Emergency contraception: randomized comparison of advance provision and information only.

OBJECTIVE: To determine whether multiple courses of emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods. METHODS: We randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about emergency contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain emergency contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability. RESULTS: Women given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken emergency contraception, although numbers were too small to permit statistically significant inferences. No women used emergency contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about emergency contraception useful, and all those receiving only information wished they had received supplies as well. CONCLUSION: Multiple emergency contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.

Emergency contraception: a review of the programmatic and social science literature.

Many biomedical aspects of emergency contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of emergency contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing emergency contraceptive services. The review also offers ideas for designing new emergency contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.

Evaluation of the Olsen technique for estimating the fertility response to child mortality.

In a previous issue of this journal, Olsen proposed a technique for quantifying the fertility response to child mortality. To estimate the extent of child replacement, one needs data only on the number of children ever born and the number of child deaths for each woman. The technique involves first running a regression of the number of births on the number of deaths and then correcting the regression coefficient in order to obtain a consistent estimate of replacement. Here we evaluate the performance of the technique by seeing how well it works on a simulated set of reproductive histories for which we known the true extent of replacement. In passing, we derive an extension of the technique to handle the situation in which replacement strategies are heterogeneous. We conclude that the technique performs very well, especially in those cases where the stochastic structure of the data can be diagnosed.

[Estimating the covariates of childhood mortality from retrospective reports of mothers (author's transl)]. / Estimacion de las covariables de la mortalidad en la ninez a partir de declaraciones retrospectivas de las madres.

PIP: In this paper, the authors compared various models for estimating the covariates of childhood mortality. Specifically, we examined how much precision is lost as various pieces of information such as dates of birth and death for each child are discarded. The conclusion reached is that even incomplete mortality data of the type collected in household surveys or censuses can yield estimates which are very close to those based on the much richer wealth of data collected in detailed maternity histories. 2 substantive conclusions of interest are that in the 2 countries (Sri Lanka and Korea) which were examined, education of the father has a significant and pronounced effect on childhood mortality even when mother's education is controlled, and once other covariates are controlled, there is no difference between urban and rural childhood mortality. (author's modified)^ieng

Estimating the completeness of reporting of adult deaths in populations that are approximately stable.

PIP: An elaboration of Preston's (Preston and Hill, 1980) procedure for determining the completeness with which deaths are recorded in approximately stable populations is presented. Both the procedures of Preston and that of Brass are conventionally limited to mortality beyond early childhood, to mortality above age 5 or age 10. The method considered here is based on characteristics of stable populations, i.e., populations that have been subject for a long time to little variation in age-specific mortality schedules or in overall levels of fertility. The essential features of a stable population are maintained even if fertility has changed. This is the case as long as no strong trend in fertility existed more than 15 or 20 years before the date at which the population is observed. Recent changes in fertility may affect the structure of the population at adult ages, but the effect on estimates of completeness of death records can generally be kept within tolerably narrow limits. Prior to showing how explicit estimates of the relative completeness of recording of numbers of deaths and persons can be derived from counts of deaths and persons by age, it is noted that a life table for a stable population can be constructed directly from the recorded distribution of deaths by age, or from the recorded distribution of persons. The procedures described are applied to several different populations in order to illustrate the computational steps necessary to estimate the completeness of death records at ages above childhood in populations that are approximately stable.^ieng