Levels Of Contraceptive Use Research Articles

Population control under various family planning schemes in Uttar Pradesh, India

Contraceptive policies have been derived to achieve desired reductions in the growth rate and also applied to the data of Uttar Pradesh, India, for illustration. Using the Lotka integral equation for stable population, expressions for the proportion of contraceptive users at different ages have been obtained. In order to reduce the present annual growth rate from 0.036 to 0.020, it is imperative that there will be 42% contraceptive users at age 20, assuming that 40% of them will discontinue at age 25 and 30% will resume the contraceptive use at age 30. Assuming furthermore that 75% of females start using contraceptives at the age of 23 years, 50% of the remaining females start using them at the age of 28 years, and the rest of the females start using them at the age of 32 years, if we set the minimum age at marriage at 20 years, a reduction of 0.019 in the growth rate will be obtained. This study describes how the level of contraceptive use at different age groups of females has helped reduce the growth rate in the state of Uttar Pradesh. It also promotes delayed marriage in the region.

Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland)

BackgroundDespite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. MethodsThis cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. ResultsIn this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women (≥35 years) were less likely while teenagers and multiparas (≥3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. ConclusionThe rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.

To Pill or Not to Pill? Access to Emergency Contraception and Contraceptive Behaviour

We examine the effects of free-of-charge availability of emergency contraception on contraceptive behaviour in Chile. Using a survey of individuals 15 to 29, we exploit variation in availability at the municipality level as a consequence of legal and judicial decisions in the late 2000s. We find an increase in the use of emergency contraception in municipalities in which it was available through the public health system, but also an increase in the use of other methods of hormonal, pre-coital contraception, and a decrease of more traditional contraceptive methods. This effect is concentrated among groups with a low starting use of contraceptives, who may benefit from the contact with the health services. Unlike previous results for developed countries, our results indicate that there is scope for an effect of emergency contraception in settings with low starting levels of contraceptive use, and a significant potential for policies to increase adoption of regular contraception.

Access to Reproductive Health Services and Maternal Perceptions on Family Planning in an Indigenous Guatemalan Valley.

Objective. To identify reproductive health barriers and perceptions regarding family planning among mothers in ten rural communities of Guatemala. Methods. Data were collected from 85 women in a Nutrition Recuperation Project (NRP) conducted by a freestanding nonprofit clinic in Palajunoj Valley, Guatemala. All nonpregnant women participating in the NRP were eligible for enrollment in this study, and NRP staff members aided in their enrollment. Participants were interviewed and data were entered into a structured questionnaire. Data analysis was conducted using R version 1.1.456. Results. After asking participants if they believed fertility is higher on certain days, only 5 women (5.9%) correctly identified these days as occurring in the middle of the menstrual cycle. 35 women (41.2%) practiced some form of family planning, and 27 (31.8%) reported that they do not know of a place where they could obtain a contraceptive method. Conclusion. There is a lack of education regarding family planning methods in this valley, and the levels of contraception use are below average for rural Guatemala. These findings may implicate substantial health risks for women and children in the valley, and they support the pertinence of education-based interventions in the area of reproductive health behaviors.

What is the association between IPV and Fertility in Uganda?

Abstract IPV, which emanates as a severe consequence of gender inequality in society, is the most pervasive form of IPV as most cases of abuse is perpetrated by intimate partners and has major health consequences for women. Women with a history of abuse are also at increased risk of reproductive health outcomes; such as high parity, inconsistent and lower levels of contraceptive use, unintended pregnancies, and adverse pregnancy outcomes. Despite concerted efforts by African governments, fertility levels in the region remain high. Africa is the region that has been least responsive to family planning programmes. This study investigates the associations between IPV and fertility in Uganda, using the Ugandan Demographic and Health Survey of 2011. Adult women of reproductive ages (15-49) that were included in the domestic violence module of the individual recode, were included in this study. Univariate, bivariate analysis, and unadjusted and adjusted Poisson Regression models were conducted for children ever born and the different forms of IPV (emotional, physical and sexual), as well as the socio-demographic and women’s empowerment variables. Both bivariate and multivariate analyses show a strong association between both these pervasive health problematics; and may therefore be one of the unexplained proximate determinants of persistently high fertility in countries such as Uganda. These results have important implications for understanding both the fertility transition in Uganda, but also for programmes and policies addressing unwanted pregnancies and unmet need for contraception that is driving fertility up, and IPV amongst women which we know from previous work has severe reproductive health outcomes but which we have now identified is a contributor to high fertility as well.

