in school when they tecama pregnant, of these only 19% returned. Teens in Jamaica have limited knowledge of reproduction and use of contraception. Recent surveys on adolescent knowledge and attitudes concerning reproduction (Jamaica-NFPB, 1987; Brody, 1981) found very low numbers of respondents ahle to explain the reproductive process and describe contraceptive methods. Over three-fourths of males and females from the Young Adult Reproductive Survey (Jamaica-NFPB, 1987) reported that their first live birth was unintended. The survey also found that ycung women were more traditional than men in attitudes towards won's roles in spite of the nunerous programs in Jamaica promoting more mcdern roles for womn. A larger percent of women than men supported the premise that a woman should work in the home ard agreed that women should not have extra-union affairs. Wcmen were less traditional concerning children however, 85.4% of the females ccmpared to 66.5% of the males agreed it was okay for a woman not to have children if she doesn't want them. Girls were also almnst four times as likely to have used contraception at first intercourse than were males (40.1% versus 11%). Both sexes agreed that the male should be financially responsible for any babies (98.8% females, 98.6% males). The Perinatal Study (Jamaica-MOH, 1989) found that despite a _low_ 12% of waoen wanting a pregnancy, 43% have never used any contraception. Family Planning services are readily available, yet there has been a long noted lack of use (Blake, 1961; Stycos & Back, 1964; Jamaica-NFPB, 1984; Brody, 1981). Women are quoted saying they "decided to take a chance" often because of inertia, they could not discuss contraception with their partner, or because they feared the contraceptive methods' side effects. Many believe they are destined to bear a certain number of children and so they may as well get on with it (Brody, 1981). Further reasons for not using family planning are discussed in the section on Family Planning Services. The pro-natalist attitudes found in all the surveys may contriblute to the problems of teen prenancy and high fertility. Most respondents are unequivocally negative abouit being unable to have a baby ard these feelings seem completely unrelated to the likelihood of wamer giving their babies up to others to raise. Wcmen voice the need for ccmpanionship when they are older as the reason for having children; the conpanionship is expected to come frmm daugilters. Negative feelings taward infertility are tempered by time and the fertility experiences of the woman (Brody, 1981). Women who had larger numbers of children from mltiple partners are less likely to feel as intensely about infertility. YoUnger and rural warren are the **MOst** concerned.

# 3.3 INFECTICUS AND CHRONIC DISEASES

Jamaica has made the transition from main cause of death being due to infectious and parasitic diseases to being the result of chronic ar i degenerative disabilities. Currently, the two leading causes of death for adult winen are cerebrovascular accidents and coronary heart disease (Jamaica4MOH, 1989); because cerebrovascular disease is more canmn, high blood pressure is a major component of adult morbidity and mortality. Ihis is consistent with worldwide concern over the greater -isks of high blood pressure in black populations, aid it explains the inportanoe of eclampia and hypertension in Jamaican maternal mortality. Important infections that affect wen in Jamaica include those that are the result of sexually-transmitted diseaLes (Sms), inappropriate care for abortions and childbirth, and poor hygiene associated with menstruation 6