[The critical period in natural fertility]. / El periodo crítico de la fertilidad natural.

In order to learn the natural expectancy period of first pregnancy as well as the influences of some biosocial variables, a clinical-retrospective study was performed within 1120 gravida I women. All of them attended the major institutes of health care in Mexico City (IMSS, ISSSTE, SS and DDF). Data were obtained by means of predetermined questions from subjects after the first postpartum hours. None of them had previously used any contraceptive method. Results showed age at the first pregnancy: 21.6 +/- 3.8 (years); gestational interval 22.1 +/- 19.9 (months) and a 67% achievement rate the following twelve months of sexual activity. Eutocia was seen in 54% of these population and significant linear correlation was attained between age of the patient and the gestational interval. It seems that this is the first information regarding the fertility critical period within our society.

PIP: The interval between first intercourse and pregnancy and the influence on it of various biosocial variables were studied in 1120 women who gave birth in maternity centers in Mexico City belonging to the Mexican Institute of Social Security (IMSS), the Institute of Social Security Services for State Workers (ISSSTE), the Secretariat of Health (SS), and the Medical Services of the Department of the Federal District (DDF). Women who had used contraceptives or who had a history of infertility or of endocrine or metabolic diseases were excluded. Data were obtained by means of questionnaires administered postpartum. The average age of the women was 22 + or - 4 years. 60% were married and 40% single. 41% were housewives and 59% were employed. 2% were illiterate, 22% had primary educations, 48% had secondary educations, and 8% were professionals. The average age at menarche varied from 12 to 13 years. Average age at first intercourse was 20 + or - 4 for the IMSS, 22 + or - 4 for the ISSSTE, 18 + or - 3 for the SS, and 17 + or - 2 for the DDF subsamples. The average age at first pregnancy was 21.6 + or - 2.8 years, and the average gestational interval was 22.1 + or - 19.9 months. But 67.5% of the total sample became pregnant in the 12 months following first intercourse, as did 82.9% of the SS and 86.3% of the DDF subsamples. The interval between first intercourse and first pregnancy was 8 years or more for 1-2% of the sample in each institution. 36% of women in the IMSS group, 73% in the SS and DDF groups, and 77% in the ISSSTE group had normal vaginal deliveries. 18% in the ISSSTE, 21% in the SS and DDF, and 51% in the IMSS groups had Cesarean deliveries.

Perceptions and practices relating to condom use among urban men in Haiti.

This report is based on a survey conducted in 1986-87 of sexually active adult male residents in a low-income community of Port-au-Prince, Haiti. The objectives were to investigate knowledge of and attitudes toward condoms; to evaluate the effectiveness of the existing condom distribution program; and to obtain information that can be used in the design of strategies to increase condom acceptance and use among men throughout Haiti. A final sample of 706 sexually active adult male residents in stable unions, including a specially drawn sample of male partners of condom acceptors, were interviewed in their homes. Although condoms are almost universally known, they are rarely used. The majority felt that the responsibility for family planning should be borne by the woman. Whereas condoms may be of limited popularity for family planning purposes in Haiti, it should be determined whether they might be more acceptable as an effective means of controlling the spread of AIDS and other STDs.

PIP: Attitudes toward condom use and the effectiveness of a condom distribution program were investigated in a survey of 706 sexually active men residing in a low-income community in Port-au-prince, Haiti, in 1986-87. All respondents were in a stable sexual relationship at the time of the survey; 554 had received condoms (or their female partner had) from the Cite Soleil Family Planning Center, while the remaining respondents were recruited through a community sampling survey. The average age of study subjects was 33 years. 20% were married; the remaining men had been in a stable union for 8 years in the case of respondents recruited from the family planning center for 6 years in the case of men identified through the community survey. 25% of men in the former group and 15% of those in the latter group reported having had sexual relations with a person other than their regular partner in the 3 months preceding the interview. Although 99% of men in the community survey had heard of condoms, none had ever used this method; ever-use of any form of contraception was only 3% in this subsample. In contrast, 43% of men recruited from the family planning center had used condoms at some point and 5% were current users (contributing 13% of all current contraceptive use). 96% of ever-users of condoms reported that their female partner had obtained the method; however, only 10% states that their partner was influential in their decision to use condoms and only 2% agreed that the husband should take responsibility for pregnancy prevention. The low prevalence of condom use in this sample does not reflect opposition to family planning (93% supported the concept), concerns about efficacy (90% trusted the method), a perception that condoms are for casual sexual encounters (only 1% stated this opinion), or supply constraints. These findings indicate the need for an IEC campaign to promote more widespread condom use and male responsibility for family planning.