Predictors of postpartum contraceptive use in rural Tigray region, northern Ethiopia: a multilevel analysis

BackgroundPostpartum family planning services is one of the recommended public health intervention aimed at reducing maternal and child morbidity and mortalities. However, there is a paucity studies in rural Tigray region. Therefore, determining the level and associated factors of contraceptive use among postpartum women has the potential to contribute in achieving the Ethiopian Health Sector Transformation Plan and to the Sustainable Development Goals on maternal and infant survival.MethodsA community-based cross-sectional study was done among 1109 postpartum women from March 29, 2017 to April 29, 2017. Face –to–face interview was used for data collection. The collected data were entered and cleaned using EPI - INFO version 7statistical software and later exported to and analyzed using STATA version 12. Mixed-effects multilevel logistic regression analysis was used to identify the individual and community-level factors associated with contraception adoption. A two side p-value< 0.05 was considered to be statistically significant.ResultsThe level of contraceptive use was 38.3%. Individual-level variables such as women belong to fourth (AOR = 1.2; 95% CI: 1.1–3.2) and fifth (AOR = 1.5; 95% CI: 1.3–2.5) wealth quintiles were identified as key predictors of contraception use. In addition, partner secondary (AOR = 2.3; 95% CI: 1.8–3.5) and diploma (AOR = 1.2; 95% CI, 1.1–2.6) educational-level and postnatal care (AOR = 2.0; 95% CI: 1.9, 4.3) were also significantly affected contraception use. Community-level variables such as high community-level antenatal care services use (AOR = 2.1; 95% CI: 1.9–4.2) and proximity of women to health facility (AOR = 3.0; 95% CI: 2.7–4.6) were also determinants of contraception uptake.ConclusionsThe status of contraceptive use in rural Tigray region was found to be low. It was found that both individual and community-level variables showed a marked determinant on postpartum contraception use. This study suggested that in order to increase contraceptive use the government should focus on increasing postnatal care, antenatal care services use and reduction of poverty level are important avenues for intervention.

Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states

BackgroundContraceptive use has numerous health benefits such as preventing unplanned pregnancies, ensuring optimum spacing between births, reducing maternal and child mortality, and improving the lives of women and children in general. This study examines the level of contraceptive use, its determinants, reasons for non-use of contraception among women in the reproductive age group (18–49 years) in two southwestern Nigerian states.MethodsThe study adopted an interviewer-administered questionnaire to collect data from 809 participants selected using a 3-stage cluster random sampling technique. We also conducted 46 in-depth interviews. In order to investigate the association between the socio-demographic variables and use of contraceptive methods, we estimated the binary logistic regression models.ResultsThe findings indicated that knowledge of any methods of contraception was almost universal among the participants. The rates of ever use and current use of contraception was 80 and 66.6%, respectively. However, only 43.9% of the participants had ever used any modern contraceptive methods, considered to be more reliable. The fear of side effects of modern contraceptive methods drove women to rely on less effective traditional methods (withdrawal and rhythm methods). Some women employed crude and unproven contraceptive methods to prevent pregnancies.ConclusionOur findings show that the rate of contraceptive use was high in the study setting. However, many women chose less effective traditional contraceptive methods over more effective modern contraceptive methods due to fear of side effects of the latter. Patient education on the various options of modern contraceptives, their side effects and management would be crucial towards expanding the family planning services in the study setting.

Women\u2019s attitudes and beliefs towards specific contraceptive methods in Bangladesh and Kenya

