Advancing Sexual and Reproductive Health and Rights
International Family Planning Perspectives
Volume 30, Number 1, March 2004


Fertility has declined considerably in most populations in the developing world over the last 50 years. In the majority of countries, the decline has been gradual and has been driven by increases in the proportion of couples who desire smaller families. However, in China and India—the world's most populous countries—the pattern has been quite different. In both cases, high rates of population growth led their governments to institute stringent birth limitation policies in the middle to late 1970s. In India, many couples were either forced or persuaded by monetary incentives to accept sterilization. In China, the one-child policy (though enforced to varying degrees across population subgroups) led to coerced abortion and IUD use.

Two of the articles in this issue explore the legacy of these policies for women's current childbearing patterns. Although most research on China has focused on government limitation of desired fertility, Yan Che and John Cleland look at the causes of unintended pregnancies among young couples in Shanghai [see article]. Surprisingly, given that the one-child policy has been strictly enforced in the city since 1979, more than four in 10 couples had experienced an unintended pregnancy after their first birth. These pregnancies, the vast majority of which were terminated, were concentrated in the 12 months after the first birth, when couples tended to use less effective methods, such as withdrawal, periodic abstinence and the condom. Noting that the rate of unintended pregnancy fell in tandem with a rise in couples' use of the IUD, the authors recommend that policies aimed at reducing unintended pregnancies in China should focus on postpartum contraception.

Although India has changed its family planning program, placing greater emphasis on reversible methods, sterilization remains dominant in the country's method mix. In "Compression of Women's Reproductive Spans in Andhra Pradesh, India," Sabu S. Padamas, Inge Hutter and Frans Willekens examine the effects of this dominance in a state where half of all women marry by age 15 and have their first birth by age 17, but where fertility is low [see article]. Noting that almost six in 10 women in Andhra Pradesh are sterilized before age 25, the authors raise the question of whether the compression of reproduction spans will lead to changing lifestyles and empowerment for women.

Also in This Issue

•In 1998, two-thirds of Brazilian men who acquired HIV through heterosexual contact had had multiple partners, compared with one-quarter of women, suggesting that many women are at risk because of their partner's behavior. Using data on married and cohabiting men from the 1996 Brazil Demographic and Health Survey, Zelee E. Hill, John Cleland and Mohamed M. Ali find that 12% had had extramarital sex in the previous 12 months, and that only 40% of these men had used a condom with their last extramarital partner [see article]. When other factors were controlled for, the risk of unprotected extramarital sex was elevated among men in nonevangelical religions, those living in the north of Brazil, those who had first had sex at age 15 or younger and those who had previously been in a marriage or cohabiting relationship.

•What makes national family planning programs successful? According to Jeremy Shiffman, who explores factors contributing to the growth of the Indonesian program during the Suharto years in a Special Report, political management is the key: Program administrators need to learn to systematically identify, understand and cultivate both potential allies and potential opponents [see article].

•Since the International Conference on Population and Development in 1994, family planning and reproductive health have lost priority as development issues. In "Whatever Happened to Family Planning and, for That Matter, Reproductive Health?" Duff Gillespie explores how reproductive health came to be excluded from the eight Millenium Development Goals, and what needs to be done to put it back on the international agenda [see article].

•Hesitations in the upward trend in contraceptive prevalence have called the effectiveness of—and continuing need for—family planning programs into question. In a Comment, John Ross, Edward Abel and Katherine Abel identify plateaus, find that most are relatively brief and explore possible reasons for their occurrence [see article].

—The Editors