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Intimate partner violence (IPV) refers to physical, sexual, psychological, and economic violence and controlling behavior that men perpetrate against their wives or sex partners. Surveys such as the Demographic and Health Survey (DHS) increasingly include questions intended to capture individuals’ attitudes about IPV and its prevalence and forms in poor settings. Questions about attitudes regarding wife beating were added to the DHS core module in the late 1990s as part of three modules designed to capture evidence of women’s empowerment over time. (The other two modules were women’s participation in household decisionmaking and refusing to have sex.) The assumption behind the questions is that truly empowered women would not agree with any justification for wife beating (Kishor and Subaiya 2008). The questions were intended to be implementable in all DHS countries with little or no change. To date, DHSs have collected data concerning IPV in more than 25 countries and on attitudes about IPV against women in more than 50 countries. The questions concerning attitudes about IPV ask women and men of reproductive age (15–49 years) to report whether they agree or disagree that wife abuse is justified in any of a prespecified list of scenarios. An analysis of surveys conducted in 23 poor countries reveals high, albeit variable, proportions of women who believe that such violence is justifiable. Seventeen percent of currently married women aged 15–49 in Nicaragua and 90 percent in Mali report that they agree with at least one of five reasons used to justify wife beating (Kishor and Subaiya 2008). In the 2007 Bangladesh DHS (NIPORT et al. 2009), 36 percent of married women of reproductive age said that a man would be justified in beating his wife for at least one of the five reasons listed (Kishor and Subaiya 2008). A study conducted in Bangladesh using DHS data from urban men found a correlation between men’s holding attitudes supportive of wife beating and the likelihood of their perpetrating IPV (Sambisa et al. 2010). A multicountry study using DHS data found that women’s justification of wife beating is associated with an increased risk of their experiencing IPV (Kishor and Johnson 2004); the causal direction is not clear, however (Koenig et al. 2003b). Although individual and community perceptions of IPV are potentially important correlates for changing this practice, our cross-cultural understanding of these attitudes and norms may be limited by weaknesses in the commonly used attitudinal survey questions about IPV. Such questions may, for example, conflate women’s own attitudes about IPV with their perceptions of norms about IPV in their communities (Schuler and Islam 2008). In light of the high prevalence of IPV perpetrated against women, the high reported levels of agreement with IPV, and the potential significance of anti-IPV attitudes for reducing women’s risk of experiencing this sort of violence, understanding the meanings and interpretations that respondents attach to attitudinal questions on gender-based violence is important. This study presents qualitative findings from a project designed to generate a more subtle understanding of what survey respondents mean when they say that men’s violence against their wives is justified, and to develop improved methodological tools to understand women’s and men’s attitudes about IPV from surveys. Two research questions are addressed here: (1) What sociocultural frames of reference influence the ways in which common survey questions regarding individual attitudes about IPV are understood and answered? and (2) How consistent are responses to these questions when study participants are given the opportunity to discuss their answers and when additional details are added to the questions?

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.

This study compares the effectiveness of audio computer-assisted self-interviewing (Audio-CASI) with face-to-face interviews and self-administered questionnaires in collecting sensitive information on risky sexual and other behaviors among young men in urban India. A randomized study design compared data collected from 900 male college students using the three data-collection approaches and from 600 young men residing in slums using Audio-CASI and face-to-face interviews. Among the college students, the reported prevalence of risky behaviors was generally higher for young men interviewed through the Audio-CASI approach than with face-to-face interviews; self-administered questionnaires failed to yield significantly higher estimates than face-to-face interviews. Among the slum residents, the results were more mixed; the Audio-CASI approach failed to yield consistently higher responses for many risky behaviors compared with the face-to-face interview mode. The results demonstrate that although Audio-CASI appears to yield higher estimates of risky behavior among college-educated, computer-literate populations of young men, the efficacy of this approach among less-educated and less computer-literate populations appears more doubtful.

Some coitus-dependent methods of family planning, such as withdrawal, periodic abstinence, and the condom, require male involvement for their use, and using these methods in combination has proved to be sensible. An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about "traditional" methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish. In order to obtain reliable responses about these methods, a survey approach different from the long-established one is required.In-depth interviews conducted with 150 women and 141 men (128 matched couples) from rural Bangladesh as part of a survey of contraceptive use patterns revealed many inconsistencies between partners, especially in terms of use of condoms, the safe period, and withdrawal. In general, respondents who used coitus-dependent methods had difficulties answering survey questions on method use. Although many couples are known to use a combination of coitus-dependent methods (e.g., condoms during the fertile period of the cycle and coitus interruptus on days considered to be associated with a lower probability of conception), the interviews did not reflect this pattern. If one coitus-dependent method was mentioned by the woman and another by the man, investigation showed that, in most cases, the couple was using a combination of all the coitus-dependent methods they had mentioned. In some cases, the method mix employed by a couple changed from month to month. As a result, different aspects of a couple's regular sexual practice might be reported by each partner. Occasional unavailability of condoms was another reason for multiple method use. Overall, these findings indicate that inconsistencies in reported use of coitus-dependent methods of family planning are not due to careless or misleading responses to survey questions. These methods are so often used in combination, in order to enhance contraceptive effectiveness, that the combination itself is really the method being used. More accurate assessment methods are needed to capture use of coitus-dependent methods.

