Contraceptive use dynamics in developing countries

Introduction: A woman’s effective reproductive span is not only important with regard to her health status but also as a deciding factor for the number of children she would bear during her lifetime. Gradually increasing age at marriage among women in India and decreasing age at sterilisation indicate that females’ effective reproductive spans are contracting.
Objectives: This study aims to analyze the effective reproductive spans of Indian women by successive marriage cohorts.
Methods: This study utilized data from the National Family Health Survey 3, India, 2005-06.
Results: From 1992-93 to 2005-06, the median age at which women married increased from 16.1 to 16.8 and the age at which they got sterilized declined from 26.6 to 25.5 years. The effective reproductive span of women of the successive marriage cohorts decreased from 11.5 years among those who married in 1970s to 9 years among those who married in 1980s, 6.4 years among those who got married in 1990s and 2.8 years among those who got married in 2000-04.
Conclusion: These findings suggest that women are opting to end their reproductive span faster than women of the older generation did sterilization there is a gradual shrink in the effective reproductive span of women.

Paper examines the contraceptive use dynamics and investigates whether there has been enough informed choice for contraceptives in South Asia using data from 3 rounds of recent DHS in four countries-Bangladesh, India Nepal and Pakistan. DHS asked the current users whether they were informed about the possible side effects, what to do if they experienced side effects, told about other methods they could use and told that sterilization is permanent. Informed choice is analyzed by selected socio-economic characteristics of users through descriptive statistics and multivariate methods.

Nepal, Bangladesh and India have made about 10% point progress (36% in early 1990s to 44%-48% in 2005-07). There is one or another dominant method of family planning in most of the countries in the region. Only 25% users in India, 38% in Pakistan and almost half in Nepal were ever informed by a health worker about other methods they could use. Also very few were informed about the side effects. Informed choice significantly differs by socio-economic characteristics of users and was low among poor and public facilities users. Finding of study that basket of contraceptive choice is limited and informed choice is significantly low, calls urgent attention from program managers and policy makers.

Family planning is generally acknowledged as an important component of the reproductive health agenda and a necessity in all programs and policies geared towards the realization of safe motherhood. Several studies have established that most maternal deaths occur in the postpartum period. This paper therefore aims to contribute to existing knowledge on the factors affecting the adoption of PPFP, with special emphasis on examining how influential the women’s contact with maternal health services (antenatal care, delivery in a health facility and postnatal care) had been on adoption of contraception in the postpartum period. The analysis was based on the data from the Women’s Questionnaire and the calendar data from the 2008 Nigeria Demographic and Health Survey (NDHS). The use of maternal health services (ANC visits and timing of postnatal check-up) is significantly associated with the use of a modern method of contraception during the postpartum period. Other significant predictors of the use of a modern method in the postpartum period include region, education, the household wealth index, and exposure to family planning messages. The findings suggest that contraceptive use among postpartum women will increase substantially if more women use maternal health care services, especially for antenatal care and postnatal care.

Side effects or fear of side effects have been shown to be an important factor in the lack of adoption of contraceptive methods, particularly modern hormonal methods, however little is known about the actual experience of side effects and their influence on contraceptive use dynamics. This study aims to explore the association between the experience of side effects, the type of method, and the duration of episodes of use. This paper uses calendar data from a longitudinal survey conducted in Southern Ghana containing monthly reporting
of contraceptive use along with concurrent reporting of side effects. Descriptive statistics and single decrement life tables are used for the analysis. The result show that injectable use is most commonly associated with side effects, with 33.8% of episodes of contraceptive use being associated with the experience of side effects compared to 28.3% of pill episodes. However due to the longer length of episodes when taking into account all months of use only 9% of women-months of injection use have side effects compared to 11% of women-months of pill use. The length of pill episodes is not affected by side effects whereas for injectables the length of episodes is shorter when side effects are experienced than when they are not.

Current measures of unmet need for family planning at a single time point mask the magnitude of need women experience across their lifetimes and the disparities in unmet need faced by women of various socioeconomic backgrounds. In this study, we consider unmet need as a transitional state and propose new approaches of measuring unmet need over time. Using the contraceptive calendar data available in the Demographic and Health Surveys (DHS), we examine the number and length of unmet need episodes women experience over a five-year calendar period for 13 developing countries in Africa and Asia, and how these measures vary by household wealth, residence, and education. Our findings suggest that substantially more women experienced unmet need over the 5-year period examined than captured cross-sectionally. However, while women of all backgrounds experience unmet need, older and higher parity women, and women of low SES are more likely to experience longer episodes. Our results indicate the need to scale up family planning services and reach women multiple times across lifetimes. These longitudinal analyses unpack the complexity of unmet need women experience over time and help enable care providers to better meet women’s contraceptive needs.

