemiology and Population Health, 49-51 Bedford Square, London WC1B3DP. E-mail: John.Cleland@lshtm.ac.uk. Whether the link, found in Benin, between postnatal abstinence and husbands' extramarital contacts can be generalized to other West African countries is assessed in this study. Data from the 1994 Demographic and Health Survey, Côte d'Ivoire, obtained from monogamous husbands concerning their extramarital sexual behavior in the two months preceding the survey were linked to data reported by wives concerning postnatal abstinence over the same time period. Logistic regression was applied to assess the link between these two factors, net of the effects of possible confounders. A significant effect of postnatal abstinence on the probability that the husband reported at least one extramarital partner was found. Unprotected extramarital sex was two times more common among men who observed conjugal abstinence than it was among other men. Other predictors of extramarital sex were urban-rural residence, region, education, and whether or not husband and wife had the same religious affiliation. Because condom use is low in this population, the protective effect of marital abstinence is offset by an increased probability that husbands will seek extramarital partners during the postpartum period. The results confirm the earlier findings for Benin and can likely be generalized to most of West Africa. (Studies in Family Planning 2001; 32[3]: 214–219)
Anrudh Jain is Senior Director, Policy and Regional Programs, Population Council, New York. In 1994, Jain and Bruce proposed an index—HARI, an acronym for Helping Individuals Achieve their Reproductive Intentions—to measure success or failure of family planning programs with a reproductive health orientation. HARI applies the principle of individual rights and well-being to the assessment of these programs. The index measures two components: the achievement of an individual's reproductive intentions and the avoidance of severe reproductive health problems associated with an individual's efforts to achieve her stated reproductive intentions. A family planning program can be deemed successful if an individual is able to avoid having an unintended pregnancy (or is able to have a wanted child) within the stipulated period and if she experiences no severe reproductive health problems in the process. If these conditions are not met, the program could be deemed a failure. The HARI index has not yet been applied in field conditions. This report illustrates the procedure for estimating HARI by using data from a panel survey conducted in Peru. It discusses the usefulness and limitations of the index in assessing the success or failure of a family planning program with a reproductive health orientation. (Studies in Family Planning 2001; 32[3]: 220–229)
ReportsRobert J. Magnani is Professor, Lynne Gaffikin is Adjunct Associate Professor, Eric E. Seiber is Research Assistant Professor, and Varja Lipovsek is a doctoral candidate, Tulane University Health Sciences Center, School of Public Health & Tropical Medicine, Department of International Health & Development, 1440 Canal Street, Suite 2200, New Orleans, Louisiana 70112. E-mail: magnani@tulane.edu. Estela Maria Leão de Aquino is Professor and Maria de Conceição Chagas Almeida is a doctoral candidate, Federal University of Bahia, Institute of Community Health, Salvador, Bahia, Brazil. An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia, Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project. (Studies in Family Planning 2001; 32[3]: 230–243)
Lindy Williams is Associate Professor, Department of Rural Sociology, Warren Hall, Cornell University, Ithaca, NY 14853. E-mail: lbw2@cornell.edu. Teresa Sobieszczyk is Postdoctoral Research Fellow, Population Studies Center, University of Michigan, Ann Arbor. Aurora E. Perez is Professor, Population Institute, University of the Philippines, Quezon City. Through a comparison of survey and in-depth interview data reported by a small sample of Filipino women and men, standard survey questions and the standard conceptualizations of pregnancy wantedness are assessed to determine whether they capture respondents' attitudes toward pregnancies and their timing in two areas in the Philippines. The study reveals that more than two-thirds of respondents were completely consistent in their survey and interview responses. Consistency was higher for women than for men, and it improved when a dichotomous measure (intended/unintended) was used rather than a more detailed variable that distinguished between intended, mistimed, and unwanted pregnancies. To the extent that the two data sources disagree, the interview transcripts suggest two possible reasons for inconsistent reports: deference to a spouse's perceived attitude or the respondent's ambivalence toward or ready acceptance of an unintended pregnancy. (Studies in Family Planning 2001; 32[3]: 244–253)
Amy Kaler is Assistant Professor of Sociology, University of Alberta, Department of Sociology, 5-21 HM Tory Building, Edmonton, Canada T6G 2H4. E-mail: akaler@ualberta.ca. Susan Cotts Watkins is Professor of Sociology, University of Pennsylvania, Philadelphia. The implementation of social welfare programs, including family planning programs, is strongly conditioned by the needs, desires, and agendas of those who carry them out, known as "street-level bureaucrats." In this study, the strategies of CBD agents in western Kenya are examined in order to understand how they use their job as a means to achieve their own personal goals. The concept of clientelism, borrowed from the field of political science, can help to explain what the CBD agents are trying to achieve for themselves in their communities, at the same time as they promote the use of contraceptive pills and injections. CBD agents are concerned with building up their own stocks of prestige and respect from their community members, while avoiding blame for any possible negative outcomes of family planning. (Studies in Family Planning 2001; 32[3]: 254–269)
Data
|
