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.     

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.     

Family planning for new mothers in the Philippines

From November 1997 to February 1998, a survey was conducted to evaluate postpartum family planning (FP) services in the Philippines. Data were gathered from records at 86 clinics in 28 provinces and from interviews with 338 FP providers and 3452 clients who began to use FP within 6 months of delivery. Only 7% of women began using FP within 6 months of delivery, and most postpartum attention was devoted to child care issues. Among the women surveyed, most resumed sexual intercourse at 2.4 months postpartum and experienced a return of menses at 4.4 months postpartum despite breast feeding for 6.2 months. The most commonly recommended method to space births was the IUD followed by the injectable contraceptive. Very few providers recommended use of barrier methods. The results indicate that many breast-feeding women are receiving hormonal contraceptives too soon and that IUD insertion may not be occurring at the ideal time postpartum. While a significant percentage of providers recommended use of the lactational amenorrhea method (LAM) and 16% of the women relied on it, the providers lacked sufficient understanding of LAM. In addition, many women switched or discontinued methods. The study led to the recommendations that postpartum FP services be promoted as an essential part of maternal-child health care and that FP providers receive improved training about contraception and LAM.     

Risk-taking and contraceptive behavior among unmarried college students

The contraceptive behavior of sexually active, never-married college women was examined using multiple regression analyses. Use of an effective method of contraception was highly situation-specific: length of relationship and frequency of intercourse were the variables most highly correlated with use of effective contraception, followed by method of contraception used at first coitus and knowledge of reproduction. Failure to use effective contraception was not associated with low estimates of pregnancy risk, nor with high utility of pregnancy, nor with uniquely high willingness to seek abortion. The results of the present study suggest that use or non-use of effective contraception is mediated by the predictability of sexual intercourse.We would like to thank Ira H. Bernstein for his assistance with computer programming and data analysis. Reprints are available from Ms. Irene Steeger, Center for Population and Family Health, Columbia Unviersity, New York.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

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.     

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.     

Child Spacing in the Philippines: The Effect of Current Characteristics and Rural Development

In this study the effects of characteristics current at the beginning of the birth interval on the time elapsing before the next birth are examined. The child-spacing process is viewed as affected by time-varying and fixed characteristics of the community, household, and individual. In the model on which the empirical research is based sociological and economic antecedents are used. The study is based on data from two panels of the Bicol Multipurpose Survey collected in 1978 and 1983. These furnish detailed histories of pregnancy and contraception, together with an extensive set of socio-economic data. Detailed information on services and facilities available in each of the 100 sample communities is also available. Because of the large rural development programme introduced in various sub-areas of the Bicol region, substantial changes in the rural infrastructure and in availability of health and family planning facilities and services occurred between 1976 and 1980, the period on which the analysis is focused. Our results clearly show that current characteristics at the individual, household, and community levels have significant and interpretable effects on the lengths of birth intervals.     

Breastfeeding as a means of contraception

The University of the Philippines Institute of Public Health (UPIPH) and the Family Health International (FHI) brought together health professionals, nutritionists, and family planning experts from different parts of the world to share and gain insights into the issue of breastfeeding and contraception. The participants met in Manila in 1983 and analyzed research findings on breastfeeding and discussed their implications relevant to nutrition and family planning policies and programs. Studies conducted in several countries show a general decline of breastfeeding practice in both urban and rural areas. The issue appears to be not whether women in developing countries breastfeed their infants but for how long. Popkin cites a study in Thailand, which showed very little change in the proportion of babies ever breastfed but large declines in the duration of breastfeeding from 1969-79. In the Philippines, national surveys since 1973 indicate that mothers throughout the country practice breastfeeding but do so for a relatively short period. Scientific data supporting the folk belief that breastfeeding delays the return of fertility after childbirth is growing. The phenomenon is believed to be governed by a sophisticated control mechanism in the female reproductive system. Some researchers suggest that prolactin may be responsible for the delay of fertility in breastfeeding mothers. In a series of studies done in the Philippines and Australia, researchers Barbara Gross and C.J. Eastman found that high prolactin levels were almost always associated with proloned amenorrhea during lactation. A decline in prolactin concentrations accompanied the resumption of menstruation. Gross and Eastman found evidence of ovulation before the 1st menses in only 1 out of 54 fully breastfeeding mothers, or less than 2%. This implies that at least the first few menses of most fully breastfeeding mothers are not accompanied by ovulation, suggesting that breastfeeding continues to affect fertility even after the resumption of breastfeeding. Zablan's study in the Philippine analyzed the various factors contributing to fertility reduction. Breastfeeding appeared to have the greatest impact on the Filipino woman's level of fertility. Zablan points out that, while breastfeeding is a major factor influencing fertility in the Philippines, it "can be relied upon only to postpone childbearing (and then only at the aggregate level), but not to prevent childbearing altogether." Much work needs to be done to help people realize the value of breastfeeding, to encourage mothers to practice it, and to do so for as long as possible.     

