Contraceptive use dynamics in developing countries

In Bangladesh, the short term methods especially the pill is gaining popularity with respect to long term methods, such as sterilization but it is worthwhile to mention that female sterilization unintentionally shortens the length of fecund life span of female and thus total fertility. This study has been conducted to identify the effects of some selected socioeconomic and demographic covariates on female age at sterilization, by applying Weibull regression model using data from standard 2004 Bangladesh DHS. Weibull survival models with and without Gamma heterogeneity have been used to find out the effect of different co-variates on the timing of age of sterilization. The findings show that the propensity of sterilization is higher among urban women than rural women in Bangladesh. The average failure time for sterilization is higher among older women in than their younger counterparts. The hazard model analyses demonstrate that education, religion, age at marriage and residence are the important significant covariates in explaining early timing of sterilization. The study shows that a significant amount of heterogeneity is present in the population with respect to timing of age at sterilization even controlling some demographic and socio-economic variables.

Objectives. To understand the mutual influence men and women have on fertility and contraceptive use decision-making. With the shifting paradigms in reproductive health, understanding male influence on female reproductive behavior is a high priority. Malawian and Nigerian women continue to have more children than they desire. Unmet need for contraceptives remains high (26% in Malawi, 20% in Nigeria), although, the two countries reflect very different contraceptive use patterns.
Methods. Data was collected using qualitative methods. A total of 47 focus group discussions and 32 in-depth interviews, were conducted across the countries. Thematic analysis was utilized to identify patterns.
Results. Women and men influence each other’s fertility preferences and contraceptive decision-making in complex ways. While men might feel dominant in marital relationships, they too feel constrained in their normative environment. Women are far from silent bystanders; they strategize to accomplish their fertility goals.
Conclusion. Women and men influence each other’s fertility and contraceptive behaviors in complex ways. Contextual realities have an important influence in determining patterns of dependence and influence between spouses. Knowledge of relationship dynamics and context can be useful to achieve couple fertility desires.

Women’s autonomy is a potentially important but less studied indicator of using contraception among women as well as ability to control their fertility. Using the data from Bangladesh Demographic Health Survey (BDHS) 2007, we try to establish a relationship between women’s autonomy variables and contraceptive behavior. Results of the study indicate that ever use of contraception is significantly associated with household decision-making autonomy, movement autonomy and financial autonomy, but only movement autonomy is significant for current contraceptive users. Multivariate analyses also indicate that both women’s decision-making autonomy and movement autonomy are significantly associated with discuss about family planning with their husband and future intention to use contraception. These measures of women’s autonomy provide additional independent explanatory power of contraceptive behavior net of some other socio-demographic variables. Thus, this study argues in favor of increasing women’s autonomy to increase contraception using rate in this population.

This study assesses the contraceptive use dynamics, its program and policy implications in India, Pakistan, Bangladesh and Nepal. Data from three rounds of Demographic and Health Survey (DHS) of each country were used, and the currently married women aged 15-49 years of the latest DHS were considered for detailed analysis. IBM-SPSS (Version 19.0) was used for bivariate and multi-variate analyses with a significance level of 5%.

Analyses indicate considerable intra-country differences in contraceptive use, trends, method mix and determinants. Contraceptive plateau was evident in Bangladesh and Nepal (each with 0.3 point annual increase), while contraceptive use had declined at (-0.6) points annually in Pakistan; between last two rounds of the surveys. Health care autonomy enhances the likelihood of contraceptive use in India (OR=1.06), but not in Nepal (OR=0.60) and Bangladesh (OR=0.45). Exposure to family planning messages increases the chances of sterilization acceptance in Pakistan (OR=1.32); contrary to India (OR=0.92) and Nepal (OR=0.71). Results suggest broadening of method choices with quality service delivery, reconsideration/ review of program focus, repositioning spacing methods in national programs, and demand assessment through monitoring age-sex distribution; all with country specific amendment are pertinent.

The latest Pakistan Demographic and Health Survey 2006-07 indicates stagnation in contraceptive use for almost a decade at 30%. The gap between ever and current use is increasing along with high discontinuation rates. However, results from a recently implemented family planning project in 14 districts of Pakistan show improvements in CPR and contraceptive continuation rates by 8.5 and 11 percentage points respectively. Using survival analysis and the decomposition techniques we examine the underlying factors leading to improved continuation rates and their effect in increasing the CPR. The analysis includes monthly contraceptive histories of 10,604 women in the baseline and 9,995 women in the endline survey. Results show that information on the management of side effects provided at the time of method adoption is significantly associated with lower discontinuations, observed in the decrease of discontinuations due to side effects. Findings will not only highlight the importance of continued contraceptive use they will also have serious implications in elevating currently stagnant CPR.

