Choosing a contraceptive method: why does it matter?

The use of contraceptives varies widely among Asian countries. Based on the most recent survey data available, the rate varies from nearly 8/10 married women aged 15-44 in Taiwan to fewer than 1/10 in Pakistan and Nepal. Women in East Asian countries are most likely to practice contraception, followed by those in Southeast Asia, with lower contraceptive prevalence rates found in South Asia. The rates of some East Asian nations now match those of the US and other developed nations, while in most South Asian nations contraception is spreading slowly. Contraceptive methods in use vary widely by country. The leading method in the greatest number of countries is sterilization, but in most countries several methods are nearly equal in popularity. Only in India is sterilization used by a majority of those people who practice contraception. Japan is the only country in which a majority of contraceptors use condoms, and only in China do 1/2 use IUDs. The choice of a particular contraceptive method is strongly influenced by 1) methods available through family planning programs, or promoted through the use of target systems; 2) religous and cultural factors; 3) concerns about side effects and safety; 4) ease of access to particular methods; 5) the medical profession; and 6) legality--in Japan the pill is illegal. In most countries the type of contraceptive that people prefer has changed since the introduction and promotion of modern methods of contraception. In general, there has been a shift to more effective methods. An increase in female sterilization at the expense of other methods such as the IUD or pill is the most common pattern. In countries where female sterilization is unpopular, use of such modern methods as the pill, IUD, or condom has increased at the expense of traditional methods.     

Tonga: family planning survey

A survey was carried out in 1975 in Tonga to determine how many families are practicing family planning. Public health nurses visited every household except the Niuas and remote islands. 4253 women out of the total of 9307 married women aged 15-44 years were using a contraceptive (45.7%). The percentage of users ranged from 4.5% in Ha'afeva District to 63.6% in the district of Kolonga. 60% of the users practice effective methods such as the pill, Depo-Provera, IUD, or sterilization; 23% use the condom, and 17% rely on withdrawal, calendar ovulation, or rhythm.     

The trends of contraceptives of people in Shanghai since early 1980s

Shanghai has had the lowest fertility rate in China for many years. Shanghai had a negative rate of natural growth during 1990-95. During 1980-93, fertility dropped continuously. In 1982, contraceptive use among married women included 29.47% using IUDs, 29.33% using oral pills, 23.44% using female sterilization, and 10.48% using condoms. Contraceptive prevalence declined slightly from 98.6% in 1982 to 92.29% in 1993. By 1993, method use changed. Oral pill and female sterilization use declined to 8.04% and 7.22%, respectively, among married women of reproductive age. IUD use increased dramatically to 72.2% in 1993. Condom use declined to 8.83% of total users. Despite reduced contraceptive prevalence, the birth rate declined from 18.51/1000 population in 1982 to 6.50/1000 population in 1993. The proportion of women accepting the one-child certificate increased from 53.32% of all married women of reproductive age in 1984 to 70.13% in 1993. The shift use of contraceptive methods means reliance on long-term reversible methods.     

