Family planning in choiseul province,Solomon Islands

The results presented are from a rural prevalence survey on family planning in Choiseul Province, Solomon Islands. Married women aged 15–49 years with at least one living child and married men whose wife met the same criteria, provided data on knowledge, attitudes and practices of contraceptive use. Fifty one per cent of the female sample were using some form of contraception, 26 per cent reversible and 25 per cent non-reversible methods. Sixty-five per cent of men claimed that they or their spouse were using a method of family planning. Tubal ligation was the most common currently used method (25 per cent in the female survey). Desired family size was four for both males and females. Knowledge and approval of family planning was high, with 83 per cent of females and 81 per cent of males knowing of at least one method. Problems in accessing information and services for family planning include cultural and logistical constraints. Religious affiliation was the major variable affecting knowledge, use and approval of contraceptive methods. Nearly a quarter of the sample lived further than two hours travel time from the nearest health clinic supplying contraceptive methods. These clinics often have only an intermittent availability of supplies. A strong interest in family planning was demonstrated by both respondents and service providers.     

New survey finds fertility decline in India

A brief indication was provided of demography, fertility, and contraceptive usage and knowledge based on the recent 1992/93 Indian National Family Health Survey. The sample included 88,562 households and 89,777 ever married women aged 13-49 years in 24 states and the National Capital Territory of Delhi. About 38% of household members were aged under 15 years. The sex ratio was 944 females to 100 males. 54% aged over 5 years were currently married; 10% were widowed, divorced, or separated. 43% were literate and 9% had secondary or higher education: 67% for females in cities and 34% in rural areas. Female literacy was 82% in Kerala but under 30% in Rajasthan, Bihar, Uttar Pradesh, and Madhya Pradesh. During 1990-92, the crude birth rate was 28.9 per 1000 population. Total fertility was 3.4 for women aged 15-49 years: 3.7 in rural and 2.7 in urban areas. 31% of parents had been sterilized. 26% desired no more children. Only 6% of women with four or more children desired another child. 99% of urban and 95% of rural respondents had knowledge of at least one modern or traditional method. Female and male sterilization were the most well-known modern methods. 47% of women had ever used contraception: 42% with a modern method and 12% with a traditional method. 41% were current users of family planning: 36% with a modern and 4% with a traditional method (45% in urban and 33% in rural areas with a modern method). The highest contraceptive use was in Kerala, Himachal Pradesh, Maharashtra, and Punjab states and Delhi (over 50%). The two most populous states, Uttar Pradesh and Bihar, had the lowest rates, which were under 25%; other low usage was in Assam and several small northeastern states. 75% of all female modern contraceptive use was female sterilization. 12% in urban and 3% in rural areas used a modern spacing method. Use increased with increased educational level. Rural sources of supply emphasized public facilities: sterilization and IUDs.     

Attitudes toward family size and family planning in nairobi

In Nairobi, 352 married African adults, 152 men and 200 women, were interviewed on their attitudes toward family size and family planning. The respondents had, on the average, slightly less than three children at the time of interview and hoped to add slightly more than three children to this total. There was little difference in desired family size by sex.About one-half of both men and women had some knowledge of family planning methods, and there was a general interest (75 percent of the men and 90 percent of the women) in learning more. In addition, two out of every three men, and nine out of every ten women, approved of family planning, and even greater majorities of both sexes were willing to have the government of Kenya provide such services.In spite of their approval, however, only 13 percent of the men, and 2 percent of the women, had ever practiced family planning. These findings are broadly comparable to those found in other emerging nations and suggest that knowledge, interest, and approval generally precede use.     

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.     

