Poster Session on Sexuality and reproductive health (2)

Sterilization is the most popular method of contraception in India. As the demand for sterilization services remains very high with a large unmet need, the country has continued with the camp mode (mobile clinic) to reach the people in under-served and under-reached areas (MoHFW, 2008). The paper compares the types of service delivery for female sterilization in India by their socio-economic characteristics and by the awareness of alternative contraceptive methods. At the same time, the study also tries to see differentials in static and mobile service delivery facilities. The present study uses the third round of DLHS (2007-08). In the DLHS-III, 1,156,932 ever married women in the age group 15-49 have been interviewed. To analyse the data, bi-variate analysis have been performed to compare static and mobile service facilities. At the same time, logistic regression analysis has been performed to look into the factors responsible for different service deliveries. The result shows that mobile facility is more effective in rural areas. The result also depicts that Muslims compared to Hindus; urban resident compared to rural resident; and women having higher education compared to no education are statistically significant and less likely to use female sterilization.

Despite the concept of unmet need for contraception undergoing some considerable revision and refinement, research has continued emphasizing on women largely ignoring men. However, it is unacceptable to ignore men’s unmet need considering that reducing it translates into lowering fertility. Including men in family planning programmes and research cannot be overlooked if challenges related to reproductive health, unmet need inclusive, are to be effectively addressed. Using 2007 Zambia Demographic and Health Survey, we estimated the level of unmet need for currently married men and examined its determinants. Results indicate that unmet need for spacing, limiting and total was 28.0%, 19.5% and 47.5%, respectively. Men’s educational attainment and exposure to family planning messages in media were the most important determinants of unmet need for spacing, whereas number of living children and region of residence were the most important determinants of unmet need for limiting. Other factors associated with unmet need were age (35-49 and 50-59) and wealth (rich). Married men in Zambia have a high level of unmet need. Family planning services are not meeting men’s demand for family planning. Concerted efforts should be made for family planning programmes to specifically target men as contraceptive users.

Efforts made to improve the availability and access to adolescent sexual and reproductive health services have not yielded the expected results and the Kintampo Health and Demographic Surveillance System (KHDSS) area is no exception. This study seeks to explore the intentions and preferences for contraceptives among adolescents in rural Ghana and examines differences and determinants of intentions and preferences observed to make contributions towards meeting MDG 5b which is described as the most off-track of all MDGs. The source of data is a survey and the KHDSS database. The outcome variable is the intention and/or willingness of adolescents to use contraceptives and the explanatory variables are demographic and socio-economic factors. Descriptive and multivariate analysis were done using STATA 11.1. The expected findings are level of adolescents’ willingness for contraceptive use, most popular and reasons for not using contraceptives. This study will also show differences in the socio-demographic and economic sub-groups and determinants of the observations made

Maternal health issue is a major global concern since pregnancy and childbirth are the leading causes of death, disease, and disability among women in their reproductive period. This concern is also well acknowledged in the fifth millennium development goal (MDG) that aims to reduce infant deaths and improve maternal health while providing universal access to sexual and reproductive health services by 2015. Contraception in postpartum period plays an essential role to prevent unwanted pregnancy and to reduce the risk of infant and maternal mortality by optimal birth intervals. Thus it calls for an investigation about the patterns and determinants of timing of postpartum contraceptive use among women. The present study is directed towards investigating the timing of contraceptive initiation among Indian women in extended postpartum period, a period which is different from other periods with regard to menstrual pattern and sexual behavior of women. Survival plots and hazard model techniques are employed to analyze the time variable with respect to various characteristics of women. The main finding obtained using the data of National Family Health Survey- III clearly demonstrate the lack of motivation among Indian women, whether amenorrheic or menstruating, about initiating modern contraceptives in this period.

Overall contraceptive prevalence rate in India has steadily increased, in spite of these gains, fertility is still high and many couples are unable to effectively choose the number and timing of their births. Most of the researchers have tried to show the impact of utilization of antenatal care services on ever-use of family planning methods. Nevertheless, research investigating the nature of this relationship is not well understood, in the sense that ever use of contraceptive is a weak indicator to capture this aspect. In the present study, with the help of a five years reproductive calendar which is first time available in National Family Health Survey 2005-06, concerted attempt will be made to examine whether utilization of maternal and child health care services is one of the major networks for adoption of contraceptive use. We will examine the type and duration of specific contraceptive use, after utilization of maternal and child health care services. Analysis shows that the intensity of antenatal service and institutional delivery service use does have a causal impact on subsequent spacing contraceptive continuation, after controlling other important socio-economic and demography factors. Result of this research work will improve policymakers understanding of determinants of maternal and child health care utilization.

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.

In India, the acceptance of family planning is voluntary and couples have the freedom and choice to accept any method they want. However, the recent conditional cash transfer (CCT) schemes for promoting the survival and welfare of girl children in the wake of alarmingly skewed child sex ratio have used inadvertently to increase sterilization coverage. The acceptance of terminal method of family planning by parents is one of the eligibility criteria to enroll the girl child in ‘popular’ schemes such as Bhagyalakshmi (Karnataka), Ladli Lakshmi (Madhya Pradesh), Girl Child Protection Scheme (Andhra Pradesh), Indira Gandhi Balika Suraksha Yojana (Himachal Pradesh),and Balri Rakshak Yojana (Punjab). It also raises a larger question - why is family planning linked with girl child promotion schemes? A study sponsored by UNFPA found that many poor parents are induced to accept family planning to join the schemes which provide financial benefits. This led to female sterilization because that was considered more socially acceptable. Many believe sex selective abortions as a danger of aggressively pursuing female sterilization and small family norm in the context of son preference. Interestingly, the measures designed to reverse sex selection also encourages sterilization, which may go against the human rights of women.

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.