BackgroundMissing from the huge literature on women’s attitudes and beliefs concerning specific contraceptive methods is any detailed quantitative documentation for all major methods in low- and middle-income countries. The objectives are to provide such a documentation for women living in Matlab (rural Bangladesh), Nairobi slums and Homa Bay (rural Kenya) and to compare the opinions and beliefs of current, past and never users towards the three most commonly used methods (oral contraceptives, injectables and implants).MethodsIn each site, 2424 to 2812 married women aged 15–39 years were interviewed on reproduction, fertility preferences, contraceptive knowledge and use, attitudes and beliefs towards family planning in general and specific methods. We analysed the data from round one of the prospective cohort study.ResultsWhile current users typically expressed satisfaction and held more positive beliefs about their method than past or never users, nevertheless appreciable minorities of current users thought the method might pose serious damage to health, might impair fertility and was unsafe for prolonged use without taking a break. Larger proportions, typically between 25% and 50%, associated their method with unpleasant side effects. Past users of pills and injectables outnumbered current users and their beliefs were similar to those of never users. In all three sites, about half of past injectable users reported satisfaction with the method and the satisfaction of past implant users was lower.ConclusionsHigh levels of contraceptive use can clearly co-exist with widespread misgivings about methods, even those that are widely used. Serious concerns about damage to health, long term fertility impairment, and dangers of prolonged use without taking a break were particularly common in the Kenyan sites and these beliefs may explain the high levels of discontinuation observed in Kenya and elsewhere in Africa. This documentation of beliefs provides useful guidance for counselling and informational campaigns. The generally negative views of past users imply that programmes may need not only to improve individual counselling but also strengthen community information campaign to change the overall climate of opinion which may have been influenced by dissatisfaction among past users.

Contraception and fertility transition in AMHARA National Regional State of ETHIOPIA: an application of BONGAARTS\u2019 model

BackgroundThe overall decline of fertility in Amhara National Regional State between 2000 and 2011 was the highest in Ethiopia. The aim of the present study was to determine the most significant proximate determinant of fertility change during the last decade in the region using Bongaarts’ model.MethodsThe sources of data were the 2000, 2005, and 2011 Ethiopia Demographic and Health Surveys. The model indices were calculated for each survey. Decomposition of fertility change into components of proximal determinants was also carried out. An index value close to 1 is a negligible inhibiting effect while a large inhibiting effect when the value very closes to 0.ResultsThe fertility-constraining effect of contraception increased from 0.93 in 2000 to 0.65 in 2011; however, it was lower than the effect of postpartum insusceptibility at all given times. The index of marriage remained unchanged in constraining fertility over the period (0.71 in 2000 and 0.70 in 2011) while the influence of postpartum insusceptibility slightly declined from 0.49 in 2000 to 0.54 in 2011 but was stronger than contraception and marriage. The contribution of contraception was most important in urban areas (0.46 in 2011 from 0.52 in 2005 and 0.64 in 2000); however, in rural areas, it became an important determinant over the period (0.95 in 2000 and 0.69 in 2011). The effect of postpartum insusceptibility in rural areas showed a decreasing trend (0.48 in 2000 and 0.53 in 2011). The index of marriage in rural areas was stable overtime (0.75 in 2000 and 0.73 in 2011) while in urban areas the effect declined from 0.42 in 2000 to 0.65 in 2011. Marriage was the most important proximate determinant of fertility among women with secondary and above education but the impact declined during the period (0.41 in 2000 and 0.61 in 2011). The importance of postpartum insusceptibility in limiting fertility among women with secondary and above education declined overtime (0.77 in 2000 and 0.87 in 2011) whereas the contribution of contraception became more important (0.44 in 2000 and 0.35 in 2011).ConclusionsAn increase in the level of contraceptive use and effectiveness overtime was the single most important contributing factor for the recent fertility decline in the region.

"Side effects affected my daily activities a lot": a qualitative exploration of the impact of contraceptive side effects in Bangladesh.

PurposeIn a country like Bangladesh that has made great progress in contraceptive use with one of the lowest levels of fertility and highest levels of contraceptive use, understanding what factors influence women’s decisions to discontinue a contraceptive method and not switch to a new method is critical in designing interventions and programs that will help enable Bangladesh to reach its FP2020 goals. Research on side effects has focused on physical manifestations like headaches, moodiness, abdominal pain, and menstrual irregularities. While physical effects alone may stop women from continuing a contraceptive method, less is known about how side effects influence women’s daily activities and lives. The purpose of this study is to understand the ways that side effects affect Bangladeshi women’s participation in different social settings.MethodsThirty-five in-depth interviews with married women who recently discontinued or switched to a different contraceptive method were conducted in Sylhet and Khulna Divisions. Interviews explored reasons for discontinuation including experience of side effects and impact of side effects on women’s lives.ResultsKey themes emerged including that side effects are not only experienced physically but are barriers to women’s participation in many aspects of their lives. The spheres of life that most commonly appeared to be influenced by side effects include religion, household, and sexual intimacy irrespective of method used or residence.ConclusionFamily planning providers need to be aware of these additional consequences associated with contraceptive side effects to provide tailored counseling that recognizes these issues and helps women to mitigate them. For Bangladesh to achieve its FP2020 goals, understanding the broader context in which family planning decisions are made vis-à-vis side effects is critical to design programs and interventions that meet all the needs of women beyond just their fertility intentions.

