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.     

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.     

Status of male contraception

At a recent meeting of the IPPF Central Medical Committee (CMC) progress made in developing a male contraceptive was reviewed. The CMC had been given expert advice, and the latest publications on the subject had been put before it. In the light of that up-to-date knowledge, the following statement was issued about the present status of male contraception: "During the last few years several clinical trials have been carried out in order to evaluate the contraceptive effectiveness of some steroidal agents in men. Antiandrogens, androgens, progestins and oestrogens have been tried. Most compounds tested have been found to be able to depress spermatogenesis, but in some cases the occurrence of undesirable side effects has curtailed their potential use as contraceptives. The most promising trials were carried out with combination treatments of an androgen with a progestin. These treatments are effective and relatively well tolerated in short-term use, but acceptability and safety for long-term use have still not been proven. As most male contraceptives areabeing used only on an experimental basis, the CMC cannot recommend their use by family planning associations at present, but sees the development of a safe male contraceptive as highly desirable." The subject will be kept under review at further mettings of the CMC.     

Progress in male contraceptive research

80% of the world's contraceptive users are women. This gender-based usage has occurred due to the emphasis of family planning programs and contraception research on female methods. Even if men desired to take responsibility for contraception, only the condom and vasectomy are available and have a reasonable assurance of protection. The Population Council has been researching male contraception through its Center for Biomedical Research. An oral contraceptive derived from gossypol, a cottonseed plant pigment, is being tested after successful clinical trials were performed in China during the 1970s. Also being investigated are male hormonal methods that regulate sperm production while protecting against loss of potency, loss of libido, and changes in secondary sex characteristics. A hormonal implant, effective for one year, has been in Phase I clinical trials since 1993. A small Phase I clinical trial is in process for a vaccine/implant for men that is effective for one year. Testing with injectables for men has suggested that different hormonal mixes could increase cardiovascular risk for men and exacerbate prostate cancer. Research has focused on new materials for condoms. Kraton-type materials are made from block copolymers and polyurethanes, and these condoms have shown some promise. The advantages of these products are that they are allergen-free, less susceptible to oxidation, and can be of thinner construction, which would increase sensitivity and acceptability. The percutaneous chemical method of no-scalpel vasectomy has been studied as a means of blocking passage of sperm in the vas deferens. In China and India, injections with liquid silicone, polyurethane, neem-oil, and n-butyl-cyanoacrylate mixed with phenol are being studied. Zinc injections that cause the epididymis to atrophy are being tested on animals in the US. Lasers and fiber cautery are other methods under investigation. Increased funding is essential for these and other research efforts.     

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.     

Indicators of contraceptive policy for nations at three levels of development

The study is concerned with examining variations in contraceptive policies among 74 nations of the world. Employing quantitative data collected by the United Nations, the national policies for three types of contraceptive devices (birth control pills, condoms and IUDs) were examined for nations at three levels of development. The policies for the three items were found to be highly intercorrelated. Given this fact, a restrictiveness index related to the commercial sale of the three types of contraceptive was constructed. A set of independent variables was then related to this restrictive index employing multivariate analysis. The results differed appreciably for the developed and non-developed nations. For the developed nations restrictiveness was significantly related to the fertility rate and the number of physicians in the society, whereas for the developing nations it was significantly related to the infant mortality rate in the society.     

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.     

Family planning in choiseul province,Solomon Islands

The results presented are from a rural prevalence survey on family planning in Choiseul Province, Solomon Islands. Married women aged 15–49 years with at least one living child and married men whose wife met the same criteria, provided data on knowledge, attitudes and practices of contraceptive use. Fifty one per cent of the female sample were using some form of contraception, 26 per cent reversible and 25 per cent non-reversible methods. Sixty-five per cent of men claimed that they or their spouse were using a method of family planning. Tubal ligation was the most common currently used method (25 per cent in the female survey). Desired family size was four for both males and females. Knowledge and approval of family planning was high, with 83 per cent of females and 81 per cent of males knowing of at least one method. Problems in accessing information and services for family planning include cultural and logistical constraints. Religious affiliation was the major variable affecting knowledge, use and approval of contraceptive methods. Nearly a quarter of the sample lived further than two hours travel time from the nearest health clinic supplying contraceptive methods. These clinics often have only an intermittent availability of supplies. A strong interest in family planning was demonstrated by both respondents and service providers.     

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.     

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.     

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.     

Population statistics] as of Oct 1, 1995

The publication of these statistics is part of an effort to provide current demographic estimates for Thailand every three months. The tabulated data pertain to October 1995. Estimates are provided for the following demographic measures: total population (59,627,000); male population (29,796,000); female population (29,831,000); urban population (18,830,000); rural population (40,797,000); population by region: northern region (11,978,000), northeastern region (19,413,000), southern region (7,464,000), central region excluding Bangkok Metro (12,936,000), and Bangkok Metropolis (7,836,000); population by age group: under 15 years (17,172,000), 15-59 years (38,102,000), 60 and over (4,353,000), 6-21 years (19,939,000), 18 years and over (38,528,000), 20 years and over (36,259,000), and women aged 15-44 years (15,393,000); crude birth rate per 1000 population (17.6), crude death rate per 1000 population (5.2); natural growth rate (1.2%); infant mortality rate per 1000 live births (30.8); male life expectancy at birth (66.6 years); female life expectancy at birth (71.7 years); male life expectancy at age 60 (18.8 years); female life expectancy at age 60 (22.0 years); total fertility rate (1.95); contraceptive prevalence rate (74.0%); and projected population for the year 2012 (71,860,000). A chart gives the estimated percentage of cumulative deaths from AIDS by age group in 2000 and 2005.     

