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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

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National level maternal health decisions : towards an understanding of health policy agenda setting and formulation in Ghana
Koduah, A. - \ 2016
Wageningen University. Promotor(en): Han van Dijk; I.A. Agyepong. - Wageningen : Wageningen University - ISBN 9789462578951 - 180
family planning - reproductive health - health policy - ghana - government policy - primary health care - gezinsplanning - reproductieve gezondheid - gezondheidsbeleid - overheidsbeleid - eerstelijnsgezondheidszorg

Maternal and neonatal deaths and morbidity still pose an enormous challenge for health authorities in Ghana, a lower middle income country. Despite massive investments in maternal and neonatal health and special attention through Millennium Development Goals (MDG) 4 and 5, Ghana still have high mortality rates. At national level, policy decision makers to improve maternal outcomes have over the years developed several public policies to increase financial and geographical access to maternal care; space child birth; provide essential obstetric care; expand midwifery coverage; make equipment available and many more.

The problem of maternal mortality persist and this raises the question of what essentially goes into public policy making given the failure to achieve targets despite several maternal health policies developed for implementation. This thesis thus aims to advance our understanding of who makes maternal health policies and the agenda setting and formulation decision making processes through which they operate, in Ghana; and out of these understanding present potential lessons for policy actors to engage in making better informed policy decisions to improve maternal health.

To understand factors and processes that influence national level maternal policy agenda and formulation decisions; we conceptualised that maternal policy decision making is predominately influenced by how policy actors within specific context use their power sources to define issues and frame accompanying course of action. The main research questions are:

Which policy actors have been involved in maternal health policy agenda setting and formulation and what roles did they play and why?What are the decision making processes related to maternal health policy agenda setting and formulation?How did contextual factors influenced maternal health policy agenda setting and formulation and why?How did policy actors define maternal health issues and why?

To investigate maternal policy agenda setting and formulation decision making in-depth, a multiple case study design with qualitative methods of data collection was used. The case study approach allowed me to look at maternal health policy decisions not merely as inputs and outputs but to better understand within context the processes and policy actors involved. Field work in the Ghanaian health sector, through observation and participation in the work of the Ministry of Health, steered the selection of the cases. Four cases: maternal (antenatal, delivery, and postnatal) fee exemption policy decisions, health sector programme of work maternal health policy decisions, free family planning as part of NHIS policy decision, and primary care maternal health service capitation policy decisions were investigated.

The field work was conducted between May 2012 and August 2014. Multiple data collection methods including document review, interviews and observations were used to collect historical and current information and contribute to the validity and reliability of the research findings. Data were analysed drawing on an analytical framework in which concepts of organizational power, context, policy actors and problem definition were central elements.

Case 1

Historical and contemporary fee exemption policies for maternal (antenatal, skilled delivery and postnatal) health services were explored. Specifically we ask: How have maternal user fee exemption policies evolved in Ghana since independence? Which actors have been involved in the policy agenda setting and formulation and why? What contextual factors influenced the process over time, how and why? Nine specific policies were identified along the pathway as, the policies evolved from user fee exemptions to national health insurance premium exemption. The policy was first introduced in 1963 and has remained on the government agenda over four and over decades in a fluid process of ebbs and flows rather than in a static fixed form. Contextual factors and various policy actors were the major influencers of the ebbs and flows. Contextual factors that influenced the ebbs and flows were: political such as Nkrumah’s ideology of free access to health care and education, changes in government, and presidential election year; economic crises and development partners’ austerity measures; worsening health and demographic indicators; historical events; social unrest; and international agendas such as the MDGs. These contextual factors served as a source of power for policy actors to sustain maternal fee exemption agenda over time. The case study showed that various categories of policy influencers (policy agenda advisers and advocates) and final decision makers (policy agenda directors and approvers) operated within these interrelated contextual factors, which sometimes worked as constraints and sometimes opened opportunities. These contextual factors shaped the timely manner in which policy content was formulated and level of deviation from the intended agenda at each specific decision period. For instance, contextual factors such as declined health budget allocation and high maternal mortality presented the ministry of health bureaucrats with an option to formulate the policy content in a less timely manner and away from the intended agenda of 1997 free maternal care presidential directive. Whilst, within the context of austerity measure and Ghana poverty reduction strategy, maternal fee exemption policy for four deprived regions was formulated in a timely manner and closely linked to the poverty strategy.

