Modelación espacial bayesiana de la estructura de los hogares y la fecundidad en municipios de México

El trabajo busca modelar el efecto de diferentes patrones de composición de hogares sobre los niveles observados de fecundidad en los municipios de México al año 2020, se trata de una investigación de tipo cuantitativo de cohorte transversal basada en la aplicación de métodos bayesianos espaciales. La hipótesis sostiene que la presencia de un mayor porcentaje de hogares familiares debería impactar en mayores tasas de fecundidad municipales. La metodología comprende la implementación de dos modelos gaussianos latentes. Un modelo nulo busca determinar si los patrones observados de fecundidad se asocian a algún mecanismo sociodemográfico o, al contrario, surgieron aleatoriamente, y otro modelo con covariables, cuyo objetivo es replicar el comportamiento de la fecundidad evaluando las consecuencias de la proporción de hogares nucleares, ampliados y compuestos presentes en los municipios. Los resultados obtenidos a partir de la estimación del modelo nulo confirmaron la existencia de una relación directa entre el aumento del índice de hogares nucleares y ampliados y el de la fecundidad municipal. Sin embargo, se puede concluir que el nivel alcanzado de fecundidad de reemplazo es producto de marcadas diferencias entre municipios, originadas por la presencia de una tipología heterogénea de hogares inmersos en contextos geográficos, sociales y culturales dispares.

This paper seeks to model the effect that different patterns of household composition have on the observed levels of fertility in the municipalities of Mexico in the year 2020; it is a quantitative cross-sectional cohort research based on the application of spatial Bayesian methods. The hypothesis is that the presence of a higher percentage of family households should have an impact on higher municipal fertility rates. The methodology involves the implementation of two latent Gaussian models. One null model, which seeks to determine whether the observed fertility patterns were generated by some socio-demographic mechanism or, on the contrary, arose randomly, and two, a model with covariates whose objective is to replicate the behavior of fertility by evaluating the effect of the proportion of nuclear, extended and compound households present in municipalities. The results obtained from estimation of null model confirm the existence of a direct relationship between increase in the proportion of nuclear and extended households and the increase of municipal fertility. However, it can be concluded that the level of replacement fertility reached by Mexico in the year 2020 is the product of marked differences between municipalities; differences originated by the presence of a heterogeneous typology of households immersed in disparate geographic, social and cultural contexts.

Children of Kenya face serious survival challenges.

PIP: Survey findings pointing to the worsening health situation for children in Kenya that were highlighted during the National Dissemination Seminar for the 1998 Kenya Demographic and Health Survey (KDHS). The survey indicates that currently, 1 in 9 Kenyan children does not live to his or her 5th birthday. Under-five mortality stands at 112 deaths per 1000 live births, a 24% increase over the last decade. The high prevalence of childhood mortality is associated with a short preceding birth interval, a low level of maternal education, and rural location (under-five mortality is 23% higher in rural than in urban areas). Moreover, the risk of children dying varies greatly across provinces. A comparison between the results of the 1993 and 1998 KDHS also indicates recent setbacks in the fight against vaccine preventable diseases. Full vaccination coverage has fallen from 79% in 1993 to 65% in 1998. One of the more positive findings is the continuing decline in total fertility rate from 8.1 children per woman in the mid-1970s to current levels of 4.7 children per woman. In addition, knowledge and use of family planning has continued to rise in Kenya. Lastly, participants in the seminar also discussed the need for further dissemination of findings and further analysis of projects.^ieng

Birth delays skew developing world's fertility figures.

PIP: This article explains that birth delays skew developing world's fertility figures. When successive groups of women who have delayed childbearing start having children, the rapid fertility decline stalls. Such change in the timing of childbearing skews the total fertility rate (TFR). Analysis of the tempo component of TFR trends in Taiwan suggests that tempo effects reduced its TFR by about 10% in the late 1970s and early 1990s and by about 19% in the late 1980s. In Colombia, on the basis of increasing mean maternal age at childbirth between the 1970s and the late 1980s, tempo distortions of the TFR during the most of the 1980s seem likely. Moreover, many developing countries are now experiencing rapid fertility declines that are in part attributable to tempo changes. These changes have accelerated past fertility transitions, but they also make these countries vulnerable to future stalls in fertility when the delays in childbearing end. Since fertility reductions caused by tempo effects lead to real declines in birth rates and hence in population growth, countries that wish to reduce birth rates can take actions that encourage women to delay marriage and the onset of childbearing.^ieng

Spotlight: Costa Rica.