Information about health and family planning infrastructures is collected through the service availability module (SAM) an important feature of the Demographic and Health Surveys (DHS) conducted in many developing countries. The DHS samples were designed to provide a representative sample of households and women of reproductive age. Using the weights routinely provided with DHS data sets service accessibility can be described straightforwardly at the individual and household levels. However without further adjustment SAM data do not provide a representative picture of service delivery at the community or primary sampling unit level where the data are collected. This report proposes a methodology for reweighting the SAM data using rural data for the Egypt DHS as an illustration so that available family planning facilities at this level may be usefully characterized at little additional cost. (authors)

Using data from the 1992 Demographic and Health Survey (DHS) in Peru population researchers compared family planning data obtained by knowledgeable informants with family planning data from visits to health facilities to assess the validity of community data. The data were based on a total number of 239 clusters. 92.5% of the responses about the presence of hospitals were consistent. The situation analysis (SA) field team found three hospitals while the knowledgeable informants said that 21 hospitals existed within a 5 km radius. 69% of responses about the presence of clinics and medical posts were consistent. The SA field team found 95 clinics or medical posts while the knowledgeable informants said that there were 123. The consistency rate for pharmacies was 77%. The field team identified 23 pharmacies while the informants claimed that there were 67. 60.6% of responses by the informants about the presence of any health provider were consistent with information obtained from an SA questionnaire. The consistency rate was highest for midwives (93.2%) and lowest for birth attendants (54.7%). These findings show that the knowledgeable informant in Peru is often not a reliable source of family planning data. Yet the service availability module assumes that the key informant is the main source of family planning information in each community. The findings also suggest that field visits to service delivery points generate more reliable family planning data. Nevertheless the researchers did not recommend routine linkage of SAs to household surveys (e.g. DHS) due to relatively high costs sampling problems and analysis issues.

This report explores the limitations of survey research for obtaining population-based data to define the magnitude of maternal morbidity in settings that lack a well-developed infrastructure to support women's health requirements. The experience gained in the Philippines Safe Motherhood Survey Project is described. The drawbacks and benefits of the preliminary validation and qualitative phase of research conducted to develop the questionnaire are presented. The survey results indicate that interview-based diagnosis, although it implies the commitment of considerable resources, may be the only way to obtain an idea of the prevalence of some kinds of maternal morbidity in a given population, information necessary to the improvement of obstetric care and women's overall health status.

This report compares two different approaches to measuring the strength of family planning programs in Bangladesh and Kenya. The first approach, the judgmental approach, has been used in a number of studies during the past two decades; scores on the characteristics of family planning programs are derived from the responses knowledgeable persons give to a series of questions. The second approach is to obtain direct measures of each item being considered. In Bangladesh, the total score varied trivially between the direct and the judgmental approaches. In Kenya, the total direct score was substantially higher than the judgmental score. The primary advantage of the judgmental approach is that comparative scores can be obtained for a larger number of countries for the same time period at a much lower cost than would be required by the direct approach.Two different approaches were compared to measure the strength of family planning programs in Bangladesh and Kenya. The judgmental approach has been used in a number of studies in the past two decades: scores on the characteristics of family planning programs are derived from the responses given by knowledgeable persons to a series of questions. The direct approach obtains measures of key program inputs based on direct evidence. The sources for the two measures were leaders' favorable statement, use of the civil bureaucracy, multiministry and agency involvement, import law and regulations, involvement of private sector agencies budgets, and social marketing. Of the 16 feasible variables, scores were obtained for 13 in Bangladesh and for all 16 in Kenya. In addition, scores were also developed for 11 other variables in Bangladesh and 6 others in Kenya. In Bangladesh, the total program effort score for 1993 for both the direct and the judgmental approaches was 72%; while in Kenya the scores differed substantially: 61% for the direct approach and 53% for the judgmental approach. In Bangladesh, the 1993 direct score was 73% of the maximum, above the judgmental score of 67%. In Kenya, the direct score for the feasible variables was 64%, above the judgmental score of 55%. There was a definite decline in effort in Bangladesh from 1989 to 1993 (75% to 67%) and a mild one in Kenya (59% to 55%). However, the full set showed little change in Bangladesh (74% to 72%) and essentially no change in Kenya (54% to 53%). The family planning program in Bangladesh was pushed vigorously in the late 1980s; however, the intensity lessened in the latter part of 1991 until 1993. The primary advantage of the judgmental approach is that scores can be obtained for a larger number of countries at much lower cost than by the direct approach.

