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.     

Socioeconomic and cultural differentials in age at marriage and the effect on fertility in Nepal

Age at marriage is one of the factors that influence the fertility behaviour of women, particularly in a society like Nepal where contraceptive use is low. Socioeconomic and cultural factors, particularly religion and ethnicity, are important variables in determining age at marriage in Nepal. Fertility was negatively related with age at marriage. Marriage duration had a greater influence on fertility than age at marriage, although these were strongly correlated.     

Proximate determinants of fertility in the Kathmandu Valley, Nepal: an anthropological case study

The analytical model of Bongaarts and Potter is employed to compare the proximate determinants of fertility among 3 populations in Nepal's Kathmandu valley. 3 sub-groups are studied: high caste (Brahmin and Chetri) urban residents, high caste urban fringe residents, and low caste untouchables (Sarki). Both survey and anthropological methods are employed. According to the analytical model, the transition in fertility follows 4 phases. The changes in fertility levels from Phase 1 to Phase 4 generally indicate that the transition from natural to controlled fertility is characterized by declines in the proportions of women married and the duration of postpartum infecundability, and a substantial increase in the prevalence and effectiveness of contraceptive practices. The results of this study show that Nepal as a whole is entrenched in Phase 1 of the fertility transition. However, data from the 3 populations reported here clearly indicate that each has begun to experience a demographic transition to different degrees. The Sarkis in this study fall between Phases 2 and 3, as indicated by the total fertility rate (TFR). The rural high castes most closely approximate a population in Phase 3, while urban high castes included in this study are approaching Phase 4. Each of the 3 populations is characterized by a decline in the proportion of women married when compared to all of Nepal. It is also apparent that the relative use-effectiveness of contraceptive methods currently employed is high. Gains in the reduction of fertility, then, will have to be made from increasing and retaining the number of acceptors and in reducing the desired family size of those at reproductive risk.     

Determinants of fertility in Nepal: applications of an aggregate model

Bongaarts aggregate model of the proximate determinants of fertility is applied to data from the 1976 National Fertility Survey in Nepal. Breastfeeding is shown to be the most important limiting factor, resulting in a reduction of about 6 children per woman. Decline in the duration of breastfeeding by 1/4 would increase fertility by 1 additional child per woman. The temporary separation of spouses due to migration is conjectured to be the 2nd most important fertility inhibiting factor, not explicitly accounted for in the standard model. Results are presented for the 3 major ecological regions, urban-rural residence and educational attainment of women. High nuptiality and virtually no contraceptive use in Nepal produce age-specific fertility rates very close to a natural fertility pattern. Total average interval between births is 36 months; about 18 months are solely due to breastfeeding, the remaining months to combined effects of gestation, waiting time to conception, intrauterine mortality and post-partum infecundability. As urbanization increases and pace of modernization becomes more pronounced, the duration of breastfeeding is susceptible to decline.     

Fertility decline driven by poverty: the case of Addis Ababa, Ethiopia

Demographic transition theory states that fertility declines in response to development, thus wealth and fertility are negatively correlated. Evolutionary theory, however, suggests a positive relationship between wealth and fertility. Fertility transition as a result of industrialization and economic development started in the late 19th and early 20th centuries in Western Europe; and it extended to some of the Asian and Latin American countries later on. However, economic crises since the 1980s have been co-incident with fertility decline in sub-Sahara Africa and other developing countries like Thailand, Nepal and Bangladesh in the last decade of the 20th century. A very low level of fertility is observed in Addis Ababa (TFR=1.9) where contraceptive prevalence rate is modest and recurrent famine as well as drought have been major causes of economic crisis in the country for more than three consecutive decades, which is surprising given the high rural fertility. Detailed socioeconomic and demographic characteristics of 2976 women of reproductive age (i.e. 15-49 years) residing in Addis Ababa were collected during the first quarter of 2003 using an event history calendar and individual women questionnaire. Controlling for the confounding effects of maternal birth cohort, education, marital status and accessible income level, the poor (those who have access to less than a dollar per day or 250 birr a month) were observed to elongate the timing of having first and second births, while relatively better-off women were found to have shorter birth intervals. Results were also the same among the ever-married women only model. More than 50% of women currently in their 20s are also predicted to fail to reproduce as most of the unmarried men and women are 'retreating from marriage' due to economic stress. Qualitative information collected through focus group discussions and in-depth interviews also supports the statistical findings that poverty is at the root of this collapse in fertility. Whilst across countries wealth and fertility have been negatively correlated, this study shows that within one uniform population the relationship is clearly positive.     