Case 2

The case explored how and why maternal health policy and programme agenda items appeared and evolved in the framework of the Ghanaian health sector programme of work agenda between 2002 and 2012. Our specific research questions were: Which maternal health policies were prioritised? How did they evolve on the agenda and why? We examined decision maker’s problem definition and decision making processes, theorizing that a policy or programme’s appearance and fate on the POW agenda is predominantly influenced by how decision makers use their source of power to define problems and frame their policy narratives and accompanying course of actions.

Ministry of health bureaucrats and donors used their power sources as negotiation tools to frame maternal health issues and design maternal health policies and programmes within the framework of the national health sector programme of work. The power sources identified included legal and structural authority; access to authority by way of political influence; control over and access to resources (mainly financial); access to evidence in the form of health sector performance reviews and demographic health surveys; and knowledge of national plans such as Ghana Poverty Reduction Strategy. Bureaucrats and donors used their power sources to define, frame and label issues for attention making some policies such as family planning long term fixtures on the agenda. They used labels such as ‘inadequate obstetric care’, ‘family planning unmet needs’, ‘maternal health a poverty issue’, and ‘poor maternal health a national emergency’ – for actions and to ensure the continuous flow of donor and government funding.

Case 3

The case investigated how and why ‘free family planning as part of the NHIS’ policy attained a position on government agenda in 2012 but has not subsequently moved into formulation and implementation in Ghana. Relying on their power sources such as access to bodies of evidence; bureaucrats, donors, reviewers and reproductive health advocates framed inadequate budgetary allocation and disbursement for family planning and exclusion of family planning services from the national health insurance benefits package - as a major challenge to family planning contribution to maternal health care; and free family planning as potential life and cost saving. Drawing on their legal and structural access to institutionalized public policy processes in Ghana, they proposed the following policy options: include family planning service in the national health insurance benefits package and increase government and donor financial support. The interests of the supporting actors were two fold to eliminate out of pocket payments for family planning service and still sustain the financial needs of the family planning programme through the National Health Insurance Scheme. A window of opportunity opened when a Minister of Health receptive to these problem definitions and policy options publically voiced support for ‘free family planning as part of the NHIS; policy and therefore pushed it high and visibly onto the public policy /government agenda. However, the policy failed to move into formulation and implementation. Factors that influenced this failure included the lack of a stronger, broad based health sector actor support and related inability to agree on and develop policy implementation guidelines; and maintain political access and interest in the issue after it was moved up the agenda.

Case 4

This case explored how and why less than three months into the implementation of a pilot prior to national scale up; primary care maternal services that were part of the basket of services in a primary care per capita national health insurance scheme provider payment system dropped off the agenda. During the agenda setting and policy formulation stages; predominantly technical policy actors within the bureaucratic arena used their expertise and authority for consensus building to get antenatal, normal delivery and postnatal services included in the primary care per capita payment system. Once policy implementation started, policy makers were faced with unanticipated resistance. Service providers, especially the private self- financing used their professional knowledge and skills, access to political and social power and street level bureaucrat power to contest and resist various aspects of the policy and its implementation arrangements – including the inclusion of primary care maternal health services. Arenas of conflict moved from the bureaucratic to the public as opposing actors presented multiple interpretations of the policy intent and implementation and gained the attention of politicians and the public. The context of intense public arena conflicts and controversy in an election year added to the high level political anxiety generated by the contestation. The President and Minister of Health responded and removed antenatal, normal delivery and postnatal care from the per capita package.

