A Family planning survey in four Delhi villages

A family planning attitude survey was conducted in four villages near metropolitan Delhi. Information was obtained through questionnaires from 455 currently married females of reproductive age: Of the women interviewed, 50 per cent were aware of family planning, 19 per cent had knowledge of a method and only 3 per cent used birth control methods. The method most commonly practised was prolonged lactation. Of the women interviewed, 253 were willing to learn about family planning; they said there was little opposition from their family members. These women thought that a family should have four children, and spacing between them should be roughly four years.     

New survey finds fertility decline in India

A brief indication was provided of demography, fertility, and contraceptive usage and knowledge based on the recent 1992/93 Indian National Family Health Survey. The sample included 88,562 households and 89,777 ever married women aged 13-49 years in 24 states and the National Capital Territory of Delhi. About 38% of household members were aged under 15 years. The sex ratio was 944 females to 100 males. 54% aged over 5 years were currently married; 10% were widowed, divorced, or separated. 43% were literate and 9% had secondary or higher education: 67% for females in cities and 34% in rural areas. Female literacy was 82% in Kerala but under 30% in Rajasthan, Bihar, Uttar Pradesh, and Madhya Pradesh. During 1990-92, the crude birth rate was 28.9 per 1000 population. Total fertility was 3.4 for women aged 15-49 years: 3.7 in rural and 2.7 in urban areas. 31% of parents had been sterilized. 26% desired no more children. Only 6% of women with four or more children desired another child. 99% of urban and 95% of rural respondents had knowledge of at least one modern or traditional method. Female and male sterilization were the most well-known modern methods. 47% of women had ever used contraception: 42% with a modern method and 12% with a traditional method. 41% were current users of family planning: 36% with a modern and 4% with a traditional method (45% in urban and 33% in rural areas with a modern method). The highest contraceptive use was in Kerala, Himachal Pradesh, Maharashtra, and Punjab states and Delhi (over 50%). The two most populous states, Uttar Pradesh and Bihar, had the lowest rates, which were under 25%; other low usage was in Assam and several small northeastern states. 75% of all female modern contraceptive use was female sterilization. 12% in urban and 3% in rural areas used a modern spacing method. Use increased with increased educational level. Rural sources of supply emphasized public facilities: sterilization and IUDs.     

Gender differences in knowledge and attitudes toward modern and traditional methods of child spacing in Malawi

This paper examines male-female differences in knowledge and attitudes towards traditional and modern methods of child spacing in Malawi, based on the survey on traditional methods of child spacing in Malawi which was conducted in 1988. The results show that most people in Malawi are knowledgeable about both traditional and modern methods of child spacing. In general more men than women report knowledge and practice of traditional methods. For modern methods, however, females are more knowledgeable than males of all the specific methods, with the exception of condoms. The greater knowledge by women of female-based modern contraceptives appears to be a manifestation of the exclusion of males from the family planning program. The high rates of knowledge do not translate into equivalent high rates of utilization for both modern and traditional methods of contraception. The study further demonstrates that, while women are involved in making decisions to use contraception, the proportion of men initiating such decisions is greater than that of women. This finding calls for family planning planners to think seriously about revising their target population to include men.     

Estimating unmet need for contraception by district within Ghana: an application of small-area estimation techniques

The importance of meeting the unmet need for contraception is nowhere more urgent than in the countries of sub-Saharan Africa, where the fertility decline is stalling and total unmet need exceeds 30 per cent among married women. In Ghana, where fertility levels vary considerably, demographic information at sub-national level is essential for building effective family planning programmes. We used small-area estimation techniques, linking data from the 2003 Ghana Demographic and Health Survey to the 2000 Ghana Population and Housing Census, to derive district-level estimates of contraceptive use and unmet need for contraception. The results show considerable variation between districts in contraceptive use and unmet need. The prevalence of contraceptive use varies from 4.1 to 41.7 per cent, while that of the use of modern methods varies from 4.0 to 34.8 per cent. The findings identify districts where family planning programmes need to be strengthened.     