Although progress has been observed in Brazilian social mobility in recent years, significant social deficits are still recognizable. In light of this finding we propose to identify how patterns in reproductive and contraceptive practices are formed in accordance with belonging to different social classes using the 1996 and 2006 National Demographic and Health Survey (PNDS) data. Although the PNDS lacks data typically employed for classifying individuals in social class, this survey has important information about reproductive histories, reproductive intentions, contraceptive practice, among other information. To work with the concept of class we will adjust the Wealth Index, an indicator of socioeconomic status that takes into account features and services to which the household has or has access to it. We aim at highlighting the differences in reproductive patterns and contraceptive practices on the basis of social class. The aim of this paper is therefore to link reproductive patterns and contraceptive practice to membership to a certain social class. More specifically, we propose to use an empirical concept of social class that takes into account more than income and assets. Thus we will use more than economic factors to account for the multiple facets of the concept of social class applied to the Brazilian reality.

In Malawi, a woman’s average fertility has declined by only one birth, from 6.7 to 5.7 children per woman in the last three decades. This study examines trends in the proximate determinants of fertility in Malawi with the view to explain their relative contribution to overall fertility level using 2000, 2004 and 2010 MDHS. First, we reconstruct age period specific fertility rates that enable us to examine past fertility trends across different age cohorts for population and consistency check. Next, for each survey, the inhibiting influence of each proximate determinant on fertility is explored in detail using proximate determinants model of fertility developed by Bongaarts and Potter (1983). The apparent decline is confined to the middle age group, an indication that fertility control primarily is as result of spacing rather than limiting births. While contraceptive use has risen tremendously, the effect of the index of contraception in reducing fertility is less pronounced due to predominance use of one method, injectables. This suggests that couples in Malawi have fewer options to control their fertility. By decomposing fertility, the level of education contributed to two fifth of fertility decline. However, the composition of women with secondary education is not sufficient enough to favour fast fertility decline.

This paper examines a decade of prospective panel survey data recording proximate fertility determinants and demographic surveillance data in a rural locality of northern Ghana where a quasi-experiment tested the impact of four contraceptive service provision strategies on fertility.
Although treatments explain variance in observed fertility, analyses also reveal that fertility implied by proximate determinant responses exceeds observed fertility in areas with convenient doorstep family planning services. Analysis of longitudinal surveillance data suggests that community exposure to these doorstep services is associated with reproductive change. Results are consistent with the hypothesis that denial is most pronounced where observed fertility decline was greatest. The gap between fertility expected from proximate determinants and fertility observed from surveillance increases over time. This finding challenges the widely held assumption that survey appraisal of contraceptive use represents a valid endpoint for studies of the reproductive impact of community-based family planning services.

In Pakistan the contraceptive prevalence rate is stagnant at 30% for almost a decade along with high unmet need for contraception (25%) and unwanted fertility as one child per woman (PDHS, 2008). The family planning program of Pakistan has long been focusing on small family size. Recently the focus of this program has been shifted to the spacing between births. It is therefore important to study the behavior of couples regarding contraception following childbirth. Using the contraceptive calendar data from the FALAH baseline survey 2008-09 from the 29 districts across Pakistan, we study the duration of uptake of contraception after childbirth by using life table techniques. We also study the type of contraceptive method adopted and the differentials in the uptake. The effect of desire for more children, antenatal care visits and the place of delivery on the subsequent contraceptive uptake was analyzed using Cox Proportional Hazard Regression Models. Results show that less than a quarter of women adopted an FP method within 6-months of childbirth and desire to limit childbearing was significantly associated with higher uptake. The findings of this study will highlight the importance of introducing the postpartum family planning use in the FP program of Pakistan.

While many researches have shown that contraceptive use tends to increase where there is spousal communication and concordance on reproductive intentions, many other studies, using couple data, have equally shown that most spouses do not accurately report the views/intentions of their partners. This study is based on the baseline data from a longitudinal couple study in a peri-urban community, Ipetumodu, in Osun State, Nigeria collected between April and May, 2010. The study shows that there is a noticeable level of discordance when the response of each wife is matched with her husband’s on several issues. For instance, only 14% of couples concurred that they use contraception. The study shows that even in a patriarchal society like Nigeria, a woman’s reproductive intention is a more important determinant of her contraceptive use than her husband’s reproductive desire, and also that couples’ agreement on reproductive intentions is an important predictor of women’s use of contraception.