Levels Of Contraceptive Prevalence Research Articles

Is Pakistan’s fertility transition stalling?

ABSTRACT This study examines the question as to whether Pakistan’s fertility transition is stalling. The paper reviews the trajectories of fertility and its various determinants and compares Pakistan’s trends with those of India and Bangladesh. Countries in the South Asia region share features such as cultural similarities (e.g. the low status of women and son preference) and high poverty levels. However, while Bangladesh and India are near replacement fertility today with modern contraceptive prevalence rates well above 50 per cent, Pakistan still has one of the highest fertility and lowest contraceptive prevalence levels in Asia. Our main conclusion is that Pakistan’s fertility transition is close to stalling in mid-transition. The key causes of this stall are a high and unchanging desired family size, stalling demand for contraception and relatively low satisfaction of this demand. These are important obstacles to future decline in fertility.

Predictors of DMPA-SC continuation among urban Nigerian women: the influence of counseling quality and side effects

ObjectivesIn 2015, private healthcare providers in Nigeria introduced DMPA-SC (depot medroxyprogesterone acetate administered subcutaneously) into the method mix. We aimed to [1] examine the sociodemographic predictors of continued DMPA-SC use after 3 months, and [2] characterize the additional influences of contraceptive counseling quality and experiences of side effects on continuation. Study designFrom March to August, 2016, we conducted phone interviews with a convenience sample of women obtaining DMPA-SC from selected providers to survey them about their experience obtaining an initial dose of DMPA-SC. Study coordinators contacted women again about 3 months later after when they were due for reinjection. We used logistic regressions to examine the likelihood of having obtained a subsequent dose of DMPA-SC at follow-up as predicted by sociodemographic characteristics, a quality of counseling indicator based on responses to a 14-item scale, and reports of side effects experienced. ResultsOf the 541 DMPA-SC users who completed the first survey, 311 were reached again via phone after 3 months to conduct a second survey. Multivariate results for sociodemographic predictors of continued DMPA-SC use show that those with some college education or more (OR=2.79; 95% CI: 1.09–7.14), and those with four or more children (OR=2.89; 95% CI: 1.09 0 7.67) were more likely to obtain another dose. Our summary quality measure showed that women overall rated the quality of their initial counseling session high. Logistic regressions indicated that higher quality during the initial counseling session is related to the likelihood of getting another dose of DMPA-SC (OR=2.04; 95% CI: 1.12–3.47) whereas experiencing more bleeding reduced the likelihood of continuation after 3 months (OR=0.15; 95% CI: 0.07–0.34). ConclusionsAmong urban Nigerian women, both counseling quality and experiencing side effects were important factors in predicting continued use of DMPA-SC after 3 months. These findings are consistent with previous studies of DMPA and injectable contraception continuation. ImplicationsNew contraceptive methods that are designed for increased access and ease of use, combined with high quality provision, have potential to increase contraceptive use in settings with low levels of contraceptive prevalence. Higher quality counseling can help encourage women's continuation of a new injectable contraceptive method at 3 months.

Stylized Facts and Review of the Relation between Contraceptive Use, Delinquency and Age Structure in Nigeria, and It’s Implications for Demographic Dividend

The young population structure of most African countries will serve as a driving force behind economic buoyancy in years to come, only if strategies are put in place to encourage smaller families. Forty percent of the Nigerian population is below 15 years, while 3 percent are 65 years and above. A large workforce with fewer children to support creates a window of opportunity to save money on health care and other social services. This study seeks to examine the association between contraceptive use, delinquency and age structure of Nigeria population; to identify ways of achieving the demographic dividend. Data were extracted from the Nigeria Demographic and Health Survey Report in 2008, United Nations World Population Prospects Report (2008) and World Population Data Sheets (2009-2016). Uses of trends (tables and charts) were adopted in presenting data in this study. Findings show that contraceptive prevalence level in the country is very low, it ranged from 11%-15% within the selected periods. The desire to limit childbearing as the number of living children increases was reported to be common among women with three or more children in both urban and rural areas. Mothers with post-secondary education on the average had 4 children, while those without education had 8 children. Education is that best contraceptive to achieve the age structure that would result in demographic dividend; hence more investments in women education are needed. Also, job opportunities for different levels of skill are required as this encourages dual role among women apart from rearing children.

Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education

Background: Since 1960, contraceptive use has risen rapidly in Asia and Latin America reaching prevalence levels among married women of 61 and 69 percent, respectively, by 2015. In contrast prevalence in sub-Saharan Africa reached only 25 percent in 2015. Some countries in Africa have experienced very rapid increases (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study examines the causes of these different trends which remain controversial. Methods: The analysis focuses on trends from 1990 to 2015 in 24 sub-Saharan Africa. Countries. Country-level regression analysis (OLS and fixed effects models) are used to estimate the separate impact on prevalence of family planning programs and socioeconomic variables (women's educational attainment, GNI/cap (PPP), percent urban and child mortality). The quality and scope of the government's public family planning program is measured with a new index developed by Bongaarts and Hardee. Findings: First, women's educational attainment and program score are the main determinants of levels of contraceptive prevalence in sub-Saharan countries. Second, the very rapid increases in prevalence in several countries since the 1990s are mainly due to the rapid strengthening of family planning programs and not to an acceleration of education levels. Third, the improvements in family planning programs are directly traceable to increases in government actions including stronger commitment from political leaders and increased funding. Interpretation: Voluntary family programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impacts above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even when education levels have risen substantially. Funding: William and Flora Hewlett Foundation Declaration of Interest: We declare no competing interests.

Contraceptive use Among Female Adolescents in Korle-Gonno, Accra, Ghana

Objective: To find out the prevalence of contraceptive use among female adolescents and the associated factors for contraceptive choice and use. Methods: Using systematic sampling technique, one female adolescent (10-19 years) from each of 110 houses was interviewed using structured questionnaire. One house was selected and a female adolescent who consented was administered structured questionnaire. Data collected included; socio-demographic factors, adolescent sexuality, contraceptive use/non-use and contraceptive choices. Data was analysed using SPSS: 16.0 and frequencies, means, Chi Squared test and Logistic regression was used, setting significance at p=0.05. Results: The mean age at first sexual intercourse was 15.9 years (12-18 years) and 55.5% of female adolescents were sexually active. Contraceptive prevalence among sexually active female adolescents was 38.0%. The commonest method used was the male condom (73.9%). Main reasons for choice of method were easy access and safety of method, and also dual protection specifically for the male condom. Most adolescents besides having not thought about protection at time of sexual intercourse had no specific reason for not using contraception. There was a generally low level of encouragement from social contacts to female adolescents to use contraceptives. Common reasons given for abstinence included being young and afraid of pregnancy and HIV/AIDS and also want to further education and achieve goals in life. Discouragement from contraceptive use was generally low and was mainly from peers and sex partners and statements used in this regards stemmed mainly from misconceptions and misinformation. Unadjusted analysis suggested that Mother’s/female guardian’s highest level of education and sex partner encouragement were significantly associated with contraceptive use (p=0.035 and 0.040 respectively) and multivariable logistic regression analysis showed that only mother’s/female guardian’s highest level of education was a significant factor (p=0.047). With the current low level of contraceptive prevalence there is the urgent need to address perceived barriers from this study such as lack of encouragement from close social contacts of this vulnerable group, misinformation and misconceptions about contraceptives and also research into appropriate ways of helping abstaining youth and practical ways of empowering women by educating the girl child must be researched.

The Catholic Church and reproductive health and rights in Timor-Leste: contestation, negotiation and cooperation

In Timor-Leste, high fertility, high maternal mortality and low levels of contraceptive prevalence demonstrate the importance of exploring perceptions, policies and practices around reproductive health and rights. This paper explores the influence of the Catholic Church on reproductive decision-making at different levels of policy and practice. Utilising a feminist qualitative research methodology, in-depth interviews were conducted with a range of participants including nuns and priests, Timorese women and men of different ages and backgrounds and local and national stakeholders working in reproductive health and women's rights. Findings reveal that the Church is reported to play a significant role in reproductive health and rights decision-making at all levels of society, from policy-making to the reproductive decisions made by individual Timorese women and men. Nevertheless, the translation of Church teachings into practice, particularly by nuns, priests and Timorese men and women, reveal a range of attitudes and opinions; some that support and others that contest official Catholic doctrine. In light of the significant influence of the Timorese Catholic Church on policy and practice at many levels of society, there is a need to prioritise the development of rights-based strategies to improve reproductive health services in Timor-Leste.

