Paper for communicator

Communicator: Journal of Indian Institute of Mass Communication,
New Delhi Vol. XLII No.1 Jan-Dec 2007
INTER-SPOUSAL COMMUNICATION
IN REPRODUCTIVE HEALTH
Dr. Y.L. Tekhre*, Mrs. Vandana Bhattacharya**, Nishith***
ABSTRACT
RATIONALE: Inter-spousal communication has been recognized widely
for sustainable family well-being. Such communication especially has
immense significance in seeking overall health care and reproductive
health care in general and family planning services in particular. Yet
demographic studies have tended to focus on women alone which
shouldn’t be confined to women only. The utility of RCH and success of
services depend upon certain aspects of inter-spousal communication in
the different communities. Therefore, with regard to decision making, data
required are to be collected from both the spouses who can answer
questions about couple communication, negotiation and the degree of
men’s influence on fertility or contraceptive usage. Family size,
conception, pregnancy, spacing and choice of contraception are directly
linked with the spousal communication. International Conference on
Population and Development held in Cairo in 1994 and the Fourth World
Conference on Women held in Beijing in 1995 emphasized the importance
of reproductive rights and reproductive health for both men and women
and greater involvement of men in reproductive health.
It is recognized that there is a dire need of equity in gender relation,
responsible sexual behaviour and active involvement of men in
reproductive health programmes in order to meet the women’s
reproductive health needs as well as their own. In order to know the level
of male participation in reproductive health services, a need for expanding
the appropriate spousal interaction/communication is felt. If the male
partners are not included in reproductive channels, the end result will
remain doubtful. It is estimated that approximately 19 million unsafe
abortions take place around the globe of which over 50 percent (10.5
million) occurred in Asia (Ahmad and Shah).
OBJECTIVE
The aims of this paper are:
(i) To examine the nature and extent of inter-spousal communication on various
aspects of Reproductive and Child Health;
(ii) To find out the attitude and decisions about contraceptive method and family size
among spouses.
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(iii) To explore the variation among the diverse segment of population/state on the
subject of inter-spousal communication and reproductive health issues.
_______________________________________________________________________
_
* Dr. Y.L. Tekhre, Director (Research), National Human Rights Commission, Faridkot
House, New Delhi 110003, (Former Professor of Social Sciences, National Institute of
Health and Family Welfare, Munirka, New Delhi) E-mail: yade_lal@yahoo.co.in
** Mrs. Vandana Bhattacharya, Research Officer, Department of Social Sciences, National
Institute of Health and Family Welfare, Munirka, New Delhi-110 067. Email:
vandanabhattacharya@rediffmail.com
*** Nishith, National Human Rights Commission, Faridkot House, New Delhi 110001
INTRODUCTION
Although both men and women make important contributions to the production of children,
demographic studies of fertility and family planning have focused on women or have
looked at men from a narrow range of approaches. Now in recent years, it is widely
recognized that communication between spouses/partners and shared decisions are at the
core of sustainable family well-being. Such communication proves especially important in
seeking overall health care and reproductive health care and family planning services in
particular. A study in India found that husbands were the principal decision-makers and
initiators of discussions about family planning use. As one group of researchers has noted,
power imbalances in marriages favour men, and the husband's opposition to contraception
may be sufficient to block use in many cases, but the reverse--the wife's opposition
preventing use if the husband is favourably inclined--will occur less often. The researchers
conclude, "This asymmetry means that when spouses disagree, women's family planning
aspirations will more often be frustrated than men's."
Current literature supports the view that couples' joint decision-making forms the beginning
of family planning use. "Programs aimed exclusively either at men or at women may fail in
their purpose, since most sexual, family planning, and childbearing decisions are made or
may potentially (and perhaps ideally) be made by both partners of a couple." It is
informative to distinguish between contraceptive use resulting from a joint planning
process and use by either spouse alone without consultation. A study in the Philippines,
however, failed to show that joint decision-making was more strongly associated with
contraceptive use than individual decision-making--presumably, as the researchers pointed
out, because the index of decision-making used could have been faulty, and husbands'
tendency to consider family planning women's concern may have muted the differences. It
remains to be conclusively shown, therefore, whether couples' joint decision-making is
more strongly associated with family planning use than is decision-making by either spouse
alone. Of particular interest are the dynamic of the decision-making process and whether
and how spousal communication affects this dynamic. Spousal communication about
family planning should be encouraged in rural areas of Nigeria. Since men as well
as women play key roles in safe motherhood, communication is necessary for
making responsible decisions (Orji Ek.O. et al 2007).