Withdrawal in Pakistan: new insight into an old method

Although family planning programs pay almost no attention to the validity of coitus interruptus (withdrawal), it is a traditional method of family planning widely used to regulate fertility in Pakistan. Large-scale quantitative studies conducted in recent years in Pakistan by the Population Council have indicated that withdrawal is the most popular temporary method of fertility regulation in the country, second among all methods only to female sterilization. Pakistani couples use withdrawal mainly because they believe that modern methods are unsafe for women and unreliable. They have some fears and misconceptions about modern methods. The method may work well in Pakistan also because users seem to feel that they own it. Withdrawal is therefore a reasonable option given Pakistanis' beliefs and circumstances. Those who use withdrawal in Pakistan practice the technique with considerable efficacy and tend to continue using it. Furthermore, couples which use withdrawal have discussed their family planning preferences and decided together to use the method. However, in order to improve the use of modern methods of contraception, information provision, counseling, and interpersonal communication must be improved.     

Secrecy and silence: why women hide contraceptive use

A recent Population Council survey of 1860 married women and 1056 of their husbands in urban Zambia found that many women who use contraception do so without their husbands' knowledge and that those women who hid their practice of contraception from their husbands did so because they found it very difficult to bring up the subject of family planning with them. These findings indicate that low levels of contraceptive use are not the result of a simple communication matter. Sex and sexuality are often the exclusive domain of African husbands. As such, if a wife initiates a discussion of family planning, she may threaten her husband's sense of control and create discord within the family. The culture of silence about sex and sexuality is very strong in Africa. 57% of women stated that were they to propose contraceptive use with their husbands and the husband opposed such practice, they would nonetheless use them without his knowledge. 7% of the women stated that if their husbands disapproved of contraceptive use, they would nonetheless openly use a method against his wishes. The majority of women correctly perceived their husbands' views on family planning use and fertility preferences. In focus groups, both men and women said that they did not believe that women have the right to independently act upon their reproductive preferences. A husband's inadequate financial support of his children could, however, justify clandestine contraceptive use. These findings point to the need to include easily hidden methods in the mix of contraceptives family planning programs offer. Moreover, service providers should not automatically encourage husbands' involvement. A client's right to privacy should always be respected.     

Developmental Idealism and Cultural Models of the Family in Malawi

This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between urban and rural respondents. We explore how these beliefs intersect with longstanding local values and beliefs in Malawi.     

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.     

Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

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.     

Family planning's benefits include improved child health and nutrition: new data from Bangladesh

2 recent studies from the Matlab in Bangladesh confirm that family planning promotes child survival. The 1st study is a longitudinal analysis of 3370 births in 1985 to women living in 70 villages who were served by the International Centre for Diarrhoeal Disease Research, Bangladesh's Matlab Family Planning and Health Services Project. The 2nd is a study of 12-26 month old children and 24-36 month old children, all of whom were born in the same 70 villages between July 1985 and June 1986. The 1st study demonstrates that family planning improves child survival by lengthening the birth interval. In fact, if women delay a subsequent birth by about 2 years, child survival improves at all ages up to 5 years. Longer birth intervals result in a reduction of very high order births. The same study also reveals that family planning improves child survival indirectly by granting mothers access to integrated maternal and child health services. The 2nd study indicates that a child is 3 times more likely to suffer malnutrition, even at age 3, than a child whose mother gives birth again at an interval greater than 24 months. Specifically, the mother removes the index child from the breast prematurely, thereby adversely affecting the index child's nutrition. The birth interval prior to the index child does not adversely affect the index child's nutritional status, however. The 2nd study's result suggest that birth spacing, as promoted by family planning programs, improves child health and nutrition. The findings from these studies show the importance of continued investments in family planning programs in developing countries.     

Increasing contraceptive use in Bangladesh: The role of demand and supply factors

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area.     

A Family planning survey in four Delhi villages

A family planning attitude survey was conducted in four villages near metropolitan Delhi. Information was obtained through questionnaires from 455 currently married females of reproductive age: Of the women interviewed, 50 per cent were aware of family planning, 19 per cent had knowledge of a method and only 3 per cent used birth control methods. The method most commonly practised was prolonged lactation. Of the women interviewed, 253 were willing to learn about family planning; they said there was little opposition from their family members. These women thought that a family should have four children, and spacing between them should be roughly four years.     

