George B. Simmons

Post-neonatal mortality in Rural India: Implications of an economic model

In this paper we develop and test a theory of childhood mortality after the first month of life. Parents are assumed to have well-defined family size and sex composition objectives and to face severe budget constraints. In this set of circumstances, it is understandable that they will make allocative decisions that will affect the survival probabilities of children. These decisions and the environmental influences on mortality are the basic forces which determine whether a child will survive through the post-neonatal period. The model is tested with survey data from rural Uttar Pradesh, India. The results are consistent with the hypothetical framework discussed above. The burden of this pattern of choice is felt particularly strongly by female births.

Husband—wife inconsistencies in contraceptive use responses

Summary The reliability of responses in fertility surveys to questions on topics such as contraceptive use has long been a subject of concern. This paper explores one type of response reliability — the consistency between spouses in their responses to questions on use of contraception — using survey and case study data from a sample of rural Indian husbands and wives. The findings suggest that response inconsistencies between husband and wife appear to result primarily from wives underreporting the actual use of contraception, and that such underreporting may in turn be traced to the subordinate status of women within the family in this society in conjunction with familial and normative values which are opposed to contraception. Response inconsistencies, and the manner in which they are resolved, are shown to have important implications for both overall estimates of contraceptive prevalence as well as for household-level analyses of fertility behaviour.

Organizing for effective family planning programs.

Following an introduction chapter general environments (social political cultural and economic) in which family planning (FP) programs operate are discussed. The task environment: a more direct set of factors affecting program activity; and the technological and resource (money; personnel; infrastructure; facilities) environments are also examined. Program management and elements are discussed in terms of context e.g. fitting programs into national structures; operational planning; integration of FP with other service delivery; developing human resources; demand generation; and program logistics. (A shortage of logistics literature is noted.) Special modes of delivery: community-based distribution under public and private sponsorship; related marketing technics; social marketing; and the role of private clinics and physicians are examined. The critical importance of the interaction between programs and client populations are emphasized. Such interaction includes visits by extension workers; service providers; and indirect contacts with leaders or professional personnel through printed materials and the media in a variety of settings: clinics; community-based FP programs; and commercial distribution systems. Ways in which user and to an extent community incentives and disincentives have been used in different countries are assessed with reference to changes over time for example in India and Singapore. Methodological issues: the measurement of inputs and contraceptive availability; the similarity of the concepts of availability and accessibility; and cost-effectiveness measurement; issues connected with measuring the causal impact of family planning; and the separation of the effects of social and economic conditions on contraceptive use and fertility. Suggestions are made for future research: little empirical evidence exists concerning several crucial elements of program implementation.

Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh.

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

Cost-effectiveness analysis of family planning programs in rural Bangladesh: evidence from Matlab.

The Family Planning Health Services Project in Matlab is often seen as more expensive than similar activities carried out by the government of Bangladesh. At the same time, it as been observed that the project is much more effective. The alleged high cost of the project is said to make it difficult to replicate throughout the nation. Previously, the true costs of the project had not been documented. This study systemically examines the cost of the project and assesses its cost-effectiveness. An experimental design framework is used as a basis for understanding the cost-effectiveness of the project, although a sensitivity analysis lends further support to the relative efficiency of the approach undertaken in Matlab. Although in the aggregate, the Matlab Project is more expensive than the governments family planning program, it is also more effective, generating enough output to offset the extra costs of the intensified delivery system.

Neo-natal mortality in South Asia: The special role of tetanus

Summary First-year mortality in rural Uttar Pradesh is characterized by a predominance (60 per cent) of deaths during the first month of life, of which 66 per cent are reported to be due to tetanus. This pattern is not typical of the historical experience of many developed countries and the current experience of some less developed countries where post-neo-natal mortality predominates. To examine this phenomenon, two causal models of neo-natal mortality (one for tetanus and one for all other diseases) are developed and tested using retrospective survey data from 2000 couples living in rural Uttar Pradesh. Neo-natal tetanus mortality is found to be primarily a function of opportunities for exposure to the disease (e.g. lack of antiseptic birth practices, ownership of large animals) rather than of socio-economic status or demographic variables. The importance of examining neo-natal mortality by cause, and the shortcomings inherent in making inferences from the historical experiences of Western nations are e...