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.     

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.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Reliability estimates of some survey data on family planning

Summary A follow-up study employing the panel design which aimed to evaluate the temporal stability of rural respondents' answers to KAP and fertility-related questions after a lapse of nearly five months revealed that reports by females on factual data dealing with socio-economic and demographic topics are as highly reliable as are those of males. The study based on 79 males and 81 females in Haryana further supports the hypothesis that re-test reliabilities of factual data such as respondent's age, religion, occupation, etc. are substantially higher than those of knowledge about contraceptives. Attitude items showed very low re-test reliabilities although the internal consistency reliabilities of the two attitude scales were found to vary within the range of 0.72 to 0.88. Both attitude scales were found to have a very high reproducibility coefficient, all higher than 0.95, for both the interview sessions. Re-test reliabilities of data on contraceptive use were also found to be moderately high. However, the rates of loop insertion and condom use as reported by female respondents are likely to show a substantial amount of gross error as is evident from their low re-test reliabilities. The findings of the present study cast serious doubt on the assumption that married males are not capable of accurately reporting the pregnancy histories of their wives. Several implications of the findings are discussed. From the methodological point of view they suggest a need to develop improved techniques for assessing attitudes toward family planning programmes and abortion as well as to knowledge of contraceptive methods and desired family size. The findings also justify the inclusion of eligible male respondents in KAP and fertility surveys.     

Attitudes toward family size and family planning in nairobi

In Nairobi, 352 married African adults, 152 men and 200 women, were interviewed on their attitudes toward family size and family planning. The respondents had, on the average, slightly less than three children at the time of interview and hoped to add slightly more than three children to this total. There was little difference in desired family size by sex.About one-half of both men and women had some knowledge of family planning methods, and there was a general interest (75 percent of the men and 90 percent of the women) in learning more. In addition, two out of every three men, and nine out of every ten women, approved of family planning, and even greater majorities of both sexes were willing to have the government of Kenya provide such services.In spite of their approval, however, only 13 percent of the men, and 2 percent of the women, had ever practiced family planning. These findings are broadly comparable to those found in other emerging nations and suggest that knowledge, interest, and approval generally precede use.     

The evolution of family planning in an African city: Ibadan, Nigeria

Summary Data drawn from a 1973 probability sample of 6,606 Yoruba females, 15-59 years of age in Ibadan City, Nigeria, are employed to analyse changing family planning practice over time. Usage and method rates are calculated for broad age groups from 1930 to 1973. Contraceptive practice is shown to have increased rapidly during the 1960s and early 1970s, from a very low initial base with a doubling period for the proportion of contraceptors of about four years, so that by 1973 one-sixth of the women had practised contraception and one-ninth were currently doing so. The major determinant of contraceptive practice is education. Oral contraceptives and IUDs account for an ever larger proportion of all contraception over time and together made up over 50 per cent by 1973. The Ibadan data give strong support to a suggestion emanating from scattered findings elsewhere that there is a special pattern of sub-Saharan contraceptive use: it begins with use in pre-marital and extra-marital relationships; then is increasingly employed as a substitute for post-marital sexual abstinence, and only later becomes the means for limiting the size of the family. Hence, the success of a family planning programme is indicated by rising average parity among the acceptors. Most couples in Ibadan will probably be practising contraception at some time in the 1980s, but even then such rates will probably still be low in rural areas.     

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.     

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.     