This report demonstrates that the estimates of contraceptive prevalence based on surveys are substantially lower than those based on the service statistics generated by the Indian family planning program. The reasons for this discrepancy were examined by contacting a subsample of acceptors recorded by female health workers as users in their registers. This inquiry indicated that the health workers themselves knew that 15-39 percent of the women who had been recorded as users of reversible methods were not really using them. About 19-27 percent of the recorded users of IUDs and only 3-4 percent of the recorded condom users confirmed use of the devices. Overall, the nonusers formed 59 and 64 percent of the recorded users contacted in Bharuch and Panchmahals districts, respectively. The estimates of nonuse of contraceptives in the follow-up survey are high enough to reconcile most of the observed discrepancy between the two sets of estimates of contraceptive prevalence.A comparison was made between contraceptive use statistics gleaned from service statistics and from survey statistics in four districts (Bharuch and Kheda as matched districts and Panchmahals and Rajkot) in Gujarat state, India. Service statistics showed increased use of reversible methods. The first survey was conducted in 1989 among two pairs of districts. A follow-up survey was conducted in 1991 among 25% of the villages in two districts among women who were service recorded users of sterilization and reversible methods during 1989-1990. The follow-up sample excluded users outside the health areas, those from the Muslim community, and duplicate names. The response rate ranged between 76% and 90%; nonresponses predominated among women aged 15-24 years, which would lead to a higher contraceptive prevalence rate (CPR). Adjustment was made for sampling error. The conclusion was that CPR may have been overstated by 1.0% to 1.5% in the follow-up survey. The findings showed that 18% and 23% of all acceptors in Bharuch and Panchmahals were duplicated names or misreports of users who were in fact nonusers. About 38-39% of pill acceptors in the two districts were found to be nonusers. 24-26% of recorded condom acceptors were found to be nonusers. Health workers misreports of acceptors in Bharuch for IUD users was 15% and over 27% in Panchmahals. The follow-up survey found about 21% unavailable for interviews (6-24% in Bharuch and 10-16% in Panchmahals). The follow-up sample was reduced from 452 acceptors to 292 acceptors in Bharuch and from 583 to 345 in Panchmahals. Contraceptive prevalence rates were thus 41% in Bharuch and 36% in Panchmahals. Sterilization records were the most accurate. Service statistics rates for the 4 districts in 1987 and 1989 were reported as higher than survey statistics. The findings suggest that reversible methods reported in service statistics were highly overstated. Target setting was thought likely to be responsible for the overstatement. Service statistics data may be useful only in follow-ups of users for home visits or in planning supply quantities, rather than as measures of service performance.

A study of 1984-1986 data from the MCH-FP Extension Project of the International Centre for Diarrhoeal Disease Research Bangladesh in Sirajganj subdistrict in north-central Bangladesh and Abhoynagar subdistrict in western Bangladesh was conducted to determine whether home visits by village workers distributing contraceptives would motivate women to be more amenable to using contraceptives. The study consisted of an initial interview and repeat interviews every 90 days for 6 successive rounds. Worker-client exchanges were indeed associated with higher rates of contraceptive use than would have occurred had the contacts not been made. Further female worker visits had a 2-fold stronger effect than did male worker visits. A woman visited by a female worker was 2.8 times more likely to use a contraceptive 90 days after the visit than a woman not contacted by a female worker. Home visits by male workers had a 1.4-fold increased effect on contraceptive usage. The net effect of service encounters initiated by female village workers was perhaps the most significant single characteristic of the women. Nevertheless male workers did have a significant positive effect on contraceptive use even though rural women tend not to talk to men outside their families and the orientation of male workers was to provide health services not family planning services and to perform clerical duties. The effects of female workers were more pronounced among women not intending to use contraceptives than those intending to use contraceptives (contraceptive acceptance odds 3.97 vs. 2.72) suggesting that the female worker-client exchanges offset the unwillingness of nonintenders. The transformed effects indicate that a home visit by a female worker increases the 45-day adoption rate by 2.6% compared to only 0.5% for a male worker. These results indicated that the principal effect of home visits was to crystallize existing latent demand for contraception and that female workers increased new demand by cultivating ideational change.

Interest in abortion research is reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to maternal mortality in developing countries. Information is lacking on all aspects of induced abortion, particularly methodological issues. This article reviews the methodological dilemmas encountered in previous studies, which provide useful lessons for future research on induced abortion and its complications, including related deaths. Adverse health outcomes of induced abortion are emphasized, because these are largely avoidable with access to safe abortion services. The main sources of information are examined, and their relevance for assessing rates of induced abortion, complications, and mortality is addressed. Two of the major topics are the problems of identifying cases of induced abortion, abortion complications, and related deaths, and the difficulties of selecting a valid and representative sample of women having the outcome of interest, with an appropriate comparison group. The article concludes with a discussion of approaches for improving the accuracy, completeness, and representativeness of information on induced abortion. Although the prospects for high-quality information seem daunting, it is essential that methodological advances accompany program efforts to alleviate this important public health problem.

The World Fertility Surveys (WFS) have contributed little information about the association between womens work and fertility yet this limited information is not insignificant. 1st the WFS confirmed that the association between womens work and fertility differs greatly between and within developing countries. Before the WFS no 2 studies gauged womens productivity in the same way or used identical statistical techniques. The surveys also revealed that some aspects of social conditions e.g level of socioeconomic development only explain part of the difference in the relationship between developing countries. Further the WFS showed that the short term relationship between entry in the work force and exit and birth timing is different from the long term relationship between completed fertility and employment history. Earlier studies did not differentiate between the short run and long run thereby making interpretation of results confusing. The last substantial information uncovered by the WFS included that in almost all countries studied womens work status accounted for statistical differences in number of children ever born. Nevertheless the WFS did not reveal the causal determinants that underlie work fertility relationships. Results of such a survey can generate hypotheses however about relationships whereby researchers can analyze the data further. They then would need to design another study to collect and analyze more indepth qualitative or longitudinal data to test the hypotheses. Any future surveys that look at the relationship between womens work and fertility should include consistent definitions of work hourly earnings or wage rates for all those working for cash at least a household survey with information on household composition and data on other factors of the division of labor within the household e.g. child care arrangements.

