Papers by James F . Phillips
75. United Nations Population Division, Trends in
69. The youth dependency ratio is the ratio of people aged 0 to 14 to those aged 15 to 64. 70. Th... more 69. The youth dependency ratio is the ratio of people aged 0 to 14 to those aged 15 to 64. 70. The liberalization of international capital flows may lessen the importance of domestic savings for economic growth.
A multivariate analysis of continued use of contraception among Philippine family planning acceptors
Population Data Information Service, 1978
3604 acceptors during 1970-1972 selected systematically from a stratified sample of 99 Philippine... more 3604 acceptors during 1970-1972 selected systematically from a stratified sample of 99 Philippines clinics were interviewed in an effort to determine the most important correlates of the continued use of contraception. The following were among the survey results: 1) IUD adopters had higher continuation rates than other method adopters; 2) husband's support was found to be an important predictor of oral contraception (OC), condom, and rhythm continuation; 3) continuation rates increased with age; 4) the desire for additional children at the time of acceptance did not appear to have an important influence upon continuation; 5) rhythm continuation was found to be strongly correlated with demographic predictors; 6) moderate supply fees charged by clinic workers were associated with higher continuation rates; and 7) acceptors who received printed materials had higher continuation rates than those who did not.
An Experiment with Payment, Quota, and Clinic Affiliation Schemes for Lay Motivators in the Philippines
Studies in Family Planning, 1975
The Philippine Commission on Population began an experiment in 1973 to test the effect of alterna... more The Philippine Commission on Population began an experiment in 1973 to test the effect of alternative payment achievement quota and clinic affiliation schemes on the performance of lay motivational workers. The study used the following 3 variables: 1) type of target: group quota individual quota or no quota; 2) type of payment scheme: salary alone salary plus bonus or payment on a per acceptor basis; and 3) type of motivator affiliation: at large or clinic based. It was hypothesized that motivator performance would change with the type of target the payment scheme and the administrative alignment of motivation. A point system was developed that would be more representative of achievement. 5 treatments were used in the study each representing a different combi nation of target payment and affiliation schemes. There was an individual target of 26 points an individual target of 16 points a target of 96 points for 6 motivators working as a group no target and as a pure control the use of the usual quota of 15 new acceptors without the experimental point system. In each of the 3 provinces 5 districts were comparable population sizes and densitites and cumulative acceptance rates were selected and randomly assigned to the 5 types of treatment. 90 motivators were chosen as subjects. The findings tend to support the hypothesis. Among the different payment and quota schemes motivators paid on a per acceptor basis with no quota claimed the largest mean number of monthly points. Motivators working at-large claimed an average of about 4 more points per month than clinic based motivators. Motivators paid on a per acceptor basis with no quota performed better than motivators in any other treatment. Motivators working under the individual quota plus bonus plan ranked second in perf ormance. The performance of motivators working under a group quota plus bonus was only slightly better than that of the control group. At-large motivators gained more points than clinic based motivators. The average motivator in the control and group quota treatments achieved well below the prescribed monthly quotas for these treatments.
The Impact of Outreach on the Continuity of Contraceptive Use in Rural Bangladesh
Studies in Family Planning, 1996
... Method used Condom 9.58*** 10.92*** 10.67*** ... typical of women in general, sustained pract... more ... Method used Condom 9.58*** 10.92*** 10.67*** ... typical of women in general, sustained practice depends more on outreach, because users are more typically contraceptive ... If de-cisions to terminate use are volitional, driven solely by personal choice, then client characteristics ...
Study Protocol, 2013
Background: During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghan... more Background: During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birthfrom a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the "Navrongo Experiment" was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn health, and generating the political will to scale up the program with strategies that are faithful to the original design.
Social Science & Medicine, 1997
This study presents a focus group investigation of reasons why women in a rural, Sahelian communi... more This study presents a focus group investigation of reasons why women in a rural, Sahelian community are reluctant to adopt family planning even when convenient services are made freely available. First, women opting to practice contraception must do so at considerable risk of social ostracism or familial conflict. Implementing individual preference is something that must be done without the support of others. Second, few women view personal decisions about contraceptives as theirs to make. Women and children are the property of the corporate family-kin and community militate against reproductive control. Third, although children are highly valued for a variety of economic, social, and cultural reasons, mortality risks remain extremely high. Low fertility imposes the unacceptable risk that a woman will have no surviving children at the end of her reproductive life. Taken together, these findings attest to the inadequacy of service strategies focused on the contribution of distribution, individual agency, or personal choice. Outreach should also build a sense of community legitimacy for the program, collective health action, and traditional leadership support for family planning behavior.