Conclusions

The general findings of the thesis are: (1) policy influencers (donors and bureaucrats) and final decision makers (Minister and President) used their power sources and contextual factors to define problems, promote their vested interest and justify actions and inactions; through technical, institutionalised, public and political decision making domains. (2) Policy influencers and final decision makers’ collective actions and inactions through interactions and power relations influenced decisions to their benefit at different levels. They used their control over and access to knowledge, authority and financial, material and human resources to push their interest and influence decisions. Therefore, this thesis concludes that the findings can serve as lessons for policy actors to strategize and make better informed policy decisions. We are in need of a health sector that pays more attention to context, power sources and power relations of final decision makers and influencers and the varied decision making domains in any maternal health policy decision.

Two is enough : Family planning in Indonesia under the New Order 1968-1998
Niehof, A. ; Lubis, F. - \ 2003
Leiden : KITLV Press (Verhandelingen van het Koninklijk Instituut voor Taal-, Land- en Volkenkunde 204) - ISBN 9067181978 - 281
gezinsplanning - menselijke vruchtbaarheid - demografie - economische ontwikkeling - vrouwen - sociale verandering - indonesië - family planning - human fertility - demography - economic development - women - social change - indonesia
Family planning and status of women in Indonesia.
Niehof, A. - \ 1994
Groningen : Fac. Spatial Sciences, Groningen (Demographic reports 17) - 28
geboortecijfers - demografie - gezinsplanning - indonesië - recht - positie van de vrouw - vrouwen - contraceptie - birth rate - demography - family planning - indonesia - law - woman's status - women - contraception
Socio-culturele structuur en innovatie : een structuur-vergelijkend onderzoek naar adoptie van family planning in de periode 1969 - 1973 door Sundanese echtparen in twee rurale gemeenschappen op West-Java
Norren, B. van - \ 1985
Landbouwhogeschool Wageningen. Promotor(en): R.A.J. van Lier. - Wageningen : Van Norren - 533
geboortecijfers - contraceptie - culturele verandering - culturele ontwikkeling - cultuur - demografie - gezinsplanning - java - echtelijke verhouding - mannen - relaties - plattelandsgemeenschappen - sociologie - vrouwen - getrouwde personen - birth rate - contraception - cultural change - cultural development - culture - demography - family planning - marital interaction - men - relationships - rural communities - sociology - women - married persons

This publication contains a comparative study of socio- cultural influences on the process of family planning adoption during the period 1969-1973 in two rural communities in the regency of Bandung, West Java, Indonesia. One community, to be called Cianyar, is a ward in an agrarian village, while the other, Citonggoh, constitutes a large dairy and vegetable farm. A few hundred people live in each community.

The book consists of two parts. In Part One. "The Theoretical Framework", a research model and two research questions are introduced. In the model society is viewed as a tension system of elements which interact on two structural levels: a basic structure of elements from which strong stucturing influences on other elements emanate, and a derived structure of elements which constitutes itself as a reaction upon structuring influences from the basic structure. In the section of society studied, namely the participation system of family planning acceptors and relevant others. the basic structure is thought to consist of four substructures: a material, a social, a cultural and a psychic substructure. The derived structure is thought to consist of the network and the definitions of the situation of acceptors and relevant others. The adoptions of family planning themselves constitute the third level of the research model. On the basis of this model we have formulated as our first research question the task to explain comparatively observed adoptions of family planning in terms of the two categories of network and definitions of the situation as the derived structure of the participation system, and subsequently to explain the network and the definitions of the situation themselves in terms of the four basic substructures of the participation system (chapter 1).

In chapter 2 the elements constituting the four basic substructures are introduced and specified. Among other things the cultural ideal of the authoritative-harmonic community is mentioned and defined. The concepts of substrate (= the division of the scarce means of property, power, knowledge and strategic contacts among the community members), social position (= an actor's disposal of these scarce means) and social class (= a category of actors with corresponding social positions) are introduced. Subsequently the community is defined as consisting of three social classes: a higher, a middle and a lower class. In order to explain observed differences between the derived structures of Cianyar and Citonggoh, four basic structural elements with very different values or forms in the two communities have been selected. These are (1) the material element of infrastructural access to the family planning clinic, (2) the social element of substrate, (3) the social element of presence of factions in the community and (4) the psychic element of type of leadership exercised in the community.

In chapter 3 the elements of the two categories of network and definitions of the situation of the derived structure are introduced and specified.