Measuring contraceptive prevalence among women who are at risk of pregnancy

ObjectivesThe contraceptive prevalence rate (CPR) is generally reported among in-union women ages 15–49. Here, union status and age serve as proxies for exposure to the risk of pregnancy. As a result of changing dynamics, age and union status proxies may be insufficient for determining the rate of contraceptive use among women at risk of pregnancy. Our objectives are to define a measure of contraceptive use among women at risk, to measure contraceptive use among such women and to compare this rate with conventional CPR. Study designUsing data from the United States 2011–2013 National Survey of Family Growth (NSFG), we explore self-reported data on contraceptive use, sexual recency, pregnancy status and fecundity to develop an alternative CPR (ACPR) measure, contraceptive prevalence among women at risk of pregnancy. After defining and measuring ACPR, we compare ACPR and conventional CPR estimates using NSFG and Demographic and Health Survey data from 48 surveys completed from 2000 to 2015 in low- and middle-income countries. ResultsFor measuring ACPR, it is best to limit sexual activity recency component to “four weeks” to minimize underreport of coital-specific methods. It is best to limit the contraceptive use component to “current use” rather than “use at last sex” to minimize underreport of permanent methods. In the United States, 86% of women at risk of pregnancy are currently using contraception. ConclusionWomen at risk of pregnancy report higher levels of contraceptive use than the conventional CPR indicates. Implications statementDevelopment of ACPR exposed some potential family planning measurement weaknesses. Specifically, because CPR is based on report of “current use,” our analyses show that CPR may underreport coital-specific methods. As a result, CPR estimates may be somewhat deflated, and unmet need estimates may be somewhat inflated.

Trends in Age at Marriage and the Onset of Fertility Transition in sub‐Saharan Africa

In this chapter the author adopts a comparative approach to examining longterm trends in female age at marriage and fertility in sub-Saharan Africa with a focus on continental countries having at least 1 million inhabitants. The author’s database on nuptiality includes over 360 censuses and national surveys conducted in these 39 countries since the 1960s. The author analyzes the association between changes in age at first union and the onset of fertility transition examining whether there is a typical pattern of association followed by most countries in the region.

“Doctors are in the best position to know…”: The perceived medicalization of contraceptive method choice in Ibadan and Kaduna, Nigeria

ObjectivesThe medicalization and clinic-based distribution of contraceptive methods have been criticized as barriers to increasing levels of contraceptive use in Nigeria and other settings; however, our understanding of how clients themselves perceive the contraceptive method decision-making process is very limited. MethodsFocus group discussions among men and women in Ibadan and Kaduna, Nigeria, were used to examine attitudes and norms surrounding contraceptive method decision-making in September and October of 2010. ResultsChoosing a family planning method was presented as a medical decision: best done by a doctor who conducts clinical tests on the client to determine the best, side effect free, contraceptive method for each client. An absolute trust in health professionals, hospitals, and governments to provide safe contraception was evident. ConclusionThe level of medicalization placed on contraceptive method choice by urban Nigerians is problematic, especially since a test that can determine what contraceptive methods will cause side effects in an individual does not exist, and side effects often do occur with contraceptive method use. Practice implicationsProvider and client education approaches would help to improve client involvement in contraceptive decision-making and method choice.

Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon.

