 Ann K. Blanc is Demographer, Blancroft Research International, 11718 Lightfall Court, Columbia, MD 21044. E-mail: ablanc@blancroft.com. Siân L. Curtis is Senior Evaluation Analyst and Trevor N. Croft is Chief of Data Processing, Macro International. This study examines the fertility consequences of contraceptive discontinuation, describes cross-national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all-method discontinuation rate for quality-related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates. (Studies in Family Planning 2002; 33[2]: 127–140)
Cornelius Debpuur is Rockefeller Fellow, Navrongo Health Research Centre, Ministry of Health, Navrongo Upper East Region, Ghana. James F. Phillips is Senior Associate and Elizabeth F. Jackson is Research Coordinator, Policy Research Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017. E-mail: jphillips@popcouncil.org. Alex Nazzar is Scientist, Health Research Unit, Ghana Health Service. Pierre Ngom is Senior Fellow, Africa Population and Health Research Centre, Nairobi, Kenya. Fred N. Binka is Associate Professor, University of Ghana, School of Public Health. The Navrongo Community Health and Family Planning Project is a quasi-experimental study designed to test the hypothesis that introducing health and family planning services in a traditional African societal setting will introduce reproductive change. This article presents the impact of the initial three years of project exposure on contraceptive knowledge, awareness of supply sources, reproductive preferences, contraceptive use, and fertility. Findings show that knowledge of methods and supply sources increased as a result of exposure to project activities and that deployment of nurses to communities was associated with the emergence of preferences to limit childbearing. Fertility impact is evident in all treatment cells, most prominently in areas where nurse-outreach activities are combined with strategies for involving traditional leaders and male volunteers in promoting the program. In this combined cell, the initial three years of project exposure reduced the total fertility rate by one birth, comprising a 15 percent fertility decline relative to fertility levels in comparison communities. (Studies in Family Planning 2002; 33[2]: 141–164)
Arnstein Aassve is Research Scientist, Max Planck Institute for Demographic Research, Doberaner Strasse 114, D-18057 Rostock, Germany. E-mail: aassve@demogr.mpg.de. Gereltuya Altankhuyag is a doctoral student at the University of Southampton, Great Britain. In 1989, after a long period of socialist rule, Mongolia initiated a democratization process of its political system together with a transition toward a market economy. This study examines how changes in socioeconomic conditions in Mongolia have affected fertility patterns in recent times. It also provides an outline of changes that have taken place in terms of pronatalist policies. Data are drawn from the Reproductive Health Survey of Mongolia conducted in 1998. Among the older cohort, the relationship between economic activity and fertility is inverse but weak, whereas among the younger cohort, the economic downturn has had a strongly depressing effect on fertility. Important effects of micro-level variables, including education and housing, are also noted. The findings suggest that the fertility decline observed for the older cohorts is part of the first demographic transition, in which the collapse of pronatalist policies was influential (Studies in Family Planning 2002; 33[2]: 165–172)
ReportsTracy E. Slanger is Research Associate and Rachel C. Snow is Unit Head, University of Heidelberg, Department of Tropical Hygiene and Public Health, Reproductive Health Unit, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. E-mail: tracy.slanger@urz.uni-heidelberg.de. Friday E. Okonofua is Director, WHARC (Women's Health and Action Research Centre), Benin City, Nigeria. To date, data linking obstetric morbidity to female genital cutting in populations with less severe types of cutting have been limited to case reports and speculation. In this cross-sectional study, 1,107 women at three hospitals in Edo State, Nigeria, reported on their first-delivery experiences. Fifty-six percent of the sample had undergone genital cutting. Although univariate analyses suggest that genital cutting is associated with delivery complications and procedures, multivariate analyses controlling for sociodemographic factors and delivery setting show no difference between cut and noncut women's likelihood of reporting first-delivery complications or procedures. Whereas a clinical association between genital cutting and obstetric morbidity may occur in populations that have undergone more severe forms of cutting, in this setting, apparent associations between cutting and obstetric morbidity appear to reflect confounding by social class and by the conditions under which delivery takes place. (Studies in Family Planning 2002; 33[2]: 173–184)
Ayaga A. Bawah is a doctoral candidate, Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104. E-mail: abawah@pop.upenn.edu. The poor performance of most family planning programs in the 1980s, especially in sub-Saharan Africa, generated concern among researchers and led to a quest for explanations. In most countries, the alienation of men from participation in these programs was subsequently identified as one of the major causes, a finding that led researchers to redirect their attention to couples instead of individuals as the focus of such programs. Lack of spousal communication about family planning was identified as one reason for the low level of contraceptive use among women. Subsequent research has persistently demonstrated a positive relationship between spousal communication and contraceptive use. Most prior studies on this topic have been based on cross-sectional data, so that whether the identified relationships are causal remains unclear. Does communication, in fact, predict contraceptive use, or does the use of contraceptives generate communication among couples? This study addresses the question of causality by using longitudinal data from the Navrongo Health Research Centre panel survey. Results from both cross-sectional and longitudinal analysis demonstrate that spousal communication does, indeed, predict contraceptive behavior, even when other factors are controlled. (Studies in Family Planning 2002; 33[2]: 185–194)
Brooke R. Johnson is Director, Research, Ipas, 300 Market Street, Suite 200, Chapel Hill, NC 27516. E-mail: johnsonbr@ipas.org. Singatsho Ndhlovu is Senior Nursing Sister and Tsungai Chipato is Senior Lecturer, Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Harare, Zimbabwe. Sherry L. Farr is a doctoral candidate, Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill. In many countries, women treated for complications from spontaneous or unsafely induced abortion lack access to contraceptive services. As a result, many of them soon have a subsequent unplanned pregnancy or a repeat abortion, placing their health at increased risk. This report presents the results of a prospective intervention study on postabortion family planning conducted in the two largest public hospitals in Zimbabwe. Women at Harare Central Hospital, in the capital, received a postabortion family planning intervention, and Mpilo Central Hospital, in Bulawayo, served as the control site. The study cohort was 982 women, 527 of whom were followed for a 12-month period. During the follow-up period, significantly more women used highly effective methods of contraception, significantly fewer unplanned pregnancies occurred, and fewer repeat abortions were performed at the intervention site than at the control site. These results offer compelling evidence that ward-based contraceptive services provided to women treated for incomplete abortion can significantly reduce subsequent unplanned pregnancies. The results also suggest that postabortion family planning services can reduce the incidence of repeat abortion. (Studies in Family Planning 2002; 33[2]: 195–202)
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