Supervivencia en función de las variables del paciente y del tumor primario

The estimates for TFR as obtained under the dif-ferent methods are presented in tables F1.6 and F1.7. The Rele and Proximate Determinant methods are mainly relied upon to arrive at an estimate of TFR, as the Regression method is be-lieved to produce an underestimate.

The estimates obtained using census and sur-vey data under the Rele method and those ob-tained through Proximate Determinant methods are in close agreement, while the Regression method, as expected, produced consistently lower estimates for all the periods. Among the former two, the major discrepancy is for TFR es-timates for the early 1980s. The Rele method, by using census data, produced an estimate of 6.82 for the TFR for the 1981-86 period and, using survey data, produced an estimate of 6.30 for the 1979-84 period. Both estimates are obtained using primarily the CWR2, which used the 5-9 age group as the numerator, hence it may be that there was some higher enumeration of this age group in the census, which is less of a prob-lem in the survey data, which are collected with greater care and attention. Both in 1961 and 1974 the population censuses have excessively enumerated the 0-9 age and particularly the 5-9 age (Bangladesh 1961; Begum 1976, 1990).

For the 1986-91 period, the Rele method, using census data, produced an estimate of 6.0 for the TFR and, using survey data, produced an estimate of 5.9 for 1984-89 period. Hence, ac-cording to this method, the TFR in the country in the 1987-89 period was around 6 per woman,

while the Proximate Determinant method esti-mated the same level for the year 1989. Thus, on the basis of Rele and Proximate Determinants method, we can conclude that the fertility level in Bangladesh before 1990 was around 6 per woman. A similar result was found by Cleland and others (1994), who report a TFR of 5.86 for 1988-89 using CPS data, and Islam and others (1996), who report a TFR of 5.83 using BFS. As a crude measure, the average number of children born to women aged 35 or over in DHS 1992/93 was 5.9, which fits with these estimates.

The Rele method, using census data for the first half of 1990s viz., for 1991-96, produced an estimate of 4.9, while using survey data pro-duced an estimate of 4.51 for 1990/92-1995/97 period. The Proximate Determinant method produced an estimate of 4.5 for 1993/94, which corresponds roughly to the mid-period of the above two periods noted for the Rele method.

From these rates, it appears the TFR in 1993/94 in Bangladesh was around 4.5.

Cc

Using BDHS use- Using Matlab use- Cm x Cc

Year Cm effectiveness effectiveness Ci x Ci * TFR*

BFS 1989 .826 .695 .730 .658 .387 5.99

BDHS 1993/94 .761 .550 .610 .667 .294 4.50

BDHS 1996/97 .756 .503 .573 .680 .276 4.23

BDHS 1999–2000 .745 .466 .545 .714 .269 4.11

Percent change, 1989–99 –9.8 –32.900 –25.3 8.5 –30.500 –31.40

Share 32.200 95.6* –27.900 100.000

Note: * Calculated using average of two Ccs.. Growth rate of TFR differs from that of product term due to rounding.

Estimated Index Values of the Proximate Determinants T A B L E F 1 . 5

Estimated Duration of Post–Partum Amenorrhoea (months)

Period Duration (months)

1989 11.9

1993/94 11.5

1996/97 10.9

1999–2000 9.5

Source: Survey reports.

T A B L E F 1 . 4

Second, as these estimates show, the fertility did decline in the country over the 1990s albeit at a slower rate than that noticed between the late 1980s and early 1990s. For example, TFR de-clined by about 25 percent between 1989 and 1993/94, while during 1993/94 and 1999/2000 the magnitude of decline has been only about 11 percent.

The dynamic behind the slowing fertility de-cline in the second half of the 1990s can be dis-cerned from the trend in index values of various proximate determinants over this time (table F1.8). As they suggest, for a big drop in TFR between 1989 and 1993/94, both marriage and contraception played a big role. Contraception use during that period increased 14 percentage points from 31 percent to 45 percent, while the never-married group in the 10-49 age group in-creased from 20 to 32 percent. Since 1993/94, marriage played only a marginal role in inhibit-ing fertility. Such role of marriage improved by less than 1 percent during 1993/94-1996/97 and by another 1.5 percent during 1996/97–1999-2000, while during the 1989–1993/94 period alone it improved by 8 percent.