PIP: 3.5 million people lived in Costa Rica as of mid-1997. There were 24 births and 4 deaths per 1000 population, respectively, contributing to the annual natural increase rate of 2.0%. Each woman in Costa Rica bears an average of 2.8 children during her reproductive lifespan and men and women were expected to live for 73 and 78 years, respectively. Costa Rica's low infant mortality rate and high literacy and life expectancy rates set it apart from the rest of Central America. Costa Rica is also the only country in the region which maintains no standing army. About 96% of the population is White or Mestizo, 3% is Black, and 1% is indigenous Indian. More than half of the country lives in San Jose and its metropolitan area, 6% of the country's total land area. Unemployment has run near 5% over the past 2 years, but much of the labor force is underemployed. Costa Rica's economy depends upon tourism and agricultural exports such as coffee, beef, and bananas. A large Intel factory opened in 1997. The government and Costa Rican environmentalists are planning a joint campaign to reconvert 80% of Costa Rica's pasture back to forest and tree crops. About 20% of the government's budget is spent upon education and the 93% literacy rate is the highest in the region. Government health services provide low-cost contraceptives to more than 75% of users and 75% of women use some form of family planning.^ieng

[Fertility in Colombia]. / La fecundidad en Colombia.

PIP: Demography, which should be the basis for planning of any program or project, has traditionally been ignored by Colombian governments. No population statistics are available for the pre-Conquest period in Colombia. Statistics during the Colonial era were based on population counts for division of lands, taxation, and similar considerations. The first census was undertaken around 1770. Colombia's most recent census was in 1993, and another is being prepared for 2000. The censuses have been useful for development purposes despite their significant limitations of completeness and accuracy. Colombia's population in 1997 was estimated at 40,300,000, making it the third most populous country of Latin America after Brazil and Mexico. Fertility has declined considerably since 1965. Colombia's crude birth rate is believed to have exceeded 50/1000 in the 18th and 19th centuries and was estimated at 45/1000 by the Latin American Demographic Center for the first half of the 20th century. The crude birth rate was 41.3/1000 in 1968, 33.1/1000 in 1973, 30/1000 in 1980, and around 26/1000 in 1990 and 1995. The total fertility rate was estimated at 7.0 in 1960-65, 6.7 in 1969, 4.5 in 1973, 3.2 in 1985, and 2.9 in 1995. Fertility declined most appreciably before 1975, but rates continue to drop in rural as well as urban areas and in all geographic zones. For Colombia as a whole the total fertility rate is 4.8 for women with less than 5 years of schooling and 2.4 for those with 8 or more years. It is 2.7 in urban and 4.4 in rural areas.^ieng

Spotlight: Bolivia.

PIP: Bolivia is one of the poorest and least developed countries in South America. As of mid-1997, the country's population was comprised of 7.8 million individuals spread across 418,680 square miles. Bolivia's population size is growing through natural increase at the rate of 2.6% per year, with 36 births and 10 deaths per 1000 population. Bolivia's total population size is projected to reach 13.2 million by 2025. The total fertility rate is 4.8 births per woman even though the 1994 Demographic and Health Survey found that only 45% of pregnancies were wanted and the average woman has reported wanting only 2.5 children. 42% of women at risk of pregnancy use some form of contraception, with 18% using a modern method. There are 71 infant deaths per 1000 live births, child mortality is especially high between ages 1 and 3 years due to widespread child malnutrition after weaning, 650 women die for every 100,000 births, and life expectancy is 59 and 62 years for men and women, respectively. Concern over the high infant and child mortality rates has led to increased interest in family planning in recent years and the government of Bolivia now provides some support for the distribution of contraceptives.^ieng

Spotlight: Nicaragua.