A survey of China's birth control among women of child-bearing age

To further implement China's family planning policy of "prevention first, birth control first," a study of the current family planning situation was conducted. A survey of the birth control methods employed by women of childbearing age and by men was based on a nationwide randomized sampling of 1/1000. In the different age groups, ranging from 15-49 years old, IUD users accounted for over 50%, tubal sterilization 25%, and vasectomy 10%. The main IUD users were women in the 20-24 age group. Tubal sterilization was more prevalent among the women in the 35-39 age group. The use of oral contraceptives (OCs) was more common among younger women but accounted for less than 10% of the total. The survey was based on the replies to questionnaires from 172,788 married women of childbearing age; 120,022 of them practiced contraceptive methods for a birth control rate of 69.46%. The breakdown was as follows: IUD, 34.84%; tubal sterilization, 17.63%; vasectomy, 6.94%; OCs, 5.86%; condom users, 1.39%; and other methods (including chemical suppositories, rhythm, or safe period method and withdrawal before ejaculation), 2.78%. There was a higher percentage of OC users in urban areas, and a marked preference for IUDs in the rural communities. The rural birth control rate was 68.58%; the urban rate was 74.17%. The use of the IUD has priority in all the areas; its percentage approaches the national average level. The use of vasectomy as a birth control method varies considerably according to area as does the use of OCs, condom, and tubal sterilization. Rural minority groups prefer the IUD and OCs; tubal sterilization, the condom, and vasectomy are preferred by the Han nationality. The birth control rate differed according to the different occoupation groups: 77.85%, workers; 76.01%, farmers; 85.15%, cadres; 59.52%, housewives; and 66.67%, others. The birth control rate was higher among those who received a college education than the illiterates, but statistics did not show a significant difference in the rate of those with a high school education and the illiterates. Mothers of 0-1 children generally preferred OCs; tubal sterilization was preferred by mothers with 2-3 children. The nonusers of contraception accounted for 30.54% among married women of childbearing age. A breakdown gives the following figures: menopause and infertility, 6.17%; divorced and widowed, 1.64%; planned parenthood, 10.51%; nonusers who should have practiced contraception, 12.22%. On a national level, the estimated number of nonusers of contraception among those who should be practicing contraception comes to about 20,000,000 women.     

Birth control techniques in China

This article describes the major birth control techniques in use in China, based on data from a contraceptive prevalence study conducted in September, 1982. 118 million of the 170 million married women of child bearing age use birth control. IUD insertion accounts for 50.2% of birth control methods used, tubal ligation accounts for 25.4%, vas deferens ligation 10.0% oral contraceptives (OCs) 8.2%, and condoms 2.0%. A table of clinical data on 9 China made IUDs reveals that pregnancy rates range from 0 (V Cu-300 model) to 5.83% (mixed ring model). A method of IUD insertion immediately after delivery has been researched and adopted, using a silastic Delta IUD with barium added to reduce the high postpartum expulsion rate. fixing the IUD by sutures during Cesarean section has also been developed. Electronmicroscopic studies of the endometrium of women who have used a stainless steel IUD for more than 20 years showes no tendency towards malignancy, nor negative effects on the endocrine functions of the ovaries. 28 million Chinese women have accepted sterilization as of June, 1982. Local anesthesia and the use of acupuncture have reduced complications due to general anesthesia seen previously. Sterilization by means of chemically induced adhesion of Fallopian tube tissue has also been performed successfully; however, this method makes later anastomosis difficult, and is not suitable for young women with only 1 child. Fallopian tube occlusion by means of a silver clip has been performed in 1,128 cases, with a pregnancy rate of only .85%. 10.62 million men have accepted sterilization. While most of the procedures are val ligations, 300,000 men have been sterilized by direct injection of an adhesive agent throuh the skin of the scrotum. No increase in auto immune or vascular disease has been found. 3 low-dose OCs, used since 1969, have proven to be reliable and freer of side effects than higher-dose compounds. In addition, longterm OCs containing quinestrol have been used since 1969 with a success rate of 98.3% women-year. These pills are taken 1x monthly. R and D priority will be given be given to monthly injectable contraceptives; megestrol and norethindrone are the compounds most preferable. In trials so far, the effective rate has been 99.9% with mild side effects. Gossypol, a male contraceptive, has shown an antifertility effect in 99% of 8000 cases studied; however, hypokalemia and irreversibility of spermatogenesis were reported in some cases. Vacuum suction is the most common method for abortion, but Radix Trichosanthis and lilac daphne terpine, traditional abortifacients, anre acceptable for 1st trimester abortions. Prostaglandins are also used.     