An assessment of contraceptive need in the inner city.

A survey of low-income areas of Los Angeles County indicates that 41 percent of nonsterile women in their childbearing years who had not made a family planning visit in three years were using some means of birth control, 21 percent were not, 25 percent were not sexually active and 13 percent were pregnant or trying to become pregnant. Given that approximately 10 percent of the respondents were using unreliable means of contraception, at least one-third of respondents were in need of effective contraception. This proportion corresponds roughly to the percentage of respondents who expressed a desire to receive family planning care from a doctor or clinic (34 percent). The percentage of women who were at risk of unwanted pregnancy but not using any method of contraception was greatest among those with incomes below poverty level and among black and Hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a family planning visit shows that those who utilized formal family planning services were substantially more likely than those who did not to be married (40 percent vs. 32 percent) and to belong to a health maintenance organization (24 percent vs. 14 percent), whereas nonusers of formal family planning services were slightly older, on average (29.6 years vs. 28.0 years), and more likely to have other types of private health insurance (47 percent vs. 25 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A survey of low-income areas of Los Angeles County indicates that 41% of nonsterile women in their childbearing years who had not made a family planning (FP) visit in 3 years were using some means of births control, 21% were not, 25% were not sexually active and 13% were pregnant or trying to become pregnant. Given than approximately 10% of the respondents were using unreliable means of contraception, at least 1/3 of respondents were in need of effective contraception. This proportion corresponds to the % of respondents who expressed a desire to receive FP care from a doctor or clinic (34%). The % of women who were at risk of unwanted pregnancy, but not using any method of contraception was greatest among those with incomes below poverty level and among black and hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a FP visit shows that those who utilized formal FP services were more likely than those who did not to be married (40% vs. 32%) and to belong to a health maintenance organization (24% bs. 14%), whereas, nonusers of formal FP services were slightly older, on average (29.6 vs. 28 years) and more likely to have other types of private health insurance (47% vs. 25%). In addition, 95% of those who were at risk of unintended pregnancy and who had made a FP visit were practicing contraception compared with 67% of women at risk of unintended pregnancy who had not made a visit. (Author's modified).

Peru 1986: results from the Demographic and Health Survey.

PIP: The Peru Demographic and Health Survey, conducted in 1986-87, collected data from 4666 households and included complete interviews with 4999 women 15-49 years of age. The survey was national in scope, covering 93% of the population. This article presents summary statistics from the survey. The 26 tables and figures that comprise this article cover the following topics: general characteristics of the population; distribution of survey sample population by socioeconomic characteristics; fertility trends; fertility differentials, 1983-85; age-specific fertility; ideal number of children by age and number of living children for currently married women; desire to stop childbearing among currently married women; planning status of births in last 12 months, by birth order; contraceptive prevalence differentials; contraceptive prevalence by age and parity; source of current method or information about method; knowledge and use of methods among currently married women; nonuse among exposed currently married women by desire for more children; reasons for nonuse among exposed nonusers; current marital status; differentials in age at 1st union; exposure status of currently married women; duration of postpartum interval by current status; differentials in breastfeeding and amenorrhea; postpartum status by duration since birth; infant mortality trends; infant mortality differentials, 1981-86; children ever born and surviving; percent of children under 5 years of age with health card, and percent immunized; prevalence and treatment of diarrhea among children under 5 years of age; and type of assistance during delivery for births in 5 years prior to survey. The ideal number of children averaged 2.8 among survey respondents. 46% of respondents were current users of a contraceptive method.^ieng

[Bases for a program designed to promote breast-feeding. I. Identification of variables in the immediate post-partum period]. / Bases para la formulacion de un programa de promocion a la lactancia. I. Identificacion de variables en el posparto inmediato

