Contraceptive use dynamics in developing countries

Determinants of Modern Contraceptive Use in Bhutan


Deki,
Senior Lecturer, Department of Social Sciences,
Royal Thimphu College, Bhutan
dekitenzin@rtc.bt


Abstract
This paper basically attempts to look into some of the prominent determinants of modern contraceptive use in Bhutan by women of reproductive age. The data set which is obtained from Bhutan Multiple Indicator survey 2011 was being analyzed using SPSS. Multivariate analysis was done using binary logistic regression model and results obtained are very contrasting. It is very striking to note that Bhutanese women of reproductive age residing in rural areas and with less educational attainment are more likely to use modern contraceptives compared to their counterparts residing in urban areas and more educated ones, this seems to be unique from any other countries experiences, however further studies has to be done to validate this result. Likelihood of modern contraceptives use increases with increase in women’s age but it decreases towards the end of women’s reproductive age. Married women are more likely to use modern contraceptives compared to their other counter parts in Bhutan.

Key words: Modern Contraceptives, Women’s of Reproductive age, Rural, Urban, Education, Age, Bhutan

BACKGROUND : Postpartum and postabortum contraception is program aimed to control birth spacing, pregnancy interval, prevent unwanted pregnancy, and increase maternal-child health.

OBJECTIVES : To explore preferences of acceptors in using contraceptive methods during postpartum and postabortum period.

METHODS : Research subject are postpartum and postabortum acceptors from 727 hospitals by 80,810 acceptors in 5 regions from 33 Indonesia’s provinces. Data taken from hospital’s reporting and recording start from January until December 2011.

RESULTS : Results are main contraceptive use nationally is injection (31.5%), and Java-Bali is highest contraceptive use (41,6%). Highest prevalence of vasectomy is Sumatera (53%). Highest prevalence of tubectomy is Java-Bali (46.9%). Highest prevalence of IUD is Java-Bali (52.2%). Highest prevalence of Implant is Sumatera (53.7%). Highest prevalence of Injection is Java-Bali (41.7%). Highest prevalence of Pill is Sumatera (47.1%). Highest prevalence of condom is Java-Bali (46.3%).

CONCLUSIONS : In order to improve the situation, health authorities should be encouraged to provide counselling on postpartum and postabortum contraceptive methods during ante and postnatal.

Gender is the social construction of attributes based on the sexes. With this in perspective, dominance is attributed to the masculinity of males; and subordination tends to be for the females. The focus of this study is based on the issue of political subordination in the private sphere of the household. Particularly, the autonomy status and need for family planning is described. This will involve an analysis between women who are cohabiting with their partners and those who are married using the 2008 NDHS.
For both types of unions among women, the variable that influence met need for family planning is education. For married women, it also includes employment and residence. Lack of justification for intimate partner violence has a positive effect whereby it decreases the likelihood of having unmet need. The curious observation is with gaining autonomy in the household; having an increased level of such leads to having unmet need. But among those in consensual union, autonomy is observed to have no effect on this regard.
There is an apparent difference between women who are formally married and those who are cohabiting with their partners; which is a social arrangement that is increasing in prevalence in the country.

Pakistan is the 6th most populous country in the world that recently exceed 7 billion
populace, with stagnated contraceptive prevalence rate in the country. It is important to promote inter-spousal communication in marital relationships to improve contraceptive usage, as it is only permissible way in Pakistan for reproduction and sex. This study aims to highlight these communication practices & their linkage with contraceptive usage.

A cross sectional survey was conducted from 710 married females males who were aged between 16–44 years in Hyderabad District of Pakistan.

Twenty-eight percent respondents had ever used contraceptives and 61% of these were female. A highly significant association was found between contraceptive usage and the ability of females to refuse sexual intercourse with their spouse (p<0.001). Of the 122 female contraceptive users, 84% females felt comfortable in asking their husbands to wear condom. There was no significant association found between contraceptive male users and those who had ability to express their sexual desire & refuse their spouse for sexual intercourse.

The study emphasize the need for strengthening communication & negotiation skills of females so that they are able to exercise their sexual rights and refuse sexual intercourse and/or ask their spouse to use a condom.

Background: Bihar is the second most populous state (106 million) in India and has highest total fertility rate (3.9) and a stagnated contraceptive prevalence rate of modern methods (29 percent). The unmet need for contraception is high.
Data and Objectives: Based on a large sample survey (N=7995), including 2937 women, 723 husbands and 592 health workers, and 150 in-depth interviews of women and their husbands, the present paper attempts to understand (a) who decides and how decision of contraceptive use is taken, (b) how socio-cultural norms influence contraceptive use dynamics, (c) barriers to contraceptive use and (d) where family planning program is failing to reach young couples.
Results: A combination of qualitative and quantitative approach including multivariate analysis shows a combination of socio-cultural and a weak FP program contribute to continued low use of contraception including: (a) large family size norm and son preference, (b) subordinate status of young women, low mobility outside home and lack of decision making power, (c) early marriage/pregnancy with no knowledge of fertility return leading to unwanted pregnancies; compounded by (c) programmatic inadequacies such as failure to provide correct and complete knowledge on FP, fear of side effects, and limited access to methods within village.

