A Survey Experiment of Women’s Attitudes About Intimate Partner Violence Against Women in Rural Bangladesh

According to the Demographic and Health Surveys (DHS) in poorer countries, 50 % of women of reproductive age report that wife hitting or beating is justified. Such high rates may result from structural pressures to adopt such views or to report the perceived socially desirable response. In a survey experiment of 496 ever-married women aged 18–49 years in rural Bangladesh, we compared responses to attitudinal questions that (1) replicated the 2007 Bangladesh DHS wording and portrayed the wife as transgressive for unstated reasons with elaborations depicting her as (2) unintentionally and (3) willfully transgressive. The probabilities of justifying wife hitting or beating were consistently low for unintended transgressions (.01–.08). Willful transgressions yielded higher probabilities (.40–.70), which resembled those based on the DHS wording (.38–.57). Cognitive interviews illustrated that village women held diverse views, which were attributed to social change. Also, ambiguity in the DHS questions may have led some women to interpret them according to perceived gender norms and to give the socially desirable response of justified. Results inform modifications to these DHS questions and identify women for ideational-change interventions.     

What Is Urban? Comparing a Satellite View with the Demographic and Health Surveys

Appraisal of urbanization trends is limited by the lack of a globally consistent definition of what is meant by urban. This article seeks to identify and explain differences in the definition of “urbanness” as used in two largely distinct research communities. We compare the Global Rural–Urban Mapping Project (GRUMP), which defines urban areas based primarily on satellite imagery of nighttime lights, to the urban classification found in Demographic and Health Surveys (DHS), which relies on the urban definitions of individual countries' national statistical offices. We analyze the distribution of DHS clusters falling within and outside of GRUMP urban extents and examine select characteristics of these clusters (notably, household electrification). Our results show a high degree of agreement between the two data sources on what areas are considered urban; furthermore, when used together, GRUMP and DHS data reveal urban characteristics that are not evident when one data source is used independently. GRUMP urban extents are overwhelmingly medium and large highly electrified localities. DHS clusters that are classified as non‐urban but that fall within GRUMP extents tend to be peri‐urban areas.     

An Agricultural Wealth Index for Multidimensional Wealth Assessments

Social scientists have increasingly used asset‐based wealth scores, like the Demographic and Health Survey (DHS) wealth index, to assess economic disparities. However, current indices primarily capture wealth in globalized market economies, thus ignoring other forms of prosperity, such as success in agricultural activities. Using a simple extension to the standard estimation of the DHS wealth index, we describe procedures for estimating an agricultural wealth index (AWI) that complements market‐based wealth indices by capturing household success in agricultural activities. We apply this procedure to household data from 129 DHS surveys from over 40 countries with sufficient land and livestock data to estimate a reliable and consistent AWI. We assess the construct validity of the AWI using benchmarks of growth in both adults and children. This alternative measure of wealth provides new opportunities for understanding the causes and consequences of wealth inequality, and how success along different dimensions of wealth creates different social opportunities and constraints for health and well‐being.     

Trends in reproductive behavior among young single women in Colombia and Peru: 1985–1999

Using "calendar" data for single women aged 15-24 from successive Demographic and Health Surveys (DHS) conducted in Colombia and Peru during the 1990s, we document trends, year by year, in sexual activity, the use of contraceptives, and subsequent reproductive outcomes. We provide evidence of the important and hitherto largely untapped potential of DHS calendar data to draw complete sexual and reproductive profiles when data from various surveys are integrated. Over the period 1985-1999, young single women in both Colombia and Peru became sexually active at younger ages. The use of contraceptives, especially the use of condoms, increased but did not fully offset the rise in sexual activity, and thus the incidence of premarital conceptions rose among young single women. In both countries, sharp declines occurred in the proportion of premaritally conceived births that were reported as being wanted.     

