Using data from the Demographic and Health Surveys (DHS) recently conducted in the Dominican Republic, Guatemala, Colombia, Ecuador, and Peru, the proposed research will undertake a comparative assessment of the contextual determinants of contraceptive practice, breastfeeding, and use of maternal and child health (MCH) services. It will also examine the interrelations between these three proximate determinants of fertility and child survival, testing the following three hypotheses: 1) Contacts with and exposure to doctors and other trained medical personnel are associated with the practice of """"""""high tech"""""""" contraceptive methods such as the IUD and surgical sterilization; 2) delivery in a hospital and exposure to doctors is associated with curtailed breastfeeding and early supplementation; and 3) the inverse association between breastfeeding and contraceptive practice is not purely the result of common causes (including the use of maternal health services), but results from synchronization, in the interval following the birth of a child, the timing of the termination of breastfeeding and the initiation of contraceptive use. A variety of methodologies will be employed in an endeavor to cope with the statistical problems inherent in such analyses, and to take full advantage of the unusual and propitious aspects of the DHS data selected for this project. The latter include the battery of community information collected on health clinics and hospitals, and the detailed five year calendars of breastfeeding and contraceptive behavior collected in the experimental surveys carried out in Peru and the Dominican Republic. The results of the study will have implications for a number of controversies concerning the determinants and consequences of reproductive behavior in developing countries.
