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.     

Significant Effects of Fatwa-Based Perception on Contraceptive Practice Among Muslim Women in South Jordan Under the Early Stage of Fertility Transition

An interview survey of 450 Muslim women in a rural village of south Jordan under the early stage of fertility transition was conducted to explore major causes of contraceptive use, taking both their sociodemographic attributes and fatwa (Islamic jurisprudence)–based perception into account. Discriminant analysis, which was performed for the subject women divided into 15- to 29-, 30- to 39-, and 40- to 49-year age groups, revealed that “the number of living children” in the former and “to do contraception for good care of children” in the latter played significant roles in discrimination into contraceptive user and nonuser groups for any age groups. To cope with demographically and socioeconmically vulnerable situations, contraceptive prevalence rate should be increased by means of government-led family planning programs in cooperation with the imam (Muslim religious leaders and priests) through fatwa, in which special attention is paid to traditional norms, represented by good childcare.     

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.     

Changes in contraceptive use and fertility: El Salvador, 1978-88

In El Salvador from 1978 to 1988, contraceptive use among married women 15-44 years of age increased from 34% to 47%, and the total fertility rate declined from 6.3 to 4.6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception.     

Assessing the reproductive behavior of on- and off-reservation American Indian females: characteristics of two groups in Montana

Only limited fertility and general reproductive health data exist on American Indians. Using data from the 1987 Montana American Indian Health Risk Assessment, we found that the fertility of American Indians in Great Falls and on the Blackfeet Reservation was similar to blacks in the U.S. and relatively high when compared with fertility of whites in the United States. The influence of the direct determinants of fertility (nuptiality, contraceptive use, and lactation) was very different for the populations examined in this study. Great Falls American Indians and the U.S. black population were similar regarding age at first sexual intercourse (very young), breastfeeding (low prevalence and short duration), planning status of pregnancies (high unplanned), and contraceptive use (only moderate use). In contrast, Blackfeet women on the reservation and the U.S. white population married relatively late, had very high contraceptive use, used effective methods of contraception, and had moderately high levels of breastfeeding. However, Blackfeet fertility was much higher than that of whites. Three interrelated reasons are suggested as possible explanations. Blackfeet couples either wanted high fertility, were relatively poor users of family planning methods, or used less effective methods until they had exceeded their desired family size after which time they turned to sterilization. These finds raise numerous questions concerning the social and economic factors that may account for these group similarities and differences. Further studies with much larger data sets are needed to address these issues adequately.     

Fertility preferences among Malaysian women: an analysis of responses to the new population policy

About 10% of 3887 ever-married women included in the 1984-85 Malaysian Population and Family Survey revealed that they were influenced by the new population policy to desire more children than they had originally wanted. These women were more likely to be rural Malays from the lower socioeconomic class. Ideal family size was more than four children. Children are desired for economic benefits and emotional support. The natality of the Malays has risen since 1980: their total fertility rate has increased while their contraceptive prevalence rate has dropped sharply. Coupled with a decline in the crude death rate, the present fertility preferences and behaviour of the Malays will render the target of the population policy more attainable than is reflected by the survey data.     

Rapid fertility decline in Iran: analysis of intermediate variables

The remarkable decline in fertility in Iran, which saw the total fertility rate fall from 7 children per woman in 1986 to 2 in 2000, has received only limited analysis in the demographic literature. Using the 2000 Iran Demographic and Health Survey and Bongaarts' age-specific fertility model, this paper examines the role of the major proximate determinants of fertility in bringing about the rapid decrease in fertility in Iran. The analysis indicates that contraception had the largest effect on fertility, accounting for 61% of the reduction in fertility from its theoretical maximum. The fertility-inhibiting effect of marriage patterns accounted for an additional 31% reduction, and was most important among the young. Further analysis of contraceptive behaviour suggests that the current period fertility rate of 2.0 children per woman is an outcome of a synchronization of delaying and spacing of births among younger women with stopping of childbearing among women in the middle and late reproductive ages. The policy implications of the results are discussed.     

