Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

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.     

The impact of mass media family planning promotion on contraceptive behavior of women in Ghana

This paper examines the influence of media messages about family planning, and attitudes toward media promotion of family planning, on contraceptive behavior of married women in Ghana. It also examines the problem of reverse causation that arises in studies of this nature when the data used provide no information on the temporal order of the actual time that respondents were exposed to family planning information in the mass media and the time of adoption of contraceptive behavior. The results show that exposure to media messages on contraception exerts strong impact on current practice of, and intention to use, contraception. Women who had heard or seen advert on contraceptive brands, and women who favor broadcast of family planning messages in the media, are significantly more likely to adopt birth control behavior than women who had not heard or seen, and women who do not favor broadcast of such media messages, respectively. Regarding the problem of reverse causation, the study demonstrates that while being exposed to media messages significantly affects a woman's contraceptive behavior, the reverse does not seem to be the case. The policy implications of these results and how mass media could be used to promote family planning in Ghana are discussed.     

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.     

The dynamics of contraceptive adoption in Bohol,Philippines: 1976-1978

A researcher analyzed 1976 and 1978 data on 414 rural women who had never used a family planning method to prevent pregnancy and lived in the predominantly Catholic island province of Bohol in the Philippines to look at the influence certain aspects of the family planning program, begun in 1976, as predictors of changes in contraceptive behavior. 34.5% accepted contraception between 1976-1978. The researchers learned that couple traits (e.g., age, income, education, and religiosity) had only an indirect effect on change in contraceptive behavior. A desire to stop, limit, or space births (motivation) was a strong predictor of family planning method acceptance (p.001). Further couples who clinic providers contacted the most often or who had received more family planning services (services) were much more likely to use contraceptives (p.001). Indeed a significant relationship existed between motivation and services (p.001). Moreover couples who were truly motivated to use family planning methods did not let distance to family planning services prevent them from seeking these services (p.001). On the other hand, couples who confronted personal obstacles to family planning including social, psychological, and other subjective costs (cost index) tended not to accept family planning methods (p.001). A negative association existed between services and location of households vis a vis the intervention program (p.001) which indicated that the program did have an effect in the area of the province where it was located. In conclusion, the strongest predictors of change in contraceptive behavior included motivation, services, and cost index. Services and cost index indicated the great importance of interpersonal and/or client staff contact, especially since they were more important in influencing behavior change than distance and family planning site.     

Pregnancy avoidance and coital behavior

This study proposes a behavioral model that identifies determinants of coital activity in the context of pregnancy avoidance and assesses the relationships using weekly panel data collected on 300 rural married women in Sri Lanka in 1988. We discuss the utility of the design, which is similar to that of an epidemiological surveillance system, for the measurement of coital behavior and pregnancy risk perceptions. Perceptions of pregnancy risk, spousal agreement on sexual relations, menstrual and lactational status, and cycle timing, all measured daily, are found to influence significantly the probability of coitus on that day. The findings suggest that substantial gains in studying fertility regulation are likely from closer investigation of the behavioral connections between motivation for pregnancy avoidance and coital incidence. Comparison of such panel data with those of cross-sectional sample surveys also provides insights into the validity of measures of coital and contraceptive behavior.     

Women's autonomy,women's status and fertility-related behavior in Zimbabwe

Women's household decision-making autonomy is a potentially important but less studied indicator of women's ability to control their fertility. Using a DHS sample of 3,701 married black African women from Zimbabwe, I look at women who have no say in major purchases, whether they should work outside the home,and the number of children. When men dominated all household decisions, women were less likely to approve of contraceptive use, discuss their desired number of children with their spouse, report ever use of a modern method of contraception, and to intend to use contraception in the future. However, women's decision-making autonomy was not associated with current modern contraceptive use. Women who had no decision-making autonomy had 0.26 more children than women who had some autonomy. These autonomy measures provide additional independent explanatory power of fertility-related behavior net of traditional measures of women's status such as education and labor force participation.     

Some estimates of the reliability of survey data on family planning

An opportunity to estimate the reliability of survey data on family planning is afforded by a longitudinal study of fertility in metropolitan areas of the United States. A probability sample of mothers was interviewed six months after the birth of their second child. Data were collected on a number of pregnancies, use of contraception, methods used, and the planning status of each pregnancy, in addition to a wide variety of social and psychological characteristics. Three years after the first interview, the same women were interviewed again and identical questions were asked about the same pregnancies. This paper reports an analysis of the consistency of responses in the basic fertility and contraceptive histories. Given the simplicity of the pregnancy histories, the relatively sophisticated sample interviewed, and the intensive preparation of the research, the reliabilities of data on family planning estimated here are assumed to approximate to an upper limit for such data at the present stage of development of survey techniques. Some suggestions for possible future improvement are included.     