Effect of declines in mortality on the birth rate and related measures

In December 1961, the government of the Republic of Korea adopted a programme of family planning as part of its public health services. In 1962 a pilot research project was begun, under university auspices, with the object of demonstrating and assessing what can be achieved through intensive family planning education and services. Wondang Myun near Seoul, with a rural population of 9,000 in seven villages, was chosen for the study. A baseline survey covering attitudes and practices related to family planning was made of the population under study, as well as of a similar population in the control area of Kimpo Myun. This report outlines the design, the programme of education and services, and some of the preliminary results of the study. After eighteen months of the programme, acceptance of birth control measures increased fourfold among the married women in the fertile age range. Acceptance was highest among the 25–39 age group, and among high-parity women. Economic considerations were foremost among the reasons given for adopting family planning. Among the traditional methods offered, the condom was the favoured method of choice, indicating that husbands were taking the initiative in contraceptive practice. A decline in the crude birth index was observed; whether the decline was due more to contraceptive practice or to abortion, at least an increase is reflected in the effective desire for family limitation. The high failure rate among Users should be investigated further. Continued effort is needed to provide more information and detailed instruction to users, and to develop social circumstances that support the practice of family planning. Along with an effort to achieve more effective use of traditional methods, other methods, including intra-uterine devices, deserve trial.     

The family planning work as suggested by analysis of the age at first marriage in Jiaxing Prefecture, Zhejiang Province]

Since 1970 when the big push for family planning began, China advocated late marriages. In general, the age for late marriage for female peasants is 23 years and 25 for males; for urban females and males, it is 25 and 27 years, respectively. In 1981 the New Marriage Law stipulated the age at marriage to be 20 years for females and 22 for males (these ages are lower than the ages advocated for marriage in actual practice). Despite the New Marriage Law, however, there was in 1981 an increase in the number of people who married before attaining the "late marriage age," thereby creating problems in family planning work. Since 1981, early marriages have been an increasing phenomenon (for the purposes of this essay, age at early marriage is 23 years for females and 25 for males). Jiaxing Prefecture had a 460.53% increase from 1979 to 1981 in the number of women who married early. The following findings were based on studies of Tungxiang and Pinghu Countries. Early marriages as well as "regular" marriages have increased greatly, with early marriage exceeding the number of other marriages. Urban marriages are far more moderate in number than rural marriages, partly because family planning work in urban areas is more effective. Early marriage in areas where family planning work was effective is less extreme than in areas where family planning work was ineffective. Findings from Kayuan Commune of Tungxiang County shows that 47.8% of all male marriages in 1981 were early marriages, as opposed to 6.3% in 1980. The average age for men at marriage in 1981 was 1.6 years younger than in 1980, and .75 years younger for females. Undoubtedly the New Marriage Law influenced the trend in early marriages, but the main reason is that the agarian economy is backwards. Further, traditional attitudes (e.g., "the sooner the children come the sooner the riches come") prevail.     

Fertility in Kenya and Uganda: a comparative study of trends and determinants

Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent, from some eight births per woman to around five. During the same period, fertility in Uganda declined by less than 10 per cent. An analysis of the proximate determinants shows that the difference was due primarily to greater contraceptive use in Kenya, though in Uganda there was also a reduction in pathological sterility. The Demographic and Health Surveys show that women in Kenya wanted fewer children than those in Uganda, but that in Uganda there was also a greater unmet need for contraception. We suggest that these differences may be attributed, in part at least, first, to the divergent paths of economic development followed by the two countries after Independence; and, second, to the Kenya Government's active promotion of family planning through the health services, which the Uganda Government did not promote until 1995.     

The marriage of mentally handicapped people and family planning services for them in Shanghai

This brief article discusses findings from a study by the Shanghai Population Information Center on marriage, fertility, and family planning among mentally handicapped adults in Shanghai, China, and population dynamics. The sample included 184 mentally handicapped persons aged 20-49 years (79 men and 116 women). 47 people had mild, 92 had moderate, and 45 had severe mental deficiencies. The mean age was 33 years. About 29% were married or ever married. 49 were married or ever married women. 6 spouses were mentally deficient. About 70% of the married or ever married had children. 43 had ever used contraception. The most commonly used method was the IUD. Several people had the approval of family members and were sterilized. Only 3 women were prevented from use of contraceptive services by family. 38% of the unmarried women's parents or relatives wanted their mentally deficient family members to be married before old age. 48% discouraged marriage because of the mental deficiency.     

