Contraceptive use dynamics in developing countries

This paper examines the poor, rich differentials in contraceptive adoption in India. Study takes advantage of calendar data, which is first time available in Indian National Family Health Survey (2005-06), to deal with the differentials between poor and rich women in type and time to initiate contraceptive method. The initiation of postpartum contraceptive use analyzed from calendar data by selecting the first use of contraceptive in subsequent month after having a last birth in 5 years preceding survey. The study employed multinomial logistic regressions to investigate a variable indicating type of contraceptive method and Cox hazard regression model to examine timing of adoption of contraceptive, for those who use, the time from birth in months until contraception is started. Result shows that, there are significant gaps in modern contraceptive prevalence between the poor and rich. About 55 percent poor household women did not adopt contraceptive after having birth, for rich women this percentage was only 30. Nearly 35 percent rich and only 10 percent poor women have adopted spacing method, although the difference in adoption of sterilization is insignificant. Findings show that 71 percent rich women and only half of poor women have adopted spacing method within six months after delivery.

Use of contraceptive and its method choice is based on the decision made by a female, her husband only or both. But it is largely depends on husbands in the Indian traditional societies. Moreover, the decision taken for the use of contraceptive and its methods is primarily affected by some socio-demographic factors. Thus, there is a need to study and estimate the prevalence of contraceptive use and its methods and also to identify the factors which influence the use of contraceptive.
The objective of the present study is to explore some socio-demographic factors associated with contraceptive use and its method choice. Type of contraceptive is taken as dependent variables (modern, traditional & no use) and some socio-economic and demographic variables are taken as explanatory variables. This analysis is carried out using multinomial logistic regression technique for the currently married females those are neither infecund nor in menopause stage using data from NFHS-III (2005-06) of Uttar Pradesh, India. Results show that place of residence, education of female, wealth index, religion, age at first marriage, type of family, desire for son, husband’s education, marital duration, parity and mass media exposure significantly affect the use of contraceptive and its method choice.

Though the contraceptive use in India has increased over time, the use of modern spacing
method remained low across socio-economic groups. The low use of spacing method may lead to
high infant mortality and increased maternal and child morbidities. This paper studies the factors
associated with contraceptive discontinuation with an emphasis on the socio-economic
differentials.
Utilizing the calendar data of National Family Health Survey (2005-06), a multiple decrement
life table approach revealed that about 40% of all modern spacing method users stop use within
12 months of initiating. The most likely stoppers were pill users (49%) followed by condom
users (44%). IUD users are the least likely to stop with 81% persisted to use the method after one
year. The main reason for discontinuation varied from the reasons like side-effects for pill and
IUD to method failure in case of traditional methods. Three types of discontinuations: failure,
switching and abandoned at the risk of pregnancy were analyzed. The multilevel multivariate
analysis suggests that the contraceptive method used, experience with the immediate previous
method, age, wealth status and parity of women were found to influence the discontinuation behavior.
A large amount of unexplained variation in discontinuation rates remains at the community level.

During the period of 2000-2010 the percentage of women who used injectable increased notably. This phenomenon will have consequences in the sustainability of the government of Indonesia to finance contraceptives and on fertility decline in the future. This research’s aim is to analyze determinants of the use of injectable contraceptives. The data used is the 2007 Indonesia DHS, employing binary logistic regression model. The dependent variable is the married women aged 15-49 years using injectables. The independent variables are age of respondents, number of living children, desire for more children, highest education level, place of residence, working status, wealth index, knowledge of modern contraceptive methods, knowledge of contraceptive side effects, one’s goals of family planning, husband’s approval on family planning and the type of service provider.

This paper examines women’s experiences of using injectable contraception (IC) from the perspectives of women and health care providers, and sheds light on the feasibility and acceptability of making IC widely available in India. The study was undertaken in 27 selected facilities of 4 NGOs in 5 states. Using a retrospective study design, 375 married women were interviewed who had initiated IC use in 12-21 months before the interview. In-depth interviews were conducted among 16 health care providers. Findings, based on lifetable analysis, indicate that just 23% of the women continued to use ICs at 12 months. Reasons for discontinuation centred on the side-effects experienced, largely menstrual disturbances. Counselling was not comprehensive for most women. Multivariate analysis suggests that women who had continued using ICs for at least 12 months tended to be younger, educated and multiparous. Notably, continuation rates were also higher among women who had experienced fewer side-effects and were provided good quality of care. In-depth interviews with health care providers corroborated many of these findings. Findings suggest that although continuation rates are low, a considerable proportion of women find IC an acceptable method. With appropriate counselling, it is possible to offer this method more widely in the RCH programme.

