The Demographic and Health Surveys (DHS) programme, operated by the Institute for Resource Development on behalf of the U.S. Agency for International Development (USAID), was established to assist less developed countries in conducting reliable national surveys on their population size and composition, and on maternal and child health. The first phase of the project (DHS-1) commenced in 1984 and comprised 34 surveys in 29 countries. In the second phase (DHS-2), scheduled for 1988 to 1993, a further 25 national surveys will be undertaken. The major intention of both sets of studies is to provide survey countries with detailed data on which to base health and population-based policy decisions, at the same time facilitating the transfer of appropriate technical skills and resources to staff from the host nation, and by so doing enabling them to independently develop and conduct demographic and health surveys in the future. Incorporation of the information collected into the international population and health data base is seen as a valuable bonus.
The first international conference to review and disseminate the findings of the DHS programme was held in Washington, D.C. on 5/7 August 1991. Besides demographers, biologists and clinicians directly concerned with the implementation of the various national surveys, the 650 participants from 63 countries included a large proportion of governmental ministers and policy-makers, and representatives of international non-governmental agencies. Three main themes were chosen for the conference: demographic trends in the 1980s, components of demographic and health patterns, and policy issues for the 1990s. Within these general subject areas, over 100 invited papers were presented on topics that included fertility, family planning, maternal and child health, infant and child mortality, survey design and implementation, data collection, and data processing and analysis.
The demand for family planning among married women varied widely across the countries surveyed, from between 28% to 35% in Mali, Uganda, Burundi and Sudan to over 80% in Brazil and Colombia, but there was evidence of a general increase in contraceptive usage. In turn, this had led to a significant overall reduction in total fertility rates (TFRs) in the less developed countries. Comparing the periods 1965/70 and 1980/85, TFRs declined by approximately 30% (from 6.1 to 4.2 births per woman), indicating that, in just fifteen years, the less developed countries had moved almost halfway to replacement level fertility of 2.1 births per woman. Included in this picture of fertility decline were a number of sub-Saharan countries, including Botswana, Kenya and Zimbabwe.
Over the same period there was a marked reduction in infant and child mortality, and a review of data from 28 countries showed that from the early 1970s to the late 1980s, deaths in the under-five age-group had fallen by 40% in six of the countries surveyed and by over 20% in the remaining 22 states. Predictably, the DHS information collected on immunization, the prevalence and treatment of diarrhoeal diseases, breastfeeding and nutritional status in children under five years, showed large between-country differentials. For example, the median duration of breast-feeding was less than nine months in many of the Latin American countries studied but over eighteen months in sub-Saharan countries, and in Indonesia and Sri Lanka. Similarly, although vaccination rates against TB, DPT, polio and measles were 10% or less in Mali and Senegal, at least 75% coverage had been attained in Botswana and Tunisia.
The information on social and demographic variation collected as an integral part of DHS surveys has been vital in enabling improved targetting of resources to high risk and previously under-served groups. With the advent of new problems, in particular AIDS, threatening to swamp the limited resources available to many national governments, the continuing work of the DHS in collecting and analyzing data of a quality suitable for informed policy choices remains critical. For individuals and institutions with interests in the demography and health status of less developed countries, the two volume conference proceed ings to be published early in 1992 will be a most useful reference source, and a pointer to strategies for meeting the family planning and health needs of a large proportion of the world’s population in the 1990s.
Alan Bittles