Organization for change : a systems analysis of family planning in rural India

This is an examination of the implementation of family planning in the rural areas of northern India during the early 1970s. The information is based on surveys of villagers in rural Allahabad Division and workers in rural health centers and interviews with administrators and officials at the district and state level of the Ministry of Health. The material level of living is low for most of the population in Allahabad few villagers have been exposed to extensive formal education or to contacts with the outside world. Average age at which wives begin to live with their husbands is less than 15 years and begin to bear children before age 18. Infant mortality rate was 200/1000 birthrate was above 50/1000 for 1967-71. A basic reason for high fertility is the role which children play in the lives of parents. A superficial awareness of family planning methods is widespread among the village population but there is very little actual use of contraceptive methods; no more than 14% of the respondents were currently using or have ever used a contraceptive method including abstinence and rhythm method. Only 3.7% were using IUDs or male/female sterilization. Many of the findings support the conclusion that organization and client related factors explain the low use of contraception. Studies on the district and state level show that the majority of the family planning extension staff of the rural primary health care (PHC) centers are not working at expected levels. The nature of family planning programs motivation background training support and organization are discussed. Some problems which are identified are the size of the population the frequent shifts in responsibility changes in approach to family planning pressures of poverty discrepancies between targets and achievements use of coercive techniques. Although there has been expansion of the PHC network the family planning program as a whole has not met with great success. Only an approach that is attentive to the interelatedness and variety of client and organization related factors will help in understanding how the system should work. 3 general guidelines to be followed are: 1) the strategy for client transactions to be chosen has to be suited to the client population 2) the organizing strategy has to be suited to client strategy and 3) organizing strategy has to be suited to the institutional and political context within which it is implemented.

Fertility in developing countries : an economic perspective on research and policy issues

The contributing authors to this collection presented both theoretical essays and empirical studies. These contributions when taken together provide a broad perspective on the current status of research on the factors which influence fertility in developing countries. Particular attention is focused on microeconomic models of fertility and their relevancy for understanding reproductive behavior is evaluated. Both the consequences and the determinants of fertility are examined. The impact of family planning programs on fertility and the relationship between fertility and mortality especially child mortality are also given special attention by many of the authors. Many of the studies are derived from the International Labor Organizations program of research and action in population employment. The program stimulated considerable research on the relationship between fertility and income employment and equality. This volume represents an attempt to draw conclusions both substantive and methodological from this research. Part I provides an overview and critique of fertility theories a summary of the findings of empirical fertility research and an assessment of significance of economic research on fertility in policy making. Part II deals with methodological issues including measurement problems techniques for pooling time series and cross sectional data aggregate level analysis estimation techniques for fertility models the role of simulation techniques in fertility analysis and policy making and the use of anthropological data and methods to expand microeconomic models of fertility. Part II presents the findings of 5 empirical investigations of fertility conducted in Kenya Nigeria India Turkey and Yugoslavia and of a comparative study of fertility patterns in Mexico and Costa Rica. Also included is an empirical analysis of the impact of income redistribution on fertility based on data from 36 developing countries. This collection should be expecially useful to policy makers economic planners demographers and economists.

On the institutional analysis of population programs.

Population programs have remained the stepchildren of the contemporary social science literature on population. They have weathered great hopes, disillusionments, and controversy. Their successes and failures in affecting fertility have received widespread attention. Yet the programs themselves, and their institutional realities, have not been given the sustained and rigorous consideration they deserve. Population programs can influence demographic behavior, but the extent of this influence depends on the quality of program design and implementation. To understand their potential impact more fully, research must address not only the basic sociocultural and economic forces affecting population change. It must also analyze how policy blueprints are translated into action, and how these actions in turn influence demographic behavior and human welfare. This has not yet happened to a satisfactory degree. Writing on population programs has been prolific, but the research component of this literature has remained weak. I In this paper we discuss the treatment of population programs in the dominant social-demographic research tradition and in the alternative tradition that derives from public administration, organization behavior, and management sciences, showing the advances and limitations of both orientations. We then propose an elaboration of the dominant social-demographic model that specifies program variables. We focus on programs to affect fertility, but many of the arguments we make apply to programs seeking to influence migration and mortality as well. Within the area of fertility we concentrate on family planning, although our conclusions would hold for programs designed to increase fertility.

The educational status of parents, and infant and child mortality in rural North India

The task of this discussion is to disentangle the various forces which influence the probability of death for children and, where possible, to identify the independent role of education. This discussion is one of a series of explorations of the mortality and fertility experiences of a sample of couples from North India. The analysis is based on interviews with a rural sample of husbands and wives living in 120 villages in Uttar Pradesh State in India. Information concerning fertility and mortality is based on the retrospective fertility histories collected in 1972. The population is heavily dependent upon agriculture, and it is poor and has little formal education. Per capita income at the time of the survey was less than