1. STATEMENT OF PROBLEM
The right to reproductive health is a key component of women’s and men’s reproductive
and sexual rights. Moreover, the achievement of reproductive health is inextricably linked
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to women’s and men’s ability to exercise reproductive and sexual rights i.e. I) reproductive
decision making 2) equality and equity for men and women and 3) sexual and reproductive
security. The catalyst to active these rights, to which we generally ignore is inter-spousal
communication which is important for sustainable family well-being. Such communication
especially has immense significance in seeking overall health case and reproductive health
care in general and family planning services in particular. The present study reveals that
with regard to decision making, data required are to be collected from both the spouses
about couple communication, negotiation and the degree of men’s influence on fertility or
contraceptive usage. Further more family size, conception, pregnancy, spacing and choice
of contraception are directly linked with the inter-spousal communication
2. METHODOLOGY
Study Area
Two states were taken for study namely, Tamilnadu & Orissa on the basis of a well
performing state and comparatively a poor performing state respectively in a large
reproductive health issues respectively.
Sampling Design and Sample Size
Four different purposive samples were selected representing urban, rural, slum and tribal
populations from each state. Tamilnadu was selected since it was a well performing state
in various parameters of reproductive health. Orissa was selected since it was a backward
state in several aspects of reproductive health scenario.
For each group of sample 300 male respondents were randomly selected with specific
criteria that the respondent should be married, whose wife was in the reproductive age
group (i.e., 15-45 years of age), had spent at least one year of married life and had at least
one child
Data Collection Tools and Techniques
The data were collected through personal interview with the help of a semi-structured and
pre-tested interview schedule specially designed for this study. To supplement the survey at
different points of investigation some qualitative techniques were used such as Focus
Group Discussion (FGD) and in-depth interview among males.
3. SUMMARY OF THE RESULTS/FINDINGS
Table 1: Distribution of Male Respondents on ‘Spousal Discussion’ about Number of
Children, the Couple Want to Have in the Family
N=2398
Discussion
within
couple
Urban Rural Slum Tribal Total
TN Orissa TN Orissa TN Orissa TN Orissa TN Orissa
Yes 220 295 198 150 244 273 201 84 863 802
% 73 98 66 50 82 91 67 28 72 67
No 80 5 102 150 54 27 90 216 335 398
% 27 2 34 50 18 9 30 72 28 33
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Total 300 300 300 300 298 300 300 300 1198 1200
The table shows that respondents discussed with their wives about the number of children,
the couple want to have. In all 72% in TN and 67% in Orissa, said yes, whereas 28% in TN
and 33% in Orissa said they never discussed the matter with their spouse. The tribal of TN
and urban respondents from Orissa were found more advance. Similarly, rural from
Tamilnadu and slum from Orissa were found more in percentage towards discussion with
couple about size of the family.
FIRST INTERSPOUSAL DISCUSSION REGARDING FAMILY SIZE
0%
10%
20%
30%
40%
50%
60%
Urban
Rural
Slum
Tribal
Urban
Rural
Slum
Tribal
Tamilnadu Orissa
AREAWISERESPONSE
Immedia t ely aft e r marriage Aft er first Child Aft er S e cond Child Aft er t hird Child
Table 2: Stages of ‘first time spousal discussion’ about number of children, the
couple wanted in the family
N=2398
Stages of
discussion
with spouse
about family
size
Segment of population and state
Total
Urban Rural Slum Tribal
Immediately
after marriage
65 172 84 84 155 80 38 5 342 341
% 22 57 28 28 52 27 13 2 29 28
After first
child
38 119 39 27 52 138 18 18 147 302
% 13 40 13 9 17 46 6 6 12 25
After two or
more
117 4 75 39 37 55 145 61 374 159
% 39 1 25 13 12 18 48 20 31 13
Never 80 5 102 150 54 27 99 216 335 398
% 27 2 34 50 18 9 33 72 28 33
Total 300 300 300 300 298 300 300 300 1198 1200
The table clearly shows that the discussion regarding the number of children, the couple
wanted in the family, for the first time took place quite later. Only 29% out of 72% in TN
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and 28% in Orissa out of 67% discussed immediately after marriage; 12% in TN & 25% in
Orissa were such who discussed after first child was born; ironically i.e. 31% in TN and
13% in Orissa discussed after the birth of second or even third child regardless of their
segment/group.