PIP: Nicaragua's previously moderate population growth accelerated after 1940 because of better health care and sanitary practices. Today the death rate is 6/1000, and birth rates remain high at 33/1000; natural increase equals 2.7% per year. Life expectancy for men and women is 62 and 68, respectively. 45% of the population is younger than 15 years. The total fertility rate is 4.6. It is higher among women with no formal education (6.9), and among rural women (6.4). 53% of women are pregnant or have at least 1 child by age 19. 35% of births occur within 2 years of an earlier birth. Although 97% of women aged 15-49 know about at least 1 form of modern contraception, only 49% who were in a union during 1992-1993 used a contraceptive. Rural women, especially those with lower educational status, have the least experience with contraceptives; 63% of urban women report contraceptive use, in comparison to 33% of rural women. Mortality rates for infants (49/1000) and children (72/1000) have decreased. The main causes of infant death are trauma or asphyxia at birth, and complications associated with premature or low-weight babies; those for children are dehydration (from diarrhea), acute respiratory infections, meningitis, and illnesses preventable with vaccines. About 75% of children are immunized, usually at a later age than recommended. The geography, climate, and ethnic composition of Nicaragua, and recent events affecting its economy are briefly described.^ieng

[The effect of contraception on fertility in the border region of Chiapas, Mexico]. / Effecto de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México.

OBJECTIVE: To estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. MATERIALS AND METHODS: In 1994 an epidemiological cross-sectional study was carried out on a representative sample of 1,560 non-indigenous women between ages 15 and 49 in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. RESULTS: The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. CONCLUSIONS: The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users.

PIP: The objective of this study was to estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. In 1994, an epidemiological cross-sectional study was carried out on a representative sample of 1560 nonindigenous women between the ages of 15 and 49 years in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate, and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users. (author's)

[Suriname and Dutch Antillean population in the Netherlands, January 1, 1994]. / Surinaamse en Antilliaanse bevolking in Nederland, 1 januari 1994.

PIP: The author provides data on the Surinamese and Netherlands Antilles population living in the Netherlands on January 1, 1994. Data are provided on sex, age, total fertility rate, death rate, marriage rate, and nationality. (SUMMARY IN ENG)^ieng

PROFAMILIA's proven ability to bring family planning to the Dominican Republic.

PIP: The Dominican Association for Family Welfare (PROFAMILIA), an affiliate of IPPF, was the first organization to provide family planning services in the Dominican Republic. In 1966, the time of PROFAMILIA's creation, the total fertility rate (TFR) was 7.5. Shortly after PROFAMILIA's inception, the TFR began its steady decline. The 1991 Demographic and Health Survey (ENDESA-91) shows that the TFR has fallen to 3.3. PROFAMILIA persuaded the Dominican Republic's government to provide full-scale family planning services. In 1968 the government set up the National Council on Population and the Family (CONAPOFA) within the Ministry of Public Health and Social Services to provide family planning services. It now provides family planning services through more than 500 health centers. The Dominican Family Planning Association, set up in 1986, provides family planning services in the Federal District and the easternmost provinces. These family planning organizations have reduced the unmet demand for family planning in the Dominican Republic to 17%, essentially the same levels as in developed countries. Even though mean family size is 3.3, ideal family size is 2, indicating a trend toward smaller families. The adolescent pregnancy rate is 13% in urban areas and 27% in rural areas. 13.3% of adolescents in a union use modern contraceptives, while only 3% of those not in a union do. 25.4% of women of childbearing age, 38.5% of women in a union, and 65.4% of 40-44 year old women depend on sterilization. Only women less than 29 years old significantly use oral contraceptives. The family planning programs need to expand family planning messages to adolescents, particularly those not in a union. PROFAMILIA still implements new approaches to expand services, such as health promotion via community-based services. CONAPOFA has since implemented such a program. ENDESA-91 demonstrates what can be accomplished when an effective government family planning program and a private organization work together.^ieng

Estimation of fertility-inhibiting indices using vital registration data.

