Expanding contraceptive choice: findings from Zambia

The Population Council's Expanding Contraceptive Choice program works to increase the contraceptive options available to women and men in developing countries. To achieve this goal, the Council is pursuing a new approach, one which begins with an assessment of contraceptive needs from which recommendations for upgrading contraceptive services are based. This new approach was tested in four countries including Zambia in which Stage I--contraceptive needs assessment--was completed. Results of the assessment indicated that despite the efforts of the national family planning program, 33% of Zambian women who do not want to get pregnant do not practice contraception. Only 9% of women use a modern contraceptive method. These results suggest that there is a need for introducing new contraceptive technologies and for expanding utilization of existing methods in the country. Also, stage I assessment yielded other positive outcomes which are enumerated in this paper. In response to this report, the Zambian government decided to proceed with stage II research on the viability of introducing new and underutilized contraceptive methods into the national family planning program.     

Racial differences in contraceptive choice: Complexity and implications

Previous research has failed to generate consensus about why black fertility has persistently exceeded that of whites in the United States. In an effort to shed light on this question, this article examines black/white differences in sociodemographic factors affecting contraceptive choice. Using data from the 1976 and 1982 National Surveys of Family Growth, we find a complex pattern of black/white differences. Not only does contraceptive choice vary by race, but the effects of such variables as age, marital status, and education also differ between blacks and whites. For example, compared with whites, black married women avoid coital methods, and compared with blacks, white women shift contraceptive behavior more as they change marital status. The complex nature of the racial differences in contraceptive choice are interpreted as reflecting differences in marriage patterns and trends.     

Community and contraceptive choice in rural Thailand: A case study of Nang Rong

This paper blends quantitative with qualitative data in an investigation of community and contraceptive choice in Nang Rong, Thailand. Specifically, it develops an explanation of 1) method dominance within villages, coupled with 2) marked differences between villages in the popularity of particular methods. The quantitative analysis demonstrates the importance of village location and placement of family planning services for patterns of contraceptive choice. The qualitative data provide a complementary perspective, emphasizing the importance of social as well as physical space and giving particular attention to the structure of conversational networks.     

Adding choice to the contraceptive mix: lessons from Indonesia

Researchers asked 1945 women of reproductive age living in East Java, Indonesia what contraceptive method they preferred during the women's 1st visit to a government family planning clinic. Soon after field workers introduced them to a method, the researchers asked the women what method the field workers suggested and what method the women planned to use. They again spoke to them 1 year later to determine contraception continuation. The field workers granted 86.3% of the women their method choice. Only 9% of these women had stopped using their chosen method while 72% of the women who were not allowed to use their chosen method stopped using the method assigned to them. Thus choice was a key factor in sustained use of contraceptives. Further if family planning workers stick to a mutual participation of both themselves and their clients, they respect clients' method choices and, by informing clients about the chosen method, they strengthen clients' decision making. In the early 1990s, another researcher had developed a system to determine contraceptive needs at various stages of the reproductive period (before 1st marriage, after 1st marriage but prior to 1st birth, after 1st birth but prior to last birth, and after last birth). She applied observed contraceptive preferences for women using contraception within each life cycle stage to the age specific contraception need, derived from data from the 1987 Contraceptive Prevalence Survey for Indonesia, to determine the ideal contraceptive mix. Her calculations demonstrated that oral contraceptive use was high, IUD use was low, particularly among older women, and too few sterilizations had occurred, particularly among older women. Thus Indonesia needed to broaden the contraceptive mix to encourage methods that better meet women's reproductive life cycle needs.     

Positive and negative affect: A maximum-likelihood approach

Using the LISREL maximum-likelihood program, the relation between Bradburn's positive affect and negative affect scales is examined for three age groups of adults. It is found that (a) unequal item loadings fit significantly better than equal item loadings; (b) the best-fitting loadings for the elderly are significantly different from those of the non-elderly; (c) the positive and negative affect scales are substantially correlated and (d) correlations with related variables are stronger when positive and negative affect scales are formed by maximum-likelihood loadings rather than by unit loadings. Given the widespread use of Bradburn's scales, implications of these results for subjective well-being are discussed.     