Table 3: Distribution of Respondents about Initiative towards Inter-Spousal
Communication on Number of Children in the Family According to Their
Category and State
N=2398
Initiative
taken by
Category/state
Total
Husband 63 103 62 36 82 97 65 34 272 320
% 21 34 21 12 27 32 22 11 23 27
Wife 16 8 10 11 10 11 31 1 67 31
% 5 3 3 4 3 4 10 0 6 3
Both 141 184 126 53 152 165 105 49 524 451
% 47 61 42 18 51 55 35 16 44 38
None 80 5 102 150 54 27 99 216 335 398
% 27 2 34 50 18 9 33 72 28 33
Total 300 300 300 300 298 300 300 300 1198 1200
It was found that 23% in TN and 27% in Orissa respondents took the initiative to discuss
the number of children the couple wanted in the family. Only 6% in TN and 3% in Orissa
wives were able to take initiative; 44% in TN and 38% in Orissa respondents said the
couple took the discussion together. The gist of the discussion indicates that most of the
communications are reciprocal in both the states. Quite a high (28 percent) in TN and 33
percent in Orissa respondents never initiated any communication or discussion towards
number of children in the family.
Table 4: Distribution of respondents based on number of Children, when the couple
adopted any family planning methods for the first time according to their
category and state.
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N=2398
Number of
children
in the family
Category/state
Total
Tamil
Nadu
Orissa
Tamil
Nadu
Orissa
Tamil
Nadu
Orissa
Tamil
Nadu
Orissa
Tamil
Nadu
Orissa
No child 5 4 3 5 5 5 0 0 13 14
% 2 1 1 2 2 2 0 0 1 1
One child 69 52 44 26 108 49 9 2 230 129
% 23 17 15 9 36 16 3 1 19 11
Two children 93 80 57 39 66 54 58 0 274 173
% 31 27 19 13 22 18 19 0 23 14
Three and more 49 95 49 49 39 50 83 4 220 198
% 16 32 16 16 13 17 28 1 18 17
Never used any
method
84 69 147 181 80 142 150 294 461 686
% 28 23 49 60 27 47 50 98 38 57
Total 300 300 300 300 298 300 300 300 1198 1200
Mean no of
children
2.36 3.5 2.5 1.44 2.1 1.1 2.97 2.3 2.5 1.34
The above table shows that total mean number of children at the time of adoption of the
first method in Tamilnadu is 2.5 whereas Orissa shows 1.34 mean no of children. At the
same time total respondents 38% in Tamilnadu and 57% in Orissa never used any
contraceptive method. One can derived that the TN respondents (19 percent) adopted any
family planning methods first time after one child, whereas only 11 percent in Orissa.
0%
20%
40%
60%
80%
100%
INTERSPOUSAL COMMUNICATION REGARDING NUMBER
OF CHILDREN IN THE FAMILY
Tamilnadu 73% 66% 81% 67%
Orissa 98% 50% 91% 28%
Table 5: Distribution of respondents on initiatives taken by them to adopt family
planning methods according to their category (Segment of population) and
state.
N=2398
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Initiatives
Total
Own 68 14 35 25 38 7 40 1 181 47
% 23 5 12 8 13 2 13 0 15 4
Wife 17 65 4 41 18 48 28 0 67 154
% 6 22 1 14 6 16 9 0 6 13
Both 120 146 98 52 142 99 55 4 415 301
% 40 49 33 17 48 33 18 1 35 25
Others 11 6 16 1 20 4 27 1 74 12
% 4 2 5 0 7 1 9 0 6 1
NA (No method
used ever) 84 69 147 181 80 142 150 294 461 686
% 28 23 49 60 27 47 50 98 38 57
Total 300 300 300 300 298 300 300 300 1198 1200
The above table gives the descriptive statistics of the total 62% of TN and 43% of Orissa
respondents, who adopted the family planning methods. The initiative in majority was
taken together by the couple i.e. 35% in Tamilnadu and 25% in Orissa. The respondents
who took the initiative themselves were 15% TN and 4% in Orissa surprisingly 13% wives
took initiatives in Orissa and 6% in TN.
