Measurement of the quality of family planning services

The quality of health services is a subject of increasing interest to health care providers and organizations responsible for financing and promoting health services. The importance of the client's perspective (and by inference, the perspective of potential clients, as well) is now well established, but efforts to define and measure quality have thus far been limited to the perspective of experts even when the experts claim to speak for the clients. In this paper we utilize family planning programs to explore issues of the quality of health services. We propose that a better understanding of the view of quality actually held by family planning program clients will clarify the influence of quality on the use of services, a clarity that has not been possible by looking at quality only as defined by providers, managers or experts. We review the literature on quality of services and identify the gaps in research that must be filled if a better understanding of what quality is and how it relates to service outcomes is to be obtained. A first step must be the research required to develop a set of measures of quality that reflects the multi-dimensional nature of quality, includes the clients' view of services in the definition of quality, and incorporates methodologies required to ascertain the true view of clients. Finally, we suggest that dimensions of quality identified as important for clients as a group will be more predictive of use of services than dimensions identified as important to providers.     

Why the rise in adolescent fertility rates in the Dominican Republic in the 1990s?

Despite concern over high pregnancy rates and levels of risk for sexually transmittedinfections, adolescent fertility rates in the Dominican Republic have not changed substantially since the early 1980's, and actually increased during the early to mid 1990s. The present study was undertaken to assess the factors contributing to the recent rise in fertility among Dominican adolescents. The findings suggest that although contraceptive use among adolescents and young adults has increased, this has been more than offset by ominous trends on other determinants of fertility. Among these are declines in mean age at first sex and first marriage/union without a commensurate decline in mean age at first contraceptive use, and stubbornly high discontinuation rates for oral contraceptives andcondoms. There is also some evidence that rates of induced abortion among adolescents may have increased, without which adolescent fertility rates would have been even higher. Demand for children among Dominican adolescents remains strong, suggesting that efforts to reduce the current high prevalence of risky sexual behaviors need to influence social norms in order to be successful.     

Market Volatility and the Structure of US Earnings

This paper studies the relationship between volatility of industry‐specific shipments and real earnings. In an efficiency wage theoretical framework I show that wage premiums for the risk of unemployment depend on the value of the worker’s outside offer net of his/her mobility costs. Empirically it is shown that wage premiums for the risk of unemployment markedly vary in a cross section of workers. The main finding is that market volatility changes the return to skill such as labor market experience and education. Its impact markedly varies across occupation groups, with managers receiving returns to labour market experience that significantly increase with product market volatility.     

Assessing the effects of monetized food aid on: reproductive behavior in rural Honduras

This article describes the methodology and findings of a study undertaken to assess whether the monetization of non-emergency food aid has adversely influenced national family planning program efforts in Honduras. Due to time constraints, an ex-post, non-equivalent group design was the strongest feasible study design. In the study, women receiving food aid in the form of cash coupons were compared with women receiving food rations and a third group of comparable women who were not food aid recipients on three types of outcomes: recent fertility, fertility preferences, and contraceptive use (both current and intended). A ‘sample selection’ model was used in the analysis to control for unobserved differences between comparison groups. No compelling evidence for either adverse demand- or supply-side effects was observed.     

The effects of monetized food aid on reproductive behavior in rural Honduras

This article presents research findings on the question of whether the monetization of non-emergency food aid has adversely influenced national family planning program efforts in Honduras. Women receiving food aid in the form of cash coupons are compared in the study with women receiving food rations and a third group of women with similar characteristics who were not food aid recipients on three types of outcomes: recent fertility, fertility preferences, and contraceptive use. The health facilities where study subjects received health/family planning services and food aid benefits were also compared to assess possible adverse cross-program effects on family planning service delivery. A sample selection model was used in the analysis to control for unobserved differences between comparison groups. No compelling evidence for adverse demand- or supply-side effects of monetized food aid on family planning efforts was observed. The most striking study finding was the extremely high level of unmet need for family planning.     

Adult vocational training for migrants in North‐East Italy

This article contributes to the study of policies for the integration of immigrants into the labour markets of European immigration countries by focusing on the specific issue of vocational training for immigrant workers in Italy. Vocational training has a central role in the European employment strategy. Moreover, with regard to migrants, it is also relevant to the topical issue of the governance of international labour migration. The article analyses both the demand and the supply of vocational training in north‐east Italy, generally regarded as the rich and industrialised heart of the country. It draws on 30 interviews conducted with key informants and experts from local and regional governmental bodies, trade unions, employment offices, and private educational agencies in the main towns of the Veneto region. Various types of vocational training for immigrant workers are considered, from traditional full‐time courses financed by the European Social Fund to new projects for the selection and pre‐training of immigrants in their countries of origin. The extent to which these policy tools are able to meet the actual needs of immigrant workers and of the local business sector is investigated, as well as their problematic interaction with the national regulatory framework for immigration control.     

Translation sociology and social capital in rural development initiatives. A case study from the Italian Alps

This article analyses the results of a European ‘research and demonstration’ project promoting multifunctional and sustainable agriculture in Alpine regions through a participatory approach. It focuses in particular on initiatives undertaken by a local farmers group in the Italian Alpine area of Val di Sole, the purpose being to draw attention to the role of social dynamics in fostering sustainable rural development in a participatory context. In order to accomplish this objective, two key sociological approaches to the study of rural development, namely social capital and the sociology of translation, are considered. The former focuses on the relational capital available to a group of actors and which can be mobilised in a development initiative. The latter views change in social practices as resulting from a cycle of phases where the problem, its solution, and the identity of the actors are constantly transformed and negotiated. By contrasting the two theoretical approaches in relation to the outcomes of two specific actions implemented in the valley we suggest that the sociology of translation offers a more effective tool with which to capture the complexity of social dynamics involved in a rural development initiative.     

Portfolios of learning in entrepreneurial internationalisation

By adopting a process approach to entrepreneurial internationalisation, we longitudinally study eleven case firms, discussing entrepreneurial learning as a portfolio of different sources of learning underpinning the exploration and exploitation of international opportunities. First, we identify the most recurring combinations of learning sources: (i) customer-centred learning with either learning by doing/trial and error or market-specific learning; (ii) imitative learning with relational learning and/or learning by doing; (iii) searching with networking learning and/or customer-centred learning. Second, we uncover instances of opportunity exploitation “looping back” to novel exploration via customer-centred, imitative, and grafting learning. Empirical results are systematised within a set of Propositions to be tested in future research.     

Family planning program effects on contraceptive use in Morocco, 1992–1995

This study illustrates the use of panel data and a fixed-effects estimator to investigate the impact of family planning program inputs on contraceptive utilization in Morocco during the 1992–1995 period. By controlling the potential bias resulting from common unobserved determinants of program resource allocation decisions and program outcomes, the methodology helps overcome an important constraint to the use of non-experimental study designs in undertaking meaningful impact assessments. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with program data from Service Availability Modules undertaken in conjunction with each survey round. The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning and the level of infrastructure at public clinics, played a significant role in the increased use of modern contraceptives during the study period.