The Demographic and Health Surveys (DHS) program has included several questions on sexual intercourse in its model questionnaires that have been used in more than 25 surveys in Latin America, Africa, and Asia over the last five years. This article assesses the quality of the data on sexual intercourse for 12 DHS surveys and shows how these data may be useful for understanding contraceptive use dynamics and for organizing the management of family planning programs. The data show that there is considerable variation among countries in exposure to pregnancy prior to first marriage. Within marriage, the level of coital frequency varies with duration of marriage, fertility intentions, and type of contraceptive method used. Finally, in all countries there is some overlap between contraceptive use and sexual abstinence. This information can be useful in family planning programs for targeting particular populations, for assisting women to choose a method, and for assessing the effect of contraceptive use on fertility.

The widespread use of the questionnaire and interview as measuring instruments in population research has been, for the large part, unaccompanied by evaluation of their reliability. More than 25,000 publications in the field of population were referenced in the Population Index during the 1960s, which gives an indication of the breadth of research in this growing field. Nevertheless, virtually none of these studies addressed the problem of the reliability of the data being used. This omission is a serious one. Without assurance that responses are reliable, a researcher can never be certain that he is measuring the variable he intends to measure. In other words, validity presupposes reliability. A recent study of fertility patterns in the United States by Ryder and Westoff (1971) includes reinterview data on 382 white, married, adult women. It thus represents one attempt to assess consistency, or stability, of knowledge, attitude, and practice responses over time. The present study adds to these much needed methodological data by presenting test-retest reliability results for teenagers in a metropolitan area in the United States who completed questionnaires focused on issues related to family formation and population. The goal of this study was to ascertain if and how reliability is differentially affected by characteristics of the questionnaire and of the respondent. Specifically, it asked whether reliability varies as a function of: (1) the content (personal history, family formation, population); (2) the psychological nature of the item (knowledge; attitudes, beliefs, and opinions; desires, expectations, and intentions); and (3) the characteristics of the respondent (sex; age [younger versus older teenagers]; race [white versus nonwhite]; religion [Catholic versus non-Catholic]).

The two rounds of the National Longitudinal Study in Thailand provide a useful opportunity to explore response reliability in a large-scale social and demographic survey in a developing country. The results indicate that nonrandom reliability at the individual level ranged from quite high (for several straightforward, facual questions) to quite low (for most attitudinal questions). There was considerable distributional stability, however, even for many of the variables with low individual-level reliability. In terms of its response reliability, the Thai study compares reasonably well with several leading US fertility surveys. However, in both countries response reliability at the individual level for attitudinal questions is distressingly low. This clearly should be a matter of major concern for social scientists using survey results.

The KAP tradition emerged from the historical need to measure the extent to which overt hostility to the idea and organization of family planning services existed. As growing numbers of countries have implemented family planning programs without arousing widespread and active opposition however the importance of this role has diminished. The usefulness of KAP studies now depends on their contribution to the evaluation and guidance of existing programs. Although this fact is clearly recognized (Berelson 1966 ch. 51) there has been a surprising reluctance to modify and refine KAP methodology for these purposes. Perhaps the great emphasis placed on international comparability and standardization while providing much needed support for inexperienced researchers has helped to create and perpetuate an inadequate orthodoxy of research design. Improvements to the KAP approach have also been impeded by the domination of the demographic component in the questionnaire. Knowledge of fertility marital and infant mortality patterns provides an essential background for strategy and evaluation. But measurement of these factors by comprehensive pregnancy histories has been accompanied in many instances by relative neglect of KAP elements more directly related to social action. (excerpt)

The objective of this analysis is to compare two different approaches to the collection of information on contraceptive use. The data for this comparison are derived from the 1986 Demographic and Health Surveys (DHS) in Peru. Approximately 7,500 women were interviewed with the standard DHS questionnaire, whereas about 5,000 women received an "experimental questionnaire." The major difference between the questionnaires is the inclusion of a six-year monthly calendar in the experimental questionnaire that records pregnancies, contraceptive use, and postpartum information, in contrast to the more common tabular format of the standard questionnaire. The analysis demonstrates that although reports of contraceptive knowledge, ever-use, and current use are relatively robust to the variations in questionnaire design, estimates of past use are dependent on the survey instrument. Several different comparisons indicate that reporting of information on contraceptive histories in the experimental questionnaire is superior to that in the standard one.

Indonesian family planning (FP) service statistics indicate that 3 out of 5 couples of childbearing age nationwide are now using modern contraception provided by the FP program. The 1980 Indonesian Census provided a unique opportunity to cross-check the FP programs contraceptive prevalence figures for every province. The results of that comparison indicate considerable variation particularly in Java between the FP program estimates of numbers of current users and the census estimates. Possible explanations for these differences are sought in the FP program approach to estimation of prevalence levels from acceptor data and by examining the possibility of census underestimation of prevalence levels. The 3 methods of contraception compared are the pill IUD and condom. The numbers of current users of the pill IUD or condom were considerably higher overall according to the service statistics in comparison to the 1980 census. The differences were greatest in Java and Bali. 1 method to deal with the possibility that the difference is due to overestimation is to compare service statistics with surveys of the same population where family planning prevalence levels have been estimated. The major source of difference on the program side is the appropriateness of the sets of usage assumptions. Studies have shown that continuation rates can vary considerably over time. A census problem of considerable importance is the policy of not necessarily asking the married woman directly about her contraceptive practice. A potential problem that arises in evaluation is the risk of obtaining lower quality acceptor data because of time pressure on field workers to get quick results.