Table 6: Distribution of respondents who had adopted family planning methods
according to their category and state
N=2398
Types of family
Planning
methods
Total
Female sterilization 126 121 82 69 73 88 143 2 424 280
% 42 40 27 23 24 29 48 1 35 23
Oral Pills 19 41 5 18 11 27 0 2 35 88
% 6 14 2 6 4 9 0 1 3 7
IUD/CuT 23 23 24 2 45 4 4 0 96 29
% 8 8 8 1 15 1 1 0 8 2
Conventional method of vasectomy 2 13 0 5 1 3 1 1 4 22
% 1 4 0 2 0 1 0 0 0 2
Condoms 20 21 18 14 30 8 1 0 69 43
% 7 7 6 5 10 3 0 0 6 4
2-3 non permanent methods
(variety of spacing methods)
26 12 21 11 58 28 1 1 106 52
% 9 4 7 4 19 9 0 0 9 4
Non scalpel vasectomy 0 0 3 0 0 0 0 0 3 0
% 0 0 1 0 0 0 0 0 0 0
Not using any method (disinterested) 84 69 147 181 80 142 150 294 461 686
% 28 23 49 60 27 47 50 98 38 57
Total 300 300 300 300 298 300 300 300 1198 1200
Table No.6 shows the descriptive statistics of the respondents 62% in TN & 43% in Orissa
in relation to the method they adopted at first time. Very high majority i.e. 35% in TN and
23% in Orissa opted for female sterilizations. The data reveals that, women alone are
7

carrying the burden of family planning (46% in TN out of 62% and 32% in Orissa out of
43%) as compared to the men. Male sterilizations were found negligible, condom user were
also very less 6 percent in TN and 4 percent in Orissa). The table clearly shows the
differential practices of contraceptive methods between spouses.
Table 7: Distribution of respondents regarding decision on various family planning
methods according to their category and state
N=2398
Decision
makers
Category of respondents and state
Total
Husband 60 54 24 42 33 44 43 2 160 142
% 20 18 8 14 11 15 14 1 13 12
Wife 18 8 10 10 62 14 27 2 117 34
% 6 3 3 3 21 5 9 1 10 3
Both 136 167 116 66 115 100 80 2 447 335
% 45 56 39 22 39 33 27 1 37 28
Others 2 2 3 1 8 0 0 0 13 3
% 1 1 1 0 3 0 0 0 1 0
N.A (Not adaptors) 84 69 147 181 80 142 150 294 461 686
% 28 23 49 60 27 47 50 98 38 57
Total 300 300 300 300 298 300 300 300 1198 1200
The above table clearly shows the statistically representation of the decision-maker, to
adopt the contraceptive method out of 62% in TN and 43% in Orissa, the couple who took
the decision together were 37% in TN and 28% in Orissa. Husbands who took the decisions
were 13% in TN and 12% in Orissa. There were courageous females (10% in TN and 3% in
Orissa) also who took the decision themselves. The above table obviously highlights that
most of the families were having joint decisions on family planning methods; this trend was
more in the state of Tamilnadu, as compared to Orissa. In case of Tribal respondents in
Orissa the mutual decisions, decision by husband and wife were almost negligible (only
one percent). Contrast to this, the Urban segment was prompt (56 percent), families took
decisions jointly on the family planning methods.
0%
20%
40%
60%
80%
100%
INTERSPOUSAL COMMUNICATION REGARDING NUMBER
OF CHILDREN IN THEFAMILY
Tamilnadu 73% 66% 81% 67%
Orissa 98% 50% 91% 28%
Table: 8 Distribution of respondents regarding history of last pregnancy
8

N=2398
Was pregnancy planned?