Assessing the impact of a family planning nurse training program in Egypt

In 1991 the Egyptian Ministry of Health introduced a new training program for family planning nurses. The training program stressed the development of nurses' counseling skills. As part of the Operations Research Program, sponsored by Family Health International in collaboration with the Egypt National Family Planning Board, managerial staff from family planning agencies designed and implemented a study to evaluate the impact of the new training program. The study objective was to assess the impact of nurse training on nurse performance in the clinic and on clients' family planning knowledge, attitudes and contraceptive use. The study was designed to provide usable information to family planning managers in the field within a time period of less than one year. The study results indicate that there is an association between improved family planning training for nurses and positive changes in family planning knowledge, attitudes and behavior among women attending MoH clinics in this study. The greatest relative change occurred in knowledge. Women in the experimental group, relative to the control group, displayed increased knowledge about contraceptives, particularly the pill and the IUD. Attitudinal change was less pronounced. Favorable attitudes toward oral contraceptives and condoms became more prevalent, and reports of husband-wife communication about family planning also increased. Finally, although contraceptive use was already high prior to the nurse training, IUD use increased significantly among women in one governorate.     

Barriers to contraceptive use among Pakistani couples

Despite the existence of a family planning program in Pakistan since 1965 and widespread knowledge among Pakistanis about contraception, there is a high level of unmet need for family planning. One recent survey found that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception. A recent Population Council study conducted in urban and rural areas of Punjab province investigated personal beliefs, family circumstances, social norms, and gender relations among 1310 married women and 554 of their husbands. The unmet need for contraception was highest among women over age 30 years, those with more living children, less educated women, and women living in rural areas. The study found that while most Pakistanis approve of family planning, obstacles to contraceptive use exist in most marriages. 97% of respondents who wanted another child wished for a boy. That preference for sons influences contraceptive use behavior. The fear of social disapproval of contraceptive use, perceived opposition from in-laws and husbands, and fear of health side effects and divine punishment were major reasons identified against contraceptive use. Female contraceptive users were more autonomous and likely to make domestic decisions without consulting their husbands, while husbands defer to social and cultural norms.     

Family growth and family planning: Responses to a family-planning action program in a rural district of Thailand

A resurvey of a rural district in Thailand, of about 70,000 population, was conducted after a family-planning program had been in operation for eight months in order to ascertain indications of effectiveness of the program. Both the "before" and "after" surveys employed a 25 percent simple random, though non-overlapping, sample of married women 20-44 years of age whose husbands were living. The only difference in design and execution was the inclusion in the resurvey of questions about the action program. Barring one or two exceptions, the characteristics of the two population samples were so similar that differences in knowledge, attitudes, and practices could be regarded as effects of the program.The action program not only made itself widely known in the district, it also evoked a highly favorable appraisal, to such an extent that nine of every ten women thought the program should be extended over the entire kingdom. Motivation to engage in family planning increased perceptibly. A substantial proportion (23 percent) of the women who formerly disapproved of the practice changed their attitudes to approval, mainly because they had become convinced of the harmlessness and the utility of fertility control. Less than 3 percent of the former approvers had become negative.The proportion of women who claimed some kind of knowledge about contraceptive methods more than doubled during the eight months of the program's operation. More impressive, however, was the change in actual use of methods, which rose from 1 to 21 percent of the eligible women (women who were not pregnant, subfecund, or sterilized). Another 16 percent, in the resurvey, planned to begin use of contraceptives in the near future, in most instances after a current pregnancy. The frequency of acceptance of family planning practice exceeded the expected frequency among women who were approaching or had attained the "ideal" number of children (4.0 children). High-parity women 40 or more years of age seldom accepted clinical assistance.