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.     

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.     

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.     

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.     

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

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

Hormonal Contraceptive Use and Discontinuation Because of Dissatisfaction: Differences by Race and Education

The unintended pregnancy rate in the United States remains high, and there are large race and education differences in unintended pregnancy and fertility. These differences make it important to study race and education differences in contraceptive behavior. Using nationally representative data from the 2002 National Survey of Family Growth, this study examines the effects of race and education on the likelihood that women have ever used particular types of hormonal contraception and have ever discontinued hormonal contraception because of dissatisfaction. The results show that blacks and Latinas were more likely to have used injectable contraceptives (??the shot??) and less likely to have used oral contraceptives (??the pill??) than were white women. Women with less education were more likely than college-educated women to have used the shot but there were no significant education differences in use of the pill. Among women who had ever used hormonal birth control, those with less than a college degree were more likely than college-educated women to discontinue the birth control because of dissatisfaction. However, net of education, this study found no significant racial/ethnic differences in discontinuation. The most commonly stated reason for discontinuation because of dissatisfaction was side effects.     

Fertility decline in Bangladesh: an emerging family planning success story

Bangladesh has a population of 115 million people, and the economic growth rate of 3.7% during the 1980s was undermined by rapid population growth. The annual population growth rate was 3% in the 1960s and early 1970s, 2.5% between 1981-91 decreasing to 2.3% in 1991. The average of number of children is 4.6/woman compared with 7 in the 1960s. Infant mortality dropped from 150/1000 births in 1976 to 118/1000 in 1991. Life expectancy rose from 47 to 54 years. The 1991 Contraceptive Prevalence Survey showed that 39.9% of married women under 50 use contraceptives in 1991 vs. 18.6% in 1981. The use of modern methods increased from 10.9% in 1981 to 31.2% in 1991, while traditional methods rose from 7.7% to 8.7%. Sterilization was most prevalent in 1981. 29,000 female family planning (FP) workers were aggressively engaged in dispensing FP services in 1990. The Social Marketing Company sells pills, condoms, and oral rehydration salts through 130,000 retail outlets. The 1989 Contraceptive Prevalence Survey showed that 40% of pill and condom users obtained them from this network, and 95.4% of women knew about 4 methods of contraception. In 1990 there were 120 private organizations providing contraceptive services. Some of the components of the government FP program include field worker distribution door-to-door of injectable contraceptives (50% injectable usage rate in the Matlab project); recordkeeping activities; a satellite clinic network with access to contraceptive services; and decentralization through the Upazila (subdistrict) approach. The logistics system of FP has improved the warehousing, transportation, and management information system. Foreign aid (mainly USAID) financing of contraceptives helped avert 14.4 million births between 1974-90. The increase of contraceptive prevalence to 50% by 1997 would avert another 21.9 million births during 1991-96 (replacement fertility requires 70% prevalence.     

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%.     

Injectable contraceptives: how safe are they?

Controversy still surrounds the use of the injectable contraceptive, Depo-Provera, in 3rd world countries, when it has yet to be approved in the US, Canada, Japan, and other developed nations. Some medical professionals maintain Depo is both safe and effective and could curb rapid population growth worldwide. With no conclusive decision made, some countries have approved Depo while others have not yet decided. Originally approved for a variety of uses, Depo is approved in the US only as a treatment for advanced endometrial cancer; however, it is now available in 65 countries and is used as a contraceptive in the Philippines. Depo and its companion Norigest are both progestonogenic injectables and were developed in the late 1950s. Injectables inhibit ovulation and thicken cervical mucus, thereby preventing fertilization. The reservoir usually lasts from 3-6 months, and its action cannot be reversed until the body has completely absorbed the drug. Injectables are highly effective; most accidental pregnancies occur shortly after the 1st injection before the drug has taken effect or at the end of an interval when its effect is wearing off. Overall the rate of fertility return corresponds to the rates for the pill and the IUD. Injectables have the advantage of preventing side effects brought on by estrogens; thus they would be beneficial to women desiring to use contraception but who cannot manage pill side effects. They do not interfere with lactation and have the lowest failure rate of the reversible methods. Important to developing countries is that injectables require no effort on the part of the user. Injectables do disrupt the menstrual pattern and Depo use often results in weight gain. Little is known about the longterm risks of Depo; however, in 1973 the US Food and Drug Administration withdrew approval of Depo for pregnancy-related uses because of links to birth defects. Other recent studies have uncovered other possible effects including uncertainty about whether injectables affect the composition of breastmilk or whether they raise blood glucose levels. Ethics have entered into the controversy with the "contraceptive double standard" where Depo has been exported to 3rd world nations when it has been ruled unsafe for American women. Campaigns have been organized against the distribution and use of injectables in the developed nations and a few in the 3rd world have begun to organize. While the Philippines has approved Depo, it is not yet considered an official method of the National Population Program. Policymakers await a more thorough analysis of factors for and against the promotion of the drug.     

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.     

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.     

More choices of birth control approaches

In rural Zhejiang Province, China, family planning intermediaries are appointed for each village to introduce comprehensive measures of birth control to the people. With an education level of junior middle school at least, they are mostly working women of high prestige in their villages. After appointment as intermediaries, these women are trained for 1-2 weeks in health stations or maternal and child health care stations in towns. Back in the villages, they take over responsibility for distributing monthly contraceptives as needed by women of childbearing age. The intermediaries also explain the advantages and disadvantages of different kinds of contraceptives to newly wedded women and give them guidance and recommendations. Intermediaries also can provide simple treatment for complaints caused by contraceptive use. For example, if women complain of nausea while 1st taking oral contraceptives (OCs), the intermediaries will give them vitamin B6. When intermediairies encounter difficulties, such as women who cannot use OCs for a long time because of a liver ailment, they refer the people to health stations or send for a doctor. The number of induced abortions has declined because of the fact that a vast number of women of childbearing age in rural areas now obtain appropriate contraceptives in time. Generally, each intermediary is assigned to be in charge of 15-20 households, making a regular monthly visit to each of these families. The contraceptives they distribute are from town governments, which give them a certain amount of annual subsidies.     

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.     

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.     

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.     

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.     

Community-based contraceptive distribution: a Korean success story

The results of a community-based contraceptive distribution program using village women canvassers in Cheju Island province, Korea, are evaluated. This rural province had the highest fertility and lowest contraceptive use before the project began. After pre-testing in another area, township-level family planning field workers recruited 365 new female canvassers per 150 women at risk of pregnancy, compared to 10,000-25,000 per worker in the previous scheme. The canvassers were to contact every household, offering them pills or condoms, or vouchers for an IUD or sterilization from the clinic. The former target system, which in reality had limited the numbers of acceptors, was suspended, necessitating an increase in budget outlays for family planning in Cheju province. By 1985 the contraceptive prevalence had doubled, and fertility fell 40.1 and 32.4% in the 2 Cheju counties. Costs per couple-year for the Cheju program were lower than those in other areas. The results of this project suggested that increasing the number of community workers or canvassers in rural areas helps reduce barriers to the use of contraceptives.