Tamilnadu
History/record of last pregnancy
Planned Unplanned
Urban Rural Slum Tribal Total Urban Rural Slum Tribal Total
82 118 157 60 417 218 182 143 238 78
% 35% 65%
In case planned, who planned
Husband 11 9 29 18 67
% 13 9 19 30 16
Wife 2 4 30 2 38
% 3 4 19 3 9.5
Both (Husband and Wife) 69 105 98 40 312
% 84 88 62 67 74.5
Total 82 118 157 60 417
If not planned, reasons of failure
Contraceptive failure 2 7 19 6 34
% 1 4 13 2 4
No use of contraceptive 216 175 124 232 747
% 99 96 87 98 96
Total 218 182 143 238 782
Orissa
Planned Unplanned
Was pregnancy planned? 261 82 209 130 682 39 218 91 170 518
% 56.8% 43%
In case of planned, who planned
Husband 3 8 5 3 18
% 1 10 3 2.3 2
Wife 2 4 30 2 38
% .5 17 14 2 5
Both (Husband and Wife) 256 60 174 125 644
% 98.5 73 84 96 94.4
Total 261 82 209 130 682
If pregnancy was not planned, reasons of failure
Contraceptive failure 1 15 3 13 32
% 1 7 3 66 62
No use of contraceptive 38 203 88 157 486
% 99 93 97 94 93.8
Total 39 218 91 170 518
The distribution of data shows that 35% of TN respondents said the pregnancy was planned
whereas 65% said it was unplanned. In Orissa 56.8% respondents aid it was planned and
only 43% said no this gives quite a different picture.
The respondents who said the last pregnancy was planned (35% in TN) the decision of
wives; in this regard was minimum (9.5%), husbands (6%) but the decision of both, the
couple was at large (74.5) as said by respondents. The picture is somewhat different in
Orissa (56.8%) said yes it was planned. Out of this only 2% husbands planned; whereas 5%
wives and 94.4%. The couples planned for the pregnancy.
9

The major reason behind the unplanned pregnancy was no use of contraceptives among the
two states. In the state of Tamilnadu, it was 96% whereas in Orissa it was 93.8% out of
total unplanned pregnancies.
CONCLUSION
Table 9: Demographic characteristics of spouses
N=2398
Variables
Urban Rural Slum Tribal Total
TN Orissa TN Orissa TN Orissa TN Orissa TN
Oris
sa
Mean age of wife at marriage
(yrs)
20 20 18 20 17 19 17 15 18.
26
17.8
3
Mean duration of marriage (yrs) 14 9.9 12 10.3 12 9.4 15 10.7 13 10
Mean Age of wife at first
pregnancy (yrs)
20 22.2 19 20 21 20 19 19.5 19.
7
20.4
Illiterate (%) 17 52 36 35 40 37 68 75 40 50
Mean No. of Children when the
couple adopted FPM at first time
2.36 3.5 2.5 1.44 2.1 1.1 2.97 2.3 2.5 1.34
A. Three too’s (too early marriage; too early pregnancy; too many pregnancies):
The results shows that mean age of marriage (women) is low in Orissa (17.83 %) as
compared to TN (18.26) stretching the span of reproductive years. This early marriages are
associated with the early pregnancies. 32% in TN and 25% in Orissa had first pregnancy
upto the 18 years of age. Another noticeable thing is that tribals of Orissa had first
pregnancy upto the Age of 13 yrs. The data also reveals that (40% in TN and 50% Orissa)
majority of women are illiterate more so in Orissa.
Tribal data of Orissa, of early marriage and early child birth as early as 13 yrs of age with
75% of illiteracy among women reflects one of the major reasons, why there was high
maternal mortality and infant mortality in the State. Various studies have shown that child
mortality found to decline with higher levels of maternal education [1,2,3]. The women
who are illiterate and housewives (29.% in TN and 36% in Orissa) have association within
side, the home and courtyard, where the family cared for. This is in context to males, who
belong to outside. Since education, health care and labour force participation all involve
interaction with the outside girls and women face special barriers in these areas [4,5,6].
As we can see the women mainly in Orissa, getting married at earlier age, the opportunity
for their education minimizes only 30% in TN and 46% in Orissa had gone upto the
primary level. There is consistent evidence from various studies that decrease in the
number of years of schooling for girls is almost always associated with early age of
marriage. To the extent that marriage is associated with initiation of sexual activity, later
marriage would have prevented early initiation of sexual activity and early child bearing,
the health risk of which are well known [7].