In Cameroon, the percentage of the use of condoms is greater for singles (73 %), against 51% for men from broken marriages and only 23% for married men. In the context of African country like Cameroon, the society generally advice the virtues of fidelity in the union and the domain of procreation. The obstacles to the use of condoms are more frequently inevitable among couples, whereby condoms usually appear in minds of individuals as a barrier to procreation and leads to sexual waywardness. Using data from the Demographic and Health Survey of Cameroon on the sample of the 1310 men “married conducted by the National Institute of Statistic, this paper used multiple logistic regression to estimate the effects of the determinents of the non-use of condoms and particularly with associated obstacles. The results showed that Factors of modernization interact with one’s culture, directly or indirectly, through one’s level of knowledge as far as condoms are concerned. Moreover, cultural characteristics influence the non-use of condoms. Finally, the effects of attitude and individual perception concerning condoms and the risks of contracting HIV over the non-use of condoms will be mediated by the geographic and economic accessibility of the latter.

For more last 2000 years Christian churches have been against artificial birth control. However, their attitudes towards artificial birth control began to change in the 19th century as theologians became more willing to accept that morality should come from the conscience of each individual rather than from outside teachings where the Anglicans were the first church to issue a statement in favour of contraception, which they did at the Lambeth Conference in 1930. Influenced by this Protestants Christian followed in the 1931. Protestant denominations permit artificial birth control to some extent. The Roman Catholic Church only allows 'natural' birth control, by which it means only having sex during the infertile period of a woman's monthly cycle. Artificial methods of contraception are banned. In this context, an attempt has been made to study the Indian women contraceptive use by different methods which were analyzed from the NFHS-3 survey. Uni-variate, bi-variate and multi-variate analyses were done to see the percentage use of each type of methods, and by various back ground characteristics of unmet need and have examined the best predictors for non-use of contraceptives. Awareness of contraception in this study is 95.5 percent. The current prevalence rate of contraceptive use was 40.7% and total unmet need was 12.6 percent.

Because of many benefits of the family planning programmes, African governments had opted to establish a FPP during in the 1980s and early 1990s. But these FPPs depended mainly on external funding. When the international funders shifted their funding priorities from FPPs to HIV/AIDS in mid 1990s, implementation of FPP became a serious challenge. Ethiopia is an exception. The government initiated the Health Extension Programme (HEP) in 2004 that provides health care services (including FP) at community level. This study is aimed at assessing the impact of HEP on family planning using three rounds of Demographic and Health Surveys conducted in 2000, 2005 and 2011. Data were analyzed using tabular and graphical methods, and a binary logistic regression model is fitted to identify factors associated with contraceptive use. Findings of the study reveal that contraceptive uptake has increased dramatically especially in the rural areas and the most popular contraception is injectables, a method provided by the extension workers. In addition, the regions where the HEP is concentrated are doing much better than other regions. So there is no doubt that HEP has a positive impact towards contraceptive use in Ethiopia and other African countries need to emulate such an initiative.

A family planning survey was conducted in Shanghai in 2011 to investigate contraceptive use and non-use among married women aged between 15 and 49. A total of 21907 participants were randomly selected and interviewed by trained field workers. Findings show that 19.3% of participants did not use any contraceptive method. Among them, 39% were due to wanting a baby, or being pregnant or breastfeeding. Divorce accounts for 23% of all non-users; infertility and menopause 18%, widows and living apart 7%, unmet needs 12% (including concerns of side-effects, health reasons, partners’ objection, etc). The prevalence of non-contraceptive use ranges from 15.7% to 27.1% between categories of district’s characteristics. The likelihood of non-use is associated with women’s age, education, type of work unit, the nature and location of women’s Hukou, family income, number of children and ideal family size. Proportions of unmet needs vary between individual’s characteristics, ranging from 4% to 27%. The older and less educated women were more likely to experience unmet needs. Family income and number of children were also important determinants of unmet needs. It can be concluded that non-contraceptive use in Shanghai was due mainly to intended pregnancy. However, some gaps of unmet needs still should be bridged.

Our study purpose is to assess data quality of self-reported current use of the Lactational Amenorrhea Method (LAM) in the Demographic and Health Surveys (DHS). LAM, an important contraceptive method during the postpartum period, is a modern contraceptive with an effectiveness rate of 98% for the six month postpartum period when used correctly. Our study’s specific objectives are: 1) to examine accuracy of self-reported LAM use compared to the constructed correct practice variable, and 2) to explore differentials in accuracy measures by characteristics at the individual-level and survey-level by analyzing data from 73 DHS conducted in 45 countries since 1998. Findings reveal that on average only 26% of reported LAM users met criteria of correct LAM practice across the surveys, indicating potentially unacceptably low user effectiveness at the population level. We discuss implications for future DHS data collection efforts, and implications for family planning and maternal and child health programming.