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Full-Text Articles in Social and Behavioral Sciences

An Assessment Of The Alternative Rites Approach For Encouraging Abandonment Of Female Genital Mutilation In Kenya, Jane Chege, Ian Askew, Jennifer Liku Jan 2001

An Assessment Of The Alternative Rites Approach For Encouraging Abandonment Of Female Genital Mutilation In Kenya, Jane Chege, Ian Askew, Jennifer Liku

Reproductive Health

Maendeleo Ya Wanawake (MYWO), with technical assistance from the Program for Appropriate Technology in Health (PATH), has been implementing an Alternative Rite of passage programme as part of its efforts to eradicate the practice of female genital mutilation (FGM) in five districts in Kenya. This study addressed the factors that influence some families and individuals to adopt the Alternative Rite while others, exposed to the same messages discouraging FGM, decide not to. It also evaluated the effect of the training component of the Alternative Rite on the girls who participated.


An Assessment Of Selected Sub-Systems Of The Egyptian Norplant® Program, Fatma El-Zanaty, Laila Nawar, Ramadan Hamed Jan 2001

An Assessment Of Selected Sub-Systems Of The Egyptian Norplant® Program, Fatma El-Zanaty, Laila Nawar, Ramadan Hamed

Reproductive Health

The Egyptian Ministry of Health and Population and FRONTIERS discussed the need for investigating service delivery aspects of the Egyptian NORPLANT® program. This study emerged from those consultations. The study provides a comprehensive assessment of the program: how services are administered and used through the ongoing Introduction Program as it approaches five years of operation. The report lists major findings with program implications and offers recommendations regarding quality of care; tracking and locating NORPLANT® users; program sustainability; and information, education, and communication strategies.


Setting Prices For Reproductive Health Services In A Public Hospital In Guatemala, John H. Bratt, Adrian Valdez, Roberto Molina, Mario Alfaro, Marco Antonio Barrientos, Carlos Brambila, Werner Figueroa Jan 2001

Setting Prices For Reproductive Health Services In A Public Hospital In Guatemala, John H. Bratt, Adrian Valdez, Roberto Molina, Mario Alfaro, Marco Antonio Barrientos, Carlos Brambila, Werner Figueroa

Reproductive Health

The Hospital Roosevelt is Guatemala’s largest hospital, and serves as a referral and training facility for the entire country. Within the Hospital Roosevelt, the Department of Obstetrics and Gynecology established a Reproductive Health Unit (RHU) to offer family planning information and services to obstetrics inpatients and OB/GYN outpatient clients, and to serve as a training site for medical residents completing their OB/GYN rotations. Hospital administrators requested assistance from the Frontiers in Reproductive Health (FRONTIERS) program to help establish a fee schedule for the RHU, with the goal of paying its own personnel costs after one year of operation. The FRONTIERS …


Promoting Reproductive Health Services In Rural Communities In Honduras, Irma Mendoza, Ricardo Vernon Jan 2001

Promoting Reproductive Health Services In Rural Communities In Honduras, Irma Mendoza, Ricardo Vernon

Reproductive Health

Using the results of a previous operations research study, the Ministry of Health of Honduras recently changed the National Women’s Health Service Delivery Guidelines to explicitly authorize nurse auxiliaries to insert IUDs, deliver Depo-Provera, and take Pap smears. These services are new to the rural communities served by rural health centers (RHCs). The objective of this project was to test whether the demand for these newly introduced services would increase if a promotional brochure was distributed in the surrounding communities by the RHC’s clients among potentially interested friends in these communities. The study found that the intervention that was tested …


An Assessment Of Youth Centres In South Africa, Annabel Erulkar, Mags Beksinska, Queen Cebekhulu Jan 2001

An Assessment Of Youth Centres In South Africa, Annabel Erulkar, Mags Beksinska, Queen Cebekhulu

Reproductive Health

Within South Africa there is much interest in expanding youth center programs, particularly in the nongovernmental sector, in part because of recognition that the HIV/AIDS crisis is disproportionately affecting young South Africans. This study was designed to give implementing agencies and donors a broad view of how the youth centers function, who they reach, and the quality of information and services. The assessment underscored the importance of monitoring the performance of programs and understanding who is being reached with what interventions. Youth centers that focus on providing recreational facilities attract a large number of clients, often boys who are repeat …