Assessing the effect of introducing a new method into family planning programs in India, Peru, and Rwanda

BackgroundIntroducing a new method into family planning programs requires careful attention to ensure it meets an actual need and has a positive effect on program goals. The Standard Days Method® is a fertility awareness-based method of family planning that is being introduced into family planning programs in countries around the world. It is different from other methods offered by programs, and may bring new couples into family planning, and increase contraceptive prevalence. The study assesses the effect on contraceptive use and prevalence of Introducing Standard Days Method into existing family planning services in whole regions of India, Peru, and Rwanda.MethodsIn collaboration with the Ministry of Health, health providers were given a contraceptive update on all methods, then trained in counseling on Standard Days Method. Efforts were made to promote demand in the context of informed choice. Routine monthly service statistics in control and intervention areas were used to assess the effect of Standard Days Method introduction at the clinic level; baseline and endline household-based surveys were undertaken to obtain results at the community level (n > 3400 women at endline).ResultsDemand for the method is evident in countries with different levels of contraceptive prevalence. The method attracts couples new to family planning, and introducing it into services may increase overall contraceptive prevalence.ConclusionsIntroducing Standard Days Method into existing family planning has the potential of benefiting men and women in diverse settings and populations. This study illustrates the critical role of evidence in scaling up a health innovation.

Traditional Roles, Modern Behavior: Intergenerational Intervention and Contraception in Rural Bangladesh

Although rural Bangladesh retains many traditional socioeconomic characteristics, the use of contraceptives has increased over the past three decades. This paper examines the influence a mother-in-law has on her young daughter-in-law's use of contraceptives in the rural community of Matlab, Bangladesh. The study uses data from 413 interviews conducted in two areas of the community with different family planning programs, which have affected differing levels of contraceptive prevalence. Results demonstrate that the mother-in-law does influence the daughter-in-law's use of contraceptives, particularly in social contexts where they are relatively limited in availability. This finding has important implications for enhancing the effectiveness of family planning programs in many areas of the developing world.

Consequences of the Shift from Domiciliary Distribution to Site-Based Family Planning Services in Bangladesh

Using data from the longitudinal surveillance systems of the Operations Research Project of the International Center for Diarrheal Disease Research Bangladesh a before-and-after analysis of the contraceptive prevalence method mix source mix new acceptance rate and dropout rate was conducted to assess the consequences of the shift in service delivery approach. The shift from domiciliary distribution to clinic-based service delivery appears to have resulted in a slight increase in contraceptive prevalence in the urban study area from 54-56% before the shift to 55-57% afterward. The changeover did not produce any discernable variation in the method mix the proportion of new acceptors of family planning or the contraceptive dropout rate. This apparent lack of change can be explained by increased use of alternative sources with a substantial rise among users in reliance on pharmacies and shops (30-35% before vs. 42-50% after). In two rural study areas the shift from domiciliary distribution to service delivery from static sites known as cluster spots resulted in an increase in the prevalence rate from 52% to 57% in Paira and from 40% to 45-46% in Durgapur. The changeover coincided with greater use of injectable contraceptives and decreased reliance on traditional methods among rural contraceptive users. A notable immediate increase in new acceptors also was evident as was a long-term decline in dropouts. In Paira following the shift 43-44% of current users obtained their contraceptive supplies from cluster spots as did 32-33% in Durgapur. The recent change in the family planning program toward clinic-based delivery of an integrated package of essential health and family planning services appears likely to maintain and perhaps even increase contraceptive prevalence levels in Bangladesh. (authors)