Contraceptive rings provide simple protection

The Population Council is currently conducting 4 clinical trials of the vaginal contraceptive ring. This device remains in the vagina for weeks or months, releasing hormone formulations tailored for a variety of contraceptive needs. Rings that deliver both estrogen and progesterone can be kept in place for 3 weeks, then removed for the last week of the cycle. Since the steroids diffuse directly from vaginal tissues to the bloodstream, smaller steroid doses can be used than for oral contraceptives (OCs). In contrast to IUDs, which require insertion and removal by medical providers, women can be taught to insert and remove the flexible device themselves. One of the rings being evaluated by the Population Council is suitable for breast feeding women. It does not contain estrogen and appears to have no adverse effect on either lactation or infant growth. Preliminary findings have confirmed the effectiveness of a ring that remains in place 6-12 months. Advantageous for distribution in developing countries would be a contraceptive ring that lasts for 12 months and could be priced competitively with OCs. In addition to contraception, the ring can be used by postmenopausal women for hormone replacement treatment.     

Priority research projects on family planning technique during the "Seventh Five-Year Plan" period

Research activities focused on family planning techniques and perinatal care will be given priority during China's 7th 5-Year Plan period. In terms of birth control technology, an emphasis will be placed on improving the reversibility of tubal sterilization and vasectomy, reducing complications (e.g., expulsion) associated with IUD use, refining methods of early pregnancy termination, and development of more long-acting contraceptive methods. Also explored will be the safety and effectiveness of herbs traditionally used for fertility control in China. To facilitate the development of more perfect types of contraceptives, basic research on spermatogenesis, sperm transportation, and fertilization will be conducted continuously. Studies on quality control indicators, pharmacodynamic indicators, and toxicological markers will be emphasized. In the area of eugenics, an emphasis will be placed on the prevention of congenital abnormalities and the monitoring of birth defects. Screening methods for the early diagnosis of genetic diseases will also be explored. Finally, attention will be given to the detection of teratogenic factors in the environment and other preventive measures.     

Pheromone trapping models for pest control: Effects of mating patterns and immigration

Summary Several models are presented which examine pest population behaviour with the release of female sex pheromones for the attraction and annihilation of males. These models include male polygamy and female monogamy, various mating frequencies, delayed mating of females, immigration of one or all individual types, and differential survivorship of males and females. In all the models there are two steady states, a stable s.s. at the origin and an unstable s.s. in the positive domain for a given value of pheromone release rate. In all the models, control relies on the reduced ability of males to fertilize virgin females following trapping and male annihilation. As such, control is very sensitive to mating frequency, being very difficult when males mate frequently. Control is also very difficult with the immigration of even a moderate number of fertilized females. Control is much easier when mating is delayed, especially if survivorship is low, or with density dependent population regulation.     

Understanding U.S. fertility: findings from the National Survey of Family Growth,Cycle III

The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.     

Credit programs for the poor and reproductive behavior in low-income countries: Are the reported causal relationships the result of heterogeneity bias?

Group-based lending programs for the poor have drawn much attention recently. As many of these programs target women, an important research question is whether program participation significantly changes reproductive behavior and whether the gender of the participant matters. Using survey data from 87 Bangladeshi villages, we estimate the impact of female and male participation in group-based credit programs on reproductive behavior while attending to issues of self-selection and endogeneity. Wefind no evidence that women s participation in group-based credit programs increases contraceptive use or reduces fertility. Men So participation reduces fertility and may slightly increase contraceptive use.     

Men and family planning: toward a policy of male involvement

The stated aim of this discussion is to examine the extent of male use of family planning and the nature of men's role in family planning in developing countries. Case studies are presented which are successful examples of strategies for involving men in family planning. Policies that aim to increase male involvement must be sensitive to cultural values, apply to a decentralized government approach toward information and supplies, include adequate political will, and consider the costs and benefits of changing values. A male family planning policy would not always be compatible with all fertility values in developing countries or traditional values of the older population. A policy should stress the value of male individuals contributing as much as possible for their own and others' welfare. Community participation is considered important in order to create a feeling of mutual support. A sizeable investment will be required for mass distribution of contraceptive information. Schools are viewed as an ideal place for educating youth about the problems of high fertility and about use of family planning methods, such as the condom. Religious organizations should be used to educate people about responsible parenthood and to minimize barriers to use of modern contraception. Comic books on how to use condoms are suggested as a good source. Local authorities who are trusted are useful in influencing acceptance among local populations. Local personnel may be trained as information disseminators. Adequate contraceptive information needs to be supplied to a wide audience. Lack of supply and inadequate information are given as two key reasons for insufficient use of male contraception. Condoms should be priced to be affordable to the average person and free to those with no income. Program strategies that proved successful are cited for Thailand's Mechai Viravaidya program and Bali's grass-roots program. The vasectomy program in Bangladesh is also noted for its success. Low levels of condom use are attributed to factors such as price, education, availability, accessibility, culture, religion, and economic conditions. Male sterilization levels can be enhanced with wider availability of clinics and provision of correct information for challenging beliefs that vasectomy is a form of castration.