A study of low-income obstetric patients shows that rates of attendance at prenatal, postpartum and family planning clinics are associated with a variety of patients' background characteristics such as age, number of living children, and years of school completed. In addition, distance of clinics from patients' homes appeared to have a substantial effect on attendance. IN COMPARISON with higher income groups, the poor are much less likely to obtain maternal health services such as prenatal and postnatal care, and family planning assistance [l]. The most apparent reason for this difference is inability to pay, but even when services are offered free or on a sliding scale based on ability to pay, the rate of use of the services is disappointingly low. In an effort to learn some of the reasons for low rates of attendance at maternal health clinics we interviewed 774 obstetric patients in two hospitals from late February through November of 1964, and later checked their records for attendance at postpartum clinics and at three family planning clinics. Wayne County General Hospital, just west of Detroit, provided 706 interviews and the other 68 were obtained at Sumby Hospital southwest of the city. Interviews were taken after delivery and before discharge from the hospital. The interviewers visited the hospitals regularly every Monday, Wednesday and Friday, and were instructed to see all patients on the wards. Some patients were missed by chance: for example those who were unavailable for interviews on a Friday and then were discharged before the interviewer returned on Monday. Such omissions were random, being dependent on date of delivery, and should in no way bias the results. With the exception of five wives of interns who were on the same wards at various times, all of the patients were defined as indigent (currently receiving financial assistance from a public agency) or medically indigent (those who declared that they were unable to pay for the services of a private physician). The married women in the sample were drawn predominantly from the western and southern suburbs of Detroit, that is, from the areas adjacent to the two hospitals. The majority of the unmarried mothers, on the other hand, came from Detroit, for it was the Detroit City Physician's policy to send unmarried mothers out to the county hospital rather than to inner city hospitals. RATES OF USE OF MATERNAL HEALTH SERVICES Only 8 per cent of the women reported that they had failed to see a doctor for prenatal care, 27 per cent reported l-4 prenatal visits, 35 per cent reported 5-9 visits and 29 per cent said they had made 10 or more visits to the doctor or clinic for prenatal care.
Taiwan has attracted a considerable amount of demographic interest in recent years because of a marked decline of fertility since 1956. In this paper the authors utilize data from the household registration system to analyse variations of fertility among 292 local administrative areas in 1961. The study reveals a strong negative correlation between total fertility and a series of indicators of social development and communication. Most of the variation in fertility is accounted for by differences in the fertility of married women aged over 30 and in the age at marriage. The decline of total fertility is accounted for primarily by a reduction of the marital fertility of women over 30. The adoption of family limitation was by no means confined to urban centres, but apparently originated there and spread rapidly to small towns and rural areas.
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