PIP: The Bongaarts model quantifies intermediate variables that have a direct impact on fertility and it is related to the classical analytic framework of intermediate fertility variables (IFVs) introduced by Davis and Blake. The model requires data on age-specific proportions of women currently married, age-specific fertility rates (ASFRs), estimates of postpartum infecundability, and proportion of women currently using effective contraceptive methods. Horne, El-Khorazaty, and Suchindran (1990) developed a childbearing model estimating projected ages at 1st and last birth (AFB, ALB) and the reproductive life span (RLS), making use of only ASFRs available from either vital statistics or sample surveys. The correspondence between Bongaarts-type indices of marriage, contraception, and infecundability and the childbearing indices is discussed. Data on both fertility-inhibiting and childbearing indices were available for 225 subpopulations. Application 1: Characterization of the fertility-inhibiting indices by the childbearing indices. Contraceptive practice is the major fertility-inhibiting factor among women who stop childbearing before age 35 years, but for those women who stop reproducing in their late thirties, long duration of breastfeeding is. Application 2: Decomposition of fertility decline by the childbearing indices. For societies with a low TFR of only 2 births, contraceptive use plays the major role in achieving this low fertility level, regardless of age at 1st birth, and age at last birth not exceeding 35 years. Application 3: Annual fertility-inhibiting indices using ASFRs. In Kuwait the TFR declined from 4.7 births in the early 1960s to well below 2 births in the late 1970s and 1980s owing to direct government support to family planning programs. The correspondence model, using only macro-level vital statistics data, can predict indirectly fertility-inhibiting indices on an annual basis for countries lacking the micro-level data necessary for estimating those indices directly.^ieng

[Fertility change in Bolivia]. / Cambios de la fecundidad en Bolivia.

PIP: This work seeks to assess rural-urban and regional fertility trends and differentials in Bolivia since 1965, and to examine the relationship between the level of fertility and the proximate fertility determinants in the different regions using the Bongaarts method. Important social and cultural differences in Bolivia's 3 principal geographic regions are reflected in reproductive patterns. The 2 Andean regions, the Altiplano and the Valles, are inhabited predominantly by Quechua and Aymara speaking indigenous populations, while the Llanos or lowlands are inhabited primarily by persons of Spanish-speaking origin. The 1976 population census, the 1988 National Survey of Population and Housing, and the 1989 Demographic and Health Survey were the basis for fertility estimates for Bolivia during 1965-90. The estimate for 1990 was an extrapolation based on recent trends. The total fertility rates estimated for the country as a whole, the urban population, and the rural population, respectively, have declined from 6.50, 5.50, and 7.00 in 1965 to 6.00, 4.90, and 6.90 in 1980 and 5.20, 4.00, and 6.30 in 1985. Total fertility rates in the Altiplano, Valles, and Llanos, respectively, were 6.00, 6.60, and 7.00 in 1965, 5.80, 6.20, and 6.00 in 1980, and 5.00, 5.40, and 5.10 in 1985. The fertility levels of the 3 geographic regions thus differ less than those of urban and rural zones. The apparent similarity of fertility levels in the 3 ecological zones masks significant differences between the regions in the proximate fertility determinants of nuptiality, contraceptive usage, and lactation. Compensatory mechanisms result in the apparent similarity. The Llanos are characterized by an earlier age at union than the other 2 regions. Almost all women marry or enter a union at some point, and about 1/3 of unions are consensual. Nuptiality patterns are consistent with maximizing the reproductive potential of women and are more similar to those of Central America than those of the rest of Bolivia. The 1989 Demographic and Health Survey showed an average age at 1st union of around 20 years for Bolivia, 18.8 for the Llanos, 21 for the Valles, and 20.5 for the Altiplano. Women in the Llanos also breast fed their infants for a shorter time on average than women in the other 2 regions. The average duration of breast feeding was 16.4 months for Bolivia, 17.8 months for the Altiplano, 16.1 months for the Valles, and 13.4 months for the Llanos. Postpartum abstinence was also 3 months shorter on average in the Llanos than in the Altiplano. These differences were clearly reflected in the durations of postpartum insusceptibility to pregnancy, which were 13.5 months in Bolivia, 14.8 and 13.8 months in the Altiplano and Valles, and only 10.1 months in the Llanos. But contraceptive usage was much more common in the Llanos, where 42.9% of women in union used a method vs. 24.7% in the Altiplano and 30.8% in the Valles. Women in the Llanos were also much more likely to use a modern method.^ieng

[The challenges of the family planning program]. / Los retos del programa de planificacion familiar.