International Journal of Gynecology & Obstetrics, 1987
Using a unique record keeping system, the use effectiveness of the Copper T-200 is examined in ru... more Using a unique record keeping system, the use effectiveness of the Copper T-200 is examined in rural Bangladesh. In Matlab the Copper T-200 is a highly effective contraceptive modality. The adopters are typically low to medium parity women under 30 years of age. The most important cause of termination among women in the study was voluntary removal of the device. The complaint most often reported was bleeding followed by pain and weakness. The Matlab experience suggests that sustained motivation and regular resupply are the two key components of this highly successful family planning program. Tatum T showed that it was associated with significantly less pain and bleeding than the popular Lippes Loop D and with markedly reduced expulsion rates. Failure rates however, were unacceptably high with this method, and it becomes apparent that to be effective the T would have to carry an antifertility agent [ 1 11.
Studies in Family Planning, 1982
Bulletin of the World Health Organization, 1990
This study examines the impact of measles vaccination on childhood mortality, based on longitudin... more This study examines the impact of measles vaccination on childhood mortality, based on longitudinal data from the Matlab maternal and child health/family planning programme in rural Bangladesh. It analyses the mortality experience of 8135 vaccinated and 8135 randomly matched nonvaccinated children aged 9-60 months, who were observed from March 1982 to October 1985. The results indicate that measles vaccination had a pronounced impact on both short- and long-term survival--the mortality rates for vaccinated children were as much as 46% less than those for nonvaccinated children. Immunization of children aged up to 3 years with measles vaccine appears to improve significantly their subsequent chances of survival. The findings underscore the need to give greater priority to measles vaccination within primary health care programmes in settings such as rural Bangladesh.
Developing a Culturally Appropriate Family Planning Program for the Navrongo Experiment
Studies in Family Planning, 1995
... This article describes thefirst ix months of the strategic planning process to develop a cult... more ... This article describes thefirst ix months of the strategic planning process to develop a culturally ... These constraints were grouped into four general themes, and the strategicplanning com-mittee was invited to identify related programmatic ob-...
Contraceptive Use in Matlab, Bangladesh: The Role of Gender Preference
Studies in Family Planning, 1992
Research in several Asian societies has suggested that sons are generally preferred over daughter... more Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh.
Matlab and the Bangladesh family planning and health program
Journal of Biosocial Science, 1988
SummaryThe levels of fertility of two rural areas, Matlab and Teknaf, of different environmental ... more SummaryThe levels of fertility of two rural areas, Matlab and Teknaf, of different environmental and cultural settings of Balgladesh are markedly different. The proximate fertility determinants that may explain this difference are identified and their possible effect is examined.Most of the variation of natural fertility is explained by the difference in breast-feeding practices of the two populations, median duration 30 months for Matlab and 22 months for Teknaf. This difference suggests that prolonged breast-feeding is as important a factor contributing to the relatively low fertility in Matlab as contraception. While the increase of contraceptive use in Matlab has greatly affected fertility, the concomitant contribution of prolonged lactational amenorrhoea is also important.
Population Change in a Rural Area of Bangladesh, 1967-87
The ANNALS of the American Academy of Political and Social Science, 1990
The Matlab subdistrict of Bangladesh is unique in the developing world in the extent of demograph... more The Matlab subdistrict of Bangladesh is unique in the developing world in the extent of demographic data available over a long time period, during which a serious famine occurred and a family planning program that employed village women as home visitors was introduced within the context of maternal and child health services. These data demonstrate that fertility in this population is well below the maximum biologically feasible, primarily due to the long and intense breast-feeding practiced, that seasonality of births is pronounced, and that fertility drops in response to drastic food shortage. Sex differences in mortality favor males, but during famine the disparity was reduced. Despite arguments that family planning programs are ineffective and use resources that could be applied in areas more relevant to development, the Matlab family planning program has led to both reduced fertility and reduced mortality and may be changing the status and roles of women.