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.     

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.     

Effect of family planning services on modern contraceptive method continuation in Vietnam

Access to and quality of services have increasingly been the focus of family planning programme managers, implementers and researchers in the developing world. In Vietnam, a country characterized by recent significant achievements in family planning, not much is known about the linkages between service accessibility and quality and contraceptive behaviour. Data for this study come from the Vietnam 1997 Demographic and Health Survey, with individual contraceptive use information recorded in the calendar section. Measures of access to and quality of services come from the Community/Health Facility Questionnaire, with key informant interviews and facility visits. The study focuses on the effects of the outreach programme and commune health centres on contraceptive method discontinuation for three modern, temporary methods: the IUD, oral pills and condoms. Longer travel time to commune health centres is found to be associated with significantly increased risks of first- and all-method discontinuation for any reason, while residence in communities with higher quality health centres is associated with significantly lower risks of method discontinuation. Access to and quality of the outreach programme are, in contrast, not significant determinants of method discontinuation for any reason. Similar results are found for first- and all-method discontinuation for service-related reasons. The effects of programmatic factors are more pronounced among older women and during the first three months of method use. This study provides evidence for the importance of family planning services for contraceptive method continuation in Vietnam. The results also highlight the need for a thorough evaluation of the family planning outreach programme in terms of its facilitation of women's continued use of contraception.     

An investigation into proximate determinants responsible for fertility differentials between two rural Bangladeshi populations

The substantial areal variation in Bangladesh's demographic dynamics is demonstrated by the differential fertility in 2 rural areas--Teknaf, where the total fertility rate is 8.0 and Matlab, where this rate is 6.5 in comparison areas and 5.0 in treatment areas. The fertility differences between the comparison and treatment areas of Matlab are usually attributed to the differential use of contraception, while the fertility difference between Teknaf and Matlab as a whole is assumed to reflect dissimilarities in socioeconomic, environmental, and cultural conditions. Application of a model proposed by Bongaarts which permits analysis of the effects of intermediate variables on fertility reveals similar marital patterns in Teknaf and Matlab but different indexes of infecundability and contraceptive use. Both the comparison and treatment areas of Matlab had 1 birth less than Teknaf because of their high infecundability due to a longer duration of breastfeeding (median duration of 30 months in Matlab compared with 22 months for Teknaf). Contraceptive use contributed 0.51 and 2.36 fewer births in Matlab's comparison and treatment areas, respectively, than in Teknaf. The reasons Teknaf mothers breastfeed their infants for shorter durations than Matlab mothers merit further investigation given the significant contribution of prolonged lactational amenorrhea to lowering fertility. Much of the effect on fertility of the increase in contraceptive use in Matlab's experimental area could not have been achieved if lactation durations were at Teknaf levels, further emphasizing the need for research on breastfeeding behavior in different parts of Bangladesh.     

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.     

Contraceptive use dynamics of Asian women in Britain

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.     

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.     

Assessing the Impact of Family Planning Advice on Unmet Need and Contraceptive Use among Currently Married Women in Uttar Pradesh,India

Background

Counseling/advice is one of the key interventions to promote family planning (FP) in developing countries, including India. It helps to improve the quality of care and reduce maternal deaths. This paper investigates the continuity of maternal health (MH) service utilization from antenatal care to post-natal care and the impact this service utilization has on contraceptive use and on meeting the demand for family planning among currently married women in rural Uttar Pradesh, India.

Methods and Findings

The study assesses the impact of FP advice on unmet need and contraceptive use by adopting the propensity score matching method. It uses data from the District Level Household Survey (DLHS) (2007–08) that covered 76,147 currently married women (CMW) in the age group 15–44 years in Uttar Pradesh. Results show that the utilization of MH services [Antenatal care (ANC), institutional delivery, Postnatal care (PNC)] and FP advice during ANC and PNC has led to increase in current use of contraception by 3.7% (p<.01), 7.3% (p<.01) and 6.8% (p<.01), respectively. However, a greater utilization of these services has not translated into a reduction of unmet need for contraception at a similar manner.