A Comparative Analysis of Contraceptive Use in North West and South West Nigeria

A comparative analysis of contraceptive use among females in Northwest and Southwest Nigeria was undertaken to assess the possibility of attaining the 50% contraceptive prevalence rate aim of the National Population Policy by the year 2000. Secondary data from the 1995 Sentinel Survey of the National Population Commission was employed to facilitate the analyses. This was based on 3950 and 3158 women from the Northwest and Southwest respectively, aged 15-49 years. Information from the 1990 NDHS was used for further comparisons. Results show that proportion of women currently contracepting was 6.9% in the Northwest compared to 16.3% in the Southwest. Using logistic regression analysis, increase in the likelihood of current use of contraceptives in the two regions was associated with increasing level of education, increasing number of living children and more importantly when “ husbands ” approve of family planning. However, while results show that women living in urban areas of the Southwest are more likely to contracept, increase in the use of contraceptives in the Northwest was associated with being resident in rural areas of the Northwest. Furthermore, in the Northwest, more women who got married under the age of 20 years have increased their contraceptive use levels. The general results show that attainment of the 50% contraceptive prevalence level by the year 2000 is not feasible. The 50% level was only attained among the surveyed women whose husbands approved of family planning. This further supports the call for men to be active participants in family planning programmes. Also, more resources should be invested in education to enhance economic productivity and hasten the demographic transition. Lastly, information, education and communication strategies of family planning programmes should be further strengthened in the rural areas where the bulk of the population lives. A special target group in the Northwest is women aged less than 20 years. IFE PsychologIA Vol 9, No1 2001, pp. 148-172

Prospects and Programs for Fertility Reduction, 1990-2015

What is the likelihood that each of the 37 developing countries with populations of 15 million or more in 1990 will reach replacement fertility by the year 2015? These countries have a combined population of 3.9 billion, 91 percent of the population of all developing countries. For this article, a composite index was used as the basis for predicting future levels of total fertility. The index was constructed from socioeconomic variables (life expectancy at birth, infant mortality rates, percent adult literacy, ratio of children enrolled in primary or secondary school, percent of the labor force in nonagricultural occupations, gross national product per capita, and percent of the population living in urban areas), total fertility rates for the years 1985-90, total fertility rate decline from 1960-65 to 1985-90, family planning program effort scores in 1989, and the level of contraceptive prevalence in 1990. Eight countries are classified as certain to reach replacement fertility by 2015, and an additional thirteen probably will also. Five countries are classified as possibly reaching replacement fertility, and eleven as unlikely to do so.

Contraception by the end of the 20th century.

Despite worldwide fertility declines, global population continues to grow. Most of the decline in fertility is due to contraceptive use, accounting for 80% of the variance in the total fertility rate between countries. Yet, some countries have much higher or lower fertility levels than countries with the same contraceptive prevalence levels, indicating that other factors also influence fertility rates. These factors are generally cultural. Africa is the only area where contraceptive prevalence is still low in most countries (e.g., 13% for Sub-Saharan Africa vs. 57% for Latin America). Use of individual contraceptive methods varies from country to country. For example, most contraceptive users in Japan use the condom, while those in India depend on female sterilization (about 75% and 75%, respectively). Between the late 1970s and the late 1980s, contraceptive prevalence increased 1 percentage point annually in 64% of all countries. In those developing countries where contraceptive prevalence rates have approached those of developed countries (e.g., Columbia and Thailand), the growth in contraceptive use is slowing. Important determinants of contraceptive use include rural/urban residence, education level, and income per capita. The difference in use rates between rural and urban areas are largely due to availability of family planning services in urban areas. Since contraceptive use plays such a significant role in fertility reduction and the slowing of population growth, improved contraception is needed worldwide, regardless of socioeconomic class. Desires of the population and not those of the scientists should be considered when developing new contraceptives. An analysis of users' needs should be done before developing new contraceptives. Such an analysis would require social and behavioral research. The approach of listening to the needs and beliefs of users should result in an increase of contraceptive use, which will benefit everyone.

