Other Notable PublicationsSource: Studies in Family Planning, Vol. 31, No. 3 (Sep., 2000), pp. 264-266Published by: Population CouncilStable URL: http://www.jstor.org/stable/172269 .

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OTHER NOTABLE PUBLICATIONS

BOOKS

Hind Khattab, Nabil Younis, and Huda Zurayk Women, Reproduction, and Health in Rural Egypt: The Giza Study Cairo: The American University in Cairo Press (1999) 220 pages.

This study examines the reproductive health of women living in an economically deprived rural area in Egypt's Giza gover- norate. The objective of the study was to explore the extent to which the health implications of reproduction go beyond mor-

tality to influence morbidity and women's quality of life and to show the interaction of the social conditions of women's lives with their reproductive health. Working in two villages from 1988 to 1998, a team of interdisciplinary collaborators, known as the Reproductive Health Working Group, used field meth- ods from clinical medicine, epidemiology, and anthropology. The results presented describe the status of these women's re-

productive health and also their own perceptions of their health, which govern their use of health services more than any other

single factor. The research shows that these women suffer re-

productive maladies in silence because reproduction is a main source of happiness and security in their lives and because they are not aware that the conditions they experience are not "nor- mal" for women and that they are treatable. Even if they wish to seek health care, their sense of family priorities, their lack of control over decisionmaking, and their fear of maltreatment by the health services stop them from seeking it. The book is based on published scientific papers and policy booklets and mono-

graphs and on the ongoing involvement of the research team in the area of women's reproductive health. It begins by setting out the conceptual framework underlying the research (Chap- ter 2). A definition of reproductive morbidity is followed by an

explanation of a determinants framework used to delineate the relevant risk factors. The measurement framework includes two

instruments, a medical examination and a questionnaire (pre- sented in Chapter 3 and Appendices 2 and 3). Although poor agreement was found between the data provided by the two

instruments, the questionnaire illuminated women's perceptions of illness and its sociocultural context that proved valuable for

formulating policy recommendations. The community from which the sample was drawn is described in Chapter 4. The sam-

pling procedure and the characteristics and activities of the

sample families are detailed. In Chapter 5, the data collection and the fieldwork are described. The findings of the research are discussed in Chapters 6 though 9. They cover the reproduc- tive pattern of the sample, the prevalence and determinants of

reproductive morbidity, the interaction of women's health with their practice of family planning, their own perceptions of their health status, and their use of the services available to them. A critical examination of the validity of women's reports of symp-

toms and a discussion of alternative methods for assessing such

self-reports are presented in Chapter 10. The final chapter, "Policy Issues," draws from the entire process of research and

analysis to serve as a guide to future strategies for improve- ments in the reproductive health environment of the women of this region. The epilogue describes the intervention the research team is undertaking as the immediate practical outcome of the

study. The text includes 27 tables and nine charts. The four ap- pendices, "Publications of the Giza Morbidity Study"; "The Medical Examination Forms"; "The Questionnaire"; and "Re-

gression Analysis," are followed by a glossary of terms and a reference list.

Anna Glasier and Beverly Winikoff

Contraception Fast Facts: Indispensable Guides to Clinical Practice Oxford: Health Press (2000) 64 pages.

This small volume is intended as a guide for health-care pro- fessionals in the United States and United Kingdom. It presents an overview of currently available contraceptive methods-how

they work, their effectiveness, and their side effects. The first

chapter describes the information to be covered in individual consultation with someone seeking to choose a contraceptive appropriate to her or his needs and situation. In exploring the

topic of safety, the authors address the concepts of absolute and relative risk and illustrate graphically the odds for survival asso- ciated with different behaviors. Throughout the book, efficacy is described as the percentage of women who experience an un- intended pregnancy during the first year of perfect use and dur-

ing typical use of a method. Different factors relating to meth- ods' acceptability are described. Individual chapters are devoted to biologically based methods, barrier methods, intrauterine de-

vices, combined oral contraceptives, progestogen-only methods,

emergency contraception, female sterilization, and male steril- ization. A description of the methods that are likely to become available in the future is presented to allow providers to antici-

pate new developments that may be of interest to their clients. The guide is clearly and colorfully illustrated and concludes with a list of references to recent publications and an index.

ARTICLE ABSTRACTS

Charles F. Westoff and Akinrinola Bankole "Trends in the Demand for Family Limitation in

Developing Countries" International Family Planning Perspectives 26(2) (2000): 56-62 & 97.

Whereas most developing countries have at least begun the tran- sition from high to low fertility, the process has progressed at

264 Studies in Family Planning

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different rates in various regions. The pattern of change in sub- Saharan Africa differs from that of other regions, a factor that has implications for family planning programs there. Data from 108 Demographic and Health Surveys, World Fertility Surveys, and Contraceptive Prevalence Surveys were assembled for 41

developing countries, covering the period extending from the mid-1970s to the late 1990s. The proportion of women who want no more children has risen slowly but steadily in sub-Saharan Africa since the 1970s, having reached a level of 20-40 percent in many countries by the late 1990s. Yet overall levels remain far below those seen in Asia and in North Africa, where the level of demand for limiting births clusters in the 40-60 percent range. The proportion of women wanting to stop childbearing is also

high in Latin America, and shows more evidence of leveling off than it does in Asia. Unmet need for the means to limit births is

increasing fairly uniformly for most sub-Saharan African coun- tries. In contrast, in Asia and North Africa and in Latin America and the Caribbean, it is generally declining with the adoption of contraceptive use. Although the evidence indicates that most women in sub-Saharan Africa who practice contraception do so to space rather than to limit births, trend data suggest that the

proportion of users practicing contraception to limit births has been increasing in recent years; in some countries, this propor- tion approaches half of all method use, and is higher than ex-

pected elsewhere. Little change is seen, however, in this balance in Asia and North Africa and in Latin America and the Carib-

bean, with the great majority of users in both regions seeking to limit rather than to space births. Although demand for contra-

ception is increasing throughout the developing world, most of the demand in Asia and North Africa and in Latin America is

being met already, whereas much of the demand in sub-Saharan Africa is not. According to the authors, in both Asia and Latin

