Demographic and contraceptive patterns among women in northern Mindanao,the Philippines

Abstract

Desired family size and contraceptive behavior of 986 ever‐married women aged 15–54 from Northern Mindanao, the Philippines, are described. Using the Dow and Werner typology of demographic and contraceptive patterns, it was found that a majority of the women were traditional in their demographic attitude and contraceptive behavior. A substantial proportion of the women desired medium to large families. Inconsistency in attitude and behavior was also manifested by women who desired small families but have never used efficient family planning methods. Sociodemographic characteristics of these women are described. A majority of the women who have never used efficient contraception also never practiced family planning. Rhythm was the primary method of birth control among demographic innovators and traditionals who have ever used inefficient methods; the pill was popular among contraceptive innovators and the moderns. A considerable proportion of the demographic innovators and the traditionals were not currently using any family planning method; a lesser proportion of contraceptive innovators and moderns were also not using birth control methods. Relevance of the findings to family planning programs is pointed out. Recommendations are given.     

Determinants of current contraceptive use among Ghanaian women at the highest risk of pregnancy.

This study uses data from the Ghana Demographic and Health Survey (GDHS) of 1988 to examine factors determining the continued low levels of contraceptive use in Ghana. The women currently using efficient contraception are those who have sexual intercourse regularly, who discuss family planning with their partner, whose husbands approve of the use of family planning, and who live in the northern sector of the country. The finding that husband's approval is an important determinant of efficient contraceptive use has significant policy implications for Ghana and other African countries, to motivate both husbands and wives to share fertility control responsibilities.     

The impact of mass media family planning programmes on current use of contraception in urban Bangladesh

A sample of 871 currently married urban Bangladeshi women was used to assess the impact of mass media family planning programmes on current contraceptive use. The analyses suggested that radio had been playing a significant role in spreading family planning messages among eligible clients; 38% of women with access to a radio had heard of family planning messages while the figures for TV and newspaper were 18.5% and 8.5% respectively. Education, number of living children and current contraceptive use were important predictors of exposure to any mass media family planning messages. There was a negative relationship between breast-feeding and the current use of contraception indicating a low need for contraception among women who were breast-feeding.     

Abortion as a backup method for contraceptive failure in China

Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women's sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50.1%, 75.3% and 80.2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women's social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.     

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.     

Contraceptive knowledge and attitudes in urban Ilorin, Nigeria

In Nigeria as in other African countries, population growth negatively affects economic development, and high parity affects maternal health. Breastfeeding, a common practice traditionally, is declining in some situations. This study was carried out in Ilorin, Nigeria. A sample population of 932 households stratified to represent different socioeconomic groups was used. 913 currently married women aged 15-35, who were in their prime childbearing ages, were interviewed on their contraceptive knowledge and on their attitudes towards modern contraception. In a bivariate statistical analysis, of 8 variables examined (i.e. ownership of a television, radio, religion, and other) only the woman's education, age, and area of residence within the city have significant independent effects on contraceptive knowledge. A linear logistic regression technic was also applied. 90% of the women interviewed thought that women should be free to practise family planning. Also, 95% of all the women believed that too frequent births could endanger the health of the mother and her children. Only the women with previous contraceptive knowledge overwhelmingly (80%) thought that the best way to prevent too frequent births is by family planning. 66.5% of those without previous contraceptive knowledge before this study suggested that traditional abstinence should be used and only 28.9% suggested family planning. Adequate awareness of the availability and usefulness of family planning methods can influence attitudes of women towards contraception and may also enhance contraceptive use. Better use can be made of broadcasting media, and efforts should be made to target younger, more fecund women, since there was evidence that more knowledge of family planning existed among women 30+ years old.     

Contraceptive Use and Uptake of HIV-Testing among Sub-Saharan African Women

Despite improved availability of simple, relatively inexpensive, and highly effective antiretroviral treatment for HIV/AIDS, the disease remains a major public health challenge for women in sub-Saharan Africa (SSA). Given the numerous barriers in access to care for women in this region, every health issue that brings them into contact with the health system should be optimized as an opportunity to integrate HIV/AIDS prevention. Because most non-condom forms of modern contraception require a clinical appointment for use, contraception appointments could provide a confidential opportunity for access to HIV counseling, testing, and referral to care. This study sought to investigate the relationship between contraceptive methods and HIV testing among women in SSA. Data from the Demographic and Health Survey from four African countries—Congo, Mozambique, Nigeria, and Uganda—was used to examine whether modern (e.g., pills, condom) or traditional (e.g., periodic abstinence, withdrawal) forms of contraception were associated with uptake of HIV testing. Data for the current analyses were restricted to 35,748 women with complete information on the variables of interest. Chi-square tests and logistic regression models were used to assess the relationship between uptake of HIV testing and respondents'' baseline characteristics and contraceptive methods. In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception. This positive association was not demonstrated in Congo, Nigeria, or Uganda. That many women who access modern contraception are not tested for HIV in high HIV burden areas highlights a missed opportunity to deliver an important intervention to promote maternal and child health. Given the increasing popularity of hormonal contraception methods in low-income countries, there is an urgent need to integrate HIV counseling, testing, and treatment into family planning programs. Women on hormonal contraceptives should be encouraged to continue to use condoms for HIV-prevention.     

