Contraceptive Intention Behavior in Rural Bangladesh: Factors in the Diffusion of an Innovation

Abstract

To elucidate the determinants of contraceptive use or nonuse in rural Bangladesh, Fishbein's behavioral intention model was modified and applied to survey data collected in 1984 in the Ghatail upazila of the Tangail district. The proposed behavioral model consists of 5 independent variables: global attitude, global motivation to comply, motivation toward fertility regulation, method-specific attitude, and method-specific availability. Of the 193 respondents surveyed, 152 expressed an intention not to use oral contraceptives (OCs)--the most accessible method in the survey area--and were generally negative about any form of contraceptive use. As expected, the 41 women who did intend to use OCs had a positive global attitude toward contraception. Global motivation to comply scores were negative for women who had no plans to become OC users, largely because of a belief that the Islamic religion prohibits contraceptive use. Concern about religion was a greater obstacle to these women than the perceived reaction of their husband and friends to OC use. The aggregate score on motivation for fertility regulation was positive, suggesting that respondents still desire more children. The pill received a negative method-specific score due to perceptions that it is unreliable and causes side effects. The mean distance to a source of OCs (method availability) was 2.55 miles among women who intended not to use the pill and 2.34 miles among potential acceptors. Stepwise logistic regression analysis indicated that global attitude and global motivation were the most significant predictors of intent to use OCs; the only other significant variable was method-specific attitude. The implications of these findings are that contraceptive availability is not sufficient to contraceptive use; creation of a favorable attitude toward contraception and support from Islamic religious leaders appear to the necessary prerequisites to more widespread fertility control.