The impact of outreach on the continuity of contraceptive use in rural Bangladesh

In 1978, the Bangladesh family planning program launched a national program of outreach services that continues to the present. Young married women were hired and trained to visit women in their homes, offer contraceptive services, provide information, and support sustained use over time. This report uses data from two rural districts to assess the effect of the household visitation program on the continuity of contraceptive use. Results of a multivariate analysis show that household outreach has had a pronounced net effect on the continuity of contraceptive use throughout the study period and that the magnitude of this effect has increased with time. This finding suggests that sustained contraceptive use continues to benefit from home-based outreach even after a decade of service encounters. Policy implications of this finding are discussed.     

Gender preference and birth spacing in Matlab, Bangladesh

Gender preference, particularly son preference, is believed to sustain high fertility in many Asian countries, but previous research shows unclear effects. We examine and compare gender-preference effects on fertility in two otherwise comparable populations in Bangladesh that differ markedly in their access to and use of contraception. We expect, and find, stronger effects of gender preference in the population that has more access to contraception and higher levels of contraceptive use. Thus gender preference may emerge as a significant barrier to further national family planning efforts in Bangladesh. We find that if a woman has at least one daughter, the risk of a subsequent birth is related negatively to the number of sons. Women with no daughters also experience a higher risk of having a subsequent birth; this finding suggests that there is also some preference for daughters. Son preference is strong in both the early and later stages of family formation, but women also want to have at least one daughter after having several sons.     

Uptake of contraception during postpartum amenorrhoea: understandings and preferences of poor, urban women in Bangladesh

In urban Bangladesh, as in many other settings, an immediate postpartum family planning strategy prevails, where providers seek to promote and provide contraception at 40-45 days following birth to women regardless of their breastfeeding or menstrual status. Despite such practices, the majority of women choose to delay the initiation of contraception until menses resumes, often several months after birth. The present paper seeks to explain this discrepancy by describing poor, urban women's understandings regarding the chances of conception and the risks associated with contraceptive use in the postpartum period. Findings from in-depth interviews reveal that the majority of women perceive no personal risk of pregnancy during amenorrhoea, though most do not recognise an association between this diminished risk of conception and breastfeeding. In addition, the data illustrate that women are primarily concerned with their own and their newly born child's health and well-being in the period following childbirth, both of which are perceived to be extremely vulnerable. These perceptions, plus an understanding that modern methods of contraception are "strong" and potentially damaging to the health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, particularly during postpartum amenorrhoea. The paper advocates that, since breastfeeding affords good protection against pregnancy for six to nine months following birth, efforts should be made to actively incorporate lactational amenorrhoea into postpartum family planning strategies in Bangladesh. Recommendations are also made for ways in which women may be encouraged to adopt contraception during amenorrhoea beyond the period of high natural protection. The paper highlights the importance of taking the client's perspective into consideration in attempts to improve the quality and effectiveness of family planning programmes.     

Factors underlying unmet need for family planning in the Philippines

The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.     

Mena, a relative of VASP and Drosophila Enabled, is implicated in the control of microfilament dynamics

This paper examines the effects of exposure to mass media messages promoting family planning on the reproductive behaviour of married women in Nigeria using cross-sectional data. Longitudinal data are also used to ensure that exposure to media messages pre-dates the indicators of reproductive behaviour. Cross-sectional analysis suggests that: (1) contraceptive use and intention are positively associated with exposure to mass media messages, and (2) women who are exposed to media messages are more likely to desire fewer children than those who are not exposed to such messages. Similarly, analysis of the longitudinal data shows that exposure to mass media messages is a significant predictor of contraceptive use. Thus, exposure to mass media messages about family planning may be a powerful tool for influencing reproductive behaviour in Nigeria.     

Covert contraceptive use: prevalence, motivations, and consequences

This article examines women's covert use of contraceptives, that is, their use of a method without their husbands' knowledge. Three questions are addressed: (1) How is covert use measured? (2) How prevalent is it? and (3) What are the factors underlying covert use? Existing studies are used together with survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and their husbands. Women's covert use of contraceptives is estimated to account for 6 to 20 percent of all current contraceptive use, and it is more widespread when contraceptive prevalence is low. The multivariate analysis indicates that difficult spousal communication about contraception is the strongest determinant of covert use. Husbands' disapproval of contraception works through spousal communication rather than as a direct influence on covert use. Husbands' pronatalism had no significant effect. The article concludes with implications of covert use for reproductive health and family planning programs, especially women's (and men's) needs for confidential services.     

Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

OBJECTIVES: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy. DESIGN: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents. SETTING: Postnatal wards of Harare Maternity Hospital. SUBJECTS: 923 mothers following delivery. MAIN OUTCOME MEASURES: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge. RESULTS: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy. CONCLUSION: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.     

Contraception in Spain

This report analyzes various aspects of contraception in Spain. One notable finding is the wide socioeconomic, cultural and health variation among regions. Since 1975 a significant drop in the birth rate has been observed overall. Twenty per cent of the women studied at risk of pregnancy are using oral contraceptives. The most widespread contraceptive method is still coitus interruptus, followed by oral contraception and the condom, as well as the rhythm method. The highest use of oral contraceptive and IUDs is seen in Catalonia (20% and 26% respectively) followed by Andalusia, Madrid and Valencia. Although contraception has only recently become legal in Spain, it is widely available either without charge or very inexpensively; all methods including abortion are available. At present, priority is given to special interest groups such as women in special circumstances, teenagers, etc. and to special programs like "Integrated Care for Women" which includes contraception, STD, pregnancy monitoring, early diagnosis of gynaecologic cancer and menopause.     

The determinants of IUD discontinuation in China: a discrete-time competing risk model analysis

This research examines the social, demographic, and family-planning-program factors that influence the occurrence of IUD discontinuation among Chinese women, using a sample of 14,639 IUD use segments from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence. A discrete-time competing-risk event history method is employed to identify the determinants of IUD discontinuation by five kinds of reasons: contraceptive failure, expulsion, switching method, side-effects and other nonmethod-related reasons. The predictors of IUD discontinuation suggest that a number of mechanisms are in operation. Some of the determinants may reflect the effects of the family planning program; some may illustrate women's physiological and biological reactions to IUD's; some may be related to women's previous history of contraceptive use; and still others may indicate social characteristics of women that lead them to have their IUD's removed.     

Hepatitis C--role of perinatal transmission

Increasing family planning acceptance and efficacy is considered a key public health issue in many Pacific island nations. To assess the structure of family planning acceptance in Samoa, structured interviews were conducted with 155 reproductive age women from seven villages in both rural and urban settings. The survey data show accord with returns on contraceptive use from Samoan clinics, and demonstrate that awareness and use of contraception have increased markedly in the previous decade but desired family size remains high in younger women. A notable feature of the Samoan women's contraceptive experience is the lack of diversity of reported contraceptive behaviours and attitudes based on age, urban versus rural residence, and education.     

Economic security, informational resources, and women's reproductive choices in urban Mozambique

Reproductive changes in sub-Saharan Africa are contingent upon women's socioeconomic conditions and informational and cultural resources. This study focuses on socioeconomic and cultural determinants and correlates of the intention to stop childbearing and of contraceptive use among urban women in Mozambique. It uses data from a survey of 1,585 married women conducted in Greater Maputo in 1993, and it employs logistic regression for multivariate analysis. The results of the analysis indicate that although the stopping intention and contraceptive use are interrelated and similarly affected by such factors as education or the area of residence, the intention to stop childbearing is mainly driven by women's perception of their material conditions and socioeconomic security, while contraceptive use is largely a product of social diffusion and the legitimization of innovative, Western-origin information and technologies. The study proposes that these findings may help explain the unique features of the fertility transition in sub-Saharan Africa.     

