Contraceptive behavior in Ghana: a two-sex model

This report uses data of the 1988 Ghana Demographic and Health Survey (GDHS), a nationally representative self-weighting sample of 4488 female respondents 15-49 years old. 943 co-resident husbands of the surveyed women were also interviewed, thus the data provided 1010 dyads, which facilitated a couple-level analysis of contraceptive behavior. The determinants of modern contraceptive adoption were examined among dependent variables, including both modern and traditional methods, and the predictors of future usage among the nonusers were also assessed. For each of dependent variables, two logistic regressions were estimated, one for females, and the second one for couple measures of intentions and male preferences. Males were older and more educated than their female counterparts, and women were more likely than men to want to cease and space childbearing. 68.8% of women were in monogamous marriages, and the average age of women was 31.8 years, compared to 41 years for men among 1008 people in the sample. 43.5% of women had lost more than 1 child, and 22.9% had urban residence. 11.7% of couples agreed that contraceptives were needed for stopping childbearing. However, 14.9% said that there was no need for contraception, while 27.7% wanted contraception for spacing of births. 46% of the sample disagreed about contraceptive need and use. 6% of the women used modern contraceptives, while 8.7% used traditional methods. In addition, 29.7% of the women intended to use contraception in the future, while 55.6% did not intend to do this. Examination of contraceptive use and selected background variables indicates urban-rural differences. Also, the advancing age of wives and all levels of female schooling means increasing contraceptive use, but secondary schooling was associated with lower use for men than primary schooling. Use of contraception was also positively associated with the desire to cease childbearing for both sexes whether users or non-users. The findings indicate that female preferences were more significant than male preferences in predicting contraceptive use in Ghana.     

Son preference and reproductive behaviour in rural Punjab

This study examines the impact of son preference on desired family size and contraceptive usage among a rural population in Punjab, India. Data are obtained from a sample survey conducted for the Center for Research in Rural and Industrial Development in 1989-90 in 7 rural districts of Punjab. The sample includes 450 currently married women aged 15-44 years. Analysis pertains to mean desired family size, the percentage not desiring additional children, the percentage desiring additional sons and daughters, and current use of contraception by sex, birth order, and number of living children. The estimation of the extent to which contraception would increase and desired family size would decline is based on methods developed by Arnold (1985) that assume no sex preference at any parity. Findings indicate a strong son preference. At every parity, women with sons only desired fewer children and were more likely to use contraception. Among women who desired more children, there was no indication that women with sons only desired a balanced sex composition. None desired a second daughter, and many desired a second son. As the number of living sons increased, so did contraceptive use. Contraception was 20% among couples with no son, 50% among those with one living son, and 81% among those with two living sons. Sterilization acceptors had an average of 2.07 living sons. At parity 2, two times as many couples had boys only compared to girls only. At parity 3, there were 7 times more families with boys only than families with girls only. If sex preferences were completely eliminated in the Punjab, there would be a 9% decline in desired family size from 3.05 children to 2.77 children. Contraceptive use would increase by 14 percentage points from 58% to 72%. The cultural practices of the Jats ethnic group place girls in the position of being an economic liability.     

Willingness to Have Unprotected Sex

Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would “sometimes” or “maybe” engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.     

The role of need for contraception in the evaluation of interventions to improve access to family-planning methods

A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on met need (i.e., contraceptive use by women who need contraception) but not on contraceptive use (i.e., contraceptive use by women who may or may not need contraception). Met need captures the woman's success in overcoming barriers to access to family planning, whereas contraceptive use confounds this construct with risk of pregnancy and fertility desires. Exceptions to this rule are identified.     

Willingness to have unprotected sex

Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would "sometimes" or "maybe" engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.     

Socio-economic and cultural differentials in contraceptive usage among Ghanaian women

Data from the Ghana Fertility Survey of 2001 married women in 1979-1980 were subjected to logistic regression to determine the factors influencing contraceptive use. In this Ghanaian sample only 22 women and no men were sterilized, 11% used an efficient contraceptive method and 8% were using an inefficient method. The most prevalent methods were abstinence by 6% and pill by 5%. The variables analyzed were birth cohort, age at 1st marriage, education, occupation, religion, ethnicity, rural/urban residence, northern/southern residence and number of children desired number of living children. All these factors were dichotomized, e.g., cohort: born before or after 1950. Factors positively significant for contraceptive use were younger women (20% more likely), married at age 20 or older (82% more), education (150% for any method, 67% for an efficient method), professional occupations, protestants, urban residence, southern residence, desire fewer children. Factors negatively associated with contraception were agricultural work (50% as likely), non-Christian religion, both traditional and Moslems (75%), desiring more children and living in the north. Unexpectedly, living in the northern undeveloped region was strongly linked with use of an efficient contraceptive. A factor without significant effect was ethnicity, Akan or non-Akan. These results were discussed with a general review of the literature on determinants of contraceptive use.     