Sampling Weights for Analyses of Couple Data: Example of the Demographic and Health Surveys

In some surveys, women and men are interviewed separately in selected households, allowing matching of partner information and analyses of couples. Although individual sampling weights exist for men and women, sampling weights specific for couples are rarely derived. We present a method of estimating appropriate weights for couples that extends methods currently used in the Demographic and Health Surveys (DHS) for individual weights. To see how results vary, we analyze 1912 estimates (means; proportions; linear regression; and simple and multinomial logistic regression coefficients, and their standard errors) with couple data in each of 11 DHS surveys in which the couple weight could be derived. We used two measures of bias: absolute percentage difference from the value estimated with the couple weight and ratio of the absolute difference to the standard error using the couple weight. The latter shows greater bias for means and proportions, whereas the former and a combination of both measures show greater bias for regression coefficients. Comparing results using couple weights with published results using women’s weights for a logistic regression of couple contraceptive use in Turkey, we found that 6 of 27 coefficients had a bias above 5 %. On the other hand, a simulation of varying response rates (27 simulations) showed that median percentage bias in a logistic regression was less than 3 % for 17 of 18 coefficients. Two proxy couple weights that can be calculated in all DHS surveys perform considerably better than either male or female weights. We recommend that a couple weight be calculated and made available with couple data from such surveys.     

The Impact of the AIDS Pandemic on Health Services in Africa: Evidence from Demographic and Health Surveys

We document the impact of the AIDS crisis on non-AIDS-related health services in 14 sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is the largest in regions that have developed the highest rates of HIV. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions shouldering the heaviest burdens have seen the largest erosion in non-HIV-related health services for pregnant women and children. Using semiparametric techniques, we can date the beginning of the divergence in the use of antenatal care and in children’s immunizations between high- and low-HIV regions to the mid-1990s.     

The estimation of Unwanted Fertility

The estimation of unwanted fertility is a major objective of demographic surveys, including DHS surveys conducted in Asia, Africa, and Latin America. Levels and trends in unwanted fertility are important input to the formulation of population policy and the evaluation of family planning programs. Yet existing methods for estimating unwanted fertility are known to be defective, among other reasons because they rely on subjective data whose validity and reliability are questionable. In this article, we propose a new estimator of unwanted fertility-the "aggregate prospective estimator"--so named because it depends on the stated preference for another child at the time of the survey, the fertility-desires item consistently shown to possess the highest validity and reliability. Under reasonable assumptions, the aggregate prospective estimator produces less biased estimates of unwanted fertility than the most widely used existing methods. The new estimator has the limitation of generating only aggregate-level estimates, but such estimates are the primary data for policy formulation and program evaluation. The new estimator is presented in this article, along with an evaluation of its underlying assumptions and its sensitivity to several sources of error. In an illustrative application to recent DHS data from six countries, the new estimator yields substantially higher estimates of unwanted fertility than existing methods in all six countries.     

Quality of care in Peru: measuring its impact. Field report

A report published in 1995 by the Population Council described the impact of the quality of family planning services on the incidence of unplanned pregnancy in Peru. This report followed a 1994 study that assessed the impact of quality on contraceptive usage by linking data from Peru's 1991-92 Demographic and Health Survey (DHS) and a 1992 Peru Situational Analysis study of the status of family planning (FP) services at 3000 individual service delivery points. The 1995 study added data from a follow-up survey of a sample of the DHS respondents. The 1994 study used an innovative quality of care index that measured the quality of FP services available in a geographic area to women with partners living nearby. This index was then assigned to every woman in the area and correlated with her use of modern contraceptives. The analysis revealed that availability of high-quality FP services greatly increased the number of women using modern contraception. The 1995 study analyzed the impact of quality of care on rates of unintended pregnancy and found that the percentage of unwanted births was significantly higher in areas with low-quality FP services. The researchers note that these results only hint at a relationship between quality of care and reproductive behavior and that the findings should be interpreted conservatively. However, the studies support the importance of investing in quality FP care.     

