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This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.

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This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.

PIP: The author presents a method implemented in Haiti by the International Planned Parenthood Federation for evaluating and monitoring the quality of care of family planning services. Trained Haitian housewives visit clinics as mystery clients on a random basis without prior notice to directly observe family planning services and clinic conditions. Observations conducted by these clients from April 1990 to April 1991 are presented. Measurements are also developed for rating the acceptability of the services, providing a quantitative assessment of services based upon mystery clients' terms. Judgement criteria include the provider/client interaction, information adequacy, and competence of the promoter. Statistical results show simulated clients to rank some criteria of acceptability higher than others. Moreover, simulated clients' direct observations of services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff, the lack of competence of promoters, and the lack of informed choice. This method is proving to be a useful tool in designing and monitoring programs.

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This report is based on fieldwork conducted in a Peruvian community in 1986, which investigated Quechua-speaking Indians' knowledge of the female reproductive organs, perceptions of the way contraceptives work in the body, folk beliefs about conception and menstruation, and opinions about modern contraceptives. The findings reveal that the men have a more accurate knowledge of the female reproductive organs than the women do. However, the women are more knowledgeable about the action of modern contraceptives in the body. Most respondents perceived modern contraceptive methods as the best methods available, but the majority reported using the calendar rhythm method. This preference for rhythm is based on its economic advantage and on its adaptability to folk beliefs about physiology. The men's dominant role in reproductive behavior is related to cultural norms that emphasize traditional gender roles and that prohibit communication about sexual matters between men and women. Educational material, based on the respondents' knowledge of reproduction and taking into account their folk beliefs, might help to decrease the fear of contraceptive side effects and increase understanding of the function of contraceptives.

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This paper examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. A study conducted in a Peruvian highland community shows that contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, husbands are concerned with family size and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: the men's positive attitude toward modern contraception contrasts with the women's traditional desire for a large family. In this study population, modern contraception is a novelty that has reached only a few families. The majority of the couples practice natural and traditional family planning methods, which are not reliable. Villagers do not use modern contraceptives as a result of cultural barriers created by family planning services that do not take into account the lifestyle of these people, insufficient knowledge of human physiology, comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.

PIP: This paper, based on fieldwork done in 1984 in a Peruvian highland community with a population of about 3,500, examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. The village is poor, with many of the villagers involved in migrant labor, but there have been modernization influences: most villagers are bilingual, men average 8 years of schooling and wives 6. Government family planning programs (FP) were initiated at the local health post in 1982. This study, sampling 54 couples, 2/3 in consensual unions shows 1st pregnancy is usually at 18, and about 5 live births take place by age 31. Only 12 couples reported not using any form of contraception, 27 unreliable natural or traditional methods, and 15 modern methods. Non-contracepting women tended to breastfeed longer and have less schooling, and tended not to be working full-time. Contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, some husbands are concerned with family size (for economic, child welfare, and health reasons) and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: men's positive attitude toward modern contraception contrasts with women's traditional desire for a large family. Villagers do not use modern contraceptives because of barriers created by FP services that do not take into account the lifestyle of these people (e.g. language, work hours, respect for privacy), disturbing and poorly explained side-effects, especially of pills and injected depo-provera, insufficient knowledge of human physiology, contraception failures due to inappropriate use (often because of poor explanations by health post staff), comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.

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