Community and individual acceptance: family planning services in the Sudan

The Sudan Community-Based Health Project, initiated by the University of Khartoum in cooperation with the Ministry of Health in 1980, sought to test the proposition that government-trained village midwives could provide maternal-child health and birth spacing services in addition to their ongoing obstetrical duties. The project area encompassed 92,000 people in 93 villages. The 120 midwives serving the project area received training in 4 interventions -- oral rehydration therapy, maternal and child nutrition, immunization, and birth spacing -- and introduced these services by means of 3 rounds of household visits over a 5-month period. Comparison of pre- and post-intervention survey data indicates that village midwives can indeed be used successfully to promote not only contraceptive use, but also health attitudes and practices that are positively associated with fertility regulation. Between the 2 surveys, the percentage of women who ever used contraception increased from 22% to 28%, while the percentage of current users rose from 10% to 13%. Parity was significantly related to current use; each child born multiplied the likelihood of contraceptive acceptance (by a factor of 0.76 in the post-intervention sample). Maternal education was the socioeconomic variable that most enhanced receptivity to contraceptive acceptance after the project's interventions. In terms of community-level variables, village location along the Nile and proximity to a paved road were significant correlates of contraceptive use. When variables related to the project itself were analyzed, women with vaccinated children were found to be twice as likely to contracept as those with nonvaccinated children and women who believed breast feeding should be continued during diarrhea episodes were 1.5 times more likely to use birth spacing than those who did not. Although midwives did not specifically emphasize contraceptive use, it appears women who were encouraged by midwives to take positive steps in the area of child health were also likely to become more innovative in terms of fertility regulation.     

Social and attitudinal determinants of contraceptive choice: Using the health belief model

The factors associated with choice of birth control pills or a diaphragm were examined, using concepts derived from the Health Belief Model (Rosenstock, 1974). Women who visited a suburban family planning clinic completed a self‐administered questionnaire (N— 632) indicating their contraceptive choice, attitudes about different methods of contraception, and perceived threat of pregnancy. Using discriminant function analysis, pill users were distinguished from diaphragm users by (a) their reported perception of greater support from others for using the pill, (b) their reported belief the diaphragm was more inconvenient to use and the pill more convenient, (c) expressing less concern about the pill's side effects, (d) believing they were more protected from pregnancy when using the pill and more susceptible when not using it, and (e) knowing less about contraception in general. They also were younger and more likely to be involved in a committed sexual relationship. Results are consistent with the Health Belief Model and also support the inclusion of a subjective‐norm factor into the model.     

A research note on male‐female differentials in the experience of heterosexual love

Debate regarding the morality of abortion has ranged from expressions of concern for the fetus by anti‐abortionists to assertions by those favoring legalized abortion that women should control their own bodies. The present research explored the possibility that the social acceptability of the sexual relationship and the extent of contraceptive conscientiousness of an abortion applicant influences favorability of response toward abortion. After responding to a measure of attitudes toward premarital contraceptive use, 40 college students read 10 brief case histories of young unmarried women who were purportedly requesting abortion. As hypothesized, participants' support for abortion was influenced by the source of contraceptive failure (method vs. personal), kind of contraceptive (artificial vs. natural), and kind of sexual relationship (steady vs. casual). Results were discussed in terms of the possibility that observers may wish to restore justice by giving greater support for abortion for conscientious contraceptive users involved in socially approved sexual relationships than for careless contraceptive users whose involvements are more casual. It was suggested that societal attitudes toward contraception for unmarried persons may interact with the reality of the prevalence of premarital sexual activity to increase the premarital pregnancy rate.     

Web-based survey 'Contraception and attitudes to sexual behaviour' completed by women accessing a UK menopause website