Background and objectivePromotion of family planning has been shown to reduce poverty, hunger, maternal and infant mortality, and contribute to women’s empowerment. But many resource-limited countries still have very low rates of contraceptive use. The present study aimed to assess the knowledge, attitude and practice of family planning among women living in a resource-poor rural setting.MethodsWe conducted a cross-sectional study in January 2010 in the Mbouda Health District, Cameroon. After a multistage random selection, 120 households were selected. Participants were women aged at least 15 years old, sexually active, and who volunteered to participate in the study. Data were collected during an anonymous interview using a structured pre-tested questionnaire.ResultsA total of 101 women were enrolled, their ages ranging from 18–58 years with a mean of 31.7 ± 8.8 years. Ninety-six percent of these women had already heard about family planning. Almost all respondents (98 %) were aware of at least one contraceptive method, the most cited being the male condom (96 %), the safe period (86.1 %), injectables (76.2 %) and oral pills (75.2 %), Sixty-six women (65.3 %) were currently practicing at least one contraceptive method, and the three prevailing methods used were: the safe period (50 %), the male condom (34.8 %), and injectables (12.1 %). The main reasons precluding women from practicing contraception were lack of knowledge (31.4 %), uselessness (31.4 %) and unbearable side effects (8.6 %). Fourteen of these women (42.4 %) expressed the willingness to start practicing contraception if they received more information about the subject. Decision on the number of children to have was made by both the man and the woman in 59.5 % of cases. The practice of contraception had been decided by the couple in 39.6 % of cases, and 9.4 % of men were not aware that their wives were currently practicing contraception.ConclusionAlthough the level of awareness about family planning and contraceptive methods is quite satisfactory, the level of contraceptive use is not optimal in our setting. Consequently, more adapted educational and counseling interventions should be undertaken among women, and family planning messages directed to men need to be included too.

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries.

While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural and peri-urban areas.

O18.1 Prevalence and factors associated with modern contraceptive use among hiv- positive women aged 15–49 years in kilimanjaro region, northern tanzania

Background Of 270,000 new HIV infections in children, 90% are in Sub-Saharan Africa. High fertility levels and high number of women infected with HIV results in high rates of Mother-to-Child-Transmission (MTCT) in SSA. To date, most efforts to prevent MTCT of HIV have focused on the third prong, a strategy that offers ARV drugs to HIV infected pregnant women and their exposed infants. However, the effective use of contraceptives to prevent unwanted pregnancies among HIV-positive women has the ability to reduce the rates of MTCT of HIV at a lower cost compared to the third prong. There is limited information on the levels of contraceptive use and associated factors among HIV positive women in Northern Tanzania. Methods This was a cross-sectional study conducted in February–May 2014 in three randomly selected districts of Kilimanjaro region. Univariate and multivariate logistic regression analysis were used to describe data and determine independent predictors of modern contraceptives use respectively. Results Of the 672 HIV-positive women participated in this study, 93% were aware of modern contraceptive methods, 54% were current modern contraceptives users and 21% were using dual contraceptive methods. Commonly modern contraceptives method used included male condom (41%), Depo-Provera (13%) and oral contraceptive pills (10%). Modern contraceptive use was significantly higher among HIV-positive women with; secondary education (aOR = 3.6, 95% CI 1.4–9.5), who do not plan to have more children (aOR = 2.2, 95% CI 1.5–3.2), counselled on contraceptives at CTC (aOR = 3.7, 95% CI 2.7–5.1), disclosed their HIV status to their partner (aOR = 2.5, 95% CI 1.8–3.4). Conclusions Prevalence of modern contraceptive use was higher than the national level. 46% of HIV-positive women are not using any method of contraception despite being sexually active. Strategies are required to increase use of long-term contraceptive methods to those who do not want more children and strengthening counselling to target non-users.

Female Romanian university students’ attitudes and perceptions about contraception and motherhood

