Contraception, unintended pregnancy and induced abortion

The paper attempts to examine the timing of initiation of contraceptive use and relative risk after recent childbirth among currently married women by sociology-economic and demographic characteristics. We tested the hypothesis-whether women who do not want any additional child initiate early use of contraceptive method. Cox-regression model has been used to analyze the first time available calendar data in NFHS-3(2005-06). Interestingly, for illiterate women the acceptance of family planning at 3+ living children as first use has gone up from 38 to 43 percent during 1992 to 2006 (NFHS-1 to NFHS-3). Prevalence of limiting method users is increasing over the period and most of the women have gone for sterilization in same month of last birth (i.e. around 35 percent) in India. The multivariate analysis suggests that antenatal care visits and place of delivery (institution) affects the relative risk to initiate the use of contraceptive method after child birth.

Despite the amendment of Ghana’s abortion laws in 1985, aimed at increasing access to safe abortion services, these services are not readily available to most women. Abortion has consistently been an important contributor to maternal morbidity and mortality in Ghana. A situation some observers attribute to the sensitivity surrounding pregnancy terminations and the low knowledge about the abortion law and its nuances. Within this context, this paper explores the decision making process of females within the ages of 15-30 years who aborted their pregnancies. The study employed a qualitative research design with 28 females who sought their abortions at an NGO run clinic. Data for the study was analyzed using Mile’s and Huberman’s framework and the social ecological model as guides. Analysis of the interviews show that pragmatic concerns like economic difficulties, child spacing, fear of parental reaction, attitude of partners, impregnation by someone other than the regular partner and health concerns influenced participants in their abortion decisions. The low level of knowledge by participants about Ghana’s abortion laws also emerged as a strong theme. The study therefore concludes that although there are social, cultural and legal prohibitions regarding abortions, pragmatic concerns force some women to act contrary to them.

Background
Nigeria’s contraceptive prevalence rate of 10% (NDHS 2008) for modern methods has remained static over the past 20 years. Similarly, the total fertility rate (TFR) in Nigeria has not shown any appreciable change floating between 5.9 in 1999, 5.7 in 2003 and 5.7 in 2008 (NDHS 2008).

Objective
The analysis aimed to assess key influencing factors of need for and use of Family Planning (FP) and duration of use.

Methodology
A secondary analysis of the 2008 Nigerian DHS focusing on both proximate and distal factors that influence the need, use, and duration of FP use was conducted.
Results
Analysis of the four proximate factors showed that both ideal family size and knowledge of modern FP methods are important factors influencing the need for and use of FP among urban women in Nigeria.

Knowledge Contribution
These findings indicated that for NURHI to achieve its goal of increasing CPR by 20% over five years, there is strong need to focus on three key strategies: increasing the proportion of women who want to delay, limit or stop childbearing; convert a greater proportion of unmet need into met need; and reducing the proportion of contraceptive users who discontinue using their contraceptive methods.


Keywords
NDHS 2008, direct influence, indirect influence, urban, Family Planning, Nigeria

The present study aims to study the couple’s inconsistency with respect to their use of family planning and factor affecting their inconsistency. The data from National family Health Survey, 2005-06 has been used. Results from the study shows that, mismatching in reporting of current use is 20 percent. Reporting of use of male method, in 93 percent cases both reported same and in 4 percent cases only husband reported that he is using method and wife does not know about that. In 12 percent cases husband does not know that wife is using family planning. In 7 percent cases only wife is reporting that she is sterilized. From the logistic regression it is clear that, Odds of having mismatch are high in the couples who got married before 10 years as compared to those who marry recently in case of reporting of all methods and female methods; whereas in case of reporting of male methods it is showing reverse results. Likelihood of having mismatch is high in urban area. Education of the women has positive and significant effect on mismatching. Education of husband has positive effect on mismatching about male methods whereas it has negative effect on reporting of female methods. Odds of having mismatch are less in schedule tribe. As compared to poor class couple rich couples are more likely to misreport about male method use.

Introduction: The study examines post-abortion contraceptive use over 12 months among women receiving induced abortion services in Nepal.
Data and Methods: The data are from a prospective cohort study of abortion clients at four health facilities. Overall, 838 women were enrolled; 654 completed 6-month interviews, and 624 completed 12-month interviews. Life table analysis methods were used to estimate contraceptive continuation and pregnancy. Further analyses will be conducted using Cox proportional hazards models to estimate factors associated with method continuation and pregnancy.
Results: At baseline, 57% of women reported adopting a modern method of contraception. This percentage dropped to 52% at 6 months and 50% at 12 months, with changes in the methods used. The overall contraceptive continuation rate for female controlled effective modern methods was 58.2 per 100 person-years. The continuation rate for the injectable was 49.6/100 person-years and for the pill was 63.8/100 person years. Although few women initiated use of long-acting reversible contraception (3.5%), continuation rates were higher for these methods than for the pill or injectable (92.3/ 100 person years, p <.01).
Conclusions: The results suggest a need to increase use of modern contraceptives by improving service quality, particularly counselling.

