 Barbara S. Mensch is Senior Associate, Wesley H. Clark is Staff Research Associate, and Cynthia B. Lloyd is Director of Social Science Research, Policy Research Division, Population Council, New York. Annabel S. Erulkar is Associate, Gender, Family, and Development Program, Population Council, Nairobi. Using data from nearly 600 adolescents aged 12–19 in combination with data collected from 33 primary schools that the adolescents attended, this report explores whether certain aspects of the school environment affect the initiation of premarital sex among girls and boys in three districts of Kenya. The results suggest that, although neither the school nor the home appears to influence whether boys engage in sex prior to marriage, for girls, a school characterized by a gender-neutral atmosphere appears to reduce the risk of their engaging in premarital sex. Furthermore, although policymakers in Kenya are clearly concerned with the problem of "schoolgirl pregnancy," the data indicate that in this sample, pregnancy is not the primary reason that girls leave school. (Studies in Family Planning 2001; 32[4]: 285–301)
Marilou Costello and Saumya RamaRao are Program Associates and Anrudh Jain is Senior Director, Policy and Regional Programs, Population Council. Marlina Lacuesta is Professor, Social Research Office, Ateneo de Davao University, Davao, Philippines. E-mail: sramarao@popcouncil.org. The reproductive health approach to family planning shifts the focus of service provision from macro-level demographic objectives to meeting clients' needs. Little field experience exists to date, however, to indicate how to implement this approach. This study describes a field project in Davao del Norte and Compostela Valley provinces in the Philippines that implemented the reproductive health approach on a quasi-experimental basis. The intervention was designed to address clients' self-defined reproductive needs by providing them with relevant and accurate information and services of good quality. It consisted of two components: Providers were trained in information exchange at fixed clinics, and supervisors were trained in facilitative supervision. The results presented here indicate that the client-centered intervention was successful in enhancing service providers' knowledge and improving the content of information exchange between providers and clients. One provincial health officer has expanded the intervention throughout his province, while other provinces are interested in duplicating the model. (Studies in Family Planning 2001; 32[4]: 302–314)
Luis Guilherme Penteado is Medical Doctor, Secretariat of Health, Santa Barbara d’Oeste, SP, Brazil. Francisco Cabral is Vice President and Margarita Díaz is President, Reprolatina, Campinas, SP, Brazil. Juan Díaz is Senior Program Associate, The Population Council, Brazil, Campinas, SP, Brazil. Laura Ghiron is Research Associate, and Ruth Simmons is Professor, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI, 48109-2029. E-mail: rsimmons@umich.edu. Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge. The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction. Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service. (Studies in Family Planning 2001; 32[4]: 315–328)
ReportsElwood Carlson is Head, Research Unit on Reproductive Health, Max Planck Institute for Demographic Research, Doberaner Strasse 114, D-18057 Rostock, Germany. E-mail: carlson@demogr.mpg.de. Vicki Lamb is Postdoctoral Fellow, Duke University Center for Demographic Studies, Durham, NC. Comparison of results from national surveys conducted in Bulgaria in 1995 and 2000 reveal little overall change in use of modern contraceptives. Dramatic increases occurred, however, among women younger than 25 who entered their reproductive period after the end of the state socialist period. This finding suggests that contraceptive gains in the country will come largely as a cohort-replacement process. From these data, no separate program impact appears for special clinics established to provide direct, subsidized delivery of modern contraceptives to women in selected cities. The special clinics opened in cities where contraceptive use was already above the national average. During these five years, other cities lacking special clinics managed to gain in prevalence of modern contraceptive use, leaving a relatively homogenous urban–rural difference in levels of use throughout the country. (Studies in Family Planning 2001; 32[4]: 329–338)
Ilene S. Speizer is Assistant Professor and B. Oleko Tambashe is Research Associate, Tulane University School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112. E-mail: ispeize@tulane.edu. Simon-Pierre Tegang is Researcher, Institut de Recherche et des Etudes de Comportements, Yaoundé, Cameroon. A quasi-experimental design is used in this study to evaluate the "Entre Nous Jeunes" peer-educator program to promote STI/HIV-preventive behaviors in Nkongsamba, Cameroon. The main objective of the study is to assess whether the young people exposed to a peer educator gained greater knowledge and practiced more protective behaviors than did those in the control community and those who were not exposed. During the 18-month intervention period, the peer educators were able to reach a large number of young people, specifically those who were sexually experienced and in need of reproductive health information. Multivariate analyses indicate that contact with a peer educator is statistically significantly associated with greater spontaneous knowledge of modern contraception, the symptoms of sexually transmitted infections, and greater use of modern contraceptives, including the condom. In the absence of a peer-education program, current contraceptive use in the intervention community would have been significantly lower. (Studies in Family Planning 2001; 32[4]: 339–351)
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