Reactions to Blake and Das Gupta’s “the fallacy of the five million women: A re-estimate”

This article reviews the methods used by Blake and Das Gupta (1972) to estimate need for contraceptive protection among single (never-married) and previously married women below the near-poverty line in 1966. More recent data than those used by Blake and Das Gupta to estimate coital activity and protection by contraception allow calculation of alternative estimates of the number of single and previously married women in need in 1966. To assess the relative accuracy of the two estimates, we introduce a validity check. Using vital data from the National Natality Survey and other sources, we calculate a birth rate and a pregnancy rate for low-income single and previously married women, using the two estimates of the number of women in need—i.e., the population at risk of these vital events. If the two estimates of the number in need of contraceptive protection are either excessively low or high, this should be apparent in the resulting birth and pregnancy rates.     

Breastfeeding women and family planning programs: special needs and opportunities

Although breastfeeding makes a major contribution to fertility control and child spacing in many developing countries, the implications of this are not widely recognized. Terminology may be part of the reason. Contraception may imply something modern, whereas the contraceptive effect of breastfeeding is a natural biological mechanism. Also, many family planning program managers are educated in the West, where breastfeeding is of little contraceptive importance. Regardless of where they were educated, they may consider the pregnancy-postponing effects of breastfeeding as mythology, or may consider breastfeeding as sufficiently effective at the individual level. Breastfeeding as a family planning method cannot be "delivered" to women by family planning methods, and requires an educational approach rather than a clinical or medical approach. A women might use breastfeeding more confidently in avoiding an unplanned pregnancy if she begins using a contraceptive method as soon as she resumes menses, when she begins giving her baby food supplements, or by 6 months post partum--whichever comes first. She can achieve high effectiveness in avoiding pregnancy by keeping the baby nearby and feeding on demand, feeding frequently, sleeping near the baby and maintaining nightfeedings, not giving the baby bottles or pacifiers, and giving the baby only breastmilk for at least 4 months. Breastfeeding can only be used by new mothers and cannot be used to postpone the 1st birth. Nor is it appropriate for women who have attained their desired family size, or who wish to avoid or postpone pregnancy at any cost.     

Contraceptive use at first intercourse among Jewish women in Israel, 1962–1988

Using data from the 1987–1988 Study of Fertility and Family Formation,this study examines the family planning practices of Jewish Israeli womenwho first had intercourse between 1962 and 1988. The overwhelming majorityof women reported using no contraception at first intercourse, and among those who did practice birth control approximately half relied on modern techniques. While the likelihood that Israeli women used contraception at first sex changed little between 1962 and 1988, there has been a marked shift towards the adoption of efficient methods of birth control. Moreover, factors which promote female empowerment, including education and military service, have been positively associated with contraceptive use at first intercourse. Among those women who practiced contraception at first intercourse, those from Africa and Asia have been especially likely to make use of inefficient methods such as withdrawal.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

The difference in unwanted births between blacks and whites

Blacks are more likely than whites to have unwanted births. A common explanation for that difference is that blacks use less effective contraceptive methods, use contraception less effectively, and use contraception less often than whites. Analysis of data from 17 cities in our family planning evaluation project suggested that, among women living in low-income neighborhoods, the black-white difference in unwanted births was not due to (1) blacks reaching desired completed parity at younger ages than whites, (2) differences in age or parity in our black and white samples, (3) black-white differences in current use of physician-administered contraception, or (4) blacks being more likely than whites to adopt physician-administered contraception after having an unwanted birth. Black-white differences which might have contributed to relatively more unwanted births among blacks were (1) blacks desired fewer children, (2) blacks were less likely than whites to use nonphysician-administered methods and more likely than whites to use no contraception, and (3) blacks had higher failure rates than whites subsequent to the adoption of physician-administered methods and when not using those methods. Comparisons are made with the 1965 and 1970 National Fertility Studies, and program implications of the findings discussed.     