Community Involvement In The Prevention Of Mother-To-Child Transmission Of Hiv: Insights And Recommendations, Naomi Rutenberg, Mary Lyn Field-Nguer, Laura Nyblade Jan 2001

Community Involvement In The Prevention Of Mother-To-Child Transmission Of Hiv: Insights And Recommendations, Naomi Rutenberg, Mary Lyn Field-Nguer, Laura Nyblade

HIV and AIDS

Mother-to-child transmission is the primary route of HIV infection in children under 15 years of age. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. Clinical trials in several countries have shown that mother-to-child transmission of HIV can be greatly reduced through administering antiretroviral therapy to pregnant women. These trials culminated in a recommendation by UNAIDS and its partners in the Interagency Task Team for the Prevention of Mother-to-Child Transmission that prevention of perinatal transmission should be a part of the standard package of care for HIV-positive women and their children. …


Evidence For The Importance Of Community Involvement: Implications For Initiatives To Prevent Mother-To-Child Transmission Of Hiv, Ann Leonard, Purnima Mane, Naomi Rutenberg Jan 2001

Evidence For The Importance Of Community Involvement: Implications For Initiatives To Prevent Mother-To-Child Transmission Of Hiv, Ann Leonard, Purnima Mane, Naomi Rutenberg

HIV and AIDS

This paper offers lessons learned from a literature review of community involvement in biomedical and other technologies that can guide appropriate and effective introduction of services for prevention of mother-to-child transmission of HIV. A companion paper discusses research in Botswana and Zambia that showed gaps in community knowledge about HIV transmission, particularly from mother to child, and yielded insights into community perspectives about barriers to using voluntary counseling and testing services; stigma and fear associated with HIV; traditional norms on breastfeeding; and the role of family and community members in women’s decisions to participate in programs to prevent mother-to-child transmission …


Hiv And Partner Violence: What Are The Implications For Voluntary Counseling And Testing?, Carolyn Knapp Jan 2001

Hiv And Partner Violence: What Are The Implications For Voluntary Counseling And Testing?, Carolyn Knapp

HIV and AIDS

Millions of women around the world face two great threats to their health and well-being: HIV/AIDS and violence by an intimate partner. One of the strongest associations between the two is the role that violence and the threat of violence play in limiting a woman’s ability to negotiate safer sex with a partner. A similar fear of violence also discourages women who receive HIV voluntary counseling and testing (VCT) from telling partners about test results. This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Researchers …


A Case Study Of Nairobi City Council's Decentralised Syphilis Screening Programme In Antenatal Clinics, Baker Ndugga Maggwa, Ian Askew, Elizabeth Mugwe, Bilhah Hagembe, Rick Homan Jan 2001

A Case Study Of Nairobi City Council's Decentralised Syphilis Screening Programme In Antenatal Clinics, Baker Ndugga Maggwa, Ian Askew, Elizabeth Mugwe, Bilhah Hagembe, Rick Homan

Reproductive Health

It has long been known that syphilis is one of the more serious sexually transmitted infections (STI), especially during pregnancy when, if untreated, at least 60 percent of infected women will experience an adverse pregnancy outcome. There has been renewed interest in its control and prevention because of its proven link with HIV transmission. In 1992, the Nairobi City Council (NCC) pilot-tested a decentralized approach to syphilis screening and management in a sample of their antenatal clinics. A case study was carried out to assess the effectiveness, readiness, and cost effectiveness of the NCC’s antenatal care program, with a focus …


Ecuador: Use Commercial Marketing To Increase Sustainability, Frontiers In Reproductive Health Jan 2001

Ecuador: Use Commercial Marketing To Increase Sustainability, Frontiers In Reproductive Health

Reproductive Health

Many nongovernmental organizations sell contraceptives through retail outlets to generate income and expand access to these products. In 1998 Centro Médico de Orientación y Planifación Familiar (CEMOPLAF) employed 25 sales agents in 14 cities throughout Ecuador. These agents sold products, including contraceptive methods and home pregnancy tests, to pharmacies, physicians, other distributors, and nontraditional outlets. Contraceptive sales were CEMOPLAF’s largest source of revenue in 1997. Sales had grown rapidly during 1996–97, but CEMOPLAF managers did not know whether product sales were profitable. With support from the Population Council and Family Health International, CEMOPLAF made a detailed analysis of product sales …


