Spousal communication and contraceptive use among the Yoruba of Nigeria

A noted feature of many less developed societies is that marital partnershardly discuss reproductive issues with the result that decisions on theseissues are usually taken by men and their kinsmen. Because of lack ofspousal communication, negotiation for individual reproductive preferenceshas been limited. Thus, the reproductive preferences of men who desirelarger family sizes and oppose contraceptive use have usually been foundto prevail. The need to encourage husband-wife communication aboutreproductive issues cannot be overemphasized. The present study examinesthe level of spousal communication and its impact on contraceptive useamong Yoruba couples in southwest Nigeria. Data for the study are obtainedfrom a survey on the Role of Men in Family Planning conducted in one of thestates inhabited by the Yoruba of Nigeria – Ondo. The sample for this study consists of 381 monogamously married couples. Multivariate analyses were used to determine the impact of background variables on dependent variables. The study shows that fairly high percentages of men and women perceive that decisions on reproductive issues are taken jointly by both partners. The significantly high proportion of women who perceive that they participate in decision making is particularly worth noting and is an indication that women's voices are heard in the study society. Although the impact decreases on controlling for other variables, spousal communication was found to affect contraceptive use: contraceptive is higher among marital partners who discuss and take joint decisions on contraception. The study also reveals that family planning counseling has a significant impact on contraceptive use.     

Measurement issues involved in examining contraceptive use among young single women

The objective of this study was to determine how research findings on contraceptive use among young single women are affected by differing operational definitions of contraceptive use. Data were analyzed from a student sample and a clinic sample. In the analysis of the student sample were 244 high school and college women aged 16–22 who had experienced sexual intercourse. In the birth control clinic sample were 432 women aged 13–20. Six operational definitions of contraceptive use were analyzed. Correlation and multiple regression analyses were used to examine the relationship of predictor variables with the six definitions separately for each sample. The variance explained for each of the contraceptive measures ranged from 8 percent to 44 percent in the student sample and from 9 percent to 24 percent in the clinic sample.     

Sexual activity and weekly contraceptive use among young adult women in Michigan

Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women’s partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.     

Upholding the freedom of couples to use a method of their choice

A recent review of the Philippine Population Program's 5-year plan, ended in December 1982, showed that in 1980, natural family planning (NFP) users were only about 12.5% of couples practicing family planning. This figure doubled by 1982. Based on these responses the decision was made to intensify the NFP program as early as 1982. The 1st step was to put more money into the NFP program. The program includes the modern scientific techniques such as cervical mucus, basal body temperature, and sympto-thermal. The program also will fund the training of doctors and other clinic personnel and the production and distribution of appropriate training and information material. Other family planning methods, such as sterilization, oral contraception (OC) and the condom, also will be promoted. Promotion of NFP will depend on the choice of the family planning practitioners themselves. The program's community based services are being intensified. NFP, together with the other family planning methods such as sterilization and OC, will always be made available to couples in the community based services. All agencies in the population and family planning program will be promoting NFP. Knights of Columbus doctors have been invited to assist the program and share their own training modules for the training of trainers. An agreement has been entered into with the Gabriel M. Reyes Memorial Foundation based in Aklan. The goal is for trainers who need further knowledge and skills in NFP to learn from the foundation's wealth of organized orientation and training techniques in NFP. NFP is emphasized at this time because it is acceptable to a great number of couples.     

Risk-taking and contraceptive behavior among unmarried college students

The contraceptive behavior of sexually active, never-married college women was examined using multiple regression analyses. Use of an effective method of contraception was highly situation-specific: length of relationship and frequency of intercourse were the variables most highly correlated with use of effective contraception, followed by method of contraception used at first coitus and knowledge of reproduction. Failure to use effective contraception was not associated with low estimates of pregnancy risk, nor with high utility of pregnancy, nor with uniquely high willingness to seek abortion. The results of the present study suggest that use or non-use of effective contraception is mediated by the predictability of sexual intercourse.We would like to thank Ira H. Bernstein for his assistance with computer programming and data analysis. Reprints are available from Ms. Irene Steeger, Center for Population and Family Health, Columbia Unviersity, New York.     

Trends and determinants of contraceptive use in Kenya

This study uses the 1977-1978 Kenya Fertility Survey and the 1989 Kenya Demographic and Health Survey to examine trends and determinants of contraceptive use in Kenya. A substantial increase in contraceptive use occurred in Kenya over the decade. Yet although the increase was shared by all groups in the country, the amount of change differed greatly. A regression decomposition procedure revealed that shifts in population composition--that is, an increase in better educated women and in the proportion of women who want to cease childbearing--were the primary sources of aggregate change in contraceptive use.     

