The impact of a family planning multimedia campaign in Bamako, Mali

An integrated multimedia campaign featuring family planning messages saturated the 900,000-person city of Bamako, Mali, for three months during the spring of 1993. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali, does not oppose family planning. A separate sample pretest-post-test quasi-experimental research design was used to evaluate the effects of the campaign and exposure to specific messages on changes in contraceptive knowledge, attitudes, and practice. Results indicate a high level of exposure to and agreement with the messages. A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project interventions, after controlling for relevant variables.     

Socioeconomic development, status of women, family planning, and fertility in Bangladesh: a district level analysis

In this paper we examine the effects of socioeconomic development, the status of women, and family planning on fertility and the extent to which these effects vary among the nineteen districts of Bangladesh. The 1983 and 1991 Bangladesh Contraceptive Prevalence Survey data are used to examine the effects of these factors on differences in contraceptive use among currently married women aged 15-49. The proportion of currently married women aged 15-49 using contraception was 46.3 per cent in 1991, a considerable increase from 26.5 per cent in 1983. Contraceptive use rates for all the districts increased substantially over the period between 1983 and 1991 and the gap between Dhaka's rate and those of other districts was narrower in 1991 than in 1983. An analytical model composed of socioeconomic development, status of women, and family planning variables is tested using logistic regression. The logit model is used to evaluate the effects of a selected group of variables on the probability of using contraceptive methods. The analysis demonstrates clearly that socioeconomic development and women's status significantly impact the use of contraceptive methods in Bangladesh. The results also suggest that better-educated, employed women are more likely to use contraception than those who have little or no formal education and who are not employed. In 1983, rural-urban differences in contraceptive use were significant, but in 1991 area of residence was not significant, which suggests that family planning programs may have played an important role in providing contraceptive information and technology to rural areas. Our analysis also suggests that family planning programs operated more efficiently in some districts than in others, and regional differences remained important in 1991 as they were in 1983. Decomposition analysis suggests that shifts in population structure favored increased contraceptive use in Bangladesh. This analysis also indicates that change in rate is also important, contributing about 21 per cent of the overall increase in contraceptive use.     

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.     

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.     

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.     

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.     

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.     

Hormonal male contraception: progress and prospects for the 21st century

During the second half of the 20th century, progress in developing novel, practical contraceptive methods for men has lagged significantly behind developments for women. Despite the lack of reliable, reversible methods, men throughout the world continue to be strongly involved in family planning but a greater involvement will require more attractive and reliable contraceptive options for men. The closest to fruition are hormonal methods the features of which are reviewed. Landmark WHO contraceptive efficacy studies have established that hormonally-induced azoospermia provides highly effective and reversible contraception for at least 12 months with minimal short-term side effects. Even among the small subgroup of men who remain oligozoospermic during hormonal suppression, good contraceptive efficacy is achieved. The present goals are to develop improved second generation hormonal regimens which provide more uniform azoospermia to obviate the need for monitoring of sperm output and to develop long-acting depot testosterone formulations used alone or with additional gonadotrophin suppressive agents such as progestins or GnRH antagonists. Significant obstacles to progress are the flight of industry from contraceptive R&D dur to the financial deterrent posed by the product liability crisis as well as the low priority accorded male reproductive health. Together those will determine whether the range of contraceptive options available to our children in the 21st century will improve, or whether the historically recent unbalanced increase in reliance on women for family planning will continue.     

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.     

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.     

The psychological well-being of women of Menoufiya, Egypt: Relationships with family planning.

Researchers surveyed the psychological well-being of 795 women of reproductive age from Menoufiya, Egypt. Five years earlier, these women had provided data relevant to their family planning behavior. This analysis links these data sets to investigate the impact of family planning on women's sense of well-being, within the context of beliefs about appropriate gender-related behaviors. Well-being measures are derived for trait and state dimensions. Use of family planning and number of children born within the preceding 5 years predicted state ratings of happiness, and number of children predicted anxious pride. Neither are related to any of the trait ratings. Further, 3 different gender-role attitudes are vital to the explanation of how women define and feel good about themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-method use among an ethnically diverse group of women at risk of HIV infection

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.     

The impact of the quality of family planning services on contraceptive use in Peru

Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p = .053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed.     

Attitudes of men towards family planning in Mbeya region, Tanzania: a rural-urban comparison of qualitative data

Family planning programmes in Tanzania date back to the 1950s. By the early 1990s, however, only 5-10% of women of childbearing age used contraceptives in the country. Low contraceptive prevalence in Tanzania is reportedly attributable to men's opposition to family planning. This paper employs focus groups to explore the role of Tanzanian men in family planning. More specifically, it presents a rural-urban comparison of the attitudes of men in Mbeya region, Tanzania, to family size preference, sex composition, partners' communication on family planning matters and contraceptive behavior. Findings indicate that men express positive attitudes towards fertility-regulating methods. There is, moreover, little rural-urban variation in male attitudes towards family planning in the study area. Possible reasons for this normative convergence (including structural similarities and rural-urban migration between the two communities) are discussed.     

Contraceptive knowledge, contraceptive use, and self-esteem among Navy personnel

This study evaluated the sexual knowledge (including contraceptive and reproductive knowledge), contraceptive use, and self-esteem among a sample of 158 male and female United States Navy sailors assigned to Navy ships. In spite of the fact that men and women viewed themselves as relatively knowledgeable with respect to contraception, results showed substantial knowledge deficits. Women demonstrated significantly greater sexual knowledge than men, and contraceptive/ reproductive knowledge was highly correlated with self-reported use of contraceptives. Finally, self-esteem was highly correlated with sexual knowledge and certain contraceptive use behaviors.     

The long-term demographic role of community-based family planning in rural Bangladesh

Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh-where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed.     

Contraceptive use and attitudes in Great Britain

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.     

Haiti: unions, fertility and the quest for survival

This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.     

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.     

Fertility and contraceptive practice: Bogota, 1964-74

The results of a 1974 survey of 6,692 Bogota women aged 15-49 conducted by the Colombian Association for Population Studies show that, in the last decade, approval of family planning practice increased 34 percent, contraceptive practice nearly doubled, and fertility declined by over 45 percent. Life-table analysis shows unusually high continuation rates for Bogota women. Data concerning crossovers between Bogota's three family planning programs and the commercial sector indicate that the manufacturers of contraceptives benefit from program activities. The study demonstrates, for the first time in Latin America, the feasibility of using a probability sample of the general female population to evaluate family planning programs.