_20_

**_Regina McNamara et al._**

It is likely that these conditions were responsible in part for the success of these projects, but not entirely. The nature and location of the promoter/distributor in the community appears to have been an important factor. In Ghana and the Sudan, the midwives were known and presumably trusted persons with whom sexual matters might be discussed. In Rwanda, the volunteers had not had this special mission before the project started, but the Abakangurambaga had a recognized and legitimized role as the government's spokespersons working for the good of the country. In their several ways, the promoters/distributors in each of the cases belonged to their communities and their IEC work was person to person.

It cannot be said that the increased use of contraceptives reported from these projects is entirely explained by the factors discussed here. It appears that in Ghana and Sudan there was a latent demand, a readiness to try modern contraceptive methods when they became available, perhaps due to the extensive public information campaigns that had been conducted in Ghana and the relative prosperity of the Sudan Extension area and its proximity to Khartoum. In Rwanda, on the other hand, the data strongly suggest that the Abakangurambaga generated demand; supply in the form of a satellite clinic was increased after the demand became evident. Questions remain as to why attitudes changed, if and when contraceptive use for family limitation will be practiced widely, and how applicable the experiences reported here are to other locations. These projects do not provide the answers. They do, nonetheless, support an optimistic view for the future of family planning in sub-Saharan Africa.

# References

- Adam, A. Y. "Fertility and prospects of family planning in the three towns." **_Sudan Journal_** _of_ **_Population Studies,_** 1(1)1983:60-74.

- Adjei, S. 'Preliminary Report: Private Midwives Survey." Unpublished report, Ministry of Health, Accra, 1987.

- Arnold, F., and A. K. Blanc. **_Fertility_** _Levels and Trends._ DHS Comparative Studies No. 2, Columbia, Maryland: Institute for Resource Development, 1990.

- Benneh, **G., J.** S. Nabila, and B. Gyepi-Garbrah. Twenty Years of Population Policy in Ghana. Accra: Population Impact Program (PIP/Ghana), June 1989.

- CaldweUl, **J.** C., and P. Caldwell. "High fertility in Sub-Saharan Africa." _Sdentific Amenrcan,_ May 1990a: 1 18125.

- Caldwell, **J.** C., and P. Caldwell. "Cultural forces tending to sustain high fertility," in **_Population Growth and Reproduction in Sub-Saharan Afinca: Technical Analyses of Fertility and its Consequence._** A Wor!d Bank Sympo6ium edited by G.T.F. Acsadi, G. Johnson-Acsadi, and R.A. Bulatao. Washington, D.C.: The World Bank, 1990b:199-214.

- Department of Community Medicine and Center for Population and Family Health. 'Sudan Community Based Family Health Project: Final Report." New York: Operations Research Program, Center for Population and Family Health, Columbia University, 1988.

- Department of Statistics. **_lhe_** _Sudan_ **_Fertility_** _Survey,_ **_1989, Vol. 1: Pndcipal Report._** Khartoum: Department of Statistics, 1982.