Low fertility and limited diffusion of modern contraception in Italy during the second half of the twentieth century

During the last two decades of the twentieth century, Italy, Greece, Spain, Portugal, and Japan were characterized by very low fertility levels and limited diffusion of the pill, IUD and sterilization for contraceptive purposes. This paradox is discussed for Italy by revisiting the history of contraception and reproduction during the second half of the twentieth century, and by using new data for the end of that century and the early twenty-first century. The main results are: (1) it has been possible to maintain low rates of planned and unplanned fertility without resorting to more effective contraceptive methods thanks to a careful use ofcoitus interruptus; (2) the pace of diffusion of the pill and IUD was so slow because of the opposition to contraception of the Catholic Church, a gender system emphasizing traditional male and female roles, and a medical culture that made physicians reluctant to prescribe the pill for their patients; and (3) the contraceptive patterns of Italian women born after 1960 are more similar to those of their Western counterparts, although new peculiarities appear, for example, substantial reliance on the condom by people living as couples as well as sexually active singles.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

Communique of the State Family Planning Commission on a nationwide fertility sampling survey of every person per thousand

In 1982, the Chinese State Family Planning Commission conducted a nationwide fertility survey of 1 person/1000 in 28 provinces, municipalities, and autonomous regions. 815 sample units were selected and 310,462 women aged 15-67 were interviewed, 99.9% of those identified. 252,094 (24.77%) were of childbearing age (15-49) with 24.76% 15-19 years old. Among women of fertile age, 31.46% were unmarried, 64.53% were married to their 1st husbands, 2.89% were remarried, .19% were divorced, and .94% were widowed. Average age of 1st marriage increased from 18.4 in the 1940s to 22.8 in 1981. Total fertility rate dropped from 5.44 in the 1940s to 2.63 in 1981. In 1981, the birth rate was 85/1000 women of fertile age. Fertility was much higher among minority nationalities. 118 million of China's 170 million married couples of reproductive age (69.46%) use birth control at present; 50.2% use the IUD, 25.4% tubal ligation, 10.0% vasectomy, 8.2% oral contraceptives, and 2.0% condoms. About 21 million married women should have begun using contraception but have not. 14 million or 42.3% of 33 million 1 child couples have pledged to have only 1 child. If the fertility level of 1981 is maintained and the average woman continues to have 2.63 children, 2.91 in rural areas, China's population will reach 1.2 billion by 1993 and will exceed 1.3 billion by 2000. The Central Committee has a target population of 1.2 billion by 2000.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.     

Comprehensive services at Fabella Center

The Jose Fabella Memorial Hospital Comprehensive Family Planning Center was the 1st family planning center to conduct minilaparotomy in the Philippines. It was also the 1st center to conduct research on family planning and to offer training in family planning to nurses, doctors, midwives, and medical students. The center is funded by the Philippine government with about 85% of hospital funds going to salaries of the staff. Supplementing the funding are medicine, equipment, and subsidies for sterilization given by the Commission on Population (Popcom). Research on chemical sterilization requires patients to take oral contraception (OC) or use the condom while under observation for about 4 months. In the case of female patients, this means until the fallopian tubes have been blocked due to the injection of an opaque solution. The patients are then checked for effects on health, sexual practices, and the regularity of menstruation. Dr. Apelo expects to implement this new sterilization method within 5 years. The center's objective is to support the National Population Program in its effort to reduce the country's population growth rate and promote family welfare. When the center was started, it occupied only 1 room of the hospital and was staffed by 1 full time doctor, 4 nurses, 4 midwives, 2 social workers, and 3 support staff. After 1 year of operation, the center recruited only 75 family planning acceptors. Information about the center's family planning services spread solely by word of mouth. During the 1st half of 1982, the center recruited 3490 acceptors of surgical and nonsurgical contraception, representing 96.94% of its 3600 target for the period. Minilaparotomy had the highest number of acceptors, 1742 or 49.92% of the total number of acceptors during the period. This was followed by the IUD with 1356 acceptors, OC, 245 acceptors; and other methods, 147 acceptors. In information and education, the center had 1882 motivational activities consisting of group discussions, ward lectures, field lectures, and mothers' classes. In training, the center conducted 10 courses, representing 100% of its target for the whole year. It trained doctors in performing voluntary surgical contraception and paramedics in assisting doctors in sterilization operations. The training courses were conducted under a subsidized contract with Popcom. The center also offers training in IUD insertion. In research, the center is active in investigating prospects for new contraceptive applications in the Philippine setting.     