PIP: The variables involved in the duration of breastfeeding were analyzed in a group of 60 mothers in Mexico who were followed from delivery until 6 months postpartum. 2 groups were formed: women without any previous breastfeeding experience (primipara) and women with previous experience (multipara). The analysis was performed by step wise regression, grouping the variables in 2 classification systems. The 1st, which was according to temporal proximity to breastfeeding practice, divided the variables into predisposing prenatal, early, and late neonatal factors. The 2nd, according to the level of organization, used the following categories: social, biological, and behavioral motivation. The results show that both groups of mothers base their breastfeeding on the confidence that they have in their own breastfeeding capacity. For the primiparal, this confidence is expressed by age, the advantages they found in nonhuman milk, their milk production, the difficulty they had in establishing breastfeeding during the 1st days, and their anticipation of future breastfeeding problems. The multiparal base their confidence on their prior experience in addition to the previously mentioned factors. The multivariate regression for the primipara explained 98.41% of the variance. Of the 3 significant variables, early postpartum contact accounted for 74.43%. In the case of multiparal, 66.70% of the variance was explained by variables. Of these, the starting age of supplementation was negatively related and explained 47.14% of the variance.^ieng

Contraceptive use and the need for family planning in Puerto Rico.

In 1982, 69 percent of Puerto Rican women in union were practicing contraception. Forty-five percent relied on contraceptive sterilization (40 percent, female, and five percent, male), eight percent were using the pill, four percent each, the IUD and the condom, five percent relied on rhythm, and three percent were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for childspacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54 percent), whereas pill use is highest among those aged 15-24 (approximately 23 percent). Overall, eight percent of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from nine percent among those aged 30-39 to 22 percent among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible family planning services, especially for young women, and those whose childbearing is incomplete.

PIP: In 1982, 69% of Puerto Rican women in union were practicing contraception. 45% relied on contraceptive sterilization (40%, female, and 5%, male), 8% were using the pill, 4% each, the IUD and the condom. 5% relied on rhythm, and 3% were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for child spacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54%), whereas pill use is highest among those aged 15-24 (approximately 23%). Overall, 8% of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from 9% among those aged 30-39 to 22% among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of the white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible planning services, especially for young women, and those whose childbearing is incomplete.

Utilization of health services by Mexican immigrant women in San Diego.

The limited empirical data available on maternal health problems among Mexican immigrant women in the United States suggest that they underutilize health services, especially general preventive care. Research conducted among legal and undocumented women in the Mexican immigrant population in San Diego, California, support these findings. Among undocumented mothers, 11.5% of their births in the U.S. occurred with no prenatal care or care sought in the third trimester, which is much higher than Mexican women legally in the country (3.6%) and the general San Diego maternal population (3.8%). When we examine births which occurred within the last five years by immigration status, we find that women legally in the country have a much higher rate of cesarean delivery of both undocumented women and women in the general San Diego maternal population. Undocumented women in our sample were much less likely than their legal counterparts to return for postpartum examinations for themselves, to seek neonatal care for their infants, and to have had Pap examinations or carry out breast self-examinations.

PIP: Between March 1981 and February 1982, personal in-home interviews were conducted with 2,103 adults born in Mexico who were living or working in San Diego County, California, regardless of their legal status in the US. Both documented, (legal) and undocumented respondents exhibited a number of socioeconomic characteristics which could influence their utilization of US medical services. The data indicate that underutilization of prenatal care exists in this population. Among undocumented mothers, 11.5% of their births in the US occurred with no prental care sought in the 3rd trimester, which is much higher than Mexican women legally in the country (3.6%) and the general San Diego maternal population (3.8%). When births which occurred within the last 5 years are examined by immigration status, it is found that women legally in this country have a much higher rate of cesarean delivery for both undocumented women and women in the general San Diego maternal population. Undocumented women in our sample were much less likely than their legal counterparts to return for postpartnum examinations for themselves, to seek neonatal care for their infants, and to have had Pap examinations or carry out breast self-examinations.

Why women don't get sterilized: a follow-up of women in Honduras.