Fertility and family planning in Accra

A sample of 1000 currently married women aged 25-39 and living in 3 geographic areas of the Ghanaian capital were interviewed about their contraceptive knowledge and practice. Slightly over 90% of the respondents said that they had heard of ways to delay or prevent pregnancy. There was no difference between the 3 areas, but more of those aged 30-34 had heard about contraception. The chances that a respondent had heard about contraception increased with the level of education. Catholics were less likely to have heard of any contraceptive methods than Protestants. Also, women engaged in traditional informal occupations were the least likely to have heard of any contraceptive methods. Overall, education emerged as the most important differentiating factor. The pill, condom, and IUD were the best known methods. Regarding actual contraceptive practice, only 41% of the respondents were currently using some form of contraception, with about 19% using modern and 27% traditional methods. Results of contraceptive usage by user characteristics show that the majority of women in 2/3 of the areas rely on a mixture of traditional and modern methods; that the % of users (any method) increases with age up to 30-34 years, after which it decreases. The % of ever-users of any type of contraception in this study is highest for the highest education levels, at 84% for women with 2ndary and post 2ndary education. With the exception of the IUD, douche and folklore methods, better educated women have higher ever-use %s for both traditional and modern methods. While the %s of users increases with education for foam, diaphragm and withdrawal; the reverse is observed for the pill and IUD, probably due to fear of negative side effects. Overall, there are no significant variations in contraceptive use by migration status; but the % of non-users is highest among recent migrants who are also the least likely to have ever used modern methods. Fertility differentials across ethnic groups have been observed in Ghana. The Akan have the highest fertility, followed by the Ewe and Ga-Adangbe with moderate fertility, and the northern ethnic groups with the lowest fertility. The Akan also have the highest % of ever users of modern contraceptives, an inconsistency which may be explained by their recent recognition of the burdens of high fertility and their attempts to control it. Religious differences are pronounced, especially between the traditional category on the 1 hand, and Christians and Muslims on the other. Results of an analysis of variance suggests that family size is the strongest motivation for adopting modern contraception, and that it may be used for limiting rather than spacing births.     

Dominance of Sterilization and Alternative Choices of Contraception in India: An Appraisal of the Socioeconomic Impact

Background

The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India.

Methods

Data for this study are drawn from the 2005–06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization.

Findings

Religious affiliation, women''s education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women''s education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant.

Conclusion

The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple cost-effective strategies such as mass media to promote awareness of modern temporary methods.     

State Variations in Women’s Socioeconomic Status and Use of Modern Contraceptives in Nigeria

Background

According to the 2014 World Population Data Sheet, Nigeria has one of the highest fertility and lowest contraceptive prevalence rates around the world. However, research suggests that national contraceptive prevalence rate overshadows enormous spatial variations in reproductive behavior in the country.

Objective

I examined the variations in women’s socioeconomic status and modern contraceptive use across states in Nigeria.

Methods

Using the 2013 Nigeria Demographic and Health Survey data (n = 18,910), I estimated the odds of modern contraceptive use among sexually active married and cohabiting women in a series of multilevel logistic regression models.

Results

The share of sexually active, married and cohabiting women using modern contraceptives widely varied, from less than one percent in Kano, Yobe, and Jigawa states, to 40 percent in Osun state. Most of the states with low contraceptive prevalence rates also ranked low on women’s socioeconomic attributes. Results of multilevel logistic regression analyses showed that women residing in states with greater shares of women with secondary or higher education, higher female labor force participation rates, and more women with health care decision-making power, had significantly higher odds of using modern contraceptives. Differences in women’s participation in health care decisions across states remained significantly associated with modern contraceptive use, net of individual-level socioeconomic status and other covariates of modern contraceptive use.

Conclusion

Understanding of state variations in contraceptive use is crucial to the design and implementation of family planning programs. The findings reinforce the need for state-specific family planning programs in Nigeria.     