Seeking Common Ground: Unmet Need and Demographic Goals

Population growth has been a world issue since the 1950s. The debates of the 1960s and 1970s focused on how best to achieve fertility decline: through family planning service provision or development. The Bucharest World Population Conference of 1974 established that socioeconomic development was a necessary precondition to fertility decline. Family planning funding stagnated until evidence was provided from the World Fertility Surveys and the Demographic and Health Surveys (DHS) that there were high levels of unwanted fertility. By 1992 environmentalists had joined family planners in addressing population growth as a serious concern. Environmentalists saw growth as an impediment to environmental sustainability. An estimated 56% contraceptive prevalence level is needed in order to achieve the UN medium variant of population projection by the year 2000. Contraceptive use worldwide has increased but the numbers of women not practicing any form of contraception has declined very little. Surveys have indicated that sub-Saharan Africa was the most behind in meeting unmet demand. Studies of the relationship between stated fertility desired and actual fertility by different development levels showed that both actual and desired fertility declined with increased socioeconomic development. Regardless of level of development unwanted fertility remains constant. Meeting unmet family planning need was considered more effective in achieving replacement level fertility than by increasing contraceptive prevalence. Satisfaction of the about 17% of women with unmet need would reduce the fertility rate by 1.13 points without including China. If China were included fertility would decline to 3.11. The fertility decrease of 44% would meet the UN medium variant of desired fertility of 3.34 by the year 2000. Contraceptive prevalence could be increased from 42% to 59% by meeting unmet need in 10 years but not 7 years. Programs should emphasize health and not targets in satisfying individual and societal goals.

Constraints on Effective Family Planning in Urban Sudan

This article is an investigation of the constraints on contraceptive use in Sudan, from the perspective of current nonusers, never-users, and discontinuers, based on data obtained from 305 married women aged 15-49 through a field survey undertaken in Khartoum city. Results indicate that lack of knowledge of contraceptive methods accounts for the low level of contraceptive prevalence, 15 percent overall, found in this study. The overwhelming majority of nonusers (85 percent) either perceive contraception as a risk to their health and fertility, regard it as unacceptable, or do not know which method to choose. A comprehensive and rigorous family planning information program is crucial to address existing constraints on the use of contraceptives in urban Sudan.

Can Family Planning Succeed in Pakistan?

While Pakistan was one of the first developing countries to support family planning (FP) its growth rate remains at 3% per year fueled by a large mortality decline and a small decline in births from 49.2/1000 in 1901-10 to 42.8/1000 in 1984-86. Much of the decline in the birth rate can be attributed to an increase in the marriage age. While 62% of women know of at least one method of FP only 12% report ever using FP. A look at the history of population activities in the country shows that after an early start population activities went through a period of dormancy with 22 administrators appointed in nearly 30 years. These shifts have been accompanied by unrealistic goals and unreliable benchmark figures. The current plan of the Population Welfare Program (PWP) includes developing multisectoral economic links to the promotion of FP and increasing coverage of FP services in order to achieve a contraceptive prevalence level of 23% by 1993. Accelerated program activity is expected to result in overall coverage of 70% (50% in rural areas) by the year 2000. Other issues include improving utilization of service providing wider outreach coverage enhancing the quality of services creating demand strengthening program management and ensuring continued political support. Factors which contribute to the high birth rate are the perceived low cost of children the low status of women and unmet need. Pakistani women are beginning to understand that smaller families increase prosperity but they need to have easy access to services. If the FP program is improved as outlined above and this effort is augmented by social programs to enhance female literacy and education as well as the status of women and to promote breast feeding then FP can succeed in Pakistan. Until such a time it is premature to conclude that FP will not be accepted by the people of Pakistan.

Contraceptive Use and Commodity Costs In Developing Countries, 1990-2000

Estimates of the level of contraceptive use (and its cost) in developing countries that will be needed over the next decade in order not to exceed the UNs medium population projection for the year 2000 are provided. The UNs medium projection calls for population in the developing world to increase to about 5 billion by the year 2000 a projection that has become somewhat of a goal for the population establishment which is concerned over the impact of rapid population growth. To comply with the medium projection population growth during the 1990s must be limited to 969 million. Relying on data from the UN USAID and a number of surveys the present level of contraceptive prevalence the prevalence of specific methods and the present costs are calculated and future needs are estimated. Presently the number of married women of reproductive age (15-44) in developing countries is estimated at 757 million a figure expected to increase to about 970 million by the year 2000 according to the UN medium projection. Currently at 51% contraceptive prevalence will have to increase to 59% to meet the medium projection. And in order to reach this level of prevalence it is estimated that over the next 10 years service providers will have to perform more than 150 million sterilizations and distribute almost 8.8 billion cycles of oral contraceptives 663 million contraceptive injections 310 million IUDs and 44 billion condoms. Providing these contraceptive commodities will likely cost about $5.1 billion. The public sector will probably have to contribute about $4.2 billion of the cost unless a concerted effort is made to increase the share carried by the commercial and private sectors.