Family planning practice and women's fertility decision-making power

This paper investigates the effects of family planning practice on fertility decision-making power in South Korea. The log-linear analysis of the 1981 survey data by the Institute of Population and Health Services Research, Yonsei University, Seoul, Korea, shows that those urban and rural women who practice family planning or have experienced abortion exercise greater influence on a couple's fertility decision making than those who do not practice family planning or who have had no abortion experience. In addition, there is the interactive effect of abortion experience and contraceptive use on fertility decision making among urban women. This finding is significant because regardless of how birth control is available within a society, birth control use enhances women's decision making power where fertility is concerned.     

The Contraceptive Confidence Idea: An Empirical Investigation

In this paper the hypothesis that ‘contraceptive confidence’ promotes accelerated childbearing is presented and examined. Methodological difficulties in investigating the question empirically are discussed. Because of the absence of a direct measure, a proxy indicator of ‘contraceptive confidence’ is used in multivariate analyses of maternity history data. These give results consistent with the existence of a contraceptive confidence effect. Evidence is also presented (a) of shorter second birth intervals among women who were in higher status occupations before marriage and (b) of an inverse association between educational qualifications and length of intervals after the first. These findings are construed as supporting the basic thesis regarding contraceptive confidence. The contraceptive confidence idea is discussed in the context of related work on an acceleration effect associated with women's labour-force participation. Several difficulties in interpreting the findings are considered and some implications are discussed.     

Contraceptive use patterns across teens’ sexual relationships: The role of relationships,partners, and sexual histories

By using data from the National Longitudinal Study of Adolescent Health, we examine how adolescent relationship characteristics, partner attributes, and sexual relationship histories are associated with contraceptive use and consistency, incorporating random effects to control for respondent-level unobserved heterogeneity. Analyses show that teens' contraceptive use patterns vary across relationships. Teens with more-homogamous partners, with more-intimate relationships, and who communicate about contraception before sex have greater odds of contraceptive use and/or consistency. Teens in romantic relationships, and who are older when engaging in sex for the first time, have greater odds of ever using contraceptives but reduced odds of always using contraceptives. Teens continue habits from previous relationships: teens with experience practicing contraceptive consistency and females who previously have used hormonal contraceptive methods are better able to maintain consistency in subsequent relationships. Also, relationship and partner characteristics are less important for females who previously used hormonal methods.     

Why is contraceptive use inversely associated with lactational amenorrhoea? Qualitative and quantitative insights from Bangladesh

Over the past 15–20 years observations in many parts of the world have revealed a negative association between the natural protection afforded by lactational amenorrhoea and contraceptive uptake. This paper uses qualitative and quantitative data to explore the possible explanations for this nagative association in two Bangladeshi populations, one urban and one rural. The findings suggest that a subconscious substitution of contraceptive protection for natural protection against pregnancy is the most likely explanation. It appears that shorter durations of exclusive breastfeeding have led to earlier resumption of menses which in turn prompts the use of contraception. However, other mechanisms appear to play a subsidiary role, at least in the rural population. Moreover, changes in breastfeeding cannot be viewed as totally independent of the promotion of modern family planning. Evidence suggests that family planning staff are poorly equipped to support breastfeeding, and may often encourage the early introduction of supplements. There is a need to consider ways of promoting exclusive breastfeeding as well as ensuring ready access to contraception when fecundity resumes postpartum. Only such an integrated approach is likely to ensure that both negative effects on child health and unwanted pregnancies are avoided.     

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.     

Herbal contraceptives: exploring indigenous methods of family planning

The study, "Herbal Contraceptives: An Alternative Strategy in Family Planning", was conducted by the Research Institute for Mindanao Culture, Xavier University, for the Population Center Foundation. The study has 2 phases: 1) phase 1 gathered information from the regional population offices on the areas where herbs are grown, and 2) phase 2 sought to obtain data on the preparation and perceived effectiveness of herbal contraceptives. Results indicate that, in most of the Philippine regions, herbal contraceptives had long been used by women in the rural areas, specifically those in the indigenous groups. The 1984 study found that many rural women in the research area preferred the Kamias drink and other herbal concoctions to the pill and other modern contraceptive methods. Among college-educated women, it was found that acceptance of contraceptives was influenced more by their religion rather than by their education. Most of the respondents said they used herbal contraceptives because they were easily obtained and were inexpensive. Generally, they considered herbal contraceptives much safer than other contraceptives methods. Some women who had been using modern family planning methods are now using herbs in delaying pregnancy; this shift is mainly due to the side effects of the modern methods. There is room for a compromise between folk practices and modern science, as in the case of herbal contraceptives.