Conclusion

MH service utilization including FP advice is more effective in increasing current use of spacing methods as compared to limiting methods. Findings support the need for “effective FP advice” interventions to reduce unintended births and unmet need. However, women from Scheduled Caste/Scheduled Tribe communities are less likely to receive MH services. Thus, efforts are required to ensure that currently married women across socio-economic backgrounds have equal opportunity to receive MH services and information on contraceptive use to meet the demand for family planning methods.     

Sterilization and union instability in Brazil

Brazilian women rely on sterilization as the main source of birth control. Sterilization has been one of the causes of the steep decline in fertility in Brazil, at least since the second half of 1970. It is hypothesized that understanding couples' relationships might be key to explaining this high rate of female sterilizations. Possible reasons for the higher level of fertility among women in unstable unions than among women in stable ones could be the less effective use of contraceptive methods, or that women in unstable unions tend to use less effective or reversible contraceptive methods. In this paper discrete time modelling of the timing of sterilization according to union histories is presented. The analysis uses the calendar data of the 1996 Brazilian DHS. It is shown that women in second or higher order unions have a lower risk of sterilization. This result should be taken into account in the analysis of the determinants of female sterilization in Brazil.     

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.     

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.     

Explaining the Role of Proximate Determinants on Fertility Decline among Poor and Non-Poor in Asian Countries

ObjectivesWe examined the overall contributions of the poor and non-poor in fertility decline across the Asian countries. Further, we analyzed the direct and indirect factors that determine the reproductive behaviour of two distinct population sub-groups.DesignData from several new rounds of DHS surveys are available over the past few years. The DHS provides cross-nationally comparable and useful data on fertility, family planning, maternal and child health along with the other information. Six selected Asian countries namely: Bangladesh, India, Indonesia, Nepal, Philippines, and Vietnam are considered for the purpose of the study. Three rounds of DHS surveys for each country (except Vietnam) are considered in the present study.MethodsEconomic status is measured by computing a “wealth index”, i.e. a composite indicator constructed by aggregating data on asset ownership and housing characteristics using principal components analysis (PCA). Computed household wealth index has been broken into three equal parts (33.3 percent each) and the lowest and the highest 33.3 percent is considered as poor and non-poor respectively. The Bongaarts model was employed to quantify the contribution of each of the proximate determinants of fertility among poor and non-poor women.ResultsFertility reduction across all population subgroups is now an established fact despite the diversity in the level of socio-economic development in Asian countries. It is clear from the analysis that fertility has declined irrespective of economic status at varying degrees within and across the countries which can be attributed to the increasing level of contraceptive use especially among poor women. Over the period of time changing marriage pattern and induced abortion are playing an important role in reducing fertility among poor women.ConclusionsFertility decline among majority of the poor women across the Asian countries is accompanied by high prevalence of contraceptive use followed by changing marriage pattern and induced abortion.     

Determinants of contraceptive use in Nepal

This 1981 study is the 1st of its kind in Nepal. Analysis using a logit-linear model showed that contraceptive use in Nepal depends on many factors. Women aged 35-49 are 3 times more likely than women aged 15-24 to use contraceptives. Women with 4 or more children are 8 times more likely to use contraceptives than women with 1 or no children, and 2.5 times more likely than women with 2 or 3 children. The use of contraceptives is greatest among women whose offspring includes more sons than daughters, and least among women whose offspring are all daughters. Women who desire no more children are 5 to 6 times more likely to use contraceptives than women who desire more children. Women who have discussed desired family size with their husbands are more than 4 times more likely to use contraceptives than women lacking this type of communication. Women with some schooling are twice as likely to use contraceptives as women with no schooling. Contraceptive use is higher among women who do nonfarm work than farm work, and higher still among women who do not work. Urban women were almost twice as likely to use contraceptives as rural women. Women with less than 1 hour access to a family planning service outlet were 2 to 3 times more likely to use contraceptives than women whose access to these facilities was greater than 1 hour. The number of previous child losses per woman had no significant effect in contraceptive use. Conclusions are based on analysis of data from the Nepal Contraceptive Prevalence Survey, 1981.