Effect of development of rural commodity economy on family planning]

The paper discusses the effects of the changes of rural income level on family planning practice based a survey of 200 rural families in a affluent vegetable producing area of suburban Beijing. In 1984, 99.7% of child birth followed the local birth planning, and 99.1% of families with one child received One Child Certificates. The annual per capita income of the 200 families was 1,092 yuan (1 US$ = 3.7 yuan) in 1984 even higher than the community average. The number of children was negatively associated with the per capita income and per capita consumption except families with 4 children, most of whom have grown up. The rural mechanization in the community has greatly increased the need for skills and technology rather than strong laborers. The provision of community welfare programs and the increased living standard changed the value of children and also changed people's perception in favor of gender equality. Among families with 1 or 2 children, most preferred to have girls. And among families with more children, the preferred family size is smaller than the actual size, which shows a tendency towards favoring a small family. Among 1 child families, 58.7% considered 1 boy and 1 girl to be ideal, and 37.7% was happy with the only child. As the community becomes richer, both the community and individual families increased their investment in education. The spending on education per child was over 2 times as high in 1 child families than the families with more children. The educational status of parents is positively associated with the exception of children's future education and current spending on education. The concern of parents over children's education is an important factor in improving the quality of labor force. Women of higher education status are more acceptable to contraception and family planning policy. The relatively high level of education of the community has been conducive to it fertility decline.     

Contraceptive Initiation Patterns in Thailand

Data from the Thailand Demographic and Health Survey permit a detailed examination of the pattern of contraceptive initiation in terms both of first post-marital contraceptive use and initiation of use following childbirth. A clear trend towards beginning contraception earlier in the family-building process over the course of the fertility transition is evident. During the earliest stage, contraception was first used mainly after a couple had already achieved their desired family size, but later on couples increasingly began use in order to space births, and most recently it has become common to begin use to delay the start of childbearing. There are two distinctive patterns of contraceptive initiation following childbirth. For women who chose sterilization, initiation occurs during the immediate post partum period, while for those who used other methods, use most commonly began shortly after the return of menses. As a result, few Thai women are at present unprotected against unplanned pregnancies for any substantial period of risk following childbirth. Beginning to use contraception early in the family-building process and rapid adoption of contraception following childbirth are now found in most segments of Thai society, testifying to the maturing of Tailand's fertility transition.     

Women--the deciding factor in family planning?

Prominent women from Korea, Nepal, India, Philippines, Thailand, and Afghanistan discuss family planning attitudes in broad terms. Educated women in urban areas make decisions regarding birth control and family size, but the tradition in most developing countries is that of the man in the authority role. Family planning is intrinsically a joint decision. Obligations to family and family lineage prohibit family planning. In the Philippines, Catholicism is the dominant religion and because of population density, encourages family planning. For economic and social reasons, rural families prefer more children. The changing role of women to include jobs and education will have a positive effect on family planning. The representative from Nepal points out that it is necessary to have family planning in order to have changing women's roles. Rather than emphasizing smaller family size, it is recommended by concensus, that family planners communicate health and nutritional benefits for each individual child.     

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.     

Migration and fertility in the Philippines: Hendershot's selectivity model revisited

A demographer compared 1983 data on 5092 currently married migrant and nonmigrant women living in the Philippines to determine whether migration was still selective in terms of fertility behavior or not. Fertility was basically the same between migrant and nonmigrant women in their early reproductive years, but clear differences existed between older migrants and nonmigrants as indicated by children ever born (CEB). In fact, migration did not significantly affect cumulative fertility at all (correlation ratio=.03). Moreover its effect was further reduced when the researchers controlled for age and duration of marriage. Besides level of education and contraceptive use status contributed more to explanations of fertility differentials (correlation ratio=.09 for both) than did migration. The mean number of CEB adjusted for all variables fell with level of education from 4.18 for those with primary education to 3.63 to those with college education. This result identified education as a means to reduce high fertility in the Philippines. On the other hand, the mean was higher among women who ever used contraception than it was for those who never used it (4.21 vs. 3.72). Apparently considerable family size motivated mothers to use contraception. Since women who migrated to cities tended to be in the beginning of their reproductive period, considerable natural increase could occur in urban areas. Therefore the Philippines needed to devise a strategy for reducing fertility among migrant women as well as strategies for other groups such as professional/career oriented women and women who remained at home to tend to children and/or the home.     