Fertility change in Costa Rica 1960-84: analysis of retrospective lifetime reproductive histories

Lifetime reproductive histories of a 1984-85 nationally representative sample of 870 women aged 25-59 years provided data to describe the evolution of fertility, contraception, breast-feeding, and natural fecundability in Costa Rica between 1960 and 1984. The contraceptive prevalence rate increased from 23% in 1965 to 58% in 1975 and 66% in 1984. Duration of breast-feeding was stable during the 1960s, decreased in the early 1970s, and increased after about 1976. Fecundability among women who did not practise contraception was lower than expected and declined between 1960 and 1975, probably because of selection effects. Despite a high consistency between estimations from the reproductive histories and other sources of data, some suggestion of omissions of short periods of contraceptive use in the distant past was detected. The survey may have reduced recall errors by using a calendar that summarizes major life events together. The analysis demonstrated the feasibility and usefulness of asking for lifetime reproductive histories in fertility surveys in developing countries.     

Reproductive mortality and its relation to different methods of birth control

This report evaluates the decrease in maternal mortality and its relation to family planning methods in Sweden during the years 1911-80. In the 1930s fertility was low but illegal abortions were at a high level and the associated maternal death rate was 18.5 per 1000 women. With the legalization of abortion and the introduction of modern contraceptive methods, the crude reproductive mortality rate in 1965-70 was 1.7 per 100,000 women and this was reduced still further, especially for younger women, by the late 1970s. Standardized reproductive mortality was then 80% higher than the crude rate, indicating the importance of modern family planning methods. Mortality associated with oral contraceptive or IUD use in Sweden during the 1960s and 1970s was lower than in England and the US. Mortality associated with sterilization was 6.2 per 100,000 procedures.     

Characteristics of users of traditional contraceptive methods in Bangladesh

Various national surveys suggest that the % of eligible couples in Bangladesh who are using traditional methods of contraception has been growing. This article presents detailed information on knowledge and use patterns of traditional methods and compares the use patterns of traditional and modern methods of contraception. The data are derived from the 1981 Contraceptive Prevalence Survey and information collected from a nationally representative sample of ever married women aged under 50, by way of field interviews using female interviewers. Quality of data was checked at different phases of the survey. Over 96% of the women reported that they knew at least 1 traditional method of contraception. The safe period was the most well known method (36.5%); about 30% reported knowledge of abstinence and 22% knew about withdrawal. Compared with modern methods, where knowledge declined with increased age, the knowledge of traditional methods shows no systematic pattern by age. Respondents with primary and higher education have higher knowledge of traditional methods than women who have never been to school. A similar pattern exists for employment status; non-Muslim women have consistently higher levels of knowledge than Muslim women. Data on patterns of use suggest that about 36% have used at least 1 contraceptive method, 15% having used traditional methods and 20.4% modern methods. The number of women who have used traditional methods increases from ages 20 to 44 and then declines. Use of traditional methods is relatively higher by the number of living children than by the number of children ever born. A similar pattern of association between background characteristics (education, employment and religion) and contraceptive knowledge is evident regarding level of use. Husband's level of education does not show any significant relationship with the use of traditional methods. The use rate of traditional methods was more than doubled among the women owning land compared to those having no land. The total current use rate of modern methods was higher among women aged 40-44 having relatively higher numbers of living children. As with current use, a positive relationship was observed between the socioeconomic variables and ever use. In general, it is concluded that socioeconomic variables played a dominant role in the decision of couples in choosing various methods of contraception. It is suggested that traditional methods still have an important role in family planning and that this should not be disregarded.     

Effects of polygyny and consanguinity on high fertility in the rural Arab population in South Jordan

Based on the authors' interview survey for 608 randomly selected women of the rural Arab population in the South Ghor district of Jordan, this paper examined the effects of polygyny and consanguinity on high fertility, which was recognized as natural fertility. The prevalence of polygynous and consanguineous marriages was 28.0% and 58.1%, respectively, largely reflecting the population's traditional marriage customs. The findings highlighted a significantly higher total marital fertility rate (TMFR) in the monogamous wives (10.5) than in the senior polygynous (8.1) and junior polygynous wives (8.6); the TMFR did not significantly differ among the wives of non-consanguineous, first-cousin and second-cousin marriages. The formation of polygynous marriage was decided by the husband, mostly as a result of his senior wife's infecundity or sub-fecundity, and the age of the husband at marriage to his junior polygynous wife was high in many cases, leading to a decline in this wife's fecundity.     

Determinants of natural fertility in Sudan

The population of Sudan (North) is at a very early stage of fertility transition and experiences high, stable fertility at a close to natural level. The high observed fertility is found to be a function of the high proportion of married women and ineffective contraceptive procedures. The data used in this study were drawn from the 1979 Sudan Fertility Survey (SUDFS), in which 3115 ever-married women 50 years old from 12,028 households were interviewed. 90% of Sudanese women breast fed for at least 6 months and 80% for at least 12. The main inhibitor of fertility is perceived to be lactational amenorrhea averaging about 11.8 months, which is reported to be high, although among younger women the duration of amenorrhea is shorter due to earlier introduction of supplementary foods. An average of 5.2 months of postpartum sexual abstinence is evidenced, but this is shorter than the period of amennorhea, and therefore has no effect on the birth interval. Neither does marital instability or mean length of separation, which are both close to nonexistent. Sudanese women are comparatively very infecund. 22% gave birth within the 1st year of marriage, 62% within the 2nd, and 83% the 3rd. The proportion of ever-users of contraception is high (e.g. 15.4% among the 25-34 among category), but current use was low (8.1% for the same). The use of contraception is responsible for a reduction of 4.2% of the fertility per married woman. The duration of temporary separation between spouses, due to temporary or seasonal migration of husbands, and the pathological causes of high primary sterility, which contribute to the low fecundability, need further investigation.     

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.     

Fertility levels, trends and differentials in Kuwait

Data used in this study come from the published reports of the censuses and vital registration systems. The crude birth rate in Kuwait is very high, although an apparent decline seems to have started in the period 1975-80. There are considerable differences between the Kuwaiti and non-Kuwaiti populations. The former had a relatively stable high rate around 50 until 1975 and then fell to 47 in 1980. The total fertility rate was 6.8 per woman. The rate for the non-Kuwaitis rose in 1965-70 and then fell sharply throughout 1970-1980, from 44 to 30. Non-Kuwaiti fertility is consistently lower than Kuwaiti fertility at all ages, the differences being relatively greater after age 35. The peak ages of fertility are 25-29 years for Kuwaitis and 20-29 years for non-Kuwaitis. For Kuwaitis, there is clear evidence of declining fertility in the younger age groups but not in the older, largely reflecting the trend towards later marriage among the younger Kuwaitis. As expected, there is a diminishing trend in completed family size from the least to the most educated women in both Kuwaiti and non-Kuwaiti women in all age groups. The illiterate women at marriage are younger than the university educated women by about 5 years. Results further show that women who are economically active have lower fertility than those who are not, both in Kuwaiti and non-Kuwaiti groups. The differences in each group are significant, as are differences in the fertility level by husband's occupation. High fertility in Kuwait, as well as in other oil-exporting Arab countries, is a result of a variety of factors including the generally pronatalist sentiment of the Arab population, improved health facilities, rising wealth, the youthful age structure, the young age at marriage and the substantial incentives in the different governmental schemes to promote native high fertility and keep a balance between the native and immigrant populations.     

Differential fertility by intelligence: the role of birth planning

Urban, white, ever-married women, aged 15-44, were sampled in low and high income census tracts in 16 U.S. cities, using a short adaptation of the Peabody Picture Vocabulary Test as a measure of IQ. After analysis of covariance, in which IQ was the independent variable and children ever born (CEB) was the dependent variable, it was found that there is .19 difference between the mean CEB of high- and low-IQ groups when covariables are controlled. It was shown that there was no significant difference in desired family size associated with IQ. But since the low-IQ women have more fertility than high-IQ women, effectiveness of contraceptive methods was examined. Examination showed that lower fertility was achieved by more effective use by the high-IQ women of methods of theoretically similar effectiveness. Also, those women not using a physician administered contraceptive (PAC) in the 3-year study period had unwanted births at about 3 times the rate of those who used PAC for the entire period. Thus, all American women will have to learn to realize their own fertility goals.