**_The_** _Matib_ **_Project_**

_13_ on fertility, but also because of the compounding effect of other proximate variables. A lower fertility level in the Treatment Area, however, has been sustained over time. Annual fertility trends are somewhat masked by seasonality in fertility (Becker and Sardar 1980).

The rise of fertility level from 1978 to 1980 in both the Treatment and Comparison Areas even with sharp increase of contraceptive prevalence in the Treatment Area during the period, as reflected in both general fertility rate and total fertility rate (Figure 1) needs explanation. It is a reflection of the fact that events external to the Matlab Project and government program can affect fertility. A marked decline in fertility occurred in Bangladesh including the Project area over the 1974-75 period owing to a devastating famine which depressed natural fertility significantly. The subsequent rise in natural fertility and the observed fertility oscillations during 1976-78 (Figure 1) were due to the secondary effect of low famine fertility on the subsequent proportions of women who were pregnant, amenorrheic, or lactating (Phillips et al 1988).

# **_Im,pact_** _on Atisde toward Family_ **_Size_** _and_ **_TIming_** _of_ **_Bilhs_**

The rise of contraceptive prevalence and decline of fertility are often associated with change in attitude toward family size and timing of births. We shall examine below the attitudinal change in both the Treatment and Comparison Areas during the period and the factors responsible for the change, if any. A significant decline in the desired number of children in the Treatment Area was evident in the findings of two surveys conducted in 1977 and 1984 (Koenig et al. 1987). For example, in 1977, 43 percent of all currently married women in reproductive age wanted no additional children; the corresponding figure for 1984 was 55 percent. The difference was sharper among women with three living children: 33 percent in 1977 and 53 percent in 1984. The responses given in a 1986 focus group study confirmed the trend of decline in family size desire in both the Treatment and Comparison Areas (Nag and Duza 1988).

Unfortunately, the 1977 survey was only conducted in the Treatment Area, so there are no survey data for estimating the change in family size desire in the Comparison Area. However, the 1984 survey mentioned above covered the Comparison Area also and it showed very little difference between the two Areas in family size desire. For example, 60 percent of women with any number of living children wanted no additional children in the Comparison Area compared to **_55_** percent in the Treatment Area. A baseline survey conducted in both the Areas in 1975 before the introduction of CDP showed very little difference in the stated ideal number of sons: the mean was 2.7 in the Treatment Area and 2.6 in the Comparison Area (Koenig et al. 1987).

It can be argued that a few decades of excellent services in diarrheal diseases through modern technology (e.g., a fleet of electrically operated speedboat for transporting patients) provided by the ICDDR,B in Matlab upazila has generated openness among the inhabitants of both the Treatment and Comparison Areas to modern ideas, thereby altering their attitude towards family size and birth spacing. But a 1981 survey conducted in six upazilas of Munshiganj division, an area contiguous to Matlab but without any access to Matlab at similar service programs, provide evidence to suggest that demographic characteristics and reproductive preference of the population were similar to the Matlab Comparison Area (Phillips et al. 1984b).

The 1986 focus group study mentioned above investigated the desired timings of birth in both the Treatment and Comparison Areas (Nag and Duza 1989). Almost all participants in the focus group sessions who expressed an opinion on desired interval between births thought that