A survey was conducted by the Family Planning Association of Hong Kong in an effort to provide information to family planning administrators for use in the formulation of future programs. Public housing estates are chosen for the survey because it is estimated by the Housing Department that in 10 years time 60% of the Hong Kong population will be living in public housing. The aim was to select a probability sample of at least 100 married women aged 15-49 in each of the estates so that the sample values could be compared a probability sample of about 50 married men aged 15-49 in each estate and a probability sample of about 50 unmarried youths within the age group 15-24 in each estate. 3 separate samples were drawn from each of the estates for the 3 different groups of respondents. The survey shows that some improvement and expansion in areas of the existing programs are urgently needed. A majority of couples have more children than they desire. 29% of the respondents did not know about the existence of a family planning clinic nearby or even within the same estate. Male respondents appear to be only superficially motivated and are very ignorant of family planning concerns generally. They also lack knowledge as to the services available. Over 3/4 of the respondents consider female sterilization a good idea and about the same percentage of female respondents indicate a desire to be sterilized when they achieve their desired family size. There is no indication that users think poorly of the quality and standard of family planning clinics. The attitude and competence of clinic personnel is generally assessed to be very satisfactory.

A multiround fertility and knowledge attitude and practice survey was conducted among currently married women in Ishan Division of the Midwestern State of Nigeria in 4 rounds of interviews at 1-year intervals between 1969 and 1972. The objective of the survey was to evaluate the impact of the family planning program initiated at Zuma Memorial Hospital in Irrua in February 1969. This program was the 1st organized attempt to introduce modern methods of family planning to the population of Ishan. Survey results show that significant changes occurred in the attitude of women toward family size limitation and knowledge and practice of family planning in the 1st 4 years of the family planning program. In 1969 approximately 1/4 of the respondents indicated a desire to limit their family size but by the end of the survey period the proportion had increased to over 1/2. The greatest change in attitude was reported for women with 2 or fewer living childre n. The proportion of such women who wished to limit family size increased from 26% in 1969 to 66% in 1972. Education appears to have more influence than age on the desire to limit family size. 13% of the respondents knew at least 1 contraceptive method in 1969. This figure rose to 55% in 1972. By 1972 almost 1/4 of the respondents were using 1 or more methods of birth control in contrast to 1% in 1969. Neither the awareness of declining child mortality nor increased parental aspirations for children however seems to have affected family size ideals for the mean preferred number of children reported by the women remained at slightly over 7 for all 4 survey years. When evaluated in the context of a rural society the Ishan family planning program has accomplished much in terms of increases in family planning knowledge and practice in a short period of time. The success of the program can be largely attributed to its indigenous character.

This 5-year world fertility survey was begun in mid-1972 to assess the current status of human fertility throughout the world and improve demographic data collection. Individual countries were informed and the participating countries had studies undertaken to acquire information from 3 levels: 1) the community level; 2) the household level; and 3) the individual respondent selected for detailed interview. The contents of the interview are described and provisions for quality control and processing are briefly described. The organization of the World Fertility Survey (WFS) is broken down into International groups (Permanent Advisory Committees and WFS Central Staff) national organizations for each country and training and timetable groups. The origins and history of the WFS are described from the proceedings of the biennial conference in 1971 of the International Statistical Institute. The association of the WFS with the African Census Program for 1972-1975 will assist the African program with fertility aspects of its census and thereby include Africa in the WFS. The Economic Commission for Europe (ECE) is studying 12 countries in Europe to find causes for postwar fluctuations in fertility and to estimate future trends; the ISI is engaged in discussions with the ECE for mutual interest studies. A pilot study will begin in Fiji in early 1974.

The characteristics of more than 12,000 persons from developing countries who received training in population and family planning subjects during 1966-78 are reviewed. During these years many changes occurred with regard to trainee origin, professional background, nature and duration of training program attended, and other important characteristics. The observed patterns of trainee characteristics over time suggest the presence of defined stages of manpower training that are largely predictable. These trends suggest an empirical basis for anticipating future training needs and for evaluating training activities.

A number of factual and attitudinal questions asked in the 1973 Taiwan KAP-4 survey were repeated in a postenumeration survey one month later in order to assess the reliability of responses of the 286 women reinterviewed. The level of reliability is found to vary depending on the measures used and on whether the focus is aggregate data or individual responses. Analysis of consistency of responses shows that while overall reliability at both aggregate and individual levels is reasonably good, there is greater reliability for factual than for attitudinal data. Nevertheless, consistency of responses on factual questions varies considerably depending on the salience of the topic to the respondent. Estimates of reliability are shown to depend on the measure used and on the skewness of the distributions of the responses.

The First National Survey on Family Planning in Singapore was designed to gather data that would aid in evaluating the program of the National Family Planning and Population Board and the influence of government population policies on attitudes toward family planning. Interviews with 2,078 currently married women aged 15--44 revealed high levels of contraceptive knowledge and use, satisfaction of clinic users with the Board's services, and attitudes that favor greater acceptance of abortion and sterilization. Continued promotion of the concept of the two-child family appears necessary in light of divided opinions of respondents on this government recommendation.

Estimates of levels and differentials of pregnancy loss are presented for 40 developing countries participating in the World Fertility Survey (WFS) program. Judged against agreed-upon levels of spontaneous loss in human populations, WFS surveys measured from 50 to 80 percent of recognizable losses. The coverage of induced abortions appears to be much worse. Consistent with data from other sources and settings, the probability of loss is strongly correlated with maternal demographic characteristics: age, pregnancy order, pregnancy spacing, and pregnancy loss history. Despite incomplete coverage, the WFS data on pregnancy loss provide considerable, and largely unexploited, insight on the dynamics of the reproductive career.

