with family size; nulliparous women had the highest rates. The average distance between services and a client's hcme was also an important determinant for the use of services. The two most popular methods were DepoProvera and oral contraceptives. A follow-up on that sample found that 37% was pregnant within 2 years of dropping out of services; most claimed they did not want the pregnancy but the majority did not use contraception; 40% of the pregnancies were blamed on contraceptive failure. 25% of the drop outs had continued contracepting on their own or were no longer at risk (ie.: were sterile, not in a sexual relationship, or desired pregnancy). Abortions are illegal in Jamaica except as deemed medically necessary. Abortions are performed in hospitals though they are not dealt with in a similar way by all hospitals: two have a separate ward, another places the women in the surgical ward, and most Type C's place the women in maternal wards<sup>3</sup> . The variations in practice make it difficult to keep track of all the abortions that are performed. One researcher estimated that the ratio of abortions to live births is about 1:1 (Segree, 1985). This seems to be very high; in a sample of 14-24 year olds, 40% reported a pregnancy and 36% eventually had a live birth (Jamaica-NFPB, 1987). The abortion rates in older women would have to be extremely high, perhaps in conjunction with a high rate of unreported pregnancies, in order to get a ratio of 1:1. We currently have no information on the cost per method per year; numbers of acceptors; or the rate of STDs treated in clinics.

# 7.2 PRENATAL CARE

Over 95% of mothers in the Perinatal Study had at least one prenatal visit although this could often have only been to confirm the pregnancy (Jamaica-M0H, 1989). The visit was usually at a public facility-most often a health center. First trimester visits wore rare, often creating time problems for taking tests and getting the results back. Seventy-three percent of the women had serological tests done and of these over one-fifth delivered before the test results returned. Only 15.7% of the women who obtained prenatal care had a first trimester visit; 66% were first seen during the second trimester. Women who were seen by private physicians were less likely to have records for the stage of pregnancy at time of visit. According to the preliminary release of results from the Perinatal Study, most women were able to give the date of their last menstrual period; from the dates the clinic staff can monitor the progression of the pregnancy. It was difficult to monitor weight gain however, because very few women know their prepregnancy weight (28%) and few ome in early enough in the pregnancy to get an estimate, additionally, many clinics have non-functioning scales (Jamaica-M0H, 1987 and 1989).

The Perinatal Study also noted that the prenatal care rendered was inconsistent in terms of taking tests, retesting positives, and monitoring for ccmmon complications such as _anrwmia_ or hypertensive disorders. Blood pressure readings were lacking for 12.3% of the mothers; hemoglobin tests had been performed on only 61% of the sample; and oedema was often noted in patient records but without appropriate descriptions. In a preliminary release of results from a partial sample of the Perinatal Study, discrepancies were reported between what the wcmen said was done and what 3 Types of hospitals are described in Table 1 later in this report.

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