In the fourth and concluding chapter of Part One the second research question is introduced as an attempt to typify observed adoptions of family planning as modern or not modern on the basis of a clearly defined concept of (individual) modernization. In order to distinguish adoptions which are "really" modern from adoptions which are only "apparently" modern, the concept of pseudo-modernization is introduced.

In Part Two, "Data and Interpretation", the two research tasks are separately carried out, the first one by successively analysing the adoption processes of Cianyar and Citonggoh in a directly comparable way in accordance with the research model (chapters 5 - 8 and 9 - 13), and the second one by typifying the observed adoptions of Citonggoh and Cianyar as modern or pseudo-modern in accordance with the concept of modernization (chapter 14). In the conclusions of the study (chapter 15) the results of the two research questions are logically and empirically combined.

Cianyar (ch. 5-8)

The circumstances of the fieldwork in the ward Cianyar of the village Ciendah are briefly discussed in chapter 5. In chapter 6 the political history of the village Ciendah during the period 1950-1975 is treated as a continuous contest for village power between two groups in the village: a moderately progressive group of village officials and school teachers and their following, headed by the relatively rich family of the village head, and a conservative group of orthodox local religious leades and their following, headed by one relatively rich family also. During this period of 25 years all major village offices were continuously held by members of the former group, the latter being

continuously in political opposition. It is shown that during the whole period the willingness of orthodox leaders to cooperate with village officials in implementing government development programs varied inversely with their momentary political power in the village.

In chapter 7 the composition of the basic structure of Cianyar is discussed. In (anticipated) comparison with Citonggoh it is shown that Cianyar is characterized by bad infrastructural access to the family planning clinic, a poly-pyramidal substrate (by which is meant unequal division of the four scarce means among the community members and the concentration of these means in the hands of various individuals from different social and occupational categories), presence of an orthodox faction in the community and absence of charismatic leadership.

In the following chapter 8 the composition of the derived structure is dealt with by means of an analysis of the local family planning programme and its development over time. The social and class positions of all actors studied were determined. The contents of the programme, its implementation, and the reations of receptors (eligible couples) were separately discussed, the essentials of which are summarized below.

(1) For several years the orthodox leaders dominated a public opinion which strongly condemned family planning. Mainly because in 1972 the orthodox leaders quite suddenly lost their (political) power in the community, could public opinion quickly change from strongly anti- to moderately in favour of family planning.

(2) Under the strongly limiting conditions of a poly-pyramidal substrate, presence of an orthodox faction and lack of charismatic leadership qualities, the most important executors of the programme, the ward head of Cianyar and his wife themselves, chose for cautious manoeuvring. They only approached couples with two or more children among the village poor, in particular those working as day labourers on their rice fields. Only after public opinion had changed did they start motivating couples belonging to the orthodox community. The ward heed almost exclusively motivated men, his wife almost exlusively women. Usually they cautiously spoke of family planning as a modern means for spacing births only. In terms of our own typology of informal leadership positions (introduced in Part One) the ward head and his wife behaved as advisors towards their receptors.

(3) Within the group of non-orthodox couples of Cianyar the adoption process started early 1970 among the school teachers of the higher class. One and a half year later (mid 1971) the process started among the beca drivers, small farmers and small officials of the middle class, and three months later (end 1971) it commenced among the agricultural labourers and plaiters of bambu walls of the lower class in the community. So within the non-orthodox group of the community the adoption process commenced in all three social classes well before public opinion started to change (1972). Within the group of orthodox couples the process started relatively late (mid 1972) among the larger farmers and traders of the higher class and the beca drivers of the middle class. Six months later (beginning 1973) the process commenced among the agricultural labourers and plaiters of the lower class. So within the orthodox group of the community the adoption process started in all three social classes only after public opinion had commenced to change(1972). At the end of chapter 8 it is concluded that, because of the motivating activities of the ward head and his wife, in both groups of the community the adoption process among the couples of the middle and the lower classes has been advanced and accelerated in time.