A national sample of 120 Jamaican physicians, public health nurses, and licensed midwives participated in a two-stage Delphi survey to identify medical opinion on proposed liberlization of Jamaica's abortion law, and to predict the likely impact of such legislative action on existing health and family planning services. More than 80 percent of the respondents favored legalization of abortion, and most supported changes in the health service delivery system to accommodate the expected demand. They believed that clandestine abortion, involving pharmacists and physicians, is already widely practiced.

An East African island nation Mauritius has one of the highest population densities in the world. Efforts to promote family planning and contraception began in 1957. In 1975 the Health Ministry sponsored a survey of 1821 ever-married women under 50 to profile their contraceptive practices. By international standards contraception awareness and use was high. The crude birthrate has dropped from 48/1000 in 1952 to 23 in 1973. Unplanned pregnancies were high among women who had used contraceptives and stopped. 42% rural women 20-24 had never used contraceptives 24% of urban women. The ideal family size 3.0 is lower than Taiwan and Singapore. 86% of those 35-39 had 3 or more children 25% had never used contraception but 59% were current users. About 70% of those with 3 or more children had ever used contraception. Programs are needed to retrieve dropouts and improve method/use efficiency.

This report investigates the consistency of retrospective and current status data on contraceptive use from a series of national fertility surveys carried out during the 1970s in Korea. Aggregate consistency is examined among random samples from the same cohort or cohorts of women interviewed in each survey. The results indicate that estimates of trends in contraceptive use from a retrospective history in 1 survey or from cross-sectional estimates in a series of surveys can each yield misleading findings. Data from the 1974 Korean Fertility Survey (KNFS) appear more reliable than those from other surveys. This is possibly the result of 1) the use of an interval by interval contraceptive history; 2) presentation of explicit definitions of contraceptive methods prior to taking the contraceptive history; or 3) the KNFS involving longer interviewer training and perhaps less time pressure during interviews. The results clearly show that there are dangers inherent in estimating trends in contraceptive use. On the other hand evidence from the 1974 survey indicates that contraceptive use data of reasonable quality can be collected in a retrospective history given adequate questionnaire design and interviewer training and effort. The fact that the results indicate large intersurvey differences in the completeness of reporting of use stresses the importance of evaluating contraceptives use data before they are analyzed.

Between July and September 1983, a two-stage probability survey was conducted in Addis Ababa, Ethiopia to obtain data on pregnancy outcomes for all women aged 13-49 in 32,215 houses. The survey covered a two-year period, from 11 September 1981 to 10 September 1983. Of the 9,315 women who were pregnant during those two years, 45 died from complications of pregnancy, delivery, and the puerperium. The maternal mortality rate for 1982-83 was estimated to be 566 per 100,000 live births. Mortality was highest for nullipara, the unmarried, women employed as maids/janitresses, and students. The most common cause of death was abortion. It appears that reliable data on maternal mortality can be obtained retrospectively through a probability survey.

Report of a follow-up survey of male family planning acceptors in the Danfa program. A sample of 100 men from each of 3 project areas (representing 47% of all male acceptors as of July 1974) was obtained with 227 acceptors ultimately interviewed. A sample of female acceptors was also interviewed using a similar questionnaire. 84% of the males were between ages 20-44. The mean age for the sampled females was 29. 19% of the males and 5% of the females reported ever using contraception before accepting it from the program. 80% of males were literate and 39% of females the importance of literacy for males further underscored by the fact that while only 36% of their spouses were literate the female respondents claimed 72% of their spouses to be literate. Controlling for other factors religion was also important with Christians most likely to accept family planning. 70% of male acceptors were married at the time of acceptance and 25% of those unmarried at time of acceptance were married by the time of the interview. 76% had at least one living child. 55% of the married men and 44% of the unmarried men claimed to have only one sexual partner. 78% of married men claimed to have discussed family planning with their wives. 66% reported that they used the accepted method only with their wives 20% only with the other partner and 12% with both partners. The most common reason given for acceptance was the health of their children. 52% of the male acceptors had first learned about family planning from the project health staff and 24% through mass media. 64% of the male respondents reported having tried to persuade another to accept family planning compared with 40% of the females. Half of the men had chosen the condom and half contraceptive foam for their partners. 16% of foam and 6% of condom acceptors had never used the methods.