Objectives The aim of our study was to investigate the knowledge, perceptions and attitudes of female Romanian university students, as possible future opinion leaders, about contraception and motherhood, by assessing their level of contraceptive use, opinions and knowledge with regard to combined oral contraceptives (COCs).Methods A knowledge, attitudes and practice questionnaire was conducted among 1105 female university students aged 19 to 30 years. The participants were recruited from six faculties at universities in Iasi and Arad, Romania. The study protocol was approved by the university ethics committees. Statistical analyses included percentages, χ2 tests and Fisher's exact test.Results Two-thirds of respondents were in a relationship or married. Average age at first sexual intercourse was 18.6 years. Two out of three (69%) students identified themselves as sexually active. The same percentage showed a positive attitude towards contraception and stated that they used it. The most commonly used contraceptive methods were condoms, COCs and withdrawal. The students’ perceptions of the benefits and adverse effects of COCs were analysed. Half of the students had heard about extended COC regimens, but only 24% showed interest in using them regularly. A large proportion of pharmacy and non-medical students appeared to have poor knowledge about contraception and reproductive health, which generated misperceptions and negative attitudes. Two-thirds of the participants considered 25 to 29 years to be the optimal age for starting a family, and 85.5% intended to have children in the future.Conclusions Medical students, but not pharmacy students, showed higher levels of knowledge. Improvement of students’ knowledge, perceptions and attitudes towards general contraceptive use, COCs and childbearing is needed. Evidence-based information is required to address poor knowledge about the physiology of reproduction, misconceptions relating to COCs, and the possibility of menstrual suppression using hormonal contraceptive methods. Compulsory reproductive health education for students is desirable.

Future intention of contraceptive use among Comorian women, 2012

Between 1996 and 2012, a stagnant performance in the contraceptive prevalence rate was witnessed in Comoros. This study aims to analyze the factors associated with future intention to use contraceptives among women aged 15–49 years who were not using any method of contraception. The Comorian Demographic and Health Survey conducted in 2012 was used. Along with weighted prevalence of future intention of contraceptive use, the binomial logistic regression was deployed to understand the net predictors of future intention of contraceptive use. Findings from the multivariate analysis suggest that the women’s age, employment, education, mass media exposure, and sex composition of living children as well as future desire for additional children were the factors significantly associated with future intention of contraceptive use. The Comorian health system should intervene to improve the overall level of contraceptive use followed by a targeted intervention among non-users. The most vulnerable women are those who have never used contraception and do not intend to use any contraceptive in the future.

Men's Perspectives on Their Role in Family Planning in Nyanza Province, Kenya.

Research has indicated that gender dynamics-and in particular men's disapproval of family planning-have had an influence on the low levels of contraceptive use in sub-Saharan Africa. Limited evidence exists, however, on effective strategies to increase male approval. We conducted 12 focus group discussions with married men aged 20-66 (N = 106) in Kenya to explore FP perceptions. Men's disapproval of FP was associated with anxieties regarding male identity and gender roles. Men often distrusted FP information provided by their wives because they suspected infidelity or feared being viewed as "herded." Men also feared that providers might pressure them into vasectomies or into disclosing extramarital sexual activity or HIV diagnoses to their wives. Suggested strategies include programs targeting couples jointly and FP education for men provided by male outreach workers. To encourage men's acceptance, community-based programs directly targeting men are needed to reduce stigma and misconceptions and to increase awareness of the benefits of FP.

Explaining the role of proximate determinants on fertility decline among poor and non-poor in Asian countries.

ObjectivesWe examined the overall contributions of the poor and non-poor in fertility decline across the Asian countries. Further, we analyzed the direct and indirect factors that determine the reproductive behaviour of two distinct population sub-groups.DesignData from several new rounds of DHS surveys are available over the past few years. The DHS provides cross-nationally comparable and useful data on fertility, family planning, maternal and child health along with the other information. Six selected Asian countries namely: Bangladesh, India, Indonesia, Nepal, Philippines, and Vietnam are considered for the purpose of the study. Three rounds of DHS surveys for each country (except Vietnam) are considered in the present study.MethodsEconomic status is measured by computing a “wealth index”, i.e. a composite indicator constructed by aggregating data on asset ownership and housing characteristics using principal components analysis (PCA). Computed household wealth index has been broken into three equal parts (33.3 percent each) and the lowest and the highest 33.3 percent is considered as poor and non-poor respectively. The Bongaarts model was employed to quantify the contribution of each of the proximate determinants of fertility among poor and non-poor women.ResultsFertility reduction across all population subgroups is now an established fact despite the diversity in the level of socio-economic development in Asian countries. It is clear from the analysis that fertility has declined irrespective of economic status at varying degrees within and across the countries which can be attributed to the increasing level of contraceptive use especially among poor women. Over the period of time changing marriage pattern and induced abortion are playing an important role in reducing fertility among poor women.ConclusionsFertility decline among majority of the poor women across the Asian countries is accompanied by high prevalence of contraceptive use followed by changing marriage pattern and induced abortion.