PIP: Mexican family planning officials used date from the 1990 population census to revise population growth estimates and determine program needs for different family planning institutions during 1990-94. Total fertility rates were used to estimate fertility, using information from sociodemographic surveys taken over the past 10 years. Total fertility rates were estimated at 3.29 in 1987, 2.8 in 1990, and projected at 2.5 in 1994. These rates correspond to a crude birth rate of 24-25/1000 in 1990 and 22-23 in 1994 and natural increase rates of 1.87% and 1.67%. In obtaining these estimates, the structure of fertility of the 1987 National Survey of Fertility and Health and the program projections of women by ages of the National Population Council and the National Institute of Statistics, Geography, and were considered. The TARGET model was used to estimate the numbers of women in union using different modern methods who would need to be served by family planning programs in order to meet the proposed total fertility rates. The prevalence of sterilization, IUDS, and oral contraceptives (OCs) in women in union would be 59% in 1990 and 62% in 1994, or in absolute terms 7.8 million women in 1990 and 9.3 million in 1994. The public sector has replaced the private as the major source of family planning services. The Mexican Institute of Social Security (IMSS) share is expected to increase from 48.3% of users in 1990 to 56.5% in 1994. The other 3 public sector institutions will maintain their current level of coverage. The private sector has played a smaller role in family planning in Mexico than in many other countries, and the state will thus have the major responsibility for service provision, including family planning education, promotion, and counseling of prospective clients. Existing services should be made more accessible as far as physical access and hours of operation, and the methods available should be increased beyond OCs and condoms. Traditional midwives in rural areas should be trained to administer modern methods in collaboration with institutional health services so that rural-urban differences in coverage and quality can be decreased. It is estimated that, of the 59% of women in union who want no more children, 44% are using a traditional method or no method. Encouraging these women to use contraception is a challenge for the family planning program. It will not be enough to communicate the general advantages of family planning; specific information on each method is needed. The integration of family planning into maternal-child health services is necessary for the focus on reproductive health and preventing high risk pregnancies. Health services should cooperate with the civil registration system to identify newlyweds and provide them with family planning information. Greater efforts are needed to reach adolescents through cooperation with educational institutions.^ieng

[Some questions for the demography of the nineties]. / Algumas questoes para a demografia dos anos noventa.

PIP: Traditional demographic analysis considers the individual as a unit of analysis, and models and theories are developed for discovering how the distribution of individual characteristics are determined by vital events. In this perspective, births, marriages, divorces, deaths, and migrations are viewed as individual events and specific models permit to estimate the risks of each social group. These events occur within social circuits defined by relationships between individuals, mainly in domestic and family relationships, with a number of personal variables that change over time. This makes it difficult and unfeasible to use such unit analysis for describing these processes. Demographic metabolism is illustrated in the lecture of Norman Ryder's Reconsideration of a Model of Family Demography, where he proposed the reformulation of the fluid rate of reproduction by criticizing that only the survival of the woman was taken into consideration for calculating this rate without considering the need for a companion for reproduction. He had introduced, in 1964, the notion of demographic metabolism, where processes of production (increments) and destruction (decrements) denoted changes in the size and structure of a population in the long term. For instance, in the 1970s the Brazilian population experienced a large number of entrants in the age group of 60 years, and deaths in this period corresponded to about 7 million, producing an increase of 2.5 million aged at the beginning of the following decade. Westoff and Bongaarts decomposed the total fertility rate into desired fertility and undesired fertility and showed that the rates of desired fertility also tended to converge between 2 and 3 children, indicating the presence of horizontal diffusion in society called the hypothesis of convergence. In Brazil, in the last decade, there has been little criticism or research of this and other theories to explain the rapid fertility changes and family transformation.^ieng

[Fertility levels, trends, and differentials in Brazil since the 1930s]. / Neveis, tendencias e diferenciais de fecundidade no Brasil a partir da decada de 30.