This report is concerned with designs for field intervention studies utilized in operations research. Beginning with an overview of the objectives of operations research the authors go on to review the difficulties associated with using true experimental designs. Proposed guidelines for designing quasi-experimental studies are then discussed. The guidelines focus on using multiple sources of data multiple measurements over time and multiple replications of the study intervention. Finally an example is presented of one ongoing operations research study in Sri Lanka. Since 1981 14 research studies have been implemented in Thailand the Philippines Sri Lanka and Nepal as part of an ongoing family operations research (OR) program in Asia. 2 features of true experimental designs often prove problematic for health and family planning field studies: random selection of study units (individuals households villages districts) from some larger grouping of these units and then subsequent random assignment of these units to experimental and control groups; and maintaining full control over timing intensity and duration of the experimental variables. Random assignment of study units to experimental and control groups relates to internal validity and is important if the objective of a study is to make causal inferences about the impact of a program intervention. Managers are concerned with such questions as: what type and length of training should fieldworkers receive? What is the most cost-effective means of providing accurate information to large numbers of rural people about the availability of services? Do incentives increase contraceptive prevalence and if so what type of incentives? A guideline for selecting field research design is the principle of the 3 multiples: seeking multiple data sources to obtain information on the same variables; seeking multiple measurements over time of the same variables; and seeking multiple replications of the study intervention in different field settings. Experience suggests that a good quasi-experimental design includes: background information from 2ndry sources; selecting multiple sites for replication of the study intervention; collecting preliminary qualitative data; conducting a baseline survey; implementing a study monitoring system; conducting a follow-up survey; collecting postintervention qualitative data; and collecting longterm followup data. The Sri Lankan IUD study which followed this basic design presented many difficulties but at least allowed the investigators to isolate statistically the data from areas known to have been affected by nonstudy intervention variables.

Increasing recognition of the need for more qualitative methods in research on motivational aspects of fertility has rekindled interest in the focus group interview. Potential advantages and disadvantages of this approach are discussed especially in light of recognized limitations of KAP Studies. Results of a Mexico study that utilized both survey and focus group techniques are evaluated concentrating on the concept of machismo as related to fertility. The group method confirmed a number of important survey findings that are sometimes attributed to limitations of the survey method. The survey produced results clearly negating the "machismo/fertility complex" while the focus group findings were at best inconclusive. (authors)

The Kavar Village health worker project recruited local men and women and trained them to serve as health workers with family planning as 1 of their responsibilities. 14 months after the workers were deployed in this rural project (in May 1975) a survey was conducted to determine their effect on family planning knowledge attitudes and practice. The 16 project villages were compared with matched control villages. In the health worker villages 28% of married women aged 15-44 were using contraceptives compared with 15% in control villages (p less than .01). In every age group except the 40-44 age group health worker villages had higher contraceptive use. Maximum impact seemed to be among women aged 25-34 whose use was 33-39% compared with 14-20% in control villages. The health worker villages also had a slightly lower termination rate. Both sets of villages had more than 90% of married women responding they knew 1 or more contraceptive methods. However health workers had a significant effect on knowledge about the pill. Most of the married respondents in both sets of villages approved of contraception either completely or with qualifications. Sex of health worker did not appear to be significant. The auxiliary health worker is called a viable means for developing countries to upgrade the health and living conditions of rural populations. An important part of this maternal and child health and lowering birthrates. This survey shows health workers are well-equipped to do this.

This study was designed and conducted to test the relative reliability of reported induced abortion obtained through a conventional survey technique (direct questioning) as compared with an estimated proportion of women with induced abortion obtained through the randomized response technique. Two independent, nationally representative samples were used, one for each approach. A total of 1,521 women were interviewed in the direct question sample, providing a 70.1 percent response rate. In the randomized response sample, 1,674 women participated in the study, representing a 72.9 percent response rate; 1,044 or 62.4 percent of these women provided usable answers. There were substantial differentials in the successful use among the subcategories of independent variables. Of the 1,044 women in the RRT sample, 33.1 percent were estimated to have had at least one induced abortion during their reproductive lives--a much higher rate than the 13.9 percent obtained from the DQ sample. The factors found to be of relevance in relation to induced abortion including age, education, place of residence, development status of the province where the woman resided, number of pregnancies and living children, occupation, and family type.

2361 respondents who had 1st been interviewed in the 1970 National Fertility Study were interviewed again toward the end of 1975 in order to analyze the discrepancies between reports about the same pregnancies that were given by the same respondents. 37 of the respondents reported different numbers of births; dates of birth discrepant by more than 12 months were reported for 56 of the 4950 births to the remaining respondents. The study is based on the characteristics of the remaining 4894 matched births. In order to measure individual consistency of response a new index that is independent of the dimension of the distribution of the coded variable was developed. For the components of the code consistency is 58% for use or nonuse of contraception 65% for success or failure with use and 35% for success or failure with nonuse. The classification of failures in timing or quantity showed a consistency of 64% for users and 75% for nonusers. Differentials in consistency of response have been examined for birth order length of recall interval religion and education. While consistency is lower for events occurring a longer time before interview for Catholics and for those with less education the main finding is that these relationships are weak.

The 3rd national Contraceptive Prevalence Survey of Thailand took place in 1984; a total of 7576 ever married women wre interviewed of which 317 were included in a special sample. The survey indicates an increase in contraceptive prevalence as measured by the % of currently married women aged 15-44 presently using a contraceptive method. The increase nationallly was from 59 to 65% between 1981 and 1984. Increase in female sterilization accounts for 86% of the increase in overall prevalence. This report breaks into 9 chapters: 1) introduction; 2) methodology; 3) fertility; 4) contraceptive awarencess; 5) contraceptive use; 6) contraceptive source unmet need and nonuser profile; 7) infant feeding practices and postpartum amenorrhea; 8) Moslem/Buddhist differentials; and 9) Summary and implications for family planning program. Discusson and tables present the findings: 1) The lowest contraceptive prevalence rate is in the South (50%) the highest in the North and Bangkok (over 70%). 2) Only 2.5% of currently married women aged 15-49 have an unmet need for spacing and only 3.5% have an unmet need for limiting; thus about 450000 of the approximately 7.5 million currently married women under 50 are not being served by the family planning program or by some commerical outlet. 3) The large majority of Thai couples practicing contraception used a government outlet as their most recent source of supply or service. 4) Total fertility at the national level declined from 3.68 to 3.47 between 1981 and 1984. 5) The modal number of children desired among women married less than 5 years is 2. 6) For Moslems overall prevalence is only about 1/2 as high as among Buddhists but language region and religion each exert an independent influence on prevalence within these groups. 7) Fertility levels and preferences differ considerably between Moslems and Buddhists: marital fertility is over 70% higher for Moslems. 8) Generally only a small proportion of Buddhists indicated that they believed that any contraceptive method was against their religion; Moslems were far more likely to express religious opposition but less toward temporary than toward permanent methods of contraception.