The demographic transition in southern Africa: Reviewing the evidence from Botswana and Zimbabwe

Part, but not all, of the observed decline in the number of children ever born reported in the 1984 CPS and the 1988 DHS in Botswana and Zimbabwe can be attributed to differences in sample composition: women in the 1988 survey appear to be better educated than women of the same cohort in the 1984 survey. Blanc and Rutstein argue that differences in education levels in the pairs of surveys are not significant. However, weighted Kolmogorov-Smimov statistics, a comparison of average years of schooling, and the proportions of women who complete primary school or attend secondary school all indicate that the differences are, in fact, significant. This is true in both Botswana and Zimbabwe. Blanc and Rutstein also claim that these differences do not account for any of the observed decline in fertility between the surveys of women age 15 to 49. Their methodology follows cohorts of women rather than age-groups and thus cannot possibly address this issue. Furthermore, to interpret their results, response error and respondent education must be uncorrelated: this is a key assumption which is violated by the data. We stand by our conclusions and argue for caution when aggregate statistics from the CPS and the DHS are used to make projections about the course of fertility and population growth in Botswana and Zimbabwe.     

The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries

The authors use household survey data from the Demographic and Health Surveys (DHS) from 44 surveys (in 35 countries) to document different patterns in the enrollment and attainment of children from rich and poor households. They overcome the lack of income or expenditure data in the DHS by constructing a proxy for long-run wealth of the household from the asset information in the surveys, using the statistical technique of principal components. There are three major findings. First, the enrollment profiles of the poor differ across countries but fall into distinctive regional patterns: in some regions the poor reach nearly universal enrollment in first grade, but then drop out in large numbers leading to low attainment (typical of South America), while in other regions the poor never enroll in school (typical of South Asia and Western/Central Africa). Second, there are enormous differences across countries in the “wealth gap,” the difference in enrollment and educational attainment of the rich and poor. While in some countries the difference in the median years of school completed of the rich and poor is only a year or two, in other countries the wealth gap in attainment is 9 or 10 years. Third, the attainment profiles can be used as diagnostic tools to suggest issues in the educational system, such as the extent to which low attainment is attributable to physical unavailability of schools.     

The demographic transition in southern Africa: Another look at the evidence from Botswana and Zimbabwe

Botswana and Zimbabwe have been acclaimed as being on the vanguard of the demographic transition in sub-Saharan Africa. This paper examines the comparability of the CPS and the DHS data for each country and finds that part of the observed decline in aggregate fertility rates in both countries can be attributed to differences in sample composition. Women of the same cohort tend to be better educated in the second survey relative to the first. This fact explains part—but not all—of the observed fertility decline; for example, it appears to account for up to half the observed decline among women age 25–34 in 1984 in Zimbabwe.     

Demographic data collection in less developed countries 1946-1996

This evolution over the last 50 years of data collection systems in less developed countries is assessed. The progress made by civil registration systems has been extremely disappointing. Except in Central and South America, their role in providing vital rate estimates is still very limited. In contrast, the promulgation of regular population censuses has been a success, particularly in Africa. The relative merits and demerits of different types of demographic surveys are described. To some extent multi-round designs have given way to single-round surveys, such as the Demographic and Health Surveys (DHS). DHS-style enquiries are particularly suitable for evaluation of interventions but are less appropriate if the main aim is to measure vital rates.     

Does female circumcision affect infertility and fertility? A study of the central African Republic, Côte d’Ivoire, and Tanzania

This study explores the association between female circumcision and infertility and fertility, using information from the Demographic and Health Surveys (DHS). In Côte d’Ivoire and Tanzania, circumcised women had lower childlessness, lower infertility by age, and higher total fertility rates than women who were not circumcised; the reverse pattern prevailed in the Central African Republic. In all three countries, however, circumcised women grouped by age at circumcision did not have significantly different odds of infertility nor of having a child than did uncircumcised women, when the effects of covariates were controlled. Thus we find evidence suggesting that the practice of female circumcision does not have a statistically discernible effect on women’s ability to reproduce.     

Do male reproductive preferences really point to a need to refocus fertility policy?