Why gender is a barrier to contraception advice

In the UK, the Contraceptive Education Service is attempting to place contraception services on the health care agenda for all health providers dealing with heterosexual and bisexual men. Contraceptive education can prompt men to take more responsibility for contraception. Recent surveys indicate that the taking of sexual histories varies not only from clinic to clinic but also among various practitioners working in the same clinic. An observational study revealed that contraceptive information was not displayed in a third of general practitioners' offices and 10% of family planning and sexual health clinics. While good reasons may exist for keeping the information under the counter, clients have expressed a desire for printed information that they can take home to read. Sexual health clinics (formerly called "genito-urinary" clinics) are being targeted as one of the best places to reach sexually active men. Currently inequalities exist between what female and male patients are asked. For example, men are not asked how many unwanted pregnancies they have caused. Nurses have a special role in health education because they are perceived to be more approachable than physicians. While nurses discuss condom use whenever they have the opportunity, most feel that schools are the best place for sexual health education. The nurses also felt that, whereas most men have no need for information about oral contraceptive usage, information on emergency contraception may prove valuable. One clinic is using new forms to take sexual histories and prompt providers to cover topics such as safer sex and risk reduction.     

Contraception: traditional and religious attitudes

Humans have tried to control fertility for centuries. Primitive, preliterate societies practiced infanticide and abortion. When primitive women understood the advantages of conception control, they tried, when possible, to use contraception. In the 4th century B.C., Plato and Aristotle advocated a one-child family. Greek medical literature reported a hollow tube inserted through the cervix into the uterus and a potion as contraceptives. Islamic physicians had much knowledge about conception control. The attitudes toward contraception. In the 5th century B.C., Saint Augustine condemned contraception, even among married couples. The condom emerged in the early modern period. Yet, they were usually worn to protect against disease, e.g., bilharzia in Egypt and syphilis in Europe. The cervical cap and the diaphragm are examples of occlusive pessaries. By 1880, contraceptives and spermicides were advertised. In 1928, the IUD joined the existing contraceptives. Today we have combined oral contraceptives. Judaic law requires husbands to fulfill their wives sexual needs, separate from their duty to procreate. It also calls men, not women, to procreate and forbids men from masturbating, thus Judaic law does not forbid women from practicing contraception. The Roman Catholic church forbids contraceptive use because it is a sin against nature. Some Protestant denominations have allowed contraceptive use. Islamic law states that children are gifts from Allah. Some Moslems believe that they must have many children, but Allah and the Prophet state that children have rights to education and future security. These rights allow couples to prevent pregnancy. Neither Hinduism nor Buddhism prohibit contraceptive use. Differences in husband-wife communication, sex roles, access to contraceptives, and traditional family values will have more of an effect on contraceptive use and fertility than theological barriers or the social class of religious groups.     

MRI of the gastrointestinal tract

To test whether the effects of marital status on health differ between never married women and divorced and separated women, this study utilizes prospective panel data for a large national sample of non-institutionalized young women in the U.S. (the National Longitudinal Surveys of Young Women). The women were aged 24-34 at the beginning of two successive five-year follow-up intervals (1978-1983 and 1983-1988). The health effects of marital status were evaluated in regressions which assessed the relationships between initial marital status and subsequent health trends in each follow-up interval. In the first follow-up interval, never married women tended to have worse health trends than divorced and separated women for physical impairments and for overall health problems. However, there were no differences between never married women and divorced and separated women in health trends for psychosomatic symptoms in either follow-up interval or for any health measure in the second follow-up interval. Our analyses of cross-sectional data showed few significant differences in health between never married women and divorced and separated women. Taken together, the evidence from our study and previous studies suggests that differences between never married women and divorced and separated women may vary by age and/or cohort. Evidence for the 1970s and 1980s suggests that, among older women, divorced and separated women may have experienced more harmful health effects than never married women; however, among younger women, this difference may have been absent or possibly reversed.     

Awareness of language in children who have reading difficulties: historical comparisons in a longitudinal study

The purpose of this study was to assess factors associated with the use of family planning at first sexual intercourse among young adults aged 15 to 24 in urban Ecuador. The study population consisted of 1443 young adults (494 females and 949 males) in the cities of Quito and Guayaquil, interviewed by the 1988 Ecuador Young Adult Reproductive Health Survey, who reported having experienced consensual sexual intercourse. Approximately 11% of females and 15% of males reported using contraception at first intercourse. Binary logistic regression was performed to assess jointly the effect of multiple factors on contraceptive use at first intercourse. The regression model was first run on the entire study population and then separately for males and females. In the overall population, the following variables were significantly related to using family planning at first sex: being male; being from Guayaquil; older age; father's completion of secondary school. Having lost one's virginity to a prostitute was significantly associated with non-use of family planning. Males were 3.6 times more likely than females to use family planning during their first sexual intercourse. For each year older a young adult was at first sex, his or her odds of using family planning was multiplied by a factor of 1.3. Twenty-eight per cent of males in this study experienced their first sexual intercourse with a prostitute, and these young men were highly unlikely to use family planning. A male who experienced first intercourse with his girlfriend was more than five times as likely to use contraception than a male who lost his virginity to a prostitute.     