Citonggoh (ch. 9-13)

After a brief discussion of the circumstances of the fieldwork in Citonggoh (chapter 9) the recent history and the organizational structure of the enterprise are described in chapter 10. From mid 1969 till the end of 1973 the enterprise was run by a new Indonesian director who succeeded in making the farm profitable again after near bankruptcy in 1968.

In chapter 11 the composition of the basic structure of Citonggoh is discussed. In comparison with Cianyar it is shown that Citonggoh is characterized by good infrastructural access to the family planning clinic. a mono-pyramidal substrate (by which is meant concentration of the four scarce means in the hands of one person, the director), absence of (orthodox) factions in the community, and exertion of charismatic leadership, again by the director. It is also shown that the families of nearly all employees - that is director, staffmembers, foremen and labourers - live within the area and in the houses of the enterprise.

In chapter 12 the character of the director's leadership and power and its development over time are studied by means of an analysis of the contents, implementation and results of a large number of his policy measures. Special attention is given to his interventions pertaining to age at marriage, polygyny, divorce, childbirth and other aspects in the realm of private and family life of his subordinates. Among other things the conclusion is drawn that the director exerted authoritative as well as authoritarian leadership. As an authoritative leader who provides quidance on the basis of exceptional qualities only, the director disposed of his disproportionately large (modern) knowledge and of his charismatic personality. As an authoritarian leader who expects obedience. he could (if he wished) make use of several formal sanctions (like prohibiting to make use of the clinical facilities of the enterprise, prohibiting to live on its area and the very heavy sanction of dismissal) and also of several informal sanctions (like making public personal matters of subordinates).

In chapter 13 the composition of the derived structure of Citonggoh is dealt with by means of an analysis of the director's family planning programme and its development over time. The essentials of the programme's contents, its implementation and reactions of receptors are summarized below.

(1) The director considered family planning as an excellent modern means for couples to plan births in all three phases of the family cycle: for young couples to delay the birth of their first child, for couples with one or more children to space the births of additional children, and for couples who had already reached or exceeded their desired number of children, to stop bearing children. Secondly. he felt that all fecund couples of Citonggoh irrespective of one's phase in the family cycle should become acceptors.

(2) The three conditions of a mono-pyramidal substrate with power being concentrated in the hands of the director, the latter's charismatic personality, and absence of an oppositional (orthodox) faction in the community offered the director as head of his own family planning programme ample opportunity to enforce acceptance by employing the formal and informal sanctions mentioned. In his position of powerful and charismatic leader the director chose for a strategy of differential pressure. All couples who in his opinion could easily understand family planning because they were well educated were not approached. The great majority of these couples belonged to the higher class and higher middle class of the community. All others, the great majority of whom were couples of the lower middle and lower class, were motivated by means of "active persuasion" as the director put it himself, by which he meant: incessant and intensive personal motivation without using any means of coercion. Those who (silently) refused were called to the office to be persuaded again. And again and again if necessary, untill they finally decided to accept. Put in our own terminology this means, that from the motivating activities of the director two influences emerged: on the one hand a real-modern influence because of his incessant efforts to explain family planning to his receptors in terms of the culture concept of rational control of one's own life situation, and on the other hand a dual, classdifferentiated pseudo-modern pressure. This pressure was a double one, because it was authoritative as well as autoritarian (imposing something and at the same time concealing possible sanctions is actually a form of intimidation), and it was class-differentiated because couples belonging to different classes were differentially exposed. In the execution of his family planning programme the director closely cooperated with the nurse of the enterprise. It was the nurse who located potential acceptors and kept track of all motivated couples. Together the director and the nurse performed an a very efficient team.

(3) The adoption process in Citonggoh started shortly after the beginning of the programs among the couples of the middle and the lower classes, by the end of 1969. Among the (young) couples of the higher class, who could decide in freedom, the process started relatively lare (mid 1971). During the period 1969-1973 nearly all potential acceptors of Citonggoh had accepted family planning. At the end of chapter 13 it is concluded that, because of the motivating activities of the director of the enterprise, the adoption process among the couples of the middle and lower classes has been advanced and accelerated in time.