Studies in Family Planning, 1998
Studies in Family Planning, 1986
Client relations constitute a icgcctcd area of resarch in fainily planning ri ndin's froni studie... more Client relations constitute a icgcctcd area of resarch in fainily planning ri ndin's froni studies in northern l:dia ai Bangladesh reveal considerable variatin in lt the quantit'y and quality of contacts ili pro,,ranis that function under rouh,ilt' comparable socioeconom ic conditions. Clie:it relations are d,-tcrmcd ib,acomnPlex set of forces in t hich bo0!h roriiuliatic factors a:d cCIUit:0 is , 'taliny to the societal .i viron ent Wpat a key role. Worker-clievl exchangcs hale a net, incrcmcntal eltect on contraceptive itsi" Family planning programs re1uire cxtensive planning, resource mobilization, and administrative mechanisms to function ..uccesstullv. Th2 impact of family planning policy decisions and administrative processes i: en in the interactions between program representatives and cur:ent or potential users. Clients interact with the pmgram through outreach sta.lf, volunteers, medical per-.onne', or government officals who promote the practice of contraception, aiAtriute intormation an supplies. cr provide medical services. Clients may perccive program representatives as sympathetic, helpful, understainding, and trustv'ortH,' individuals who visit regularlv. Conversely, they mu see program staff as abrupt, insensitive officials whose m:'ssages are incomprehensible and sometimes frightening. Program ,epresentatives, in turn, may encounter clients who desire services or resist them, who want to limit their faroi size but fear the ,seof contracepti,.e methds, or who want frimily plannirg but also need help with other pressing personal ,i health problems. The behavior and pLc eptions o(prograio re-iesentatives and clients toward each other are caled client re
Factors hampering program effectiveness
Population forum : monthly newsletter of the Commission on Population, 1976
Findings of the University of the Philippines evaluation research of family planning programs in ... more Findings of the University of the Philippines evaluation research of family planning programs in the Philippines identify 4 major problems which limit effectiveness: 1) acceptance is leveling off; 2) greater proportions of acceptors are choosing the less effective methods; 3) women who switch methods tend to choose a less effective method than the first used and 4) continuation rates for the effective methods are declining. The authors suggest causes and possible remedies for the problems.(AUTHORS MODIFIED)
Family Planning Programmes and Fertility
Population and Development Review, 1992
Part 1 The role of family planning programmes as a fertility determinant: introduction, James F.P... more Part 1 The role of family planning programmes as a fertility determinant: introduction, James F.Phillips and John A. Ross the role of family planning programmes as a fertility determinant, Ronald Freedman and Deborah Freedman methods for measuring programme impact - a review of applications in the last decade, John A. Ross and Cynthia B. Lloyd. Part 2 Theoretical perspectives on the intersection of demand and supply: supply and demand, not supply vs. demand - appropriate theory for the study of the effects of family planning programmes on fertility, George B. Simmons relationships between fertility and individual deamnd and community programme supply - the role of family planning in determining fertility, T.Paul Schultz the influence of contraceptive costs on the demand for children, Warren Robinson and John Cleland the spread of fertility regulation as collective behaviour, Rodolfo A. Bulatao and Eduard Bos. Part 3 Addressing the role of demand: demand for family planning - estimates for developing countries, Charles F. Westoff and Lorenzo Moreno the use of payments and benefits to influence reproductive behaviour, John Cleland and Warren Robinson. Part 4 Addressing the role of supply: the proximate operational determinants of fertility regulation behaviour, Ruth Simmons and James F. Phillips, quality of service, programme efforts and fertility reduction, Anrudh Jain, Judith Bruce and Sushil Kumar service proximity as a determinant of contraceptive behaviour - evidence from cross-national studies of survey data, Amy Ong Tsui and Luis Hernando Ochos. Part 5 Social, institutional, and political constraints to family planning programme effectiveness: constraints on supply and demand for family planning - evidence from Rural Bangladesh, Michael A. Koenig and Ruth Simmons state-society links - political dimensions of population policies and programmes, with special reference to China, Susan Greenhalgh the determinants of impact and utilization of fertility research ion public policy, China and Mexico, Axel I. Mundigo. Part 6 Summary and conclusion: family planning programme sand fertility effects - an overview, James F. Phillips and John A. Ross.
The Demographic Impact of Family Planning Programs
Studies in Family Planning, 1990
In response to concerns about the adverse consequences of rapid population growth, family plannin... more In response to concerns about the adverse consequences of rapid population growth, family planning programs have been implemented in many developing countries. The aim of the present study is to assess the impact of this programmatic approach on long-range population growth. The result of a new and hypothetical population projection indicates that in the absence of family planning programs the population of the developing world could be expected to reach 14.6 billion in the year 2100 instead of the 10 billion that is currently projected by the World Bank. Despite the apparent success of existing interventions, fertility control is far from complete, as many women continue to bear unwanted births. To assess the impact of this unintended childbearing a second hypothetical projection is made. With perfect implementation of reproductive preferences, the population size of the developing world in 2100 would be reduced by an estimated 2.2 billion below the current projection. Further strengthening of family planning programs and improvements in birth control technology are therefore likely to provide important demographic benefits.
Analysis of motivation to contraceptive use applying the weighting procedure
Biodemography and Social Biology, 1989
This paper presents a technique for scaling contraceptive use motivation for the sample populatio... more This paper presents a technique for scaling contraceptive use motivation for the sample population of the Family Planning Health Services Project in Matlab. The project, which began in 1977, is conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh. The hypothesis of the research is that through the use of a scaling algorithm the power of demographic characteristics, attitudes, and intentions for predicting contraceptive use can be enhanced. The analysis shows that two factors explain use motivation. Scale 1 is weighted for demographic variables and desire for additional children, while Scale 2 is comprised of education and intentions of contraceptive use. Both scales have a pronounced independent predictive power. We conclude that scaling has improved upon the predictive power of indicators of reproductive motivations.
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Papers by James F . Phillips