Similarly, during the 1989–1993/94 period, while the fertility inhibiting effect of contracep-tion increased by 19 percent, it improved by a much smaller degree after that. During 1993/94–

1996/97 the fertility-inhibiting effect of contra-ception increased by 7 percent and by 6 percent during 1999-2000. While the lesser degree of in-crease in the contraception use after 1993/94 compared to 1989-1993/94 may in part be re-sponsible for this, there is also evidence that in the latter part of the 1990s, contraception use re-lied more on relatively less-effective methods and the use-effectiveness of the method experi-enced some decline during this period.

Throughout this period the role of post-partum infecundability has been in the opposite direction viz., it favored fertility increase. Not only this, this role increased noticeably over time, offsetting part of the fertility-inhibiting ef-fect exerted by other proximate determinants.

During the 1989–1993/94 period the fertility in-hibiting effect of Ci slackened by 1.4 percent, it slackened by another 1.9 percent during the For 1996/97 the Proximate Determinant

method has produced an estimate of 4.23 and, for 1999-2000, 4.11. On the other hand, the Rele method using census data produced an estimate of 3.93 for the second half of 1990s viz., for 1996-2000, which corresponds to the mid-period of 1998, while using survey data produced an esti-mate of 3.78 for 1995-2000, corresponding to the year 1997. Hence, from these estimates we can conclude that the TFR in the country during 1996/97 was perhaps around 4.2 and that during 1999-2000 it was around 4.

Summary

Two major conclusions can be drawn from this analysis. First, national sample surveys con-ducted in the country consistently underesti-mated the true fertility level in the country.

According to these estimates, of three BDHS conducted in the country in the 1990s, under-estimation of TFR by highest margin has taken place in 1993/94.

Estimates of TFR Using Rele Method

Period Census estimates Period Survey estimates

1981–86 6.82 1979–84 6.3

1986–91 5.97 1984–89 5.86

1991–96 4.89 1987–89–1992–94 5.22

1996–2000 3.93 1990–92–1995–97 4.51

1995–2000 3.78

T A B L E F 1 . 6

Proximate determinant method Using Cc Using Cc Average

estimated from estimated from of two Regression Year 1993/94 BDHS Matlab data estimates method

1989 5.85 6.14 5.99 5.16

1993/94 4.27 4.74 4.50 4.25

1996/97 3.96 4.51 4.23 3.96

1999–2000 3.79 4.43 4.11 3.65

Estimates of TFR Using Proximate Determinant Method and

Regression Method T A B L E F 1 . 7

F E R T I L I T Y

193/94–1996/97 period and another 5 percent during 1996/97–1999/2000.

The outcome of all these effects has been continuous weakening of collective strength of the fertility-inhibiting effect of various proxi-mate determinants. During the 1989–1993/94 period mentioned above, three proximate de-terminants viz., Cm, Cc, and Ci together could improve their fertility-depressing effect by an-other 24 percent. While they could continue im-proving such an effect throughout the rest of 1990s, they could do so only to lesser degree.

During 1993/94–1996/97 such improvement has increased another 6 percent, and during 1996/97 and 1999/2000 it improved by another 2.5 percent.

Percentage Change in TFR and Different Indices of Proximate Determinants Since 1989

Combined effect of

Period Cm Cc* Ci Cm, Cc, Ci TFR

1989–1993/94 –8.0 –18.6 +1.4 –24.0 –17–22

1993/94-1996/97 –0.7 –7.2 +1.9 –6.1 –6–15

1996/97-1999/2000 –1.5 –6.0 +5.0 –2.5 –5–10

* Change for Cc has been calculated from average value.

T A B L E F 1 . 8

ANNEX G: ANALYSIS OF BINP’S COMMUNITY-BASED