In chapter 14 the hypothesis is tested that social pressure from authority or public opinion leads to pseudomodernization. The hypothesis is only slightly confirmed. Only three cases of pseudomodernization in its full extent were encountered in Cianyar, none in Citonggoh. In Citonggoh pseudo-modernization only seems to have occured a few times as an aspect of real-modern adoption. These and other observations led to the conclusion that in alle three social classes of both communities the great majority of fecund couples possesed an unespectedly strong modern mentality in matters concerning planning births of children.

In chapter 15 the theoretical essentials of the comparative study are restated and several theoretical conclusions drawn, the most important one being recapitulated here: The community leaders of Cianyar and Citonggoh have executed their family planning programmes on the same cultural basis of a twofold ideal of real modernization and exertion of leadership in accordance with the ideal of the authoritativeharmonic community. Because of the structuring influences of four basis structural elements with very different values and forms in the two communities, the two programmes have been very different in their contents and implementation. However, probably due to the unexpectedly strong modern mentality among the couples of all three social classes in both communities both programs have essentially had the same effect of advancing and accelerating the adoption process among the couples of the middle and lower classes.

Vrijwillig kinderloze vrouwen : verkenningen rond een keuze
Bandt, M.L. den - \ 1982
Landbouwhogeschool Wageningen. Promotor(en): G.A. Kooy. - Wageningen : den Bandt - 378
sociologie - verwantschap - gezinnen - positie van de vrouw - vrouwen - besluitvorming - demografie - gezinsplanning - geboortecijfers - contraceptie - vrouwenbeweging - feminisme - vrouw en samenleving - personen - sociology - kinship - families - woman's status - women - decision making - demography - family planning - birth rate - contraception - women's movement - feminism - woman and society - persons

This research on voluntarily childless married women was carried out by the direction of the "Netionaal Programma Demografisch Onderzoek (NPDO) (National Program for Demographic Research). To all appearances, the percentage of voluntarily childless married couples is increasing in various western countries, including the Netherlands. This makes this relatively new topic of research extra interesting.

The problem-definition of the research was as follows:
- Which factors influence the choice for voluntary childlessness? How does the decision-making process around this choice take place?
- What role does women's emancipation play?
- As the number of women who do not conform with traditional sex-roles increases, will the number of voluntarily childless women also increase?

In the research design I tried to link the findings of research abroad (Bram, 1974; Veevers, 1973b) and my own observations on the role of women in society with the Fishbein theoretical model on behavioral intention (Fishbein & Ajzen, 1975).

The sample was drawn from the 90,000 inhabitants of a city in the western part of the country. All the women who had been married for at least 3 years, were under age 35 and who had no children were sampled (about 1200). A control group of 100 mothers with the same characteristics, but with one child no more than 2 years old, was also drawn from this population. These preliminary subjects received a letter of introduction and a small screening questionnaire. As a result of these questionnaires four groups of women were selected (N=170). Because of the non-normal distribution of the voluntarily childless in the general population, the childless sample was supplemented by subjects chosen in a purposive manner. A lengthy (2-4 hours) personal interview was conducted with open-ended and pre-coded questions. (Material collected in 1978). A total of 158 of the respondents was used in the final analysis, the four groups are:
1- Voluntary childless WC): 65 women who ware sure that they wanted to be permanently childless;
2- Hesitators (H): 43 women who were (very much) in doubt whether they wanted to have children;
3- Delays (D): 23 women who were delaying having children;
4- Mothers (M): 29 women who had one child age 2 or younger.

The research report comprises 14 chapters.

In chapter 1 it is established that no reliable data on the numbers of VC within a population are available. This is partly due to incorrect interrogation during fertility surveys and other such research, where the desire for children was always presumed. This also holds true for the Netherlands: considerably more material concerning voluntary childlessness could have been available if the right questions had been asked in earlier research. On account of the predicted massive increase in the percentage of VC among recently contracted marriages in the Netherlands (an expected 18 to 20% of marriages contracted in 1980 and later (among others: CBS, 1976; Frinking & Niphuis-Nell, 1979)), a change in the way of thinking around motherhood can be established.