Independently collected data from a 1994 survey in Accra, Ghana, are used here to verify earlier findings from Demographic and Health Survey (DHS) data which indicate the existence of a closer tie between men's reproductive preferences and contraceptive use, than between the latter and women's preferences. Indeed, the findings corroborate the earlier studies and suggest that fertility transition in Africa may be accelerated if the family planning establishment would recognize the contribution of the male role, and bring men into the mainstream of their agenda.     

An alternative sampling strategy for obtaining child health data in a reproductive health survey

Retrospective demographic surveys typically collect substantial information about child health. This information is often collected for all children born during a specified period. For women with several young children, the interview can become quite long. To shorten the interview, some surveys have asked child health questions only for the last child born. However, data on the last birth may be biased because last children have a younger age distribution and have longer subsequent birth intervals than does the average child. In this paper, we propose an alternative approach to collecting child health data - that child health questions be asked only for a child chosen randomly from among the respondent's children younger than age five. This alternative has the advantage of keeping the interview shorter but does not lead to biased information.Abbreviations DHS Demographic and Health Surveys     

Case study: fertility decline in Iran

Iran has experienced one of the most successful family planning programs in the developing world, with 64 percent decline in total fertility rate (TFR) between 1986 and 2000. This paper focuses on Iranians’ unique experience with implementation of a national family planning program. Recognition of sensitive moral and ethical aspects of population issues resulted in successful collaboration of technical experts and religious leaders. Involvement of local health workers, women health volunteers and rural midwives led to great community participation. Demographic and Health Survey (DHS) data in 2000 indicated a TFR of 2.0 births per women and 74 percent contraceptive use among married women. This case study will help policy makers and researchers in Moslem countries and other developing countries with high fertility rate to consider a successful family program as a realistic concept with positive impacts on nation’s health and human development.     

Late marriage and the HIV epidemic in sub-Saharan Africa

The causes of large variation in the sizes of HIV epidemics among countries in sub-Saharan Africa are not well understood. Here we assess the potential roles of late age at marriage and a long period of premarital sexual activity as population risk factors, using ecological data from 33 sub-Saharan African countries and with individual-level data from Demographic and Health Surveys (DHS) in Kenya and Ghana in 2003. The ecological analysis finds a significant positive correlation between HIV prevalence and median age at first marriage, and between HIV prevalence and interval between first sexual intercourse and first marriage. The individual-level analysis shows that HIV infection per year of exposure is higher before than after first marriage. These findings support the hypothesis of a link between a high average age at marriage and a long period of premarital intercourse during which partner changes are relatively common and facilitate the spread of HIV.     

Fertility changes in Latin America in periods of economic uncertainty

We explored the relation between fertility and the business cycle in Latin America. First, we used aggregate data on fertility rates and economic performance for 18 countries. We then studied these same associations in the transitions to first, second, and third births with DHS individual data for ten countries. The results show that in general, childbearing declined during economic downturns. The decline was mainly associated with increasing unemployment rather than slowdowns in the growth of gross domestic product, although there was a positive relationship between first-birth rates and growth. While periods of unemployment may be a good time to have children because opportunity costs are lower, in fact childbearing was reduced or postponed, especially among the most recent cohorts and among urban and more educated women. The finding is consistent with the contention that, during this particular period in Latin America, income effects were dominant.     

Measuring socioeconomic status in health research in developing countries: Should we be focusing on households,communities or both?

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.     

Marriage and childbirth as factors in dropping out from school: an analysis of DHS data from sub-Saharan Africa

Leaving school prematurely is often claimed to be among the most negative consequences of early marriage and pregnancy for girls in less developed countries. However, an analysis of the relative frequency with which these events actually occur or are named as reasons for leaving school reveals that, at least in the case of francophone Africa, they explain no more than 20 per cent of dropouts. To the extent that demographic events trump school or family factors as determinants of school-leaving, our data indicate that it is union formation--defined by the DHS as first marriage or cohabitation--rather than childbirth that is more likely to have this effect. 'Schoolgirl pregnancy' typically accounts for only between 5 and 10 per cent of girls' departures from school. Furthermore, the risks of leaving school because of pregnancy or marriage have declined over time with the decline in rates of early marriage and childbearing.