A meta-analysis of research on adolescent contraceptive use

Meta-analysis was used to summarize the results of 134 studies of adolescent contraceptive use in relation to two major explanatory models, the career model and the decision model. There was evidence in support of both models, although there has been less research conducted on variables related to the decision model. The major variables found to affect young women's contraceptive use were partner influence to use contraception, acceptance of one's sexuality, future orientation, positive attitudes toward contraception, an exclusive sexual relationship, and frequency of intercourse. The major variables affecting young men's contraceptive use were partner influence, frequency of intercourse, and positive attitudes toward contraception; however, there was relatively little research on young men compared to young women. A number of possible future directions for research are noted.We would like to thank Nancy Adler and Catherine Chilman for their comments on an earlier version of this article. Portions of this research were presented at the 1984 meeting of the American Psychological Association.Requests for reprints should be addressed to Bernard E. Whitley, Jr., Department of Psychological Science, Ball State University, Muncie, Indiana, 47306.     

Marital relations and fertility control decisions among lebanese couples

This study examines how marital relations affect fertility control decisions among couples who want no further pregnancies. Marital relations studied include the degree of communication between husbands and wives, the extent that couples report marital tension, conflict, and separation, and the amount of intimacy and mutuality achieved in their sexual relations. Findings are based upon the responses of 530 Middle Eastern women who used the facilities of the University Hospital Family Planning Program of the American University of Beirut, Lebanon; 257 women were interviewed in their homes throughout Lebanon, and the remaining 273 were interviewed at the clinic. Three decisions were studied: (1) IUD/pill use; (2) tubal sterilization use; and (3) consideration of and refusal to use tubal sterilization. Women were interviewed using a standardized questionnaire prepared in colloquial Arabic. The decision to choose a reversible versus a permanent method was primarily sociodemographically determined. Among women who considered a permanent method, however, differences in their decisions were mainly attributable to their marital relations rather than to their demographic characteristics. Wife's attitude toward marriage and educational attainment were important and interactive components in the explanation of the association between marital relations and tubal sterilization use.I appreciate the assistance and critical comments offered by Drs. Joseph Veroff and George Simmons of the University of Michigan, and Dr. Joseph Chamie of Population Division, UN, New York. This article is a modified section of my doctoral dissertation which was recently completed at the University of Michigan. The anonymous reviewers' comments on the organization of this paper are greatly appreciated.     

Gender role equity and marital satisfaction among Korean couples

This study examines gender role behaviors and attitudes related to marital satisfaction. Nontraditional attitudes and behaviors are expected to affect negatively marital satisfaction due to the lack of guidelines and due to the other positive alternatives to marital roles. DAta, collected from a survey of 291 married couples in Seoul, Korea in 1991, largely support the hypotheses, which are fairly consistent with the results of studies of American couples. Nontraditional gender role attitudes and wife's employment are related to lower marital satisfaction. However, the housekeeper role has changed somewhat more than the male provider role, so that nontraditional tendencies, in attitudes and behaviors, with respect to the housekeeper role have been related to higher marital satisfaction. Findings of this study show that measures of actual division of household labor are better related to marital satisfaction than are measures of perceived division of household labor. The consistent trends in marital satisfaction in Korea compared with those in the US suggest a further high marital instability in Korea.     

Social security reforms and poverty among older dual-earner couples

Existing retirement studies have, in the main, focused only on labor supply decisions of couples in which the husband has been the sole earner. This paper extends the focus of analysis to examine retirement among dual-earner couples. It further develops a framework for assessing how several past and prospective Social Security reforms might be expected to affect older working couples' retirement ages and retirement incomes. Two questions are addressed in some detail: (1) What are the likely effects of various changes in Social Security rules on the retirement decisions of older working women and their husbands? and (2) How might these changes alter the incidence of poverty among retired dual-earner couples? Empirical evidence from the United States suggests that many benefit reforms currently being discussed in policy circles will enhance Social Security system revenues, but will also worsen the economic status of an important segment of dual-earner couples.     

Changes in motivation for parenthood among young married couples

The perceived satisfactions, costs, and overall motivation associated with having a first or second child was assessed at two time points for 507 married couples. Motivation associated with parenthood varied systematically over time and was influenced by attainment of cultural fertility norms and the impact of a birth. Among those who experienced a birth between Times 1 and 2, couples who already had a child showed a much greater drop in motivation for a future child than did initially childless couples. Husbands perceived lower costs associated with an additional child than did wives.This research was supported by NICHD Center for Population Research Contract No. HD 52807 and Research Scientist Development Award No. AA00002 from NIAAA to the author. The important contributions of Philip Bardsley to this research and to earlier drafts of this paper are gratefully acknowledged. Thanks are also due to Tom Day and Linda Moody Chilingar for their data analytic and statistical skills and to Cathey Heron for her assistance throughout the course of this project.     

