Contraceptive Availability and Family Limitation in Mexico and Rural Korea

Abstract

In a comparative study of World Fertility Survey (WFS) data from the rural portion of the 1974 Korean survey and from the 1976 Mexican survey, the levels of perceived availability and actual accessibility of contraceptive services are assessed, and their joint relationship with contraceptive use and fertility is examined. In Mexico, 53 percent of married women exposed to the risk of childbearing say that they know of a place where they can obtain contraceptives; the proportion ranges from 25 percent of women in areas where there is no source within five km of their communities to 72 percent in areas with five or more sources. In rural Korea, regardless of actual accessibility, 86 percent of women say that they know where they can get contraceptives. This knowledge is uniformly distributed across all levels of actual accessibility. Perceived availability is significantly correlated with actual accessibility in both Mexico and rural Korea; the proportion of women who report that a source of contraceptive services is fairly close to their homes increases steadily with rising actual accessibility. Overall, 31 percent of Mexican women live in areas where both perceived and actual availability are low or nonexistent, compared with only eight percent of rural Korean women. Twenty-eight percent of both Mexican and rural Korean women live in areas where services are highly accessible and report that contraceptives are easy to obtain; women in Mexico more frequently underestimate than overestimate accessibility, but rural Korean women more often perceive contraceptive accessibility to be better than it actually is. In Mexico, variations in levels of perceived and actual availability are found to have a statistically significant effect on current contraceptive use, current use of effective methods, discontinuation of use and unmet need; in rural Korea, such variations affect all the use-categories except discontinuation. Multiple classification analyses show that, independent of other background factors and of accessibility, wife's education and urban residence each have a significant impact on prevalence of contraceptive use in Mexico. Husband's occupation and the desire for more children have significant net effects on current use in both countries. Combined perceived and actual availability is also found to significantly influence levels of contraceptive use, net of the other factors. Bivariate analyses show that combined perceived and actual availability has a statistically significant impact on recent fertility rates in Mexico, but not in rural Korea. Multiple classification analyses indicate, however, that there is no significant independent effect on recent fertility in either Mexico or rural Korea. Perceived and actual availability does significantly affect the likelihood that a woman is currently pregnant, though, in both countries. The desire for more children significantly affects both fertility measures in each country as well. There may be many different reasons for the varying effects of contraceptive availability in the two countries. Family planning programs have only recently been begun in Mexico, while Korea's program has been in operation for more than 20 years. In addition, Korean women depend on abortion much more frequently than do Mexican women. This study finds that increasing perceived and actual availability of contraceptive outlets can increase contraceptive prevalence and reduce unmet need for family planning services. Maximizing contraceptive availability and accessibility is vital for successfully meeting the potential demand for family planning services in Mexico and for achieving higher levels of contraceptive practice in rural Korea.