In chapter 2, the results of research done recently in the Netherlands and abroad concerning the backgrounds of the VC are reviewed. The fact that the VC are under considerable social pressure to conform with the pronatalist norm also comes up for discussion; although according to the results of national opinion polls, the VC are less disapproved of than some 15 years ago.

In chapter 3, the choice of Fishbein's theoretical model is accounted for. This model emphasizes the importance of two basic social-psychological concepts that were traditionally treated independently - the "attitude concept" and the "concept of social norm". This theoretical model provides a bridge between these two approaches to the study of human behavior. In addition, Veevers' decision-making typology for the VC (1973b) is described; this was tested during this research. A schedule was constructed in order to clarify the notion of sex-roles. A description of the sex-role socialization is given, in the course of which it is made clear that girls are still "programmed" for motherhood.

In chapter 4 an account is given of the criteria which were required of the population to be investigated and the recruit ment and other technical details of the preliminary stage of the field work and the field work itself are discussed.

In the subsequent chapters, the research results are presented. Chapter 5 is one of the central chapters of the report as it comprises the results of measurements using the Fishbein model. The attitude-items for the model were derived from questionnaires. used during the "Nationaal Onderzoek Vruchtbaarheids- en Ouderschapsmotivatie" (NOVOM) (National Research on Fertility and Parenthood Motivation) and those used by Bram (1974). These in turn were based on Arnold & Fawcett's "Value of Children scale" (Niphuis-Nell, 1976) and Hoffman & Hoffman's model of the values and costs of children (Bram, 1974) respectively. Both attitude and subjective norm components appeared to be good predictors of behavioral intention. The multiple correlation of attitude (Σb.e) and subjective norm (ΣNB.MC) with the behavioral intention was .74 (p<.001).

Twenty of the thirty-nine attitude-items which were taken into account showed significant differences between the four groups; the differences between VC and M being the most obvious. The VC saw fewer satisfactions and more "costs" as consequences of having children than the other groups. It is remarkable that the scores of the H were very often near those of the VC, and the scones of the D near those of the M. Personal freedom, the opportunity to work outdoors and to do things spontaneously with one's spouse were very important for the VC.

As far as the normative component is concerned, the following can be mentioned: in four of the nine subjective norm-items significant differences between the groups could be established. The respondents did not care much about the opinion of others (referents) with regard to having children. An exception was the husband, who was the most important referent for all four groups, but the "motivation to comply" of the VC was significant ly lower.

The attitude and subjective norm components together formed 54% of accounted for variance of behavioral intention. A detailed reconstruction of the course of the decision-making process of the VC brought to light that Veevers' decision-making typology is only applicable to very few of the VC in this research. (This conforms with the experiences of the VC in the NOVOM-research). Veevers' notion that first "delaying" VC would, to a large extent, implicitly decide to remain voluntarily childless also appeared not to apply to these VC respondents: nearly 75% of them said that they had made an explicit decision (chapter 61. All this could be a consequence of the phenomenon of voluntary childlessness becoming better known and more discussable in the Netherlands in the second half of the seventies.

In answering open-ended questions on consequences of having children and on the respondents' motivation "to parent or not to parent", freedom again is a very important consideration for the VC. Many of them were worried about the chances children would have in this world (because of over-population, pollution, danger of war and the like).

The motives which were mentioned turned out to link up well with the scores of the various groups on the attitude-items of the Fishbein model (chapter 7).

In chapter 8 the social pressure to procreate, which 60% of the respondents said they were under, is described. Parents and in-laws were mentioned most as the source of this pressure (68% of those mentioned). The reaction of the respondents in actual and hypothetical social pressure situations was usually said to be rejective. This tallies with the scores on the normative component of the Fishbein model, where a minimal motivation to comply emerged. In general the VC appeared to be the most sensitive in pronatal pressure situations.

Nearly all the respondents turned out to have either a positive or a neutral opinion of VC (they think that those concerned should decide for themselves).

The VC were highly dedicated to upholding their childfree lifestyle. Almost one third of them reported their own or their spouse's sterilization, and most others ware inclined to be sterilized in the (near) future (chapter 9).