Purpose: The aim of this study was to examine the magnitude of unintended pregnancy, unsafe abortion and to assess awareness towards emergency contraceptives (EC) among antenatal care attendees in Ethiopia.
Method: A cross sectional study was conducted from August 19th to September 30th 2011 among 310 antenatal care attendants (age of 15-49) that were selected by using simple random sampling technique. The data were entered and analyzed using SPSS for windows version 16.0.
Result: Among 310 respondents, 87 (28%) reported their pregnancy was unintended and 56 (18%) had ever practiced unsafe abortion one or more times. Only 105 (34%) of respondents had heard about EC and among those only 11.8% had used the method previously. A considerable proportion of respondents (59.1%) reported their fear on using EC due to safety misconceptions.
Conclusion: This study indicated unintended pregnancy and unsafe abortion are very high due to lack of knowledge, practice and misconception towards EC among antenatal care (ANC) attending women. Therefore, it is necessary to promote emergency contraceptive awareness and use for ANC attendants with appropriate education methods.
Key words: Antenatal care attendees, unintended pregnancy, unsafe abortion, emergency contraception, Ethiopia

Couples use different types of modern contraceptive methods to limit as well as space between two children according to their wish to complete their desired family size or delay according to their needs. Thus, effectiveness as well as use of contraceptives is the main theme of most of the Family Planning Program for any country. Study of contraceptive use is quite useful for developing country like India for making policies and programs. In this paper, the effect of contraceptive use for different characteristics, attitude and behavior of couples has been studied. Multivariate logistic regression analysis has been used to find the effect of modern contraceptive methods on different socio-demographic and economic variables. Total marital fertility rate (TMFR) has been calculated separately for the females who are using limiting as well as spacing methods of contraceptive. Furthermore, it has been observed that use of modern contraceptives methods reduces TMFR. Permanent method of modern contraceptive users has 0.51 less TMFR, whereas, temporary method of modern contraceptive users has 0.57 less TMFR than non-users. The finding may be useful to give an idea to implement for implementation the new family planning program according to need or effectiveness of contraceptives among the couples.

Women aged 35 and older are often left out of the conversation on contraception. This study seeks to examine the influence of household decision-making power on current modern contraceptive use among Nigerian women aged 35-49 years, using secondary data from the 2008 Nigerian Demographic Health Survey. Non-pregnant women who were 35-49 years of age were eligible to be included in the analysis. The key independent variable was women’s decision-making power and assessed based on a score, calculated using principal component analysis. The mean (SE) age of women in the sample was 40.8 (0.07) years. All women (4827) were married or cohabiting with a partner, with 37.5% in polygamous unions, and 18.7% using a modern contraceptive method. Contraceptive users reported higher decision-making scores, were younger, more educated, richer and were not in polygamous unions. Following multivariate logistic regression, decision-making power remained independently associated with modern contraceptive use. Women in the highest tertile of household decision-making had a 61% higher odds of modern contraceptive use when compared with women in the lowest tertile [OR: 1.61 (1.25, 2.08)]. Programs and policies that encourage women to be involved in household decision-making will also be encouraging them to make a choice regarding modern contraception.

Background:
Unintended pregnancies pose pernicious consequences on health and well-being of families globally. Although Tanzania is one of the countries experiencing higher rates of unintended pregnancies, characteristics women who conceive unintentionally are less clear and rarely documented.

Methods:
Data were collected in a cross-sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania in 2011. Women, 15-49 year-olds, who had given birth in the past two years, formed our sample. Unintended pregnancies were twofold – mistimed and unwanted-. A multinomial logistic model was used to identify characteristics of women whose pregnancies were unintended at the time of conception.

Results:
Participants were 870 women in total and averagely aged 27.9 years. While 49.3% had intended pregnancies, 34.9% and 15.8% had mistimed and unwanted pregnancies respectively. Women who were younger, multi-parous, educated, not using contraceptives, reside in urban, unmarried and ever married were more likely to conceive unintended pregnancies than their counterparts.

Conclusion:
Socio-demographic characteristics of women in the three districts in Tanzania influence pregnancy intentions. Women should be empowered with fertility control mechanisms to avoid unintended pregnancies.

Using qualitative data based on 154 participants from 18 focus group discussion and 16 key informant and in-depth interviews, information on men’s involvement in family planning and contraceptive use was collected. The study objective was to examine in-depth explanations for men’s non-involvement in family planning services and promotion of contraceptive use. Of interest men aged 15 to 54 and women in the reproductive age group participated in the group discussions. Selection was based on age, gender, residence of the participants. While the criteria for inclusion for the indepth interviews was based on those who had reported the highest number of children born or fathered. Data collection was done until we reached saturation. Manifest content analysis was used to identify key thematic areas for data analysis. Results show men’s lack of interest in contraceptive use. Limited method choices for men, affected by side effects, domestic violence in families where women used contraceptives stealthily and marital breakdown. In conclusion, there is an urgent need for introduction of other male contraceptives and an integrated family planning approach for both men and women at all levels. Men ought to be brought on board as without them contraceptive uptake will remain continuously low in patriarchal societies.