Use of contraceptives by Chinese women

In April 1985 the State Statistical Bureau of China conducted a fertility sampling survey in the provinces of Hebei and Shaanxi, and Shanghai municipality covering a population of 93,000,000. The target group was married women under 50 whose knowledge and use of contraceptives are the main content of this survey. The IUD has been used by 62% in Hebei, 61% in Shaanxi, and 55% in Shanghai, and is most popular with women over 30 who have had at least 1 child. Married women who have used the pill make up 33% in Shanghai, 14% in Hebei, and 7% in Shaanxi. Female and male sterilization are used by women who have had more than 2 children (15.7% in Shanghai, 40% in Hebei, and 28% in Shannxi). 70-80% have used contraception of some type, reflecting the success of the family planning program.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

Understanding calendar rhythm

Rhythm has been among the family planning methods endorsed since the start of the National Population Program in the Philippines, but it has not been given as much emphasis as the other methods such as oral contraception (OC), the IUD, and sterilization. For several years, no systematic effort was made to promote the effective use of rhythm. The 1978 Community Outreach Survey (COS) tried to determine the extent to which contraceptive methods were being used in the Outreach Project areas. The project covered 2,000 barangay service points (BSPs) with 1.76 million married couples of reproductive age (MCRA), representing 32% of the estimated total MCRA in the Philippines. The COS findings revealed that, of the total sexually active married women aged 15-49, 48% were using contraceptive methods. Of these, only 11.4% were using modern methods, 20% were using other program methods (rhythm, condom, and combination of rhythm and condom); and 16.7% were using nonprogram methods (withdrawal, abstinence, and others). When used in combination with other methods, rhythm had a monthly continuation rate of 96%; when used alone, 94%. The COS data showed that the rhythm method is practiced by a large number of Filipino couples. With the renewed interest in rhythm, it became imperative for the program to help rhythm acceptors use the method more effectively and thus reduce user failure. There continues to be need for data on the "product image" of rhythm. These include the emotions that come into play in the acceptance or rejection of rhythm, the perceived side effects as well as advantages of the method, the ways women communicate their "safe" and "unsafe" days to their husbands, the manner in which couples prevent sexual contact during "unsafe" days, and the attitude of couples toward abstinence. Among important study findings were the following: couples choose rhythm because it does not disturb the sexual act, has no side effects, and poses no religious objections; 1 of the problems of rhythm users is that they get varied explanations and instructions from service delivery personnel on the correct way to practice rhythm; and many rural women do not have a clear understanding of the menstrual cycle. Requirements of successful rhythm practice include cooperation, regular cycle, and the couple's age.     

Contraceptive use in China

A national sampling survey carried out in China in 1988 showed that 90.71% of the population were using some form of contraception: male sterilization (10.99%); female sterilization (38.24%); and IUDs (41.48%). Compared with 1982, the figures gathered in 1988 showed an increase in male sterilization and female sterilization and a decrease in condoms, oral or injected contraceptives, IUDs and spermicides. A great difference was found between the contraceptive methods used by women in rural areas as compared to women in urban areas. In urban areas IUDs accounted for 58%, female sterilization for 15%, male sterilization for 1% and condoms for 13%. In the country, female sterilization accounted for 42%, IUDs for 39%, male sterilization 15%, condoms 1% and oral contraceptives for 4%. There was also a strong difference between women of certain ages; the use of IUDs was highest among women between the ages of 15-29 years, while female sterilization was more prevalent for women over the age of 30. There was also a considerable difference between the birth control taken by women with children and those without; the majority of women (31%) without children used condoms; the majority of children (78%) with 1 child used IUDs; the majority of women (65%) with 2 children were sterilized. The sample study shows that 91% of the women using contraception used long-acting contraception.     

