[Survey of men provides reliable data on contraception in the Dominican Republic].
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The low utilization of family planning methods in Ghana, and by inference in much of Africa, is explained by reference to traditional sociocultural values held by males. A LISREL model is tested using data collected from educated males working in the Ghanaian government. Among the findings are that lack of couple communication, segregated conjugal role relationships, and male-dominated decision-making are all significant predictors of non-use of family planning methods (pronatalist attitude is not). Possession of knowledge of family planning among Ghanaian males alone is unlikely to initiate use of family planning methods. Additional sociodemographic and modernization findings are reported.
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The authors argue that "birth control technologies have fundamentally altered the nature of male-female relationships.... New sequences of love, intimacy, sex, and marriage in male-female relationships emerged. The expanded number of choices for individuals has simultaneously created new freedom and opportunity, as well as uncertainty and confusion in male-female relationships. New norms for cross-sex interactions and the new post-birth control morality are still evolving." The geographic focus is on developed countries.
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Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. This study analyzes survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.
BACKGROUND: Mothers, but not fathers, are the usual focus of strategies to maximize immunization coverage in low income countries. METHODS: A study of the immunization determinants of children aged 12-18 months was conducted in 1991 in the Eastern Region of Ghana using structured interviews of a population sample of 294 mothers and 170 (67%) of the children's fathers. RESULTS: Fathers were more likely than mothers to perceive that the fathers had participated in the decision to send children for immunizations. Where both parents reported that the father had participated in the decision, and he could speak English, the child was more likely to have completed the immunization schedule by 12 months (OR = 5.7, 95% confidence interval [CI]: 1.5-21.7), independently of other factors. Neither the father's participation, nor his ability to speak English, was independently associated with the child's immunization status. CONCLUSIONS: The results of the study suggest that, where fathers have a higher level of education, programmes which are designed to involve them in decisions about their children's use of preventive health services have the potential to increase timely immunization coverage levels.
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