Impact of having a high-risk pregnancy on future postpartum contraceptive method choice

BackgroundTo compare the knowledge and preference of preconceptional contraception to future postpartum contraceptive method choice in high-risk pregnancies.Research questionDoes a high-risk pregnancy condition affect future postpartum contraceptive method choice?MethodWomen hospitalised at the High Risk Pregnancy unit of a tertiary research and training hospital were asked to complete a self-reported questionnaire that included demographic characteristics, presence of unintended pregnancy, contraceptive method of choice before the current pregnancy, plans for contraceptive use following delivery and requests for any contraceptive counselling in the postpartum period.FindingsA total of 655 pregnant women were recruited. The mean age, gravidity and parity of the women were 27.48 ± 6.25 years, 2.81 ± 2.15 and 1.40 ± 1.77, respectively. High-risk pregnancy indications included 207 (31.6%) maternal, 396 (60.5%) foetal and 52 (7.9%) uterine factors. All postpartum contraceptive choices except for combined oral contraceptives (COCs) usage were significantly different from preconceptional contraceptive preferences (p < 0.001). High-risk pregnancy indications, future child bearing, ideal number of children, income and education levels were the most important factors influencing postpartum contraceptive choices. While the leading contraceptive method in the postpartum period was long-acting reversible contraceptive methods (non-hormonal copper intrauterine device Cu-IUD, the levonorgestrel-releasing intrauterine system (LNG-IUS) (40%), the least preferred method was COCs use (5.2%) and preference of COCs use showed no difference between the preconceptional and postpartum periods (p = 0.202). Overall 73.7% of the women wanted to receive contraceptive counselling before their discharge.ConclusionA high-risk pregnancy condition may change the opinion and preference of contraceptive use, and also seems to affect the awareness of family planning methods.     

Appropriate methods for analyzing the effect of method choice on contraceptive discontinuation

The contraceptive method chosen is an important determinant of contraceptive discontinuation. However, method choice is endogenous to contraceptive discontinuation. Using data from the 1997 Indonesia Demographic and Health Survey, we apply a multilevel multi-process model to examine the impact of method choice on three types of contraceptive discontinuation. We confirm that method choice is endogenous to the processes of contraceptive abandonment and method switching, but not failure. Ignoring the endogeneity of contraceptive choice leads to various biases in the magnitude of estimated effects of method choice on abandonment and method switching, but the general conclusions are robust to these biases.     

The legacies of context: Past and present influences on contraceptive choice in Nang Rong,Thailand

This study explores the ways in which women's contraceptive behavior in a rural area of Thailand is shaped by both past and present context, based on the life course framework. Although the importance of contextual influences for contraceptive behavior is well established in the literature, relatively little research has been conducted that explores how behavior is influenced by historical and contemporaneous contextual factors and by individual life experiences. In addition, much of this research has neglected the role of the normative environment within which contraceptive use takes place. The focus of this paper centers on the effect of contraceptive environment at both early and late stages of the life course and on how this effect is shaped by individual experience with migration to urban areas. This study takes advantage of a unique, prospective longitudinal data set with detailed information on community context at multiple points in time, an important improvement upon prior research. The results show that contraceptive behavior is particularly responsive to current community context, with past context primarily exerting an indirect effect on behavior through shaping current contextual influences.     

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.     

HIV and population dynamics: A general model and maximum-likelihood standards for East Africa

In high-prevalence populations, the HIV epidemic undermines the validity of past empirical models and related demographic techniques. A parsimonious model of HIV and population dynamics is presented here and fit to 46,000 observations, gathered from 11 East African populations. The fitted model simulates HIV and population dynamics with standard demographic inputs and only two additional parameters for the onset and scale of the epidemic. The underestimation of the general prevalence of HIV in samples of pregnant women and the fertility impact of HIV are examples of the dynamic interactions that demographic models must reproduce and are shown here to increase over time even with constant prevalence levels. As a result, the impact of HIV on population growth appears to have been underestimated by current population projections that ignore this dynamic.     

The abortion decision: A qualitative choice approach

Using data from the National Longitudinal Survey, Youth Cohort, logistic regression models are estimated to show the impact of various sociodemographic and economic factors on the abortion decision for 1867 pregnancies occurring between 1983 and 1985 in the data set. The results suggest a profile of a woman choosing the abortion decision as being White, unmarried, residing in the Northeast or West, relatively well-educated, and either in-school or working. Additionally, the female is likely to have a relatively high person income and, if present, a relatively low spousal income. Being Baptist or Catholic appears to have no significant influence on the abortion decision, and the same is true for Baptists and Catholics who are religious (attend church more than two times per month). The degree of religiosity is a predictor of abortion outcome, irrespective of religious affiliation. Finally, it is found that for low income women, access to Medicaid funding does significantly increase the probability of choosing the abortion option.     

Community-level determinants of contraceptive use in the Philippines: A structural analysis

We use household and community data from the Philippines to estimate a multilevel model of contraceptive use. We go beyond previous efforts in this field by developing a structural model that recognizes joint endogeneity and the temporal ordering of variables, by considering a wider range of community influences on fertility behavior, and by employing an econometric procedure allowing for a multilevel error structure. The results suggest that there are significant effects on fertility behavior of community-level family planning services, labor-market conditions, and infrastructure development. These results provide insights regarding the structural determinants of contraceptive use and fertility that are useful for drawing policy implications.     