A major 4-phase experiment was conducted in Euiryong about 150 km northwest of Pusan City Korea to test 3 alternative delivery systems of family planning determine which is most feasible for Korean rural areas to investigate possible conflicts between the new systems and the government health network and to devise a suitable information system for a later large study. Distribution in addition to the government program seems advisable because of the inconvenience of walking or traveling to government clinics the inability of mass clinics to give personal help and reassurance and the reluctance of women to go to government clinics. The 1st delivery system was called the 100% method; all households with 1 or more eligible women were canvassed and the eligible women were offered contraceptives. The 2nd system involved group meetings with partial canvas of households not represented at the meeting. The 3rd method called the 10% method divided the households into groups of 10 and a woman from each group recruited to be responsible for family planning supplies. All 3 systems were successful in that they increased contraceptive use considerably during the 4-month trial they were culturally acceptable and they were cost-effective. The group meetings proved least effective and the leaders ended up canvassing each household by the end of the trial. The 10% method proved to be a nightmare for crew leaders who were continually recruiting new canvassers. Therefore the 100% method was chosen for the larger trial. All 3 methods increased contraceptive use about 20-25% during the 4 months. The larger study began in 1976 in Cheju province.

This review covers cross-sectional health interview surveys in which respondents were asked about their recent illness and their use of preventative and curative health services. Any attempt to compare morbidity rates between studies is thwarted by the lack of standardization of survey methodology and methods of analysis and classification. This review of the literature has highlighted the most important methodological issues to consider when planning health interview surveys. The primary objective of health interview surveys should be to produce useful results for health service planners. The study design should be tailored to fit the detailed objectives of the survey which should be explicitly stated in quantitative terms. Once the questionnaire has been finalized multistage random sampling techniques should be used to determine the sample population. Interviewers should reside in the study area. The order in which the interviewer asks the respondent questions can affect the results substantially. Surveys must clearly specify whether events that started prior to the recall period but extended into it should be included. Some index of illness severity should be included in the questionnaire. Morbidity results should be reported by a symptom or grouped into functional systems. The internal consistency of completed questionnaires should be checked within 24 hours.

Family planning programs might become more efficient if it were possible to predict which women are particularly willing to adopt contraception. In this report a special computer program was applied to data from the Koyang family planning study in Korea to identify groups of women with especially high and especially low acceptance rates in the program. This analysis was conducted by Dr. John Ross during a postdoctoral year at the University of Michigan Population Studies Center with the assistance of Dr. Sook Bang. Dr. Ross is now on the staff of The Population Council and Dr. Bang is Associate Professor at Yonsei University in Seoul. This effort is presented as an ingenious approach to this problem. Additional such efforts may well produce some clear and useful guidelines for administrative action as the Korean experience is tested against similar activities elsewhere. This is an abridged version of the full technical report which is available upon request from Dr. Ross. (excerpt)

This article by William Seltzer Staff Associate in the Demographic Division of The Population Council is based on a paper he gave before the American Association for the Advancement of Science on December 29 1969 in the session entitled "Evaluation of Family Planning Programs" arranged by Dr. Zenas Sykes of the Department of Population and Family Health The Johns Hopkins University. The author wishes to acknowledge the helpful comments he received from many of his colleagues at The Population Council in connection with the preparation of the earlier version of the report. In addition the present version particularly benefited from the suggestions of Ronald Freedman Eli S. Marks and Benjamin Tepping. The report is of interest because it illustrates many of the difficulties involved in measuring the fertility changes attributable to family planning programs. (excerpt)

It is suggested that family planning and fertility studies can offer an exceptional opportunity for research in the behavioral sciences. The opportunities are enhanced by the fact that high quality sample surveys can be carried out in this field especially in the developing areas. In Malaysia for example questions about a wide range of variables related to each other as well as to fertility can be asked. Perhaps the most important contribution that social science techniques have made so far to the program is to provide some facts to replace speculation and myth. A great deal of empirical work pertinent to family planning in recent years describes the distribution of behavior for some intermediate variables and their connection to fertility on the one hand and to social and demographic classifications of the other hand. Studies are now emerging that are trying to establsih what proportion of women insserted with an IUD terminate at various periods of time as a result of pregnancy expulsion or intentional removal of the device. Such studies also take into account the characteristics of the couples involved the areas in which they live and the program itself. Attitudes norms and values about family life are important to know in studying fertility. The most basic general question is: What are the necessary and sufficient conditions for a sharp reduction in fertility from preindustrial levels? Another crucial question is: What are the barriers that prevent some countries from organizing and really implementing the plans they have on paper when even money and technical personnel seem to be availabe and there seems to be consensus on the objective?