B. Inter-spousal Communication – Inter-spousal communication is a measure of
couple’s personal, social, emotional interpersonal interaction, which helps to understand the
dynamics of power relations and adjustments in the day to day life. The data from this
study revealed that irrespective of place of residence, a significant percentage of
respondents (50% to 98%) reported that they discussed with their wives regarding the
number children they would like to have in the family. However, only 28% of tribal
10

respondents of Orissa discussed with their wives regarding number of children they would
like to have in the family. It was also important to note that about one third of the
respondents in Tamilnadu did not discuss with their wives regarding number of children.
More than one fourth of respondents in both the states irrespective of their place of
residence except tribals discussed immediately after marriage and rest respondents after
first child, second or third child was born. While more than fifty percent of urban
respondents of Orissa and slum respondents of Tamilnadu discussed immediately after
marriage, a few tribal respondents of Orissa ever discussed with their wives.
Reproductive decision making is another aspect of the Inter spousal communication. The
respondents of TN as a progressive State reported that 65% of the last pregnancies were
unplanned; whereas, in Orissa, which is comparatively backward State, 43% of the last
pregnancies were unplanned. The major reason in both the states (96% in TN and 93.8 in
Orissa) what respondents reported was no use of any contraceptive methods. The last
pregnancy in majority of cases was planned by the couple in both the states.
The results of the FGDs also reported that unplanned pregnancies could have been avoided;
communications among the couple were scanty on this issue, whose consequences were
born by the respective women.
As far as adoption of family planning methods are concerned, mean number of children
after which the couple adopted the Family Planning Method is 2.5 in TN and 1.34 in
Orissa. In this TN is showing a different picture. There were also respondents (38% in TN
& 57% in Orissa) who never used any method of contraception. The initiative to adopt the
Family Planning method was taken together by the couple (35% TN & 25% or), as reported
by respondents. Only 6 % in TN & 13% in Orissa, Women took initiative to adopt the FP
method. 10% TN and 3% in Orissa females were able to take their decision which shows
Orissa has social taboos, associated with family planning and women and minimum inter-
spousal communication. The respondents who were not using any contraceptive method is
less in TN as compared to Orissa which shows awareness level of importance of family
planning is been created among masses in TN which resulted in fairly in fairly good
communication exposure among the couple.
The FGD’s conducted showed that there was a huge gap between the knowledge and
awareness regarding different contraceptive methods and their actual use or practice among
the respondents of both the states irrespective of their place of residence. Awareness about
the contraceptive methods was also very low among tribals of Orissa only 3 NSV, cases
were found, out of 2400 respondents in both the states.
Out of total, very high majority, i.e. 35% in TN and 23% in Orissa decided for female
sterilization. The study also reveals that only women (75% in TN & 77% in Orissa) carries
the responsibility of family planning which very clearly emphasis on the fact that yet recent
national policy statement emphasis on the importance of choice, this change in approach
has not occurred at the programme level. And since clients have limited knowledge of
reversible methods, female sterilization remains the dominant method in the programme.
This fact can be supported by the data related to the reasons of not using any contraceptive
method by the respondents.
11

The data clearly reveals male dominance and inferior status occupied by majority of
women in the family leads to lesser or no inter-spousal communication. All decisions
related to reproductive health issues were likely to be influenced by dominant males.
Recommendations
The study revealed lack of inter-spousal communication on various aspects of
reproductive health. Special efforts should be made to emphasize men’s shared
responsibility and promote their active involvement in responsible parenthood, sexual
and reproductive behaviour, including family planning. Special emphasis should also be
given on family counseling, IEC activities, community mobilization and active
involvement/participation of males in the entire process of RCH programme. Counseling
on various aspects of reproductive health, has to be organized by health personnel on
regular basis in the community.
12

REFERENCES
1. Abdullah, Rashidah (1999). “Overview,” in Taking up the Cairo Challenge.
Asian-Pacific Resource and Research Centre for Women. Kuala Lumpur. 3-46.
2. Ahman, Elizabeth and Iqbal Shah (2002). “Unsafe abortion: worldwide
estimates for 2000,” Reproductive Health Matters, vol. 10(19): 13-17.
3. Arends-Kuenning, Mary (2002). “Considering the doorstep-delivery system in
the Bangladesh family planning program’, Studies in Family Planning. vol.
