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It is an enormous privilege for me to present the Deane–Stone lecture. As a young academic at the University of Southampton, I read so much of the work that came out of the National Institute of Economic and Social Research (NIESR) and was always impressed. Also, as an undergraduate and as a master's student at the London School of Economics, Sir Richard Stone and Professor Phyllis Deane featured prominently on my reading list. In my opinion, they were pioneers of economic measurement and, today, economists benefit hugely from their legacy.

Bangladesh has experienced a substantial decline in fertility that has been achieved by means of a large increase in the use of modern methods of contraception. As contraceptive prevalence increases, aspects of contraceptive‐use dynamics, including reasons for discontinuation and behavior after discontinuation, become important influences on fertility. This report uses calendar data from the 1993–94 Bangladesh Demographic and Health Survey to examine contraceptive behavior following discontinuation of modern‐method use. The individual‐level characteristics found to influence switching behavior include the method used, method‐related difficulties with previous contraceptive use, and education. A large amount of unexplained variation in switching rates remains, however, largely at the individual level, but also at the community level for certain types of transition.

The data from the Demographic and Health Survey conducted in Ghana in 1988 are used to identify determinants of immunisation uptake for children under 5 years. The logistic binomial analysis shows that socioeconomic factors are significant, especially women's education and region, and that the type of prenatal care received by the mother is also important. There is a strong familial correlation of vaccination behaviours, and there is also clustering of data within enumeration areas.

SummaryContraceptive failure was an important determinant of fertility in China in the 1980s. Based on the data from the China Two-per-Thousand Fertility Survey, this study shows that about 7% of the general fertility rate of currently married women aged 15–49 for a 12-month period is attributed to contraceptive failure, mainly due to the high failure rate associated with IUD use. A number of demographic characteristics are associated with contraceptive use, and with contraceptive failure and its outcome. Relevant socioeconomic differentials are also identified.

AbstractFertility trends in Botswana have been the subject of much debate in recent years as a number of surveys in the mid to late 1980s suggested that a fertility decline was under way. This paper first reviews the demographic evidence for a fertility decline and argues that the magnitude of the decline was rather less than some commentators had suggested. The paper then places the trends in fertility in the social and economic context of Botswana in the 1980s. It is argued that there could have been a short‐term decline in childbearing as a result of economic crises brought on by a major drought and helped by the government of Botswana's strategies to alleviate the effects of the drought on its people.

SummaryThe 1988 Malawi Traditional and Modern Methods of Child Spacing Survey data are used to identify determinants of infant mortality in Malawi. The logistic binomial analysis shows that socioeconomic factors are significant even during the neonatal period while the length of the preceding birth interval is significant in the post-neonatal period only. There is a strong familial correlation of mortality risks during both the neonatal and post-neonatal periods but the effect of geographical area of residence is stronger in the post-neonatal period.

This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280 deaths per 1000 admissions. The risk for similar women at low-risk hospitals is about 4 deaths per 1000. To complement results from the analysis of individual patient records, the paper includes findings from hospital staff reports regarding the maternal mortality situation at the hospitals.

Studies addressing factors associated with adverse birth outcomes have almost exclusively been based on hospital statistics. This is a serious limitation in developing countries where the majority of births do not occur within health facilities. This paper examines factors associated with premature deliveries, small baby's size at birth and Caesarean section deliveries in Kenya based on the 1993 Kenya Demographic and Health Survey data. Due to the hierarchical nature of the data, the analysis uses multilevel logistic regression models to take into account the family and community effects. The results show that the odds of unfavourable birth outcomes are significantly higher for first births than for higher order births. Furthermore, antenatal care (measured by frequency of antenatal care visits and tetanus toxoid injection) is observed to have a negative association with the incidence of premature births. For the baby's size at birth, maternal nutritional status is observed to be a predominant factor. Short maternal stature is confirmed as a significant risk factor for Caesarean section deliveries. The observed higher odds of Caesarean section deliveries among women from households of high socioeconomic status are attributed to the expected association between socioeconomic status and the use of appropriate maternal health care services. The odds of unfavourable birth outcomes vary significantly between women. In addition, the odds of Caesarean section deliveries vary between districts, after taking into account the individual-level characteristics of the woman.

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.