In chapters 10, 11 and 12 the results of a number of questions concerning childhood background variables, demographic variables and situational variables are described. As was mentioned earlier, the contents of these questions were partly inspired by the results of foreign research on VC. With the aid of the chi-square test, the question of whether VC differed on all these points from other groups of respondents was looked into. Not many significant differences were found hare. The childhood situation of the VC were pretty much the same as those of other respondents and the social-demographic characteristics hardly differed either. The only fact worth mentioning is that a significantly higher percentage of M felt religously bound. The differences which manifested themselves in the situational variables can be mainly attributed to the differences in situation of all the (still) childless on the one hand and M on the other (among others: less opportunities to work outdoors, lower family income, more household duties etc.) . One outcome which seems interesting at first sight, viz. the lack of difference in the average educational level between the groups, will be cancelled when those who are currently following some form of higher education complete their studies: then the M will fall behind. (However, it was established that within the group of respondents there was an unintentional over-representation of women with a higher educational level compared to the national percentages which may be expected for women with the same demographic characteristics).

Chapter 13 mentions first of all that measurements with the aid of existing scales of personality characteristics such as self-esteem, assertiveness and sensitivity towards criticism, brought no significant differences to light. However, other points did result in interesting differences. During the investigation, it was supposed that the more a woman perceives the existing sex-roles and the resulting positional distribution in society as traditional and restrictive for women (and especially for mothers), while she herself has a modern sex~ role conception, the more she will consider the consequences of motherhood more seriously than a woman with a traditional sex-role conception. The latter will see motherhood as a must in order to prove herself as a woman and feel content. Two scales constructed during this research in order to map the sex-role perception and sex-role conception of the respondents yield remarkable differences between the groups. In accordance with expectations, the sex-role perception of the VC was the most traditional and the sex-role conception of the VC (and the H) the most modern. The discrepancy between sex-role perception and sex- role conception was greatest within the group of VC. The VC were more positive towards women's lib than the M.

In chapter 14, the connection is made between the Fishbein model and the "external" variables described in chapters 10, 11, 12 and 13. The results of the correlation of relevant external variables with behavioral intention are given. The correlations were generally weak: <.30. The highest correlating variables were to do with emancipation, a job outdoors, valuation of household duties and religion. For the significance of the correlations, partial correlations were calculated in order to check whether the relationship between the external variable concerned and the behavioral intention ran via the attitudecomponent, the subjective norm component or both. Most of the relationships disappeared, in particular via the attitudecomponent. The only variable which appeared to have a direct relationship with fertility intention was a preference for a full- time to a part-time job (this was highest among the VC). This put the total accounted for variance at 56%.

From the research results, it can be established that socialpsychological factors have the most influence on the forming of behavioral intention to remain VC and that the VC cannot be distinguished in any obvious way from the other groups of women as far as social-demographic, situational characteristics and childhood background are concerned.

A distinction between "primary" and "secondary" VC is proposed. Primary VC will stick by their decision under all circumstances, secondary VC, however, could reconsider their decision (e.g. because of a lack of employment opportunities or social changes which meant that bringing up and caring for children would not be the sole responsibility of the woman). The research results support predictions of an increase in the percentage of marriages remaining VC, where women's lib seems to be an important condition.

Population regulation : a biological or a physical phenomenon (1960 t/m 1980)
Anonymous, - \ 1980
Wageningen : Pudoc (Literatuurlijst / Centrum voor Landbouwpublikaties en Landbouwdocumentatie nr. 4376)
bibliografieën - contraceptie - gezinsplanning - bevolking - veranderingen in de bevolking - theorie - bibliographies - contraception - family planning - human population - population change - theory
Ontstaan, doel en werkprogramma van de Commissie voor het geboorte - onderzoek
Hofstee, E.W. - \ 1949
Amsterdam : Unknown Publisher (Publicatie / Commissie voor het geboorte-onderzoek. Instituut voor sociaal onderzoek van het Nederlandse volk no. 1) - 32
geboortecijfers - demografie - gezinsplanning - contraceptie - birth rate - demography - family planning - contraception
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