Indonesia: Train Journalists To Write About Reproductive Health, Frontiers In Reproductive Health Jan 2001

Indonesia: Train Journalists To Write About Reproductive Health, Frontiers In Reproductive Health

Reproductive Health

After government control over the media was liberalized in 1998, Indonesian journalists had a new mandate to explore new issues and foster public debate. Several studies had found evidence that women’s health worsened from 1997–99, yet media coverage of this topic was limited. To increase press coverage of reproductive health (RH) topics, the Population Council conducted an 18-month media project in collaboration with the State Ministry for Women’s Empowerment and other key agencies. The project focused on improving RH knowledge and reporting skills among 22 print journalists. Project staff monitored RH coverage in 22 major newspapers, magazines, and tabloids. After …


Special Studies Program Of The Pilot Health Project: West Bank And Gaza, Mahmoud Shaheen, Laila Nawar, Dale Huntington, Sahar Hegazi Jan 2001

Special Studies Program Of The Pilot Health Project: West Bank And Gaza, Mahmoud Shaheen, Laila Nawar, Dale Huntington, Sahar Hegazi

Reproductive Health

The Special Studies Program was implemented as part of the Pilot Health Project in the West Bank and Gaza to provide small grants to Palestinian researchers, research organizations, and advanced graduate students to conduct research that examines critical reproductive health topics related to maternal and child health care, including family planning. The research implemented under the Special Studies Program covered a range of topics including male involvement in reproductive health, clients' satisfaction with family planning programs, the relationship between early marriage and the delivery of premature infants, factors affecting compliance for iron supplementation, and diabetes mellitus during pregnancy. The research …


An Assessment Of The Zimbabwe National Family Planning Council's Community Based Distribution Programme, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Ronika Nyakauru, Barbara Janowitz Jan 2001

An Assessment Of The Zimbabwe National Family Planning Council's Community Based Distribution Programme, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Ronika Nyakauru, Barbara Janowitz

Reproductive Health

Since its inception, the Zimbabwe National Family Planning Council’s (ZNFPC) community-based distribution (CBD) program has made significant and well-documented contributions to the demand for and use of family planning in Zimbabwe. Data from several studies have shown, however, a steady decline in this contribution and that the CBD agents spend more time resupplying existing clients than recruiting new acceptors. Moreover, the CBD program urgently needs to be able to address the AIDS crisis in the country. ZNFPC has undertaken this review to guide it in making appropriate decisions about the future direction of the program, allowing CBDs to have a …


Power In Sexual Relationships: An Opening Dialogue Among Reproductive Health Professionals, Population Council, Interagency Gender Working Group (Igwg) Jan 2001

Power In Sexual Relationships: An Opening Dialogue Among Reproductive Health Professionals, Population Council, Interagency Gender Working Group (Igwg)

Reproductive Health

The discussions summarized in this report indicate that gender-based power inequalities hinder communication between partners, limit the ability of individuals and couples to talk about or achieve desired child spacing and family-size goals, limit effective use of reproductive health services, undercut men’s and women’s attainment of sexual health and pleasure, and increase substantially their vulnerabiliy to HIV/AIDS and other sexually transmitted infections. This report summarizes the proceedings of a meeting, co-sponsored by the Population Council and USAID’s Men and Reproductive Health Subcommittee, that responded to an increasing groundswell of interest in opening a dialogue on power in sexual relationships. The …


Whose Education Counts? The Impact Of Grown Children's Education On The Physical Functioning Of Their Parents In Taiwan, Zachary Zimmer, Albert I. Hermalin, Hui-Sheng Lin Jan 2001

Whose Education Counts? The Impact Of Grown Children's Education On The Physical Functioning Of Their Parents In Taiwan, Zachary Zimmer, Albert I. Hermalin, Hui-Sheng Lin

