Measuring potential fertility through null segments: an exploratory analysis

The demographic effectiveness of a family planning program must measure the difference between actual fertility and the "gross" potential fertility, i.e., the natural fertility which would have been achieved without use of contraception. The various methods of measuring "gross" fertility which have been used are described. It is understood that users of contraception are never a random sampling of the general population; they tend to be higher in fecundability and lower in proportion of sterile. For this reason, the best strategm of measurement involves utilization of preacceptance fertility rates over some given period of time among those reporting no contraceptive usage during that period. A procedure of measurement is proposed whereby natural fecundability is estimated from null segments. Possible biases are taken into account. Application of the method is made to 2 sets of data collected in Taiwan. Results of the application of the method to the Taiwanese data are tabulated. Fecundability functions derived from unrestricted null segments are different from those constructed from restricted subsets of "closed" null segments. Choice of whether to use restricted or unrestricted null segments will depend on the nature of the data available.     

Ethnicity and contraceptive use in sub-Saharan Africa: the case of Ghana

Using a sub-sample of ever-married women from the 1993 Ghana Demographic and Health Survey (GDHS), this study examines differentials in contraceptive use in six cultural groups: Ga-Adangbe, Twi, Fante/other Akans, Ewe, Guan/others and Mole-Dagbani. Multivariate analysis is used to explore whether reported ethnic differentials in contraceptive use can be attributed to ethnicity or to other characteristics that distinguish the ethnic groups. Overall, the findings are generally more consistent with the 'characteristics' hypothesis, because contraceptive use differentials by ethnic group is accounted for by differences in socioeconomic and demographic characteristics of these women. However, for the Fante/other Akans, even after the necessary controls, ethnicity continued to emerge as a significant determinant of contraceptive use. Programmatic implications of these results are discussed.     

Determinants of contraceptive use and method choice in Turkey

In this study, the determinants of contraceptive use and method choice are examined based on various variables, classified as individual, cultural, fertility and contextual. The data used came from the 1993 Turkish Demographic and Health Survey. The main finding is that there exists a positive association between the educational level of both spouses and the use of contraceptive methods in Turkey. After all individual, cultural, fertility and contextual variables are controlled, a woman's education is a stronger predictor of method use and method choice than that of her husband. Increasing the educational level of women may be the most effective means of advancing family planning acceptance and increasing the demand for contraceptive services in Turkey. The study also shows that, to a great extent, contraceptive use and choice of modern method depend on the sex of a couple's living children, implying some preference for sons, although generally women prefer to have children of both sexes.     

Changes in contraceptive use and fertility: Panama, 1976 to 1984

Abstract

From 1976 to 1984 important demographic changes occurred in Panama. The total fertility rate declined from 4.5 to 3.7, and contraceptive use amongmarried women 20–44 years of age increased from 55 per cent to 63 per cent. However, using data from three national level reproductive health surveys which were conducted in Panama in 1976, 1979, and 1984, we found that most of the changes took place between 1976 and 1979. Since 1979, overall contraceptive use and fertility have remained virtually unchanged, although there has been an important method‐mix shift toward an increase in the use of contraceptive sterilization and IUD's, with an accompanying decline in the use of oral contraceptives. Although the singulate mean age at marriage remained relatively constant, the average duration of breastfeeding rose 23 per cent during the period. Further gains in contraceptive prevalence and reduction in unplanned fertility in Panama will largely depend on enhanced program efforts first begun in the early 1970's by the Panama Ministry of Health. Future program efforts especially should be directed toward encouraging young couples to space their children more effectively by using temporary methods of contraception.     

Low dosage progestagen as an oral contraceptive: a clinical study

A low dose of an oral progestagen (norethindrone 0.35 mg. daily) was used as a contraceptive agent in a group of 70 women. The average period of use was 16.7 months; it was over two years in 21 subjects. Eight patients withdrew from the trial because of excessive or irregular bleeding. The incidence of side effects was lower than with the combined type of contraceptive preparations. Of the six pregnancies that occurred, only two could be attributed to failure of the method.     

The effects of maternal-child health service utilization on subsequent contraceptive use in Morocco.

There are a number of reasons for anticipating that contact by women in developing country settings with modern maternal-child health (MCH) services will lead to increased use of family planning services. Indeed, the expectation of such a relationship underlies the integrated service delivery strategy that has been adopted on a more or less global basis. However, the available empirical evidence in support of this proposition is inconclusive. This study re-examines this issue in Morocco. Household survey data and data on the supply environment for health and family planning services gathered in 1992 are analysed in the study. A full-information maximum likelihood estimator is used to control for the possible endogeneity of health care and contraceptive choices. The findings indicate a substantial and apparently causal relationship between the intensity of MCH service use and subsequent contraceptive use. Policy simulations indicate that sizeable increases in contraceptive prevalence might be realized by increasing the coverage and intensity of use of MCH services.     