Ovarian volume in gynecologically healthy women using no contraception, or using IUD or oral contraception

OBJECTIVE: The aim of this study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using intrauterine contraceptive device, or using oral contraceptive. MATERIALS AND METHOD: The study had a cross-sectional design. The ovaries of 428 women aged 1445 who contacted the family planning clinic in the county of Funen were examined. Most of the statistical analyses were carried out using standard techniques. However polynominal regression analysis was used to model ovarian volumes as a function of the day of cycle. RESULTS: No differences between the volumes of the right and the left ovary were found in any of the groups. Significant differences were found between the ovarian volumes of the three groups. The ovarian volumes were found to be largest in women using intrauterine contraceptive device, lesser in women using no contraception and smallest in women using oral contraception. A significant difference was found of the ovarian volumes throughout the menstrual cycle in women who were not using oral contraception. The ovarian volumes did not change throughout the menstrual cycle in women using oral contraception. In women not using oral contraception the largest ovary increased in volume from the start of the cycle to day 19, thereafter the volume declined. No evidence of any change of volume over the menstrual cycle was found in the smallest ovary and, for women using oral contraception, both ovaries. There was no correlation between age, height, weight, parity, and ovarian volume in any of the groups. CONCLUSION: The ovarian volumes, in gynecologically healthy women using intrauterine contraceptive device, are larger than in women using no contraception. It appears that oral contraception reduces the volumes of both ovaries in all phases of the menstrual cycle to equal levels.     

Family planning knowledge, attitudes and practices in women with schizophrenic spectrum disorders

This study set out to test three hypotheses about family planning in women with schizophrenic spectrum disorders, as compared to demographically comparable non-mentally ill control women: that they (1) report at least as much unprotected intercourse while not desiring pregnancy; (2) have less knowledge about contraception; and (3) perceive more, and different, obstacles to obtaining or using birth control. A semistructured Family Planning Interview was administered to subjects (n = 44) with Research Diagnostic Criteria diagnoses of schizophrenia and schizoaffective disorder, and to non-mentally ill control subjects (n = 50). The participants had high rates of unprotected intercourse, as did non-mentally ill controls. They had significantly less reproductive and contraceptive knowledge than the control subjects, and were more likely to perceive birth control as difficult to obtain. The most common reason women with schizophrenic spectrum disorders gave for failing to use birth control was that they did not expect to have sex, while that given by non-mentally ill subjects related to side-effects of birth control. Important obstacles to family planning in women with schizophrenic spectrum disorders include relative lack of knowledge and difficulty planning ahead. Although many women with schizophrenia could benefit from long-acting, reversible contraception, many may be unaware of those options and/or may find them difficult to obtain. Integrating family planning with mental health care might better address the unique needs of this population.     

Influence of son preference on the contraceptive use and fertility of Sri Lankan women

The effect of moderate son preference on family size is analysed using data from the 1982 Sri Lanka Contraceptive Prevalence Survey whose respondents were followed-up in the 1985 Sri Lanka Contraceptive Survey. Reported reproductive intentions on desire for additional children were not always reflected in overall contraceptive use. Complicating factors were the use of modern and traditional methods and the role of induced abortion. Longitudinal observations of the 1982-85 period relating women's individual reproductive behaviour to their intentions show no consistent behavioural difference between those with and without sons. However, at any given parity, the proportion reporting at least one additional child born during the intersurvey period was higher among those women who intended to have at least one additional child than among those who wanted to stop childbearing. This analysis suggests that son preference finds expression more through reproductive intentions than through actual fertility behaviour in the follow-up period.     

Iron supplementation during pregnancy. Standards and alternatives]

CONTEXT: Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. METHODS: A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. RESULTS: Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. CONCLUSIONS: Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.