_14_ _Regina McNamara_ **_et_** _a]._ 40-44 and 45-49 reported 6.00 and 6.03 children ever born. A family of four children was, on average, desired in Egypt and Tunisia, six children in North Sudan, and nine children in Mauritania. The current family size at which a least 50 percent of the women interviewed said they wanted no more children ranged from three children in Egypt, seven in Yemen, nine in the Sudan, and more than nine in Mauritania. Five percent of the currently married fecund Sudanese respondents reported current use of contraceptives, compared with 36 percent in Tunisia and one percent in Mauritania and Yemen. In the Sudan, 87 percent had never used contraception, and 79 percent stated that they did not intend to use in the future.

These estimates are not descriptive of urban Sudanese women, women who had completed primary school, or women in the Khartoum province. Close to 20 percent of Khartoum women were currently using a contraceptive method (traditional or modern) and 27 percent stated they wanted no more children (Department of Statistics, 1982). The five percent of the sample who had completed primary school differed sharply from the 82 percent with no schooling in their ever use of family planning (62 percent and 6 percent, respectively) and their current use (42 percent and 2 percent). They differed by two children in desired family size, 4.7 among the educated and 6.7 among those with no formal education.

The population of the two areas covered by the Sudan Community-Based Family Health Project had been exposed to modernizing influences. The Original Area project was conducted in 90 villages with about 100,000 population, just north of Khartoum. The Extension Area comprised 65 villages along 125 kilometers of the Nile River, from the northern border of Khartoum Province to Shendi, the Nile Province capital. Although both are rural areas, they have the advantage of proximity to the Nile for irrigation and access to rail service to Khartoum. Both the Original and Extension projects received funds from the USAID/Khartoum Mission and technical assistance from the Columbia University Operations Research Program. Additional information on both projects can be found in Department of Community Medicine and Center for Population and Family Health (1988) and El Tom (1985) and El Tom et al. (1984; 1984-85; 1987; 1989).

# _The_ **_Original_** _Project_

The public health system in the Sudan has had a strong commitment to physician-oriented curative care, yet cadres of paramedics have been deployed in rural regions. A complete paramedic complement includes a medical assistant who has had three years of nursing training, field experience, and two more years of rural health care training; nurses; and community health workers. The community health workers, who are the main providers of primary health care ie the villages, have little to do with MCH (UNFPA, 1986). Village women selected by their communities for nine months of midwifery training at a government school are under the supervision of nurse-midwives but they are not paid by the official system. They receive stipends from their communities or payments in cash or kind for deliveries. All but the midwives are male and their orientation is curative.

In 1980, the Department of Community Medicine of the Faculty of Medicine, University of Khartoum (DCM) initiated the Original Area program as an operations research project to test expanding the functions of the village midwives to include family planning, oral rehydration therapy, nutrition education, and mobilization for immunizations. Proximity of the area to the capital offered the advantage of a relatively well-developed health infrastructure and ease of