“We're Very Careful …”: The Fertility Desires and Contraceptive Behaviors of Cohabiting Couples

A growing proportion of nonmarital births are to cohabiting couples, though childbearing is more common among moderately educated cohabitors than among cohabiting college graduates. In this study reasons for social class divergence in fertility behavior are explored. Data are from semistructured interviews with 30 working‐class and 31 middle‐class cohabiting couples. The authors inquired about readiness for parenthood, contraceptive usage, and concurrence about childbearing plans and contraception. Middle‐class couples generally utilized the most effective methods, often relied on two methods, concurred regarding fertility goals, and reported contracepting consistently. Among the moderately educated, contraceptive utilization was lower and reliance on less effective methods greater; they expressed greater ambivalence about preventing conception and discussed contraception less than their middle‐class counterparts. Less educated respondents also mentioned forgetfulