Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000

Our study estimates the effects of exposure to a family planning program which promoted surgical contraception for the first time in Peru on women's use of birth control methods and their children's health. While a broad program, the Programa de Salud Reproductiva y Planificación Familiar forced many indigenous women to undergo sterilization. We compare provinces affected by the program earlier with provinces affected later, before and after the policy. Overall, the results indicate that women in treated areas were more likely to use both temporary and permanent contraceptive methods and their children were less likely to die within their first year of life, partly due to longer breastfeeding. However, we observe heterogeneity by ethnicity. In treated provinces, nonindigenous children benefited from the policy regardless of their mothers’ choice of contraceptive method, while there were few positive impacts for indigenous children whose mothers underwent sterilization. This suggests that coercive or aggressively implemented family planning programs may not confer health benefits on children.     

我国已婚育龄人群避孕水平及避孕方法使用趋势

利用中国20世纪60年代到2004年的全国计划生育调查数据,深入分析我国已婚育龄人群避孕水平及避孕方法的使用趋势。结果表明,我国一直是全球总避孕水平最高的国家,避孕方法以长效措施为主。90年代后,主要避孕方法中宫内节育器现用率逐年上升,女性绝育逐年小幅下降,男性绝育逐年明显下降,避孕套现用率逐年递增,口服避孕药、外用避孕药和其他避孕方法呈逐年下降趋势;且避孕方法的选择存在省市、城乡差异。     

Adolescent Contraceptive Method Choices

This article analyzes determinants of contraceptive method choices among adolescent women in the United States. By using data from the 1982 National Survey of Family Growth, we examined factors that differentiate users of various methods early in the sexual careers of teenaged women. We find that patterns of method choice not only vary by race and region within the United States but also change over the teenager's life course. In addition, among teenagers who did not use a method at first sex, the likelihood of adopting a method soon thereafter was low for both whites and blacks and was unaffected by social structural characteristics.     

Contraceptive sterilization in the U. S.: 1965 and 1970

There was an impressive increase between 1965 and 1970 in the prevalence of contraceptive sterilization, an increase that accelerated in the later years of the period and was shared in by virtually all subgroups considered. Among couples in 1970 for whom sterilization had been an option (recognizing that it is a terminal method), about one of every five had chosen this method of contraception. About half of all sterilizations were vasectomies, though vasectomies have outnumbered tubal ligations in recent years. Differentials in prevalence and in increases during 1965–1970 are reported for a number of life-cycle and social variables. In addition, a profile of the contraceptive sterile is presented for recent sterilizations. Significant proportions are relatively young and of low parity at the time of sterilization. In the context of the continued diffusion of the pill and IUD and increases in legal abortion, the net demographic effect of increasing sterilization is regarded as low, though sterilization is an important component of an effective fertility control regime.     

The trends of contraceptives of people in Shanghai since early 1980s

Shanghai has had the lowest fertility rate in China for many years. Shanghai had a negative rate of natural growth during 1990-95. During 1980-93, fertility dropped continuously. In 1982, contraceptive use among married women included 29.47% using IUDs, 29.33% using oral pills, 23.44% using female sterilization, and 10.48% using condoms. Contraceptive prevalence declined slightly from 98.6% in 1982 to 92.29% in 1993. By 1993, method use changed. Oral pill and female sterilization use declined to 8.04% and 7.22%, respectively, among married women of reproductive age. IUD use increased dramatically to 72.2% in 1993. Condom use declined to 8.83% of total users. Despite reduced contraceptive prevalence, the birth rate declined from 18.51/1000 population in 1982 to 6.50/1000 population in 1993. The proportion of women accepting the one-child certificate increased from 53.32% of all married women of reproductive age in 1984 to 70.13% in 1993. The shift use of contraceptive methods means reliance on long-term reversible methods.     

The legacies of context: Past and present influences on contraceptive choice in Nang Rong,Thailand

This study explores the ways in which women's contraceptive behavior in a rural area of Thailand is shaped by both past and present context, based on the life course framework. Although the importance of contextual influences for contraceptive behavior is well established in the literature, relatively little research has been conducted that explores how behavior is influenced by historical and contemporaneous contextual factors and by individual life experiences. In addition, much of this research has neglected the role of the normative environment within which contraceptive use takes place. The focus of this paper centers on the effect of contraceptive environment at both early and late stages of the life course and on how this effect is shaped by individual experience with migration to urban areas. This study takes advantage of a unique, prospective longitudinal data set with detailed information on community context at multiple points in time, an important improvement upon prior research. The results show that contraceptive behavior is particularly responsive to current community context, with past context primarily exerting an indirect effect on behavior through shaping current contextual influences.     

Adding choice to the contraceptive mix: lessons from Indonesia

Researchers asked 1945 women of reproductive age living in East Java, Indonesia what contraceptive method they preferred during the women's 1st visit to a government family planning clinic. Soon after field workers introduced them to a method, the researchers asked the women what method the field workers suggested and what method the women planned to use. They again spoke to them 1 year later to determine contraception continuation. The field workers granted 86.3% of the women their method choice. Only 9% of these women had stopped using their chosen method while 72% of the women who were not allowed to use their chosen method stopped using the method assigned to them. Thus choice was a key factor in sustained use of contraceptives. Further if family planning workers stick to a mutual participation of both themselves and their clients, they respect clients' method choices and, by informing clients about the chosen method, they strengthen clients' decision making. In the early 1990s, another researcher had developed a system to determine contraceptive needs at various stages of the reproductive period (before 1st marriage, after 1st marriage but prior to 1st birth, after 1st birth but prior to last birth, and after last birth). She applied observed contraceptive preferences for women using contraception within each life cycle stage to the age specific contraception need, derived from data from the 1987 Contraceptive Prevalence Survey for Indonesia, to determine the ideal contraceptive mix. Her calculations demonstrated that oral contraceptive use was high, IUD use was low, particularly among older women, and too few sterilizations had occurred, particularly among older women. Thus Indonesia needed to broaden the contraceptive mix to encourage methods that better meet women's reproductive life cycle needs.     

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.     

Fertility regulation technology: status and prospects

The current status of and prospects for contraceptive methods is reviewed. Regulations governing the development, safety, and effectiveness of contraceptive methods are discussed, as well as the nature of the female and male reproductive system. Methods reviewed include coitus interruptus, the condom, spermicidal contraceptive agents, postcoital douching, the vaginal diaphragm, male and female sterilization, the rhythm method, oral contraceptives, IUDs, induced abortion, progesterone-releasing IUDs, postcoital estrogens, abortifacient agents (prostaglandins), immunization against human chorionic gonadotropin (HCG), pharmacologic suppression of the corpus luteum, long-acting injections of Depo-Provera, implantation of capsules containing norgestrel, the intravaginal ring, intracervical devices, release of contraceptive steroids through an arm bracelet, and male contraceptive agents. New areas of contraceptive research include influencing the release of luteininzing hormone-releasing hormone, 'turning-off' corpus luteum function in early pregnancy by competitors for HCG, affecting sperm or ovarian membranes to prevent fertilization, and interferring with sperm and egg development.     

The Persistence of Outmoded Contraceptive Regimes: The Cases of Mexico and Brazil

Two of the most striking characteristics of contraceptive practice in the world today are the wide variation in patterns of use across countries and the tendency of the distribution of use by method to persist or narrow, even as new methods become available. The argument advanced in this article is that the disposition to commit to a reduced range of methods results from positive feedback in the process of contraceptive choice, and follows the logic of path dependence. The positive feedback derives, in large part, from social interaction among both the providers and the users of contraceptive methods. The persistence of outmoded contraceptive regimes is illustrated with the experience of Mexico and Brazil. In each case, it is argued that the conditions, events, and policies in the early stage of the adoption process have had a determinant bearing on the contraceptive practice prevailing in the late 1990s.     

Is Maternal and Child Health Service use a Causal Gateway to Subsequent Contraceptive use?: A Multi-Country Study

The purpose of this study is to examine the relationship between MCH service utilization and contraceptive use in five countries: Bolivia, Guatemala, Indonesia, Morocco, and Tanzania. The analysis is carried out at the level of the individual woman, with contraceptive-use status modeled as a function of: (1) the availability, quality, and packaging of MCH and family planning services; (2) community- and individual-level determinants of health service and contraceptive use; and (3) intensity of prior MCH service use. Data for the analysis comes from DHS data on women of reproductive age linked with data from service-availability surveys. We use full-information, maximum-likelihood regression techniques to control for the effects of unobserved heterogeneity that might otherwise bias our estimates. In three of the five countries (Morocco, Guatemala, and Indonesia) the results of the analysis suggest that the intensity of MCH service use is positively associated with subsequent contraceptive use among women, even after controlling for observed and unobserved individual- and community-level factors. This result lends support to the proposition that, at least in the context of these three countries, the intensity of MCH service per se use does have a “causal” impact on subsequent contraceptive use, even after controlling for factors that “predispose” sample women to use health care services.     

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.     

The Role of Contraceptive Supply and Demand in Mexican Fertility Decline: Evidence from a Microdemographic Study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

Workshop on long-term contraceptives

The National Population Council Secretariat (NPCS) of Ghana held a three-day workshop on long-term contraceptives in 1996 in collaboration with the Ministry of Health, the Association of Voluntary Surgical Contraception, and the Johns Hopkins Population Communication Services. The session was funded by USAID. The executive director of NPCS, Dr. Richard Turkson, said that the slow rate of contraceptive acceptance was an obstacle to population control despite political concern that rapid population growth exerted an adverse impact on the economy. Only 10% of married women were using long-term or permanent methods of contraception. The hope was voiced that the participants would devise practical and cost-effective education, information, and communication (IEC) strategies to boost the demand for long-term contraceptive methods among sexually active people in Ghana. It was essential that these strategies and activities were based on a realist assessment of the demographic and social situation of the country. The examination of case studies in cultures similar to Ghana would also offer valuable lessons. The factors that hinder the acceptance of long-term methods include misconceptions, myths, and false rumors rooted in a general lack of knowledge among the people. Participants were urged to come up with strategies to counter these problems, and service providers were encouraged to improve their knowledge about contraceptive methods and counseling skills. Male involvement in contraception was also advocated. Statistics show that most Ghanians practicing contraception were using short-term methods such as foaming tablets, pills, and condoms. However, it is necessary to shift to long-term methods such as injectables, implants, and sterilization in order to achieve significant reductions in fertility.     

The roles of individuals' socioeconomic characteristics and the government family planning program in China's fertility decline

This paper explores answers to the following two questions: first, did individuals' socioeconomic characteristics play any role in the rapid fertility decline that occurred in China during the 1970's? Secondly, if the rapid fertility decline during the 1970s is mostly a result of the government policy, as many have perceived, to what extent was the government policy effective? Using the 1982 Chinese 1/1000 fertility survey data for Hebei province of China, this paper examines variation in fertility among women of two age cohorts by linking their fertility outcome with their socioeconomic background and earlier reproductive experiences. In addition, this paper assesses the effect of government policy by comparing the determinants of fertility outcome between two cohorts of women and by studying the factors affecting their current contraceptive use. The findings reveal that the individual's socioeconomic background was important in explaining earlier fertility variation. Government policy, although powerful enough to override most of the effect of socioeconomic factors on fertility, was not able to eliminate differences in contraceptive behavior among Chinese women.     

高校学生生殖健康、性行为及避孕节育的调查研究

深化研究高校学生生殖健康、性行为及避孕节育具有非常重要的战略意义,通过对北京等七城市各类院校、各年级学生进行调查,分析研究高校学生生殖健康、性行为及避孕节育状况。调查研究内容主要涵盖了三个方面:高校学生生殖健康知识掌握及态度状况;高校学生避孕药具及避孕服务的利用情况;避孕节育服务需求情况。在此基础上,确立和探究了高校学生生殖健康、性行为及避孕节育的导向原则、服务模式及推进措施。     

The Life Course,Cohort Dynamics,and International Differences in Aging Trajectories

In recent years, population health research has focused on understanding the determinants of later-life health. Two strands of that work have focused on (1) international comparisons of later-life health and (2) assessing the early-life origins of disease and disability and the importance of life course processes. However, the less frequently examined intersection of these approaches remains an important frontier. The present study contributes to the integration of these approaches. We use the Health and Retirement Study family of data sets and a cohort dynamic approach to compare functional health trajectories across 12 high-income countries and to examine the role of life course processes and cohort dynamics in contributing to variation in those trajectories. We find substantial international variation in functional health trajectories and an important role of cohort dynamics in generating that variation, with younger cohorts often less healthy at comparable ages than the older cohorts they are replacing. We further find evidence of heterogeneous effects of life course processes on health trajectories. The results have important implications for future trends in morbidity and mortality as well as public policy.     

The Risk of an Unwanted Birth: The Changing Context of Contraceptive Sterilization in the U.S.

Life-table estimates indicate that one-quarter of U.S. women intend no more births by age 25, one-half by age 27, and three-quarters by age 30. The resulting long period at risk of unwanted fertility is argued to be an important underlying dimension of the revolution in attitudes to and practice of sterilization. Life-table estimates are then considered of the timing of sterilization after the last wanted birth. Almost one-quarter of all couples select sterilization within the first year after they have had the number of children they desire. Recent experience would imply that four-fifths of all couples will eventually use contraceptive sterilization. In order to examine the determinants of men's and women's sterilization, logistic regression is used with a polytomous dependent variable: sterilization of the woman, sterilization of the man, or no sterilization within four years of the last wanted birth. Covariates considered are age and parity at last wanted birth, year and duration of marriage at last wanted birth, wife's and husband's education, wife's and husband's religion, whether residence is in a central city, region, pill-use history and timing-failure histories before the last wanted birth, and unwanted birth. Large and significant effects are found for most of these variables, and these effects change in interpretable ways between early innovative behaviour and sterilization during the most recent period when it was widely accepted.     

Determinants of contraceptive switching behavior in rural Sri Lanka

This study examines the influence of a selected set of determinants of contraceptive method switching in rural Sri Lanka. Of interest is the question of how change in contraceptive practice at the individual level can account for patterns observed at the aggregate level. Based on calendar data on contraceptive use over a 3-year period, collected for more than 3,000 married women in a 1986 survey, the multivariate analysis shows that women who attain all or a significant proportion of their desired fertility tend to switch to more effective methods. Women who experience method failure tend to switch methods, usually to a type that is more effective. The woman's background determinants of age and education have small but significant effects on method switching, whereas the effect of household economic well-being is not significant. There is strong indication that rural couples are practicing contraception in a nonrandom fashion, switching methods in accordance with changes in their fertility motivations and contraceptive experience.