Background and methodology Sociodemographic trends mean increasing numbers of new relationships in later life. These trends may not only have health consequences for women and health services but also impact on the targeting of sexual health messages. This study aimed to examine attitudes and knowledge surrounding contraception, sexual health and unwanted pregnancy among those accessing the website www.menopausematters.co.uk. A voluntary online survey was completed. RESULTS: Survey was completed by 550 respondents. Three hundred and sixty-six women, 94% of whom self-classified as pre- or perimenopausal, had been sexually active with a male partner in the previous four weeks. Commonest contraceptive methods used by perimenopausal and postmenopausal women were condoms, combined oral contraceptive pill (COCP) and male sterilization. Up to 42% of women surveyed were unhappy with their contraception. A total of 27% premenopausal, 32% perimenopausal women and 40% postmenopausal used no contraception. One-third of women were unhappy about this and 19 unplanned pregnancies had occurred. The majority of women were informed regarding COCP use over 35 years, hormone replacement therapy, emergency contraception and ceasing contraception. The majority of women were unaware that more terminations of pregnancy are performed in women over 40 than any other age group per total pregnancies.Almost a third of women were unaware that chlamydia incidence is increasing in older women. Most would use condoms in new relationship. Discussion and conclusions Women accessing www.menopausematters.co.uk are well informed about contraception and sexual health. The majority of those accessing the site are sexually active, but many use no contraception, or are unhappy with their chosen method, leaving them vulnerable to unwanted pregnancy or sexually transmitted infection.     

Girls' education and their change of attitudes: a case from Sudan

This study examines the association of girls' education and changes in attitudes and other socioeconomic changes in Sudan. Data were obtained from in-depth interviews, structured questionnaires, and secondary data among 810 educated Sudanese women who lived in the Central and Eastern Regions. Women responded to 10 opinions about the status of women. Findings show a significant association between level of education, even at the lowest levels, and the attitudes held by women. Women held relatively positive attitudes toward social change and economic development. Level of education was highly significantly associated with holding a view of educated women working. 54.1% of secondary school leavers agreed and 92% of well educated women disagreed with a family's objection to women having a job. 57% of secondary school leavers agreed that it is essential to give up work in order to care for family; however, 96% of postgraduates disagreed. 74% of respondents were indecisive, of which 44% were secondary school leavers and 2% had postgraduate degrees. Decisiveness increased with level of education. Only 32.6% of secondary school leavers agreed that most of a woman's time should be spent on family responsibilities. 100% of the highest educated women and 40% of secondary school leavers disagreed that women should take part-time work. 96% of postgraduate women disagreed and 73.6% of secondary school leavers agreed that women should not feel obligated to work after training. Employment was highly influenced by level of education. 83% of single women and 76% of married women agreed with using contraception. Rural women tended not to support women working and using contraceptives. Younger women were less traditional in their attitudes. Postgraduates came from families with high levels of income.     

Sexual decision making and safer sex behavior among young female injection drug users and female partners of IDUs

Data from interviews with 94 young women who were injection drug users (IDUs) or partners of IDUs were analyzed to examine associations between self-reported sexual decision making and condom use, contraceptive use, and relationship characteristics. Most women (73-85%) reported participating in decisions about condom use, contraception, and when to have sex. Adjusting for potential covariates, respondents who reported participating in decisions about condom use and when to have sex were 7 and 19 times, respectively, more likely than others to report recently using condoms. Respondents who reported participating in decisions about contraception were 20 times more likely than others to report recently using contraceptives. Longer sexual relationships were associated with decreased likelihood of condom or contraceptive use.     

Conjugal Role Definitions,Value of Children and Contraceptive Practice*

This study deals with the differential impact of conjugal role definitions on contraceptive practice and the value attached to children. A modified version of Motz's Role Conception Inventory was used to ascertain conjugal role definitions of the 433 married women included in the sample. Contraceptive practice was measured by the stage in the wife's childbearing history at which reliable contraception was initiated, and the value of children was determined by responses to statements concerning the costs and rewards of parenthood. The findings indicate that both reliable contraceptive use and the value attached to children are related to the wife's definition of appropriate role behavior. However, the extent of the impact of role definitions is a function of the wife's educational background and the economic circumstances of the family.     

Out of Cairo: forging a new population policy

The 1994 International Conference on Population and Development (ICPD) was the first where thousands of women contributed to the agenda. The previous emphasis of population policies on the simple provision of family planning (FP) services has led to abuses such as coercion to have only one child in China or financial incentives for undergoing sterilization in India. The 1994 ICPD Program of Action provides a more humane basis for population programs by emphasizing the fact that women have fewer children when they are educated and gainfully employed. Thus, improving women's reproductive health and social status has become a central issue, and widening access to contraception remains an important objective. In addition to the 500,000 women who die of pregnancy-related causes each year, half a billion suffer infections of the reproductive tract. By failing to address these problems, many FP services actually exacerbate them. In Giza, for example, although 39% of 500 women studied used contraception (45% of those married and living with their husbands), only 1 in 7 was free of gynecological problems, urinary tract infections, and syphilis (50% had at least 2 of these conditions). The women who used contraceptives were no healthier than their neighbors who did not. Once FP clinics attempt to tend to reproductive health issues, they encounter cultural and religious constraints. For example, a woman may obtain an IUD and then suffer from severe side effects rather than return to the clinic for attention. Another woman may become infected from an illegal abortion obtained at her husband's insistence. The infection may preclude an IUD for months, so the woman may obtain oral contraceptives from a pharmacy although she knows her high blood pressure should preclude their use. Full implementation of the ICPD Program of Action would improve the status of women such as these, fostering their self-esteem, their access to education and employment, and their participation in the political process; eliminating violence against them; and making them aware of their legal rights. The success of the readjustments in FP programs, government resource allocation, and family structures which will accomplish this task will depend largely on the women who helped put reproductive health on the ICPD agenda.     