Contraceptive use patterns in Matlab, Bangladesh: insights from a 1984 survey

An experimental maternal and child health and family planning programme has been in existence in Matlab for almost 10 years. During this time the project has achieved remarkable success in the area of family planning. Based upon a 1984 survey, this study examines the pattern of contraceptive use in the Matlab treatment area, and contrasts it with the regular government programme in the neighbouring comparison area. Important differences between the two areas are observed, with the treatment area characterized by substantially higher levels of current contraceptive use, greater reliance upon temporary methods for birth spacing and, among acceptors of sterilization, more prior experimentation with other methods. In the comparison area lower rates of contraceptive use are observed, with heavy reliance upon tubectomy for limiting family size. The findings suggest that an intensive and innovative family planning programme in rural Bangladesh can achieve success not only in terms of contraceptive prevalence, but can also attract users interested in child spacing and others wanting to limit their family size, by offering the widest range of contraceptive methods.     

Social network- and community-level influences on contraceptive use: evidence from rural Poland

The diffusion of ‘modern’ contraceptives—as a proxy for the spread of low-fertility norms—has long interested researchers wishing to understand global fertility decline. A fundamental question is how local cultural norms and other people''s behaviour influence the probability of contraceptive use, independent of women''s socioeconomic and life-history characteristics. However, few studies have combined data at individual, social network and community levels to simultaneously capture multiple levels of influence. Fewer still have tested if the same predictors matter for different contraceptive types. Here, we use new data from 22 high-fertility communities in Poland to compare predictors of the use of (i) any contraceptives—a proxy for the decision to control fertility—with those of (ii) ‘artificial’ contraceptives—a subset of more culturally taboo methods. We find that the contraceptive behaviour of friends and family is more influential than are women''s own characteristics and that community level characteristics additionally influence contraceptive use. Highly educated neighbours accelerate women''s contraceptive use overall, but not their artificial method use. Highly religious neighbours slow women''s artificial method use, but not their contraceptive use overall. Our results highlight different dimensions of sociocultural influence on contraceptive diffusion and suggest that these may be more influential than are individual characteristics. A comparative multilevel framework is needed to understand these dynamics.     

Trends of Modern Contraceptive Use among Young Married Women Based on the 2000, 2005, and 2011 Ethiopian Demographic and Health Surveys: A Multivariate Decomposition Analysis

Introduction

Accessing family planning can reduce a significant proportion of maternal, infant, and childhood deaths. In Ethiopia, use of modern contraceptive methods is low but it is increasing. This study aimed to analyze the trends and determinants of changes in modern contraceptive use over time among young married women in Ethiopia.

Methods

The study used data from the three Demographic Health Surveys conducted in Ethiopia, in 2000, 2005, and 2011. Young married women age 15–24 years with sample sizes of 2,157 in 2000, 1,904 in 2005, and 2,146 in 2011 were included. Logit-based decomposition analysis technique was used for analysis of factors contributing to the recent changes. STATA 12 was employed for data management and analyses. All calculations presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance.

Results

Among young married women, modern contraceptive prevalence increased from 6% in 2000 to 16% in 2005 and to 36% in 2011. The decomposition analysis indicated that 34% of the overall change in modern contraceptive use was due to difference in women’s characteristics. Changes in the composition of young women’s characteristics according to age, educational status, religion, couple concordance on family size, and fertility preference were the major sources of this increase. Two-thirds of the increase in modern contraceptive use was due to difference in coefficients. Most importantly, the increase was due to change in contraceptive use behavior among the rural population (33%) and among Orthodox Christians (16%) and Protestants (4%).

Conclusions

Modern contraceptive use among young married women has showed a remarkable increase over the last decade in Ethiopia. Programmatic interventions targeting poor, younger (adolescent), illiterate, and Muslim women would help to maintain the increasing trend in modern contraceptive use.     

Mortality among oral contraceptive users: 20 year follow up of women in a cohort study.