PIP: The total fertility rate (TFR) estimated for the period of 1930-35 was 6.22 children per mother, which declined to 5.80 during 1940-45, increased slightly to 5.86 during 1950-55, and to 6.0 during 1960-65, to drop to 4.97 during 1970-75. The decline was 17.2% between 1963 and 1973, 14.3% between 1943-1973, and 20.1% between 1933 and 1973 (or an average decline by 1.26 children per woman in 40 years). The evolution of the national and regional levels of fertility was estimated by a unique methodology that utilized the average births per woman with data extracted from censuses and research samples. In particular, the technique of Brass was used with correction for P2/F2 as valid data 5 years prior to taking the information. In this manner the TFR was estimated at 3.5142 based on the 1984 national household survey and specific rates for age groups encompassed the period of 1979-84. In this case it was estimated that 3,311,000 births must have occurred on the average annually during this period. It was only in 1980 that the Civil Register recorded 3,860,000 births. During this same period the hypothesis of constancy, utilizing current fertility rates corrected for P2/F2, yielded 2,745,000 births in the course of 5 years. In recent times fertility in Brazil has been on a declining trend, starting in the 1960s. The intensity of this decline varied according to the sources of information: the Civil Register and the national survey of households. Prior to the 1960s the less developed regions of the north experienced pronounced increases, while the southeastern and southern regions showed declines. From the mid-1960s all regions experienced a forceful decline in fertiltiy levels. The results indicate the convincing nature of the proposed model for estimating the levels and patterns of fertility, and it is particularly useful for other levels of disaggregation.^ieng

International evidence on the role of literacy in the demographic transition.

PIP: The author gathered 1965 and 1975 socioeconomic data on 71 developing countries from a variety of sources such as UNESCO and the World Bank. He applied these data to strict tests to confirm the nonlinear fertility literacy relationship. The total fertility rate (TFR) was the dependent variable. In 1975, the TFR was as low as 2.2 in Singapore and as high as 8.1 in Rwanda. The unweighted mean stood at 5.8. Independent variables included real gross domestic product/worker (earnings); ratio of female literacy over male literacy; natural logarithm of fraction of labor force engaged in agriculture, forestry, hunting, and fishing; population density; male literacy; and strength of the family planning program. The statistical regression revealed that fertility rose slightly (mean=0.25 of a child) with an initial growth in the literacy rate. In fact, it peaked when 25-50% of the adult male population were literate. As the adult male literacy rate increased to the point where almost everyone was literate, fertility fell swiftly to 2 children. These changes were stable across the board. Between 1965-1975, the male literacy rate increased from 46-57% which resulted in a reduction of .51 children in the TFR. Algeria, Nigeria, and Pakistan whose male literacy levels ranged only from 23-42% stalled at high fertility levels. Fertility decreased considerable in countries where family planning programs were valued at least 4.7, even when no significant changes occurred in literacy, earnings, density, or agricultural composition. Morocco, valued at 4, only experienced a change of -.561 whereas China, valued at 25, experienced a change of -1.506. Thus to reduce fertility, policy makers must set high literacy levels as goals recognizing, however, that fertility will 1st rise as literacy bigins its ascent. Further they should either estiablish or strengthen existing family planning programs.^ieng

[Profamilia: immense unknown contribution]. / Profamilia: inmenso aporte desconocido.

PIP: In late 1965, when he presented himself to the International Planned Parenthood Federation headquarters in London weeks after founding the Profamilia Foundation, Dr. Fernando Tamayo was an unknown Colombian physician with a mission to modify Colombia's very rapid rate of population growth. Colombia in 1964 has a population of 17.5 million growing at an annual rate of 3.4%. By 1973, the population was 22.9 million and growing at 2.7%. Cultural, religious, and moral obstacles precluded an aggressive family planning campaign, which would have aroused violent resistance. Profamilia personnel worked discreetly but persistently, convinced that they would see few short term results but that their effect would be immense in the long run. Family planning is partly a process of educating families in the health, socioeconomic, and psychological benefits of smaller families. Profamilia has a centralized organization which administers 3 main programs, the clinical program with 40 traditional clinics in major cities and 8 well-accepted male clinics, the sterilization program in clinics and mobile units, and the community-based distribution program which distributes pills, condoms, and IUDs through 3000 community posts under the direction of 120 instructors. Between 1964-90, Colombia's total fertility rate declined from 9.2 to 4.4 in rural areas, from 5.2 to 2.2 in urban areas, and from 7.0 to 2.8 overall. The rate of population growth declined from 3.4 to 1.8%. It has been estimated that over half the decline is due to Profamilia services. The total investment by Profamilia during its history was US $100 million. The average cost of protecting a couple against unwanted pregnancy is US $5.26 per year. Colombia's population is projected to increase from 30 to 54 million between 1985 and 2025 even if the growth rate declines from 1.8% in 1990 to 1.3% in 2025. The most worrisome aspect of the projected growth is its concentration in urban areas, which are already beset by poverty, inadequate basic services, and a limited potential water supply already threatened by deforestation. It is clear that the work of family planning in Colombia is not done and that much remains to be accomplished.^ieng

Survey report: El Salvador.