Poverty, Gender, and Youth

Research has identified education as an important predictor of physical functioning in old age. Older adults in Taiwan tend to experience close ties to family members and high rates of adult child coresidence, much more so than is typical in Western cultures. These circumstances might imply additional health-related benefits stemming from the education of grown children. This association could arise in a number of ways, for instance through the sharing of health-related information between child and parent, the quality of caregiving efforts, monetary assistance for medical and other services, or through other psychosocial avenues. In this study, a nationally representative …


Living Arrangements Of Older Adults In The Developing World: An Analysis Of Dhs Household Surveys, John Bongaarts, Zachary Zimmer Jan 2001

Living Arrangements Of Older Adults In The Developing World: An Analysis Of Dhs Household Surveys, John Bongaarts, Zachary Zimmer

Poverty, Gender, and Youth

Using data from Demographic and Health Surveys, this study examines living arrangements of older adults in 43 developing countries and compares patterns by gender, world regions, and macro-level measures of socioeconomic development. Indicators include household size, headship, relationship to head, and coresidence with spouse, children, and others. Unweighted regional averages and OLS regressions determine whether variations exist. Average household sizes are large, but a substantially higher proportion of elderly adults live alone than do individuals in other age groups. Females are more likely than males to live alone and are less likely to live with a spouse or to head …


Introducing Emergency Contraception In Bangladesh: A Feasibility Study, M.E. Khan, Sharif M.I. Hossain Jan 2001

Introducing Emergency Contraception In Bangladesh: A Feasibility Study, M.E. Khan, Sharif M.I. Hossain

Reproductive Health

Approximately 28,000 maternal deaths occur every year in Bangladesh due to pregnancy and delivery-related complications, while many more women suffer major physical and psychological injuries. Available statistics indicate an increase in menstrual regulation (MR) and abortions, most performed by untrained practitioners under unhygienic conditions. Introducing emergency contraception (EC) in the national family planning (FP) program in Bangladesh could substantially reduce unwanted pregnancies and as result MR/abortions should also decrease. Because MR/abortions in Bangladesh significantly contribute to high maternal morbidity/mortality, introducing EC could be an important reproductive health intervention to provide couples with a back-up support to prevent unwanted pregnancy. EC …


Reproductive Tract Infections: A Guide For Programme Managers, Sarah Hawkes, Anjali Nayyar, Johannes Van Dam, Kevin R. O'Reilly, Bidia Deperthes, Dinesh Agarwal Jan 2001

Reproductive Tract Infections: A Guide For Programme Managers, Sarah Hawkes, Anjali Nayyar, Johannes Van Dam, Kevin R. O'Reilly, Bidia Deperthes, Dinesh Agarwal

Reproductive Health

Reproductive tract infections (RTIs) including sexually transmitted infections represent a silent worldwide pandemic that adversely impacts the reproductive health (RH) of women and men. Various community- and hospital-based studies in India have provided insights into the magnitude of the problem. The International Conference on Population and Development (1994) emphasized integration of RH services to meet the needs of men and women especially with prevention and management of RTIs/STIs. The emergence of HIV and the identification of STIs as a risk factor for the spread of HIV have further lent a sense of urgency for a programmatic response to address this …


Operations Research In Reproductive Health And Family Planning At The Cairo Demographic Center, Magdi A. Ibrahim, James R. Foreit, M.E. Khan Jan 2001

Operations Research In Reproductive Health And Family Planning At The Cairo Demographic Center, Magdi A. Ibrahim, James R. Foreit, M.E. Khan

Reproductive Health

This report evaluates the effectiveness of a two-year training program at the Cairo Demographic Center to increase the number of researchers using operations research (OR), and to help institutionalize the ability of the Center to offer training in operations research in reproductive health. It also provides feedback for OR curriculum development. The project trained researchers with program and policymaking responsibilities and provided participants with the experience of designing an OR project, and built participants’ skills in communicating research results to managers. Participant evaluations showed that, overall, the course met its objectives. The training that the students received in OR has …


Ecological Degradation, Rural Poverty, And Migration In Ethiopia: A Contextual Analysis, Markos Ezra Jan 2001

Ecological Degradation, Rural Poverty, And Migration In Ethiopia: A Contextual Analysis, Markos Ezra