Pakistan's population growth: the need for action

Despite the existence of a national family planning program that dates to 1965 Pakistan has not seen a reduction in the fertility rate. One of the poorest countries in the world, Pakistan has 1 of the highest population growth rates in the world at about 3.0% annually. For over 2 decades, the average woman in Pakistan has given birth to more than 6 children. At the current fertility rate, the country's current population of 120 million will increase to over 150 million by the year 2000, and it will increase to 280 million by 2020. And even if today every woman were to begin having only 2 children, the population would still reach 160 million before leveling off. But reducing fertility in Pakistan will prove difficult. One of the leading obstacles is the low status of women. Few women in Pakistan have advanced education or professional jobs. Only 1/4 of those women without education or who are not working have any knowledge concerning contraception. Family size and composition also fuel the high rate of fertility. On the average, women desire 5 children (the fact that women average more than 5 suggests an unmet need for contraception). And due to social, cultural, and economic conditions, Pakistanis generally prefer male offsprings. Islamic opposition to family planning has also contributed to the continued high rates of fertility. Finally, administrative and management weaknesses have hindered Pakistan's family planning program. In order to overcome these obstacles, Pakistan will have to enlist the commitment of political, religious, and community leaders. The status of women will have to be improved, and the attitudes of people will need to change.     

Motivations for the use of birth control: Evidence from West Africa

A conventional assumption in the family planning literature is that birth control in developing countries is first adopted by high parity women who wish to cease childbearing. The empirical support for this belief has mainly been drawn from interview surveys on the motivations for, and the timing of, the inception of birth control among married women in areas where there is no cultural precedent for birth spacing by traditional means. This study, on the other hand, is based on data drawn from an area sample of 6,606 women, married or single, aged 15–59, in Ibadan, Nigeria, where there is a tradition for the practice of abstinence after a birth for the purpose of birth spacing. The Nigerian pattern revealed in the data presented here is indeed distinctive in many respects: (a) although premarital sex is prevalent, levels of premarital contraception are high; and (b) within marriage, spacing is the most prominent motivation for contraceptive practice, more important than the limitation of family size.     

Expanding contraceptive choice: findings from Zambia

The Population Council's Expanding Contraceptive Choice program works to increase the contraceptive options available to women and men in developing countries. To achieve this goal, the Council is pursuing a new approach, one which begins with an assessment of contraceptive needs from which recommendations for upgrading contraceptive services are based. This new approach was tested in four countries including Zambia in which Stage I--contraceptive needs assessment--was completed. Results of the assessment indicated that despite the efforts of the national family planning program, 33% of Zambian women who do not want to get pregnant do not practice contraception. Only 9% of women use a modern contraceptive method. These results suggest that there is a need for introducing new contraceptive technologies and for expanding utilization of existing methods in the country. Also, stage I assessment yielded other positive outcomes which are enumerated in this paper. In response to this report, the Zambian government decided to proceed with stage II research on the viability of introducing new and underutilized contraceptive methods into the national family planning program.     

Family planning communication between spouses in Sri Lanka

Drawing on data from a national follow-up survey of 2310 currently married women aged 15-49 conducted in Sri Lanka in 1985, this study examines patterns of family planning communication between spouses, social and economic factors related to those patterns, and the consistency between spouses in their responses to questions about family planning attitudes and practice. The results of the analysis indicate a high degree of family planning communication between spouses in Sri Lanka. The communication, however, varied according to couples' number of living children and to wives' age, education, place of residence, religion, and work status. Multivariate logistic regression generally confirms that older women, those with little or no education, those living on tea estates, and Muslims were less likely to communicate with their husbands on family planning matters than were women in other age, education, residence, and religion categories. These findings suggest the existence of social and cultural obstacles to communication between spouses about family planning matters in Sri Lanka. Among the 577 pairs of spouses whose answers were compared for consistency, a large proportion of wives reported hearing about male contraceptive methods directly from their husbands, and a large proportion of husbands reported hearing about female methods from their wives. These findings are a reminder that both spouses are potentially important sources of information about contraception.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.