Fertility differences between the family of orientation and the family or procreation in Barbados

Data from an island-wide probability sample of 4119 Barbadian females aged 16-50 were used to study whether there has been an intergenerational fertility decline between the respondents and their mothers. The fertility of the respondents, all from the low or lower middle class, was significantly lower than that of their mothers. However, the size of the family of procreation was seen to be positively related to the size of the family of orientation; i.e., those from large families tended to have large families and vice versa. There was, however, a regression to the mean. There were no differences between women from small and large families as to fertility norms, age at 1st use of contraceptives, or actual practice of contraception. Women from small families did tend to enter sexual relationships and get pregnant at a later age. The women from small families were better educated, earned higher incomes, and had higher status occupations, all factors which might have influenced their fertility. Women from larger families cited higher numbers for both small and large families than did the women from small families. This indicates a perceptual difference which was, in turn, related to fertility differences.     

Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction

Objective: This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women. Participants: A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015. Methods: Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC). Results: While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information. Conclusions: This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.     

Barrier versus oral contraceptive use: a study of female college students

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.     

Women's acceptance of the diaphragm: the role of relationship factors

The vaginal diaphragm is a candidate for a female-controlled method of reducing risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18-49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom-use negotiation self-efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.     

More Than a Physical Burden: Women’s Mental and Emotional Work in Preventing Pregnancy

In the United States, responsibility for preventing pregnancy in heterosexual relationships disproportionately falls on women. While the biotechnological landscape of available methods may explain the assignment of the physical burden for contraception to women, this does not mean the concomitant time, attention, and stress that preventing pregnancy requires must also be primarily assumed by women. Building on work identifying health care providers as contributors to the construction of normative ideas about reproduction, this study analyzed 52 contraceptive counseling visits with women who reported they did not want future children for the construction of responsibility for the mental and emotional aspects of contraception. Offering a case of how gender inequality is (re)produced through clinical encounters, findings demonstrate that clinicians discursively constructed these responsibilities as women’s and point to structural aspects of the visit itself that reify this unequal burden as normal. Results are consistent with research identifying the broader feminization of family health work in heterosexual relationships. To the extent that the distribution of the mental and emotional responsibilities of preventing pregnancy is both a product of and contributor to gender inequality, this analysis yields insight into the production—and possible deconstruction—of (reproductive) health care as a gendered social structure.     

Labor force participation and fertility: a study of married women in Bangladesh

Most researchers support the notion that a direct negative relationship exists between married women's labor force participation and fertility behavior, yet female employment shows no consistent, general relationship with declining fertility at individual and societal levels. Specific conditions under which employment lowers fertility are therefore explored for the case of Bangladesh. The economic, sociological, and world-system theoretical approaches to the relationship and empirical studies in developing countries including Bangladesh are reviewed. 1975-76 Bangladesh Fertility Survey data on births, deaths, nuptiality, and family planning knowledge and practice for 5772 currently married women of 6513 ever married women under 50 sampled are subjected to multivariate analysis for the study. Analysis revealed that women's modern and traditional occupation as well as higher and secondary education significantly lower their fertility, and that higher age, Islamic religion, use of modern contraceptives, and husband's occupation in transitional and modern sectors have significant positive effects on fertility. The correlation between higher fertility and contraceptive use may be due to women's delay in practicing family planning until reaching desired parity and/or high infant mortality driving women to cease practice in order to replace lost offspring. Future research should be conducted with larger samples and also consider occupations of both husbands and wives. Societal attitudes about women's education should be reformed in support of opening rural schools for women. With 90% of women residing in rural areas and women with traditional occupations having lower fertility, more traditional sector opportunities for women in cottage industry and agriculture production are also recommended, and would help balance skewed urban growth and hypertrophication of the tertiary sector. Finally, motivational efforts should be focused upon encouraging younger instead of older married couples to limit fertility.