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.     

Family Planning Knowledge,Attitude and Practice among Married Couples in Jimma Zone,Ethiopia

Background

Understanding why people do not use family planning is critical to address unmet needs and to increase contraceptive use. According to the Ethiopian Demographic and Health Survey 2011, most women and men had knowledge on some family planning methods but only about 29% of married women were using contraceptives. 20% women had an unmet need for family planning. We examined knowledge, attitudes and contraceptive practice as well as factors related to contraceptive use in Jimma zone, Ethiopia.

Methods

Data were collected from March to May 2010 among 854 married couples using a multi-stage sampling design. Quantitative data based on semi-structured questionnaires was triangulated with qualitative data collected during focus group discussions. We compared proportions and performed logistic regression analysis.

Result

The concept of family planning was well known in the studied population. Sex-stratified analysis showed pills and injectables were commonly known by both sexes, while long-term contraceptive methods were better known by women, and traditional methods as well as emergency contraception by men. Formal education was the most important factor associated with better knowledge about contraceptive methods (aOR = 2.07, p<0.001), in particular among women (aOR_women = 2.77 vs. aOR_men = 1.49; p<0.001). In general only 4 out of 811 men ever used contraception, while 64% and 43% females ever used and were currently using contraception respectively.

Conclusion

The high knowledge on contraceptives did not match with the high contraceptive practice in the study area. The study demonstrates that mere physical access (proximity to clinics for family planning) and awareness of contraceptives are not sufficient to ensure that contraceptive needs are met. Thus, projects aiming at increasing contraceptive use should contemplate and establish better counseling about contraceptive side effects and method switch. Furthermore in all family planning activities both wives'' and husbands'' participation should be considered.     

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.     

Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey

ObjectiveTo describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies.DesignTelephone survey.SettingNational survey of women living in Sweden.PopulationWomen between 16 and 49 years.MethodsThe survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy.ResultsA total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness.ConclusionsSweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.     

Making family planning accessible in resource-poor settings

It is imperative to make family planning more accessible in low resource settings. The poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet need for contraception. It is also in the low resource settings where maternal and child mortality is the highest. Family planning can contribute to improvements in maternal and child health, especially in low resource settings where overall access to health services is limited. Four critical steps should be taken to increase access to family planning in resource-poor settings: (i) increase knowledge about the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (iii) ensure supply of contraceptives by making family planning a permanent line item in healthcare system''s budgets and (iv) take immediate action to remove barriers hindering access to family planning methods. In Africa, there are more women with an unmet need for family planning than women currently using modern methods. Making family planning accessible in low resource settings will help decrease the existing inequities in achieving desired fertility at individual and country level. In addition, it could help slow population growth within a human rights framework. The United Nations Population Division projections for the year 2050 vary between a high of 10.6 and a low of 7.4 billion. Given that most of the growth is expected to come from today''s resource-poor settings, easy access to family planning could make a difference of billions in the world in 2050.     

Contraceptive practice of Irish married and single first-time mothers

This study surveys 100 married and 100 unmarried primiparous mothers, attending the National Maternity Hospital, Dublin, with regard to their contraceptive practice, their planning of their pregnancy and the timing of their first antenatal visit. Nineteen per cent of the married women, but 64% of the unmarried women, had never used any contraceptive method. The contraceptive pill was the most popular method for both groups, but while three in five of the married women had at some time used the pill, only a little more than one in five of the unmarried women had ever used it. One quarter of the women who had used contraception reported that their pregnancy was the result of a failure in their contraceptive method. Eighty-nine per cent of the single group and 20% of the married had not planned their pregnancy. None of the married women, but almost a quarter of the single, delayed their first antenatal visit until after they were 20 weeks pregnant.     

King's Termination Study II: Contraceptive Practice before and after Outpatient Termination of Pregnancy

A selection of psychological and social factors present in 360 women who underwent legal termination of pregnancy are related to their contraceptive practice. One-third of the group were ignorant about contraceptive methods, ignorance being more common in women from social classes IV and V and in those under the age of 19. Nearly half of those who had some knowledge of contraceptive practice became pregnant after knowingly taking a risk. A total of 41% had been using some form of contraception immediately before conception. The reliability of contraceptive methods used was found to be inversely related to neuroticism scores obtained from the Eysenck Personality Inventory, neuroticism being highest in women who had not used any form of contraception.Of 91% of the group seen three months after their termination 86% were using reliable contraceptive methods. A follow-up study one or two years after termination has shown that 81% of the 215 women contacted so far are using a reliable method of contraception; two unwanted pregnancies have occurred but both were due to contraceptive failure. This satisfactory outcome has been ascribed to the system of counselling all women before and after termination.     