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

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

Launching a no-birth bonus scheme in South India

The United Planters Association of Southern India (UPASI) initiated a research program in five states to find out basic facts on family composition necessary to start family planning. In 1971 it started a No Birth Scheme. Its objectives go beyond the immediate need of adopting measures to produce smaller families. It cares about the worker's family as a whole. UPASI thought that a deferred incentive was better than cash, and, if more successful than other campaigns, it could be adapted to rural areas. As a voluntary industrial association it could play a major role in developing countries since their participation in social programs depends on the degree of confidence and acceptance of the workers. The eligible women work together with the state manager and medical staff. The plantation workers come from the rural community and their way of life and habits are similar to those living in rural areas. The Scheme introduced a bonus as an obligation of the state management. Each acceptor had an account book in which she would make the proper entries, showing thus her compliance to the rules of the Scheme. There were no conditions about the contraception used and no deduction was made unless a baby was born. 90.8% of the eligible women who registered, only 5.7% were defaulters. The birth rate per 1,000 population was 40.4 in 1969/70 and 38.9 in 1970/71; 37.3 in 1971/72; 27.2 in 1972/73; 25.4 in 1973/74. The birth d ata for the most recent years is not available. 'UPASI is still a plantation industrial association, but the project staff believe that similar schemes can function in the rural areas with some organizational modifications.     

Central Mindanao: selling family planning informally

A research study was conducted in Central Mindanao, Philippines, to evaluate the effectiveness of " selling" informally the idea of family planning to potential acceptors. The study, entitled "the Extent of Involvement of Satisfied Acceptors Clubs/Satisfied Users Clubs" was conducted for the regional office of the Commission on Population (Popcom) by the Notre Dame University Socioeconomic Research Center in Cotabato City. Organized by fulltime outreach workers (FTOWs), the clubs are concerned primarily with the promotion of family planning. The first such club in the region was organized in 1979. Currently, the clubs are linked with other development agencies. The study's respondents were 200 continuing users of a family planning method and were members of the clubs in Illigan City and Cotabato City. Respondents were mostly women (191 or 95.5%), in their early 30s (31%), had 4 children on the average, had reached high school, and belonged to low income families. On the average, respondents had been practicing family planning for around 4 years and 7 months. They were aware of or knowledgeable about the condom, oral contraception (OC), IUDs, rhythm, tubal ligation, vasectomy, and withdrawal. Some of them were aware of injection, abstinence, foam, and the diaphragm. The majority of respondents indicated they had tried other family planning methods before changing to the method they were using. The primary reason for method change was the desire to use a more effective method. The respondents became club members either by being recruited or by applying for membership on their own. Motivating clients to practice contraception was the club's primary activity. 133 club members (66.5%) "claimed to have successfully motivated persons/couples to practice family planning." Among the problems encountered by the clubs, the indifference of people toward the family planning program appeared to bethe most serious from the respondents' perspective. Inactivity of some members was cited as the 2nd most serious problem. The study concluded that despite problems the clubs had been "fairly successful" in helping Popcom promote family planning.     

A suggested framework for analysis of urban-rural fertility differentials with an illustration of the Tanzanian case

This paper offers a framework for analyzing how individual characteristics and urban or rural "place" factors interact to influence fertility decisions. The framework builds on the Davis-Blake model and additionally shows how place or community variables influence exposure to intercourse, conception, and birth, either with or without a conscious decisionmaking process. The framework emphasizes the way person and place related factors combine to determine a woman's perception of her life options before bearing any children, as well as how changes in these factors may affect subsequent child decisions. The framework is briefly illustrated by the Tanzanian case. The analysis highlights urban-based considerations, such as education-wage differentials, which may influence the rural couple's decisions. A comparison of two rural cohorts shows that specific community variables such as cultural attitudes, accessibility, general educational levels, and child mortality mediate the influence of these urban-based phenomena.Research for this project was completed while the author was affiliated with GETEMPO, Washington, D.C., under contract to the Office of Urban Development, U.S. Agency for International Development. The author gratefully acknowledges the comments and assistance of Ann C. Orr, James E. Kocher, Paula E. Hollerbach, and two anonymous referees. Requests for reprints should be directed to Sally Evans Findley, Minnesota State Planning Agency, Room 101 Capitol Square Building, 550 Cedar Street, St. Paul, Minnesota 55101.     

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.     

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.