Sterilization and IUD target achieved

Voluntary acceptance of permanent contraceptive methods showed an upward trend in Bangladesh over the past 5 months. 62,399 sterilizations were performed in October, 1983, a 98% realization of the monthly target. 70,618 sterilizations were performed in November, 1983, a 111% achievement. IUD acceptors in October totaled 22,004, a 142% achievement, and the figure was 24,324 in November, a 157% achievement of the monthly target. In October 1982 the total number of sterilization acceptors was 54,705; the figure was 9802 for IUD acceptors. In November 35,485 persons accepted sterilization and 9682 accepted IUDs.     

我国已婚育龄人群避孕水平及避孕方法使用趋势

利用中国20世纪60年代到2004年的全国计划生育调查数据,深入分析我国已婚育龄人群避孕水平及避孕方法的使用趋势。结果表明,我国一直是全球总避孕水平最高的国家,避孕方法以长效措施为主。90年代后,主要避孕方法中宫内节育器现用率逐年上升,女性绝育逐年小幅下降,男性绝育逐年明显下降,避孕套现用率逐年递增,口服避孕药、外用避孕药和其他避孕方法呈逐年下降趋势;且避孕方法的选择存在省市、城乡差异。     

Child support awards: Differentials and trends by race and marital status

This study has analyzed data from combined 1979 and 1982 April supplements to the Current Population Survey to study differences in the award of child support by race and marital status. The following findings emerge from this study: The percentage of women with children present from an absent father who are awarded child support varies greatly by race and marital status. Among all women, nonblacks are more than twice as likely as blacks to have a child support award, and the ever-married are almost six times as likely as the never-married to have an award. Among the ever-married, currently separated women are approximately half as likely as the ever-divorced to have secured an award. The lower probability of child support awards among blacks can be attributed in part to their disproportionate membership in marital status groups with lower award probabilities. Blacks are four and one-half times as likely as nonblacks to be among the never-married and almost twice as likely to be among the currently separated. Racial differences in award probabilities exist within all marital status groups except the never-married. Among the currently separated, blacks are one-third less likely than nonblacks to have an award. Among the ever-divorced, blacks are almost one-fourth less likely than nonblacks to have an award. Among the never-married, unlike the ever-married, virtually no statistically significant socioeconomic characteristics appear to distinguish mothers who have a child support award from those who do not. Among all women, 50 to 60 percent of the gross racial differential in award rates can be explained by observed differences in such economic and demographic characteristics as marital status, educational attainment, age, place of residence, and number of children. Among the ever-married, 50 percent of the gross racial difference can be explained by these factors. Among the ever-married, the likelihood of being awarded child support at marital disruption has increased over time, but this upward trend has been different for blacks and nonblacks. Among nonblacks, the proportion of women obtaining a child support award increased 1.3 percent per year between 1960 and 1975 and then declined 0.4 percent per year since then. Among blacks, the proportion increased 0.8 percent per year between 1960 and 1975 and then accelerated to 1.6 percent per year since then.(ABSTRACT TRUNCATED AT 400 WORDS)     

Communique of the National Sample Survey of Fertility and Birth Control (abstract)

The State Family Planning Commission in China surveyed 2,151,212 people, including 459,269 married women aged 15-57 on fertility and birth control, in July, 1988 from 30 provinces and other regions. From 1980- 87 the average total fertility rate was 2.47 vs. 4.01 in the 1970s. Fertility rates in the 80s were 1.33 for cities, 2.43 for towns, and 2.84 for villages. 1st parity births rose from 44.15% to 52.55% from Jan. to July of 1988 and 2nd parity births were about 30%. Women aged 50-57 had an average of 5.27 children while women aged 45-59 had an average of 4.44 children. 71.21% of childbearing-age women use contraception: 10.99% use male sterilization, 38.24% use female sterilization, 41.48% use IUDs, 4.91% oral pills, 2.65% condoms, 0.42% external contraceptives, and 1.32% use other methods. 13.79% of the married, childbearing-age couples have one-child certificates. The population of China as of April 1989 was 1.1 billion. In 1988 the birth rate was 20.78/1000 and the death rate was 6.58/1000.     

The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

The Role of Contraceptive Supply and Demand in Mexican Fertility Decline: Evidence from a Microdemographic Study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.