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.     

Perceived contribution of children to marriage and its effects on family planning behavior.

The impact of the perceived consequences of having children on a couple's contraceptive practices and the tendency to plan births are examined. 2 separate measures of family planning were utilized, contraceptive pattern and proportion of unplanned pregnancies. It was found that the more a woman viewed children as an essential part of the marital experience the less likely she was to use reliable contraception early in marriage. The influence of the evaluation of children on contraceptive practices also was contingent upon the number of children a couple had had and the number of years they had been married. Differences in incidence of unplanned pregnancies among women was more a result of socioeconomic circumstance and the tendency to have a large family than attitude towards children. These 2 aspects of family planning have different implications for policy decisions. Changing the incidence of unplanned pregnancies would entail attacking those conditions which handicap couples in changing their life circumstances. It would involve educating them to the concept of family planning and the techniques of birth control and also increasing economic opportunity. Changing contraceptive patterns, on the other hand, might involve encouraging alternative adult roles, and creating differential incentives for childbearing.     

Cessation of childbearing in the absence of contraception in Sri Lanka

In data from the Sri Lanka Fertility Survey, 1975, the cessation of childbearing is examined among women who have never used contraception. The sample consisted of 6810 currently or previously married women, 57% of whom reported that they had never used contraception. Cessation of childbearing is studied according to age and marriage duration. The variables analyzed are age at last birth, proportions infertile during the last 5 or 7 years, and the infertile open interval. The duration of breastfeeding is taken into account where necessary, and the contraceptive users and nonusers are compared where appropriate. Non-users tend to cease childbearing early, and therefore are infertile for longer periods during their marriages. It is probably age of the 1st child that influences decisions on future fertility. Among women aged 45-49 who married before age 20 and continued in their 1st marriage, mean age at last live birth in non-users, was 34.5 years, about 2 years earlier than in those who had used contraception. Non-users who married at any age below 30 years cease childbearing well below age 40. The proportion not currently pregnant and infertile over the past 5 years increases with marriage duration among the fertile non-users in each age group. When age at last birth and the duration of breastfeeding in the open interval are taken into account and the reference period is increased to 7 years, the period of infertility increases with marriage duration among nonpregnant non-users below age 45. The proportion of women who were currently not pregnant and had remained infertile over the past 7 years is higher among the older non-users whose 1st child was born more than 10 years ago.     

The changing pattern of contraception in Lahore, Pakistan: 1963-80

This paper attempts to test the dictum that social change begins in better educated, economically well-off and relatively less tradition-bound strata of the urban society and that it then spreads to the lower social strata and eventually affects the rural populations also. It analyzes temporal changes in the prevalence of contraception as reported by female respondents in 2 sample surveys conducted in the city of Lahore during 1963 and 1980. Altogether 1960 ever-married females aged over 15 were interviewed in the 1963 survey and 993 in the 1980 survey. Compared to 1980 respondents, those in the 1963 survey were older, educated and belonged to a medium or high socioeconomic status category. In 1963, 18% of the respondents were not aware of any method of contraception; by 1980 this proportion was reduced to 11%. The most spectacular change was observed in the prortion of respondents who were practising family planning. In 1963, only 7% of the respondents had ever used any method of contraception; this proportion increased to 48% in 1980. Moreover, substantial differences were noted with regard to the methods of contraception used. The use of condoms seems to have declined while that of the IUD the pill, sterilization and withdrawal seems to have increased. It is interesting that abstinence remained an important method of contraception. Use of contraception is found to vary with age, education and socioeconomic status of respondents. The degree of association between these 3 characteristics and contraceptive usage increased substantially from 1963 to 1980. 1980 survey results indicate that current as well as ever use of contraception show an inverted V-shaped pattern with age and parity. The prevalence of contraception increases with age, reaching a maximum of 41% for current users and 63% for ever users in the age group 35-39. A similar pattern is observed in relation to the parity of respondents with a maximum amongst women who had borne 6 children. Education shows a positive association with both the current and ever use of contraception. The pattern of current methods used is very similar to that noted for methods ever used. The only major differences relate to the condom and abstinence which show higher prevalence as current methods. In the 1963 survey religion was the main reason given by those expressing an unfavorable attitude toward family planning. In the 1980 survey questions were asked about the specific reasons of the respondents for never using any method of contraception. The desire for more children was the most commonly given reason and recent marriage was the 2nd most common. The strength of religious opposition to contraception seems to have declined substantially in the 1980 survey.     

The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh,Pakistan: A Multilevel Analysis

IntroductionRapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan’s national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior.MethodsIndividual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan.ResultsOnly 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use.ConclusionsQuality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty.