 The Proximate Determinants of the Decline to Below-replacement Fertility in Addis Ababa, Ethiopia
Amson Sibanda is Research Associate, University of Pennsylvania, Population Studies Center, 3718 Locust Walk, Philadelphia, PA 19104. E-mail: sibandaa@pop.upenn.edu. At the time this article was written, he was Research Associate, Department of Sociology and Population Studies and Training Center, Brown University, Providence, RI. Zewdu Woubalem is a doctoral candidate, Dennis P. Hogan is Robert E. Turner Distinguished Professor of Population Studies, and David P. Lindstrom is Associate Professor, Department of Sociology and Population Studies and Training Center, Brown University. Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility. (Studies in Family Planning 2003; 34[1]: 1–7)
Barbara S. Mensch is Senior Associate, Policy Research Division, Population Council, New York. E-mail: bmensch@popcouncil.org. Barbara Ibrahim is Senior Associate and Regional Director for West Asia and North Africa, Population Council, Cairo. Susan M. Lee was a fellow at the Population Council, Cairo, when this study was begun and is currently a graduate student at the Population Studies Center, University of Michigan. Omaima El-Gibaly is Lecturer, Department of Public Health and Community Medicine, Assiut University, Egypt. Using nationally representative survey data, this study explores gender-role attitudes among unmarried adolescents aged 16–19 in Egypt, a society characterized by distinct and often segregated roles for men and women. Adolescents’ views about desirable qualities in a spouse as well as more direct indicators of gender-role attitudes are examined, including opinions about whether wives should defer to their husbands, share in household decisionmaking, and have the responsibility for performing domestic tasks. The findings regarding spousal characteristics reflect strong gender differentiation. Girls and boys provide divergent profiles of an ideal spouse, profiles that reflect traditional gender roles. Girls are significantly less likely than boys to favor educational inequality between spouses, however. Neither boys nor girls have egalitarian gender-role attitudes, although girls are significantly more likely to express less traditional attitudes. Multivariate analyses indicate that girls’ and boys’ attitudes do not vary consistently and significantly by socioeconomic background; in particular, increased schooling does not always promote egalitarian attitudes. The implications of these findings are discussed. (Studies in Family Planning 2003; 34[1]: 8–18)
Associations of Mass Media Exposure with Family Planning Attitudes and Practices in Uganda
Neeru Gupta is Technical Officer, Department of Health Service Provision, Evidence and Information for Policy, World Health Organization, Geneva. At the time of this study, she was Evaluation Analyst, MEASURE Evaluation Project, ORC Macro. Charles Katende is Senior Monitoring and Evaluation Officer, PATH–Africa Youth Alliance Project, Kampala, Uganda. At the time of this study, he was Research and Evaluation Officer, DISH Project. Ruth Bessinger is Evaluation Analyst, MEASURE Evaluation Project, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705. E-mail: Ruth.E.Bessinger@orcmacro.com. This study examines the associations between multimedia behavior change communication (BCC) campaigns and women’s and men’s use of and intention to use modern contraceptive methods in target areas of Uganda. Data are drawn primarily from the 1997 and 1999 Delivery of Improved Services for Health (DISH) evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Additional time-trend analyses rely on data from the 1995 Uganda Demographic and Health Survey. Logistic regressions are used to assess the associations between BCC exposure and family planning attitudes and practices, controlling for individuals’ background characteristics. To minimize the biases of self-reported exposure, the analyses also explore cluster-level indexes of the penetration of BCC messages in the community. Results indicate that exposure to BCC messages was associated with increased contraceptive use and intention to use. Some evidence of self-reported bias is found, and the pathways to fertility-related behavioral change appear different for women and men. (Studies in Family Planning 2003; 34[1]: 19–31)
Reports Inequality and Changes in Women’s Use of Maternal Health-care Services in Tajikistan
Jane Falkingham is Professor of Demography and International Social Policy, Department of Social Statistics, University of Southampton, Highfield, Southampton SO17 1BJ England. E-mail: j.c.falkingham@soton.ac.uk. Using recently available survey data for Tajikistan, this study explores changes in the pattern of maternal health care during the last decade and the extent to which inequalities in access to that care have emerged. In particular, the links between poverty and women’s educational status and the use of maternal health-care services are investigated. The survey findings demonstrate a significant decline in the use of maternal health-care services in Tajikistan since the country gained independence from the Soviet Union in 1991. They show changes in the location of delivery and the person providing assistance, with a clear shift away from giving birth in a medical facility toward giving birth at home. More than two-fifths of all women who gave birth in the year prior to the survey delivered their baby at home. Women from the poorest quintile are three times more likely than women from the richest quintile to undergo a home delivery without a trained assistant. (Studies in Family Planning 2003; 34[1]: 32–43)
Contraceptive Use Before and After Marriage in Shanghai
Yan Che is Research Fellow, Shanghai Institute of Planned Parenthood Research, 2140 Xie Tu Road, Shanghai 200032, China, and Postdoctoral Research Fellow, Centre for Population Studies, London School of Hygiene & Tropical Medicine. E-mail: yan_che2002@hotmail.com. John Cleland is Professor, Centre for Population Studies, London School of Hygiene & Tropical Medicine. Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples’ needs in Shanghai and that the family planning program’s attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services. (Studies in Family Planning 2003; 34[1]: 44–52)
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