Reproductive decisions are influenced by biology, psychology, and society. The significant complexity of reproductive decision making demands that the issue be approached with a psychological construct which lends itself well to that complexity. The author believes that intention is such a construct because it allows for gradation. Decision making implies an either/or outcome, but intentions to choose one course of action or another are graded both in terms of degree and, in some cases, by the presence of counter-intentions. Data are discussed from a study of intended and unintended pregnancy in a longitudinal study of 967 women living in the San Francisco Bay Area. Sections are: intendedness and wantedness; motivations, desires, and intentions; couple interaction; a theory of regret; beyond regret; and progenesis.
The purpose of this chapter is to describe the implementation of China's one-child policy in terms of embeddedness in the Confucian tradition of morality in government. To do this, the authors describe the modern Chinese efforts to control its population. They describe briefly how the one-child policy evolved from earlier family planning policies and how it has been implemented in ways consistent with Confucian views. Finally, the authors describe key aspects of the implementation of this policy within four Chinese provinces from the perspective of the families who participated in a survey of schoolchildren in 1990.
Research on adolescent pregnancy in the US has tended to be driven more by the politically motivated agendas of funding agencies than by careful considerations of this phenomenon's psychosocial context. In the 1970s, when adolescent pregnancy was already showing a trend of progressive increase, funding agencies issued calls for papers on the adverse consequences of early parenthood and programs were designed on the basis of such pathology-oriented research. In 1978, an Office of Adolescent Pregnancy Programs was established in the Department of Health and Human Services. Starting in 1982, the National Survey on Family Growth included unmarried adolescents in its surveys, enabling the quantification of trends in premarital sex, contraceptive use, and adolescent pregnancy. Cross-national comparisons of adolescent pregnancy rates have underscored the importance of sociocultural constructions of partnerships and sexuality on the meaning of adolescent fertility. Since condom use is the most feasible acquired immunodeficiency syndrome prevention method for adolescents, researchers have been forced to assess effective strategies for engaging young people in open discussions of premarital sexuality and to refine understanding of the influence of partners, parents, peers, and community norms. Also encouraging is awareness that interventions aimed at influencing high-risk behaviors must start in middle childhood.
Contraceptive social marketing is a way of supplying contraceptives to consumers who cannot afford to buy them at full market price, yet are not reached by the free public distribution program. The process involves supplying a subsidized product through existing commercial distribution networks, using the mass media and other retail marketing techniques to commercially advertise the products. India was the first country to introduce this concept to its family planning program. India's social marketing program is also the largest in the world. Over the past 25 years, total condom sales in India have expanded under the program from less than 10 million per year to more than one billion. The authors present an overview of India's social marketing initiative, describe the firms participating in the program, and summarize the lessons learned from the social marketing experience. Problems and prospects, and experiences and implications are discussed.
In the past, operations research has played a significant role in providing donor agencies and family planning program managers with information to guide the development of services most likely to reduce fertility. As family planning programs have become more established, however, the focus of operations research has shifted from an emphasis solely on outcome variables such as contraceptive usage to consideration of psychosocial and quality of care variables. There is new awareness that aspects of the service delivery system itself determine client transactions (proximate psychosocial variables), which in turn affect client satisfaction and contraceptive use. Such aspects include choice of contraceptive methods, client education and counseling, providers' technical competence, client-staff relations, mechanisms to encourage continuity of use, eligibility restrictions, provider bias, and an appropriate constellation of services. Increasing emphasis is being placed on operations research to guide the process of introduction of new contraceptive technologies (e.g., Norplant) into family planning programs. Finally, there is greater appreciation of the need in operations research for nonexperimental, qualitative data collection methods such as focus group discussions, in-depth unstructured interviews, and direct observation techniques, as well as multi-level analyses that reflect the perspectives of both providers and users. As family planning programs become more complex, the disciplines of organizational psychology and sociology should be drawn upon for theoretical and methodological guidance.