Contraceptive prevalence rate (CPR) is one of the most important indicators in evaluating the success of population policies and programs. In the last three decades, Egypt achieved a remarkable success in promoting contraception; the percent of women currently using any contraceptive method, over 15-year period from 1980 to 1995, has more than doubled; CPR increased from only 24 in 1980 to 47.9 in 1995. After 1995 CPR plateau with a slight increase from 56.1 in 2000 to 59.2 in 2005 and then to 60.3 in 2008. The main concern of this paper is to discuss this plateau effect of the family planning program in Egypt. After a successful period of contraceptive promotion came the results of the last Egypt Demographic and Health Surveys to show that plateau effect of the family planning program and to warn policy makers about this trend in contraceptive prevalence.

This paper aimed at identifying factors that contribute to unmet need for family planning among women in rural Kenya. Logistic regression analysis was carried out on 2008/09 Kenya demographic and health survey women-file data that left out currently pregnant and amenorrheic women. Among the variables found to be significantly related to unmet need for spacing, limiting childbearing and total unmet need were: marital status, current age, level of education, number of living children, employment status, region, household wealth index and exposure to mass media communications. In order to reduce unmet need for family planning in rural areas of Kenya, region-specific programmatic family planning action should be adopted; the government should prioritize female education and economic empowerment to women in rural areas; agencies involved in family planning provision and communication in rural Kenya should offer suitable services that target specific age groups, and with a greater focus on married women.

Using the 2004 Cameroon Demographic and Health Survey, we examine the association between various women's status variables and contraception use. We find that certain dimensions of female autonomy are indeed important for contraception use in the Cameroonian context, while there is no clear relationship for other dimensions. We find that the decision-making index is the most important dimension of female autonomy in predicting a woman’s use of modern contraception. The mobility index and the gender role index are respectively the second and third most important dimensions of women’s autonomy that predict a woman’s modern contraception use. Surprisingly, none of the financial autonomy variables are significant. We conclude that although certain women’s autonomy variables predict a woman’s modern contraception use, a place of residence and regional level of development is a much stronger predictor.

Couples characteristics and their variations and implications is an area where there is a need for much focus and further research. Inter-spousal communication, though not a new dimension of fertility and family planning research has remained much less explored especially in the Indian context than any other correlates of contraceptive use and current fertility. Most of the demographic researches on fertility, reproductive health and contraception focus on females of particular age group who are in their reproductive period. Important demographic indicators like fertility, contraception and mortality are estimated on the basis of reporting of the eligible female respondents. This particular study makes an attempt in exploring the degree of mismatch and its spatial variation in reporting of the contraceptive use by the couples in India. The study analyses the concordance and discordance of the reporting of the contraceptive use as reported by the wife and by the husband separately by using information of 42185 couples. Multivariate analysis has been used to find the causal relationship between various socio-economic-demographic factors and the mismatch in reporting of the contraceptive use. In India , wife's reporting of current use of contraception (60 percent) is higher than as reported by the husband(52 percent

Sullivan,Rachel (Dept Demography, U Califonia, Berkeley 94720-2021 [e-mail:rachsull@demog.berkeley.edu]), Competing Pressures:Predicting Population Policy Adoption in sub - Saharan Africa.

Why did pronatalist African countries adopt grownth limiting population policies? This paper uses a country - level data set i constructed for the period 1985 - 1999 to predict which sub - Saharan African countries adopted national population policies, & when? Using a variety of analytic techniques ( geographic comparison, logistic regression & event - history analysis, 2) politically "weaker" countries were somewhat more likely to adopt policies, & 3) countries experiencing demo graphic pressure were also more likely to adopt policies.
I conclude that policy adoption occurred at the nexus of internal & external pressure.