America, where contraceptive use is already high, providers need to gear their services toward helping clients to continue use and to improve the effectiveness of their contraceptive prac- tice. On the other hand, in sub-Saharan Africa, where use is low,

programs should aim to encourage adoption of modern methods.

A. Prual, M.-H. Bouvier-Colle, L. de Beris, and G. Breart "Severe Maternal Morbidity from Direct Obstetric Causes in West Africa: Incidence and Case Fatality Rates" Bulletin of the World Health Organization 78(5) (2000): 593-602.

Data on maternal morbidity make possible an assessment of how

many women are likely to need essential obstetric care, and per- mit the organization, monitoring, and evaluation of safe-mother- hood programs. Operational definitions of severe maternal mor-

bidity are proposed, and the frequency of such morbidity is re-

ported as revealed in a population-based survey conducted from December 1994 to June 1996 of a cohort of 20,326 pregnant wom- en in six West African countries. The methodology and question naires used were the same for all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhea, during delivery, and

60 days postpartum. Direct obstetric causes of severe morbidity were observed among 1,215 women (6.17 cases per 100 live

births). This ratio varied significantly between areas, from 3.01

percent in Bamako to 9.05 percent in Saint-Louis. The main di- rect causes of severe maternal morbidity were: hemorrhage (3.05 per 100 live births); obstructed labor (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive dis- orders of pregnancy (0.64 per 100), 38 cases of which involved

eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2 percent of cases. Case fatal-

ity rates were very high for sepsis (33.3 percent), uterine rup- ture (30.4 percent), and eclampsia (18.4 percent); those for hem-

orrhage varied from 1.9 percent for antepartum or peripartum hemorrhage to 3.7 percent for abruptio placentae. Thus at least 3 to 9 percent of pregnant women required essential obstetric care. The high case fatality rates of several complications reflect a poor quality of obstetric care.

G. Walraven, M. Telfer, J. Rowley, and C. Ronsmans "Maternal Mortality in Rural Gambia: Levels, Causes, and Contributing Factors" Bulletin of the World Health Organization 78(5) (2000): 603-613.

A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths

among women aged 15-49. An estimation of maternal mortal-

ity among these 74 deaths is reported based on a survey of re-

productive-age mortality that identified 18 maternal deaths by verbal autopsy. During the same period, 4,245 live births oc- curred in the study area, for a maternal mortality ratio of 424 deaths per 100,000 live births. This maternal mortality estimate is substantially lower than estimates made in the 1980s for the same area, which ranged from 1,005 to 2,362 deaths per 100,000 live births. A total of nine of the 18 deaths had a direct obstetric cause: hemorrhage (6 deaths), early pregnancy (2), and ob- structed labor (1). Indirect causes of obstetric deaths were ane- mia (4 deaths), hepatitis (1), and undetermined (4). Low stan- dards of health care for obstetric referrals, failure at the com-

munity level to recognize the severity of the problem, delays in

starting the decisionmaking process to seek health care, lack of

transport, and substandard primary health care were identified more than once as probable or possible contributing factors to

these maternal deaths.

Sam Rowlands, Hassy Devalia, Ross Lawrenson, John Logie, and Bernard Ineichen "Repeated Use of Hormonal Emergency Contraception by Younger Women in the UK" The British Journal of Family Planning 26(3) (2000): 138- 143.

In 1993, a cohort of women aged 14-29 was identified from the General Practice Research Database in Great Britain and fol- lowed up for a period of four years. Patient files were searched

Volume 31 Number 3 September 2000 265

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for evidence of use of emergency contraception and regular con-

traceptive methods. Of the 95,007 women identified, 15,105 (16 percent) had received emergency contraception during the study period (an average of 5 percent per annum). A small year-on- year increase was seen in uptake of emergency contraception between 1994 and 1997. Only 4 percent of emergency contra-

ception users received emergency contraception more than twice in any year. More than 70 percent of those who had no pervi- ous record of use of regular contraceptives had used regular methods within one year of using emergency contraception. Teenagers were more likely than those in other age groups to use emergency contraception, to use it more than once, and to fail to start use of regular methods after they had used emer-

gency contraception until later into the study period. The au- thors aver that these results disprove the notion of widespread repeated use of emergency contraception. They show that pro-

vision of an emergency contraception service does not result in failure to initiate regular contraception or in abandonment of

regular methods. Rather they show that many women begin us-

ing regular methods for the first time after use of emergency contraception.

Books, journal articles, reports, and occasional papers are reviewed

for inclusion in this section by the Editorial Committee of Studies in

Family Planning. Abstracts of journal articles are adapted from the

authors' abstracts. Other abstracts are prepared by Karen Tweedy- Holmes. Publications for consideration should be addressed to Julie

Reich, Managing Editor, Studies in Family Planning, Population Council.

266 Studies in Family Planning

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