OBJECTIVE--To see whether the use of oral contraceptives influences mortality. DESIGN--Non-randomised cohort study of 17,032 women followed up on an annual basis for an average of nearly 16 years. SETTING--17 Family planning clinics in England and Scotland. SUBJECTS--Women recruited during 1968-74. At the time of recruitment each woman was aged 25-39, married, a white British subject, willing to participate, and either a current user of oral contraceptives or a current user of a diaphragm or intrauterine device (without previous exposure to the pill). MAIN OUTCOME MEASURES--Overall mortality and cause specific mortality. RESULTS--238 Deaths occurred during the follow up period. The main analyses concerned women entering the study while using either oral contraceptives or a diaphragm or intrauterine device. The overall relative risk of death in the oral contraceptive users was 0.9 (95% confidence interval 0.7 to 1.2). Though the numbers of deaths were small in most individual disease categories, the trends observed were generally consistent with findings in other reports. Thus the relative risk of death in the oral contraceptive users was 4.9 (95% confidence interval 0.7 to 230) for cancer of the cervix, 3.3 (95% confidence interval 0.9 to 17.9) for ischaemic heart disease, and 0.4 (95% confidence interval 0.1 to 1.2) for ovarian cancer. There was a linear trend in the death rates from cervical cancer and ovarian cancer (in opposite directions) with total duration of oral contraceptive use. Death rates from breast cancer (relative risk 0.9; 95% confidence interval 0.5 to 1.4) and suicide and probable suicide (relative risk 1.1; 95% confidence interval 0.3 to 3.6) were much the same in the two contraceptive groups. In 1981 the relative risk of death in oral contraceptive users from circulatory diseases as a group was reported to be 4.2 (95% confidence interval 2.3 to 7.7) in the Royal College of General Practitioners oral contraception study. The corresponding relative risk in this study was only 1.5 (95% confidence interval 0.7 to 3.0). CONCLUSIONS--These findings contain no significant evidence of any overall effect of oral contraceptive use on mortality. None the less, only small numbers of deaths occurred during the study period and a significant adverse (or beneficial) overall effect might emerge in the future. Interestingly, the mortality from circulatory disease associated with oral contraceptive use was substantially less than that found in the Royal College of General Practitioners study.     

Family Planning in the Hospital Setting

Although the availability of oral contraceptives and the development of improved intrauterine contraceptive devices have greatly increased the general utilization of family planning services, there are still great segments of our population which are not yet reached, especially in the economically deprived areas. Since over 98 percent of all obstetrical deliveries now occur in hospitals, it seems logical that it is on hospital maternity services that these deficiencies might often be best overcome. Although this is primarily a medical problem, the use of paramedical personnel can greatly augment the physician''s practice in these areas. Family planning services should be an integral part of comprehensive maternity care, not alone in the physician''s office but also in the hospital setting.     

Determinants of spacing contraceptive use among couples in Mumbai: a male perspective

This study aimed to determine the factors influencing the use of spacing contraceptive methods in India, particularly from men's perspective. Data were obtained through a semi-structured interview schedule from 2,687 married men aged between 18 and 40 years from central Mumbai City, India, during 1999. Chi-squared tests and binary logistic regression analysis was carried out to determine the relationship between various variables and the likelihood of a couple using spacing contraceptive methods. Of the 2,687 couples, 1,395 (51.9%) were using one or other method of spacing contraceptives and 1,292 (48.1%) were not using any method at the time of survey. Male participation in contraceptive use was 23% (condom and withdrawal). The results indicate that the use of spacing contraceptive methods was significantly higher among those couples where the men desired one or two children (OR=4.3), had knowledge of five or more contraceptive methods (OR=1.9) and discussed with their wives obtaining family planning information (OR=3.2), spacing (OR=2.7) and permanent (OR=2) contraceptive methods. Age, income, desired number of children, knowledge of a greater number of contraceptive methods, inter-spouse communication regarding obtaining family planning information, spacing and permanent methods were found to be strong predictors of the use of spacing contraceptive methods. The study underlines the importance of intervention programmes aimed at promoting a small family norm, increasing the number of contraceptive choices available and encouraging inter-spouse communication. Hence, policymakers and programme managers should encourage interventions in this direction, targeting couples to enhance the use of spacing contraceptive methods.     

Differentials in fertility among black doctorates

Abstract

The 1978 Contraceptive Prevalence Survey for Guatemala provides an opportunity to examine fertility levels and a number of determinants of fertility for three broad segments of the country: the Department of Guatemala and, in the remainder of the country, the Ladino and Indian populations. While Ladinos had a much higher rate of contraceptive use than did Indians, the two groups had similar birth rates. The lack of difference in fertility appears to be due to the pattern of prolonged breastfeeding among Indians and perhaps to differences in the rate of conception due to nutrition, coital frequency, or other factors.     

Hypertension developing in women using oral contraceptions]

Attention to the problem of hypertension in women using oral contraceptives has been increasing as the use of these preparations has increased. It is estimated that between 1-5% to 15-18% of those women using these preparations suffer from hypertension. Some sources have linked the occurrence of hypertension to a concentration of renin in the blood. It is not clear to this author, though, whether this is the result of some physiological disruption caused by the contraceptive, or caused by some other malfunction of this mechanism. The appearance of hypertension in the course of hormonal contraceptive use is considered to be an indication for the discontinuation of its use.     