Secrecy and silence: why women hide contraceptive use

A recent Population Council survey of 1860 married women and 1056 of their husbands in urban Zambia found that many women who use contraception do so without their husbands' knowledge and that those women who hid their practice of contraception from their husbands did so because they found it very difficult to bring up the subject of family planning with them. These findings indicate that low levels of contraceptive use are not the result of a simple communication matter. Sex and sexuality are often the exclusive domain of African husbands. As such, if a wife initiates a discussion of family planning, she may threaten her husband's sense of control and create discord within the family. The culture of silence about sex and sexuality is very strong in Africa. 57% of women stated that were they to propose contraceptive use with their husbands and the husband opposed such practice, they would nonetheless use them without his knowledge. 7% of the women stated that if their husbands disapproved of contraceptive use, they would nonetheless openly use a method against his wishes. The majority of women correctly perceived their husbands' views on family planning use and fertility preferences. In focus groups, both men and women said that they did not believe that women have the right to independently act upon their reproductive preferences. A husband's inadequate financial support of his children could, however, justify clandestine contraceptive use. These findings point to the need to include easily hidden methods in the mix of contraceptives family planning programs offer. Moreover, service providers should not automatically encourage husbands' involvement. A client's right to privacy should always be respected.     

Strength of fertility motivation and contraceptive use in Nepal

The study's purpose was to test whether new survey questions on strength of fertility motivation, included in Nepal's 1986 Fertility and Family Planning Survey, enable improved prediction of current contraceptive use. Intent to use contraception in the future was also tested, over and above the effects of socioeconomic background. While controlling selected demographic and socioeconomic background characteristics of the respondents, the authors found the effect of the strength of fertility motivation on current contraceptive use to be substantial and highly significant statistically. Nevertheless, the background factors largely captured the effect of motivational strength on current use when motivational strength was deleted from the model, inasmuch as measures of global fit declined only slightly as a consequence of the deletion. These findings indicate that respondents' demographic and socioeconomic background characteristics affect motivational strength, so that motivational strength does not have a large independent effect on use. These results raise the question of whether strength of fertility motivation can be affected by educational efforts mounted by family planning programs to increase contraceptive use. The analysis shows that strength of motivation does have some independent effect on contraceptive use, and it is quite possible that this independent effect could be enhanced by educational programs operating independently of the socioeconomic characteristics of program recipients. Because the 1986 survey lacks relevant data, we have not been able to explore this possibility empirically.     

Quality, accessibility, and contraceptive use in rural tanzania

We examine how informants' reports on community perceptions of the quality and accessibility of family planning facilities relate to the use of modern contraceptives by individuals in rural Tanzania. Using information on individual-level contraceptive use in conjunction with community-level information on the accessibility and quality of family planning facilities, we employ two distinct statistical procedures to illustrate the impacts of accessibility and quality on contraceptive use. Both procedures treat the community-level variables as imperfect indicators of characteristics of the facilities, and they yield nearly identical implications. We find that a community-level, subjective perception of a family planning facility's quality has a significant impact on community members' contraceptive use whereas other community measures such as time, distance, and subjective perception of accessibility have trivial and insignificant direct impacts, net of the control variables. Future research that uncovers the determinants of perceptions of both community-level and individual-level quality could provide key insights for developing effective and efficient family planning programs.     

A methodology for identifying married couples in medicare data: Mortality, morbidity, and health care use among the married elderly

Wedescribe a method for the development of cohorts of up to three quarters of the 14 million married couples aged 65 and over in the United States. The health care experiences, illness histories, and mortality of these identified couples can be assessed longitudinally using Medicare data. We summarize strengths and limitations of using data from Medicare administrative records for the study of marriage, health, and aging. We illustrate the method by demonstrating substantial differences in survival in a cohort of hospice patients as a function of not only the patient's own diagnosis and illness burden but also the patient's spouse's illness burden.     

Analysis of oral contraceptive use through multiple decrement life table techniques

Multiple decrement life table technique is used to analyze the oral contraceptive use in a sample of once married women in Metropolitan Toronto. The overall pattern in the Canadian data is found to be essentially similar to that found in the U. S. Continuation rates show differences by cause of decrement. Two types of rates, net and absolute, are presented, and the relationship between single decrement continuation rates and total continuation rates is examined. Some problems of clinical versus retrospective sample survey data in studies of contraceptive effectiveness are commented on.     

Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

IntroductionThe use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options — such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management — are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.ObjectiveThis research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.MethodsParticipants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.ResultsThe fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.ConclusionPregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.