Family Planning in Rural Uganda: Knowledge and Use of Modern and Traditional Methods in Ankole

Ankole has recorded the highest fertility in Uganda over the past several decades. One of the main proximate determinants of fertility in the area is the low level of contraception. A study of knowledge and use of modern and traditional contraceptive methods is reported in this paper. It is shown that higher proportions of women known and practice traditional methods compared with modern ones. Several factors contributing to past low use of modern contraceptives in the area are examined and current contraceptive use is also examined.

Impact of a self-reliance programme on family planning activities in Bangladesh

Despite the long history of the family planning programme in Bangladesh, the contraceptive prevalence level remains low and consequently the rate of population growth has remained persistently high. Several factors can be attributed to low contraceptive prevalence. The most important factors are low levels of socio-economic development, the lower status of women, the strong preference for sons, the high level of infant and child mortality and limited access to health and family planning facilities.

Components of stably high fertility in three areas of West Africa

The constancy of fertility levels in Ghana, Senegal and southwest Nigeria since 1970 is separated into its nuptiality and marital fertility elements. The age-specific changes in the two components are examined and these show that the apparent stability in observed total fertility rates is essentially the outcome of the offsetting impact of increased marital fertility below age 25 and above age 40, over the effect of the increasing proportion of women remaining single up to 25 yr of age. Continuity in traditional fertility behaviour and stable nuptiality has remained operative over the broad middle segment of the reproductive lifespan of women in the three areas. The paper thus concludes that West Africa is likely to continue to display stably high fertility for many years into the next century. The social and cultural conditions behind this trend are discussed with special reference to the continued high demand for children and the low and only slowly rising contraceptive prevalence level.

Swedish Women Prefer Reversible Methods; Few Choose to Be Sterilized

Swedish women have a very high level of contraceptive prevalence. Oral contraceptives (OCs) are the most popular method among 15-34 year olds but older women tend to use the IUD or barrier methods. Approximately 12% or OC or IUD users use condoms concurrently especially younger women according to findings of a 1987 contraceptive use knowledge and attitudes survey by the International Health Foundation. Questionnaires were mailed to 1000 Swedish women aged 15-44 and 744 responses were received. 40% of the women were married and 23% were cohabiting. 47% of the women had no children 28% had 1 or 2 and 12% had 3 or more. Most women had experienced their first intercourse as teenagers. 49% had been 16 or younger 34% had been 17-19 years old 8% had been 20 or older and 9% had never had intercourse. 71% of all women surveyed and 95% of those exposed to the risk of pregnancy were practicing contraception. Among women at risk of pregnancy 99% used contraceptives in the 25-34 year old age group 90% in the 15-19 year old age group and 88% in the 40-44 year old age group. 34% of women exposed to the risk of pregnancy used OCs 21% used condoms and 19% used the IUD. 6% were protected by their own or their partners sterilization 6% used the diaphragm or spermicides and 6% relied on rhythm or withdrawal. Between 1981 and 1987 contraceptive prevalence among women aged 20-44 years increased from 64 to 75%. OC use increased from 19 to 27% sterilization rose from 2 to 6% while IUD prevalence declined from 17 to 16%. OC use peaked at 66% in those aged 20-24 years old and declined to 5% in the 40-44 year old age group. The sterilization rate was low compared with rates of other European countries and waiting for a year or longer to become sterilized is not unusual. 79% of Swedish women had accurate knowledge about fertility and 68% about the action of OCs. This was the highest rate among the European countries surveyed and was indicative of the value of having contraceptive counseling units in all communities.