The role of place in shaping contraceptive use among women in Africa

Background

Contraceptive prevalence is low in the African region despite considerable family planning programmatic efforts. This study is the first to examine how community factors shape contraceptive use for married women in an entire region, comparing results across 21 African countries with a DHS in the last 5 years. The analysis builds on previous studies through an examination of the individual, household and community level factors that shape contraceptive use.

Methods

The data used in this analysis were from nationally representative Demographic and Health Surveys completed between 2005 and 2009. A separate multi-level logistic model was fitted for the outcome of current modern contraceptive use in each country.

Results

After controlling for individual and household level factors, community level factors of demographics and fertility norms, gender norms and inequalities, and health knowledge remain significantly associated with contraceptive use, although the magnitude and direction of these community effects varied significantly across countries.

Conclusions

The results highlight the importance of harnessing community level factors in planning interventions for increasing access to and utilization of modern contraceptive methods.     

Contraceptive decisions and HIV/AIDS concerns among married couples in Malawi

This study investigates current contraceptive use among Malawi couples. The data examined are from the 2001 Malawi Diffusion and Ideational Change Project (MDICP). The aim of the study is to explore whether contraceptive use among married couples is affected by the couple's concerns about HIV/AIDS and couple's age difference. Contraceptive use was found to be associated with the couple's HIV concern and family planning goals. There is no significant association between spousal age difference and contraceptive use. The findings are important for future work on the connection of marital concerns about HIV/AIDS with contraceptive behaviours, especially the use of condoms, and for informing HIV preventive strategies in marriage.     

Son preference in Bangladesh: an emerging barrier to fertility regulation

This study investigates the effect of son preference on contraceptive use and desire for additional children using national level survey data from Bangladesh for the years 1969 and 1979. National probability samples of ever married women between the ages of 10 and 50 were selected and stratified by urban-rural residence. Specifically, the study focuses on contraceptive use and desire for additional children and separates the effect of sex preference from that of high parity on fertility control. Son preference has a negative effect on contraceptive use and a positive effect on the desire for additional children regardless of socioeconomic and demographic characteristics. This advese effect of son preference on fertility regulation seemed to have persisted over the years. Relevent socioeconomic conditions in Bangladesh are described. In 1979, the effect of sex composition on contraceptive use or desire for additional children varied by parity. The negative effect of fewer living sons on contraceptive use and its positive effect on desire for additional children was higher in parities between 2 and 4 than in other parities. The effect of sex composition was stronger on desire for additional children than on contraceptive usage. In 1969, however, there was no consistent positive relationship between sex composition and contraceptive use. The relationship between sex composition and desire for more children was positive. Among women of parities 2 to 4, an excess of daughters continued to have a major positive effect on desire for additional children, and a negative effect on contraceptive use, after controlling for other sociodemographic variables. For parities 1 and 5 or above, the effect was either weak or inconsistent.     

Carcinoma in situ specimen classification based on intermediate cell measurements

In this study the possibility of classifying carcinoma in situ and normal specimens by measuring normal-appearing intermediate cells was explored. Twenty-five histologically verified carcinoma in situ specimens and 99 normal specimens, matched with the abnormal specimens for age and use or nonuse of an oral hormonal contraceptive, were examined. The smears were monolayer preparations stained with Thionin-Feulgen Congo red. Twenty-one nuclear features were measured. A discrimination among the experimental groups could be made on the basis of the relationship between two features, area and average optical density (AOD). A regression of AOD on area for each smear was performed. The correlation, coefficient of variation, slope, intercept, as well as the mean of the AOD level and the age of the subject were used in a discriminant analysis. This resulted in a smear classification with a false-positive rate of 14% and a missed-positive rate of 32%. When contraceptive use was taken into account the overall classification was improved with a false-positive rate of 12% and a missed-positive rate of 20%.     

Fertility on the US-Mexico border

Using Bongaarts' model, the relative importance of the proximate determinants of fertility is explored in five populations on the US-Mexico border. For the groups closest to natural fertility (the two Mexican groups), lactation, use of contraception, and marriage all were moderately important in terms of their direct effect on fertility. For the group with lowest fertility (Anglo-American), contraceptive use was an important factor inhibiting fertility; marriage was important but not nearly as important as contraceptive use. For the two US Mexican-American groups, contraceptive use was an important intermediate variable, not as important as for Anglo-Americans, but more important than it was for the two populations in Mexico. The proportion married was a moderately important factor for the Mexican-American groups. For these five populations the principal differences in fertility rates result from substantial differences in the use of effective contraception. Bongaarts' model proved very useful as an analytical framework in this study.