The study is an attempt to understand the contraceptive use pattern and method’s choice among currently married women in India. The present study has been utilized DLSH-3 data which is a nation wide survey and collected information from 643944 ever married women aged 15-49 years regarding family planning, contraception, HIV/RTI and other socio-demographic aspects. Bi-variate and Multivariate analysis have been used for this study. Result shows contraception use increases with women’s age. Prevalence of contraceptive usages is higher among Hindu religion, women having no sex preference of child and women belonging in richest wealth quintiles. Women age is found significant determinant of contraceptive methods choice. Condom use is highest in the youngest age. Female sterilization is higher among poor women where as condom use is higher among richest women. Rural women are 17 percent lees likely and working women are two times more likely to choice condom over sterilization.

Strong son preference which has been a common demographic phenomenon in most of the developing countries could imbalance sex composition of population by altering sex ratio at birth. This has been the center of focus in Nepal after legalization of abortion in 2002. Anecdotal information points to the existence of pre-natal sex selection. Assessment of sex ratio at birth in 1991 and 2001 censuses showed more male than female babies born in many districts in Southern plains. Logistic Regression analysis of NDHS 2006 data on births of order 2 and higher results show that socioeconomic factors have no statistically significant effects. Interaction effects of birth order and number of living sons have emerged as most powerful predictors. Findings signify the tendency towards pre-natal sex selection and sex selective abortion. Such behaviour of demographic masculinization would have far reaching demographic consequence including the problem of marriage squeeze in Nepal in future.

Mass media has numerous functions in the society and the most prominent of these is information dissemination that can lead to changes in behavior, knowledge and practices of individuals towards certain matters such as family planning. In the context of the increasing prevalence of contraceptive use in the Philippines over the last 40 years (NDHS 2008), this paper hopes to provide inputs on the relationship between exposure to family planning (FP) messages in the tri-media (i.e. print, radio, and television) and use of contraceptives by Filipino women 15-49 years old. The data forms part of the 2008 Philippines National Demographic and Health Survey (NDHS). Bivariate and multivariate analyses were employed and Chi-square test of association was used to examine relationships between the variables. Results show that among the tri-media, television is most popular source of FP messages among Filipino women. A positive relationship exists between women’s exposure to FP messages in any of the tri-media and contraceptive use most especially on modern contraceptive methods. Albeit weak, women’s contraceptive use and exposure to FP messages in television and radio were significantly associated. Education was found to affects the relationship between exposure to FP messages in tri-media and contraceptive use.

Pakistan’s high rate of abortion estimated at 29 per 1,000 women aged 15-49 in 2002 (Sathar et al. 2007) may be explained by the low CPR and high unmet need for family planning (30 percent and 25 percent, PDHS 2006-2007). Using national level qualitative and quantitative data we show that in fact a significant proportion of pregnancies and abortions occur due to contraceptive discontinuation. In-depth interviews with 44 women who had experienced abortion reveal that half of them were contraceptive users at the time of pregnancy. Inconsistent and ineffective contraceptive use, typically involving condoms and explained by a lack of motivation on the part of husbands and ambivalence of wives, lead to unwanted pregnancy. Under-studied in countries with low CPR, contraceptive failure merits research in Pakistan as this can help family planning providers and policy makers support more effective contraceptive use to avoid unwanted fertility and abortions and their consequences.

Trussell et al.’s provocative analysis of women’s classifications of contraceptive failures from the 1995 NSFG found inconsistent retrospective reporting of intentions and feelings. Looking to the 2006-2010 NSFG, we find that such incongruent reporting of happiness about pregnancies resulting from contraceptive failure is more prevalent among Latina women. Is this a function of ambivalence about avoiding pregnancy, retrospective bias, or a meaningful distinction between happiness and intention?
Using prospective data from the Border Contraceptive Access Study, we shed new light on Trussell et al.’s apparent paradox. We find that incongruent happiness and intention, rather than constituting ambivalence, reflect distinct concepts for Latinas. Wanting no more pregnancies, and using contraception to implement such intentions is not incompatible with positive feelings about pregnancy, and such happiness may reflect cultural influence, and the impact of pregnancy on relationship wellbeing. Retrospectively reported intentions show considerable bias, but the majority of retrospective happiness is consistent with prospective feelings, suggesting that happiness is not merely an artifact of retrospective reporting. Findings have implications for the meaning and measurement of unintended pregnancy in national surveys like NSFG and PRAMS.