Poverty, Gender, and Youth

The interrelationships between ecological degradation, poverty, and rural out-migration in Ethiopia are examined using data from a Household and Community Survey conducted in 1994-95. The survey, which covered a sample of 2,000 households, collected retrospective data on changes in household composition, including migration of household members, during the period 1984 to 1994. The study hypothesizes that the decision to out-migrate in the impoverished rural areas of northern Ethiopia is influenced by a combination of factors based on individual, household and community characteristics. A multilevel analysis is applied to determine the role of these factors in the decision. The findings show …


Social Networks And Contraceptive Dynamics In Southern Ghana, Mark R. Montgomery, Gebre-Egziabher Kiros, Dominic K. Agyeman, John B. Casterline, Peter Aglobitse, Paul C. Hewett Jan 2001

Social Networks And Contraceptive Dynamics In Southern Ghana, Mark R. Montgomery, Gebre-Egziabher Kiros, Dominic K. Agyeman, John B. Casterline, Peter Aglobitse, Paul C. Hewett

Poverty, Gender, and Youth

There is accumulating evidence that social diffusion processes affect the pace of the adoption of modern contraception in societies undergoing fertility transition. In settings where mortality has declined and many other social and economic changes are underway, decisions about contraception are fraught with uncertainty and risk. In such circumstances, couples may rely on other persons for information and guidance. In this paper, we examine the influence of informal social networks on the contraceptive behavior of reproductive-age women, using longitudinal data collected in six communities in southern Ghana. Our results confirm the hypothesis that adoption of modern contraception is strongly affected …


The End Of The Fertility Transition In The Developed World, John Bongaarts Jan 2001

The End Of The Fertility Transition In The Developed World, John Bongaarts

Poverty, Gender, and Youth

By the late 1990s fertility in the developed world had declined to 1.6 births per woman, a level substantially lower than projected in the 1980s. This study examines recent trends and patterns in fertility in the developed world with particular emphasis on the effects and implications of changes in the timing of childbearing. The main objective is to demonstrate that while fertility in these countries is indeed low, women’s childbearing levels are not as low as period measures such as the total fertility rate suggest. To obtain a full understanding of the various dimensions of fertility change, several indicators are …


Strengthening Social Science Research On Women's Health: Lessons Learned From A Capacity Building Programme, M.E. Khan, Bella C. Patel, John Townsend Jan 2001

Strengthening Social Science Research On Women's Health: Lessons Learned From A Capacity Building Programme, M.E. Khan, Bella C. Patel, John Townsend

Reproductive Health

The International Conference on Population and Development in 1994 led to an upsurge in interest in implementing reproductive health (RH) programs worldwide. The urgency to act has led to the development of disparate activities in several developing countries including India. While programs have been growing in numbers, their quality is in question. A fundamental problem has been lack of capacity at all levels of the health service system to respond to the paradigm shift articulated by the advocates of the reproductive health and rights agenda. To redesign programs, considerable research must be undertaken to understand the health needs and sociocultural …


West Bank And Gaza: Stress The Importance And Cost-Effectiveness Of Postpartum Care, Frontiers In Reproductive Health Jan 2001

West Bank And Gaza: Stress The Importance And Cost-Effectiveness Of Postpartum Care, Frontiers In Reproductive Health

Reproductive Health

To assess maternal health care in the West Bank and Gaza, the Health, Development, Information, and Policy Institute conducted a study from May to August 2000. This study served as a baseline for the Pilot Health Project (PHP), which seeks to improve antenatal and postpartum services in three areas of the West Bank and Gaza. Seven local and international agencies are implementing PHP in collaboration with the Palestinian Ministry of Health and with funding from the U.S. Agency for International Development. Data sources for the baseline study consisted of service statistics, interviews with health-care providers, and exit interviews with antenatal, …


Trafficking And Human Rights In Nepal: Community Perceptions And Policy And Program Responses, Celine Daly, Vaishali Sharma Mahendra, Pankaja Bhattarai, Nick Langton, Jyoti Sanghera, Catrin Evans, Ratna Kapur, Dill Ram Dahal, Siobhan Crowley Jan 2001

Trafficking And Human Rights In Nepal: Community Perceptions And Policy And Program Responses, Celine Daly, Vaishali Sharma Mahendra, Pankaja Bhattarai, Nick Langton, Jyoti Sanghera, Catrin Evans, Ratna Kapur, Dill Ram Dahal, Siobhan Crowley

