IN THIS ISSUE
The world, and the family planning field, has changed enormously since the first issue of this journal--then titled International Family Planning Digest--was published in 1975. The issue of greatest concern at that time was the rapid pace of global population growth (particularly in developing countries) and its implications for human survival and well-being. Over time, as population growth slowed, the concerns of the field shifted to include the needs of individuals as well as those of nations and the world as a whole. Thus, family planning policymakers and providers began to focus on enabling women to prevent unintended pregnancies and achieve healthy pregnancies and births, as well as on decreasing overall birthrates. The content of the journal has evolved to reflect these changes, incorporating articles on such topics as the prevalence and consequences of risky sexual behavior among young people, the effects of short birth intervals on infant health and survival, and the use of contraceptives to prevent transmission of HIV and other sexually transmitted infections (STIs).
Through all of these changes, the basic look and approach of the journal remained essentially the same. Over the last few years, however, the editors reached the conclusion that the time for a total reassessment had come. With input from independent consultants, our editorial advisory committee, readers and authors, as well as our colleagues at The Alan Guttmacher Institute and the Institute's board of directors, we evaluated every aspect of the journal--from content and design to internal operations. While we received enthusiastic feedback about the scope and depth of the journal's content, staff and readers alike felt the journal needed a face-lift. During the past year, we worked with a designer to create a modern look that is airier, more inviting and easier to read. We're pleased with the results, and hope you will be as well.
Seeking the 'Why'
It is fitting that the content of this issue reflects the changes that have taken place in the field over the more than 25 years of the journal's existence. One of the most striking differences is the shift from largely descriptive research to studies that mainly focus on explanation. For example, early studies documented which women used--or did not use--contraceptive methods, while recent studies attempt to discover why that is the case, especially among women who want to delay or end childbearing and those who need protection against STIs. Increasingly, too, the manuscripts we receive--and publish--recognize the need to study the role of men in sexual and reproductive decision-making.
• In the lead article, for example, Mark VanLandingham and Lea Trujillo use data from interviews with 10 young Thai men from varied backgrounds to examine recent changes in the sexual attitudes and behavior of their peers, and the shifts in the social context that brought about those changes [see article]. The good news: Because they fear contracting HIV, young men are increasingly rejecting the tradition of sexual initiation in brothels, and those who do patronize sex workers tend to use condoms. The bad news: Young men are increasingly having noncommercial sexual relationships with their female peers, and few are using condoms in those relationships. Will HIV incidence, which Thailand has struggled successfully to lower, rebound as a result of these behavioral changes?
• Communication between men and women is central to the article by Mona Sharan and Thomas W. Valente [see article]. Building on earlier studies that have found links among mass media exposure, spousal discussions about family planning and adoption of a method, the authors explore the complex interrelationships among these factors. Their results suggest that exposure to family planning messages in the mass media acts as a catalyst for contraceptive use by stimulating discussions between spouses.
• Karen Katz and colleagues use in-depth interviews with providers, reports from simulated clients and data from focus-group discussions to examine the reasons for the low level of IUD use in El Salvador [see article]. Taken together, the information from these sources points to myths and rumors about the IUD, inadequate attention to the method during family planning counseling and insufficient provider experience as the major factors impeding IUD use. The data suggest that provider training will not be enough to increase use of the IUD; providers must be encouraged to give clients clear and adequate information about the method, and clients need to be encouraged to try it.
• John Ross and colleagues focus on accessibility as a factor in method use. Using data from 64 countries, they show that both overall prevalence and the use of individual methods rise with the number of methods offered by a national program and the proportion of the country's population that has access to those methods [see article]. The authors recommend that public policy address not only the variety of contraceptive methods included in national programs, but also the many barriers that impede their use.
• Does high fertility cause poverty, or does poverty encourage high fertility? Thomas Merrick's Comment revisits a controversial issue whose answer has profound implications for family planning programs [see article]. His examination of new research suggests that neither the neo-Malthusians who touted the provision of contraceptive services as the best method of reducing poverty nor the economists who argued that economic policies were the key were quite right--or completely wrong.