In 1980, a study to determine interest in and access to sterilization for females was initiated at two Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42 percent of women desiring sterilization from the Tegucigalpa hospital and 21 percent from the San Pedro Sula hospital had had a tubal ligation. A second study was conducted two years later, following up the interested but unsterilized women from the baseline study. Results show that 33 percent of women in the Tegucigalpa group, compared to 15 percent in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the two years after the baseline study was conducted. Among the major reasons women gave for not having been sterilized were financial and time constraints. Over the two-year period, the authors estimate that, of women interested in sterilization at delivery, 52 percent in total were sterilized in Tegucigalpa and 29 percent in San Pedro Sula.

PIP: In 1980, a study to determine interest in and access to sterilization for females was initiated at 2 Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42% of women desiring sterilization from the Tegucigalpa hospital and 21% from San Pedro Sula hospital had had a tubal ligation. A 2nd study was conducted 2 years later, following up the interested but unsterilized women from the baseline study. Results show that 33% of women in the Tegucigalpa group, compared to 15% in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the 2 years after the baseline study was conducted. Among the reasons women gave for not having been sterilized were financial and time constraints. Over the 2-year period, the authors estimate that, of women interested in sterilization at delivery, 52% in total were sterilized in Tegucigalpa and 29% in San Pedro Sula. Results show that in Honduras as elsewhere in Latin America, obstacles to sterilization exist in the form of cost, travel time and family-related constraints. Institutional requirements and availability of facilities also creat barriers for clients. Fear of surgery was not a very important reason for not getting sterilized among women in the baseline study, only those who said they still wanted to be sterilized were interviewed for the 1982 study. The fees for sterilization are US$17.15 at Materno Infantil (or blood can be given instead) and US$10.0 at Leonardo Martinez and Centro Medico Quirurgico, but financial help is available for women who cannot pay. A new study will be carried out in Tegucigalpa to determine the impact of the various changes aimed at improving access to sterilization there. Programs to be studied include the availability of new facilities to provide postpartum sterilization at Materno Infantil and the provision of travel money and additional facilities that make it easier for a women to complete sterilization requirements at Centro Medico Quirurgico.

Assessing the effects of intermediate variables on birth interval-specific measures of fertility.

PIP: This paper proposes a technique to simultaneously assess the effect of selected intermediate variables on the dynamics of birth intervals and to aggregate such effects across births of different order. The essentials, virtues and limitations of other approaches are 1st summarized. A method to link measures of birth interval dynamics to aggregated measures of fertility such as the age-specific fertility rates and total fertility is explained. A set of operations is suggested, required to translate estimates of birth interval-specific effects of intermediate variables into aggregate effects (e.g., effects at the level of fertility rates). These operations effectively permit the synthesis of results from multivariate procedures and those of techniques aimed at decomposing the effects of intermediate variables. Discussed are estimation and measurement procedures to deal with deal available from retrospective interviews carried out as part of the World Fertility Survey (WFS) program. The effects of marriage pattern are not considered. The effects of lactation are measured by using a dichotomous variable with a value of 1 if the preceding child was breast fed for at least as long as 9 months less than the beginning of the segment of interest and 0 otherwise. Following the assignment of a measure of effectiveness, 3 groups are distinguished in measuring contraceptive use: non-contraceptors, those using an ineffective method, and effective contraceptors. With respect to measuring the effects of induced abortion and spontaneous fetal losses, a variable is created indicating whether or not a birth leading to a fetal loss or the fetal loss itself had occurred within the segment being examined. 2 indicators, 1 a binary variable and the other aimed at measuring gradations of sterility are introduced to measure exposure to intercourse and sterility. Logit regression coefficients for selected intermediate variables are presented for Peru. The tables reveal the power of the variables measuring contraception. The evidence offers strong indications to support the contention that some form of birth control makes a difference as it does to confirm a priori expectations about success of different types of users. The inhibiting effects of breast feeding are generally in the direction expected but they are not always statistically significant. They appear to be stronger at higher parities and more intense in the earlier parts of the birth intervals. The effects of the variable representing continuity of marital union are surprisingly strong and significant for all segments of 10 months of width and for all births of order higher than 1.^ieng