HIV and AIDS

In recent years, millions of women and girls have been trafficked across national borders and within countries. The trafficking problem is particularly acute in Nepal, one of the least developed countries in the world, with 42 percent of its citizens living below the poverty line. An estimated 5,000 to 7,000 girls are trafficked from Nepal to India and other neighboring countries every year, primarily for prostitution, and 200,000 Nepali girls and women are currently working in the sex industry in India. The occurrence of trafficking in Nepal is generally attributed to widespread poverty, low status of girls and women, and …


Prevention Of Trafficking And The Care And Support Of Trafficked Persons In The Context Of An Emerging Hiv/Aids Epidemic In Nepal, Celine Daly Jan 2001

Prevention Of Trafficking And The Care And Support Of Trafficked Persons In The Context Of An Emerging Hiv/Aids Epidemic In Nepal, Celine Daly

HIV and AIDS

This study is a collaborative effort between the Asia Foundation (Kathmandu) and the Horizons project of the Population Council (New Delhi) to document the current intervention models and community-based study of human trafficking in the context of an emerging HIV/AIDS epidemic in Nepal. To address the human rights component of trafficking, the three components of this study focus on the rights and needs of trafficked persons as well as those who are vulnerable to trafficking. An analysis and assessment of the effectiveness of laws, policies, and interventions in the apprehension, prosecution, and conviction of alleged traffickers is not included in …


The Case For Microbicides: A Global Priority, Kathy Attawell Jan 2001

The Case For Microbicides: A Global Priority, Kathy Attawell

HIV and AIDS

The HIV/AIDS epidemic continues to spread, undermining development, reversing health gains, and exacerbating poverty. It will be some time before a vaccine is available and accessible, thus there is an urgent need to identify additional prevention options, in particular a method that women control, which could save millions of lives. This report from the Population Council and International Family Health presents the case for microbicides—products used vaginally to prevent infection from HIV and other STIs in women and their sexual partners—and discusses recent progress and developments, outstanding challenges, and the action required to ensure that products will be made available …


Youth Livelihood Opportunities In Egypt, Safaa El-Kogali, Nagah Hassan Al Bassusi Jan 2001

Youth Livelihood Opportunities In Egypt, Safaa El-Kogali, Nagah Hassan Al Bassusi

Poverty, Gender, and Youth

This report presents results from a quantitative and qualitative study on youth livelihood opportunities in Egypt. The study was motivated by growing evidence of increasing unemployment among the young at a time when new entrants into the labor force are also increasing at unprecedented rates. Egypt has a youth population of over 13 million aged 15–24—over a fifth of the total population. They constitute the largest segment of the economically active population. Whether this bulge of young workers entering the labor force is a “demographic gift” or a “demographic burden” depends in large measure on the policies that are in …


Increasing Coverage Of Reproductive Health Issues In The Indonesian Print Media, Wanda Firmansyah, Sahar Hegazi, Siti Rokhmawati Darwisyah, Lila Amaliah Jan 2001

Increasing Coverage Of Reproductive Health Issues In The Indonesian Print Media, Wanda Firmansyah, Sahar Hegazi, Siti Rokhmawati Darwisyah, Lila Amaliah

Reproductive Health

With the reform movement in Indonesia, the FRONTIERS project recognized the new opportunities for influencing public debate and informing public opinion on reproductive health issues and undertook a project for disseminating the results of contemporary research on reproductive health. The project had three main objectives: 1) to increase print media coverage of critical reproductive health issues by enhancing journalists’ role as responsible communication agents; 2) to contribute to public debate on emerging reproductive health issues in order to influence policy development and guide program management; and 3) to increase public awareness of key health issues, with a particular focus on …


Obstacles To Contraceptive Use In Pakistan: A Study In Punjab, John B. Casterline, Zeba Sathar, Minhaj Ul Haque Jan 2001

Obstacles To Contraceptive Use In Pakistan: A Study In Punjab, John B. Casterline, Zeba Sathar, Minhaj Ul Haque

Poverty, Gender, and Youth

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Our concern is those factors that prevent women from translating a desire to avoid becoming pregnant into contraceptive practice, a common predicament in Pakistan in recent decades. We analyze survey data collected in Punjab province in 1996 that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and …