33(1): 87-102.
4. Attane, Isabelle (2002). “China’s family planning policy: an overview of its past
and future,” Studies in Family Planning. vol. 33(1): 103-113.
5. Bairagi, Radheshyam (2001). “Effects of sex preference on contraceptive use,
abortion and fertility in Matlab, Bangladesh,” International Family Planning
Perspectives. vol. 27(3): 137-143.
6. Bang, Rani, M. Baitule, S. Sarmukaddam, Abhay Bang, Y. Choudhary, and O.
Tale (1989) “High prevalence of gynaecological diseases in rural Indian
women,” The Lancet, vol. 1 (8,629): 85-88.
7. Behm H. The determinants of child survival; an analytical frame of reference.
Paper prepared for the UN Meeting on the Internal Collaboration Study of
Geographic and Socio-economic Differentials in Early-Ae Mortality; 1987
December 7-9; New York. New York: UN; 1987.
8. Berer, Marge and TK Sundari Ravindran (1999). “Preventing maternal
mortality: Evidence, resources, leadership, action,” in Safe Motherhood
Initiatives: Critical Issues, Marge Berer and TK Sundari Ravindran (eds).
Blackwell Science: Oxford: 3-9.
9. Bhatia, Jagdish and John Cleland (1995). “Self-reported symptoms of
gynaecological morbidity and their treatment in South India,” Studies in Family
Planning, vol. 24 (4): 203-216.
10. Blanc, Ann. (2001). “The effect of power in sexual relationships on sexual and
reproductive health,” Studies in Family Planning. vol. 32(3): 189-213.
11. Bruce, Judith (1990). “Fundamental elements of the quality of care: a simple
framework.” Studies in Family Planning. vol. 21 (2): 61-91.
12. Caldwell, John. James Philips, and Barkat-e-Khuda. (2002). “The future of
family planning programmes,” Studies in Family Planning. vol. 33 (1). 1-23.
13. Cochrane S, Leslie, J, O’Hara DJ. Parental education and child health: Bhutan.
Thmphu: Ministry of Health; 1998 (Unpublished document.)
14. East-West Center (1993). Changes in Fertility patterns can Improve Child
Survival in Southeast Asia. Asia-Pacific Population and Policy Paper no. 27.
East-West: Honolulu.
15. East-West Center (2002). The Future of Population in Asia. East-West Center,
Honolulu.
16. East-West Centre (1999). Nepal Survey Shows that “Family Planning Saves
Lives.” Asia-Pacific Population and Policy Paper no. 29. East-West: Honolulu.
17. Economic and Social Commission for Asia and the Pacific (ESCAP) (1998).
Asia-Pacific Population Policies and Programmes: Future Directions. Asian
Population Studies Series No. 153, United Nations: New York.
13

18. Fortney, Judith (1987). The importance of family planning in reducing maternal
mortality. Studies in Family Planning. vol. 18 (2): 109-114.
19. Ganatra Bela and Siddhi Hirve (2002). “Induced abortions among adolescent
women in rural Maharashtra,” Reproductive Health Matters, vol. 10(19): 76-85.
20. Gopalan S, Shiva M, editors. National profile on women, health and
development: India. New Delhi: Voluntary Health Association of India; 1999.
21. Gubhaju, Bhakta (2002). Adolescent Reproductive Health in Asia. Paper
presented at the IUSSP Conference on Southeast Asia’s Population in a
Changing Asian Context, Bangkok, 10-13 June.
22. Kulkarni S. Dependence on agricultural employment. Economic and Political
Weekly 1994; nos. 51-52
23. Orji1 E.O. ， C.A.Adegbenro ， B.I.Akinniranye ， G.O.Ogunbayo ， and
A.E.Oyebadejo (2007): Spousal communication on family planning as a safe
motherhood option in sub-saharan African communities: Journal of Chinese
Clinical Me3dicine, vol. 2.No.6,2007: 319-327.
24. Self Employed Women’s Association. Shramshakti: a summary of the report of
the national commission on self-employed women and women in the informal
sector. Ahmedabad, India: SEWA; 1989.
25. United Nations, Department of Internal Economic and Social Affairs,
Population Division. Socio-economic differentials in Child mortality in
developing countries. New York: UN; 1985.
14

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