PIP: Among the recent studies documenting trends in fertility and contraceptive behavior in El Salvador is the 1988 Family Health Survey (FESAL88). Conducted by the Asociacion Demografica Salvadorena with technical assistance from the US Centers for Disease Control, Division of Reproductive Health, FESAL88 (between May-July 1988) interviewed a total of 3579 women, ages 15-44. Total fertility declined from 6.3 to 4.5 lifetime births/woman between 1978-85, but no significant change was found between 1985-88. Similarly, contraceptive use increased by 26 percentage points between 1975-88, with a slight increase occurring after 1985. Approximately 47% of married women use modern methods of family planning, with female sterilization used by 1/3 of all married women. About 1/2 the women currently not using family planning say they intend to do so, but only 1/2 of these women know where to obtain a method. Other determinants of fertility also showed little change between 1985-88. In these years, the average age of marriage rose from 19.8 to 20.3 years, but almost all of the increase occurred in urban areas. 95% of women interviewed breast fed their last child; the average duration of breast feeding was 17 months. In focusing on Salvadorian women 15-24 years of age, FESAL88 found that their fertility rate was 139 birth/1000 women, the highest rate for any country in Latin America or the Caribbean. 9 in 10 women age 15-24 think there should be special family planning services for young adults. Finally, among the married women who had a birth in the 5 years prior to the survey, 2/3 received a prenatal examination, and 2/3 received an antitetanus toxoid injection. Even though only 40% of married women with a new baby report receiving postnatal care, 76% of infants received well-baby care.^ieng

Ecuador 1987: results from the demographic and health survey.

PIP: The Ecuador Demographic and Health Survey (DHS), a national survey covering 97% of the population, collected data from 4578 households and completed interviews with 4713 women aged 15-49. Fieldwork for the survey took place between January-March 1987. Summary statistics are presented on the general characteristics of the population -- demographic and economic; fertility and fertility preferences; current contraceptive use; nuptiality and exposure-to-conception status; postpartum variables; infant mortality; and health -- disease, prevention, and treatment. In 1965, the crude birthrate/1000 was 45.0 and the crude death rate/1000 was 13.6; these figures were 37.5 and 8.8, respectively, in 1980. The total fertility rate was 6.9 in 1955-60 but had dropped to 4.3 for the 5 years prior to the survey, 1982-87. 33% of the rural and 53% of the urban population were using contraception. 44.3% of those surveyed were currently using contraception. The infant mortality rate had dropped to 58/1000 for the 1982-86 period (including January and February of 1987) from 130/1000 over the 1955-60 period.^ieng

Medical influences on birth spacing in rural Mexico.

PIP: In order to determine the impact of the available health services in rural areas on women's reproductive decisions, researchers documented fertility changes in rural Mexico from 1969-1981, determined rates of contraceptive use and breastfeeding, and examined medical personnel attitudes towards these 2 factors. Figures showed that the marital fertility rate of Mexico's rural population dropped from 10.6 children/per woman in 1969 to 8.1 in 1981; the same period saw a drop in the total fertility rate from 7.8 to 5.3. Researchers also noted a reduction in the mean length of breastfeeding, from 17.9 months to 15.1 months, and a rise in the use of contraception, from 1.9% to 33.8%. Knowledge about contraception increased significantly during the period, with doctors becoming an important vehicle for the its promulgation. Though doctors favored breastfeeding over bottlefeeding, they usually recommended shorter breastfeeding periods and early supplementation. Traditional midwives, however, recommended longer breastfeeding duration and later supplementation. This indicates the effects of health services in rural areas: where it is present, there is a significant positive impact on contraceptive use and some negative impact on breastfeeding. Overall, researchers conclude that Mexico's family planning program is working among its rural population, but point out some weaknesses, such as the lack of medical attention at delivery, medical personnel's ignorance over the possible adverse effects of early suspension of lactation and early supplementation. This suggests the need for some reeducation of the medical personnel.^ieng