Poverty and choice of marital status: A self-selection model

Over the last few decades in the United States, the poverty rate for female-headed families has been about five times the poverty rate for other family types. This paper addresses the question of why, in general, female-headed families are so much poorer than other families. Recognizing that individuals choose their own marital status, a self-selection model is used to identify the factors which determine the poverty rates for married-couple families, families headed by females with no husband present, and families headed by males with no wife present. The following control variables are found to be important determinants of poverty for all three family types: education of family members; age, race, disability, and unemployment of the family head; geographical location, size and composition of the family. Both married-couple families and male-headed families are found to be less poor than female-headed families mainly because the marginal effects of the control variables, and to a lesser extent the mean levels of the control variables, favor the former two types of families over female-headed families.     

Effect of aggregation on the estimation of trend in mortality

There are three approaches to analyzing and forecasting age‐specific mortality: (1) analyze age‐specific data directly, (2) analyze each cause‐specific mortality series separately and add the results, (3) analyze cause‐specific mortality series jointly and add the results. We show that if linear models are used for cause‐specific mortality, then the three approaches often give close results even when cause‐specific series are correlated. This result holds for cross‐correlations arising from random misclassification of deaths by cause, and also for certain patterns of systematic misclassification. It need not hold, if one or more causes serve as “leading indicators”; for the remaining causes, or if outside information is incorporated into forecasting either through expert judgment or formal statistical modeling. Under highly nonlinear models or in the presence of modeling error the result may also fail. The results are illustrated with U.S. age‐specific mortality data from 1968–1985. In some cases the aggregate forecasts appear to be the more credible ones.     

Effect of aggregation on the estimation of trend in mortality

"There are three approaches to analyzing and forecasting age-specific mortality: (1) analyze age-specific data directly, (2) analyze each cause-specific mortality series separately and add the results, (3) analyze cause-specific mortality series jointly and add the results. We show that if linear models are used for cause-specific mortality, then the three approaches often give close results even when cause-specific series are correlated. This result holds for cross-correlations arising from random misclassification of deaths by cause, and also for certain patterns of systematic misclassification....The results are illustrated with U.S. age-specific mortality: (1) analyse age-specific mortality data from 1968-1985. In some cases the aggregate forecasts appear to be the more credible ones." This is a revised version of a paper originally presented at the 1990 Annual Meeting of the Population Association of America (see Population Index, Vol. 56, No. 3, Fall 1990, p. 407).     

Child schooling and contraceptive use in rural Africa: A Ghanaian case study

In this study, I examine the contributions of childrens schooling to fertility decline in Africa. I use cross-sectional data collected in the late 1980s to look at how household child schooling patterns and community access to schools affect contraceptive use among rural Ghanaian women. My results indicate that the schooling of children is associated very strongly with increased use of modern and traditional contraceptive use and thereby suggest that educational policy has played a role in initiating and sustaining fertility decline in Ghana and possibly elsewhere in Africa.     

The influence of psychological and situational factors on the contraceptive behavior of single men: A review of the literature

The study of contraceptive behavior has focused on women with relatively few studies examining the psychological and situational factors that influence male contraceptive behavior. A review of empirical studies indicates the importance of the personality variable of sexual anxiety and the cognitive variables of attitudes toward contraception and sex roles in influencing the contraceptive behavior of single males. However, the situational variable of having an established sexual relationship is the best predictor of whether contraception is used. Although the contributions of attitude and utility theorists have been of substantial assistance in understanding the contraceptive behavior of married couples, the affect-reinforcement theory appears to be more applicable to contraceptive behavior in general. An analysis of the socialization of males and females in terms of utility theory also helps explain the relative failure of adolescent couples in contraception.This research was funded by team grants from Health and Welfare, Family Planning Division, Canada and from Ministère des Affaires Sociales, Quebec. In addition, the second author was supported by a Bourse de I'Enseignement Superieur from the Quebec Government. Address reprint requests to Dolores Gold, Psychology Department, Concordia University, 1455 de Maisonneuve Boulevard West, Montréal, Québec, H3G 1M8.     

The determinants of the duration of contraceptive use in China: A multilevel multinomial discrete-hazards mdeling approach

Often in demography, individuals may change state over time for a variety of reasons. Competing-risks hazards models have been developed to model such situations. This paper describes the extension of the discrete-time competing-risks hazards model to a multilevel framework that allows for data at different levels of aggregation. The model is illustrated with data from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence, which collected complete contraceptive histories. Women may stop using a method of contraception for a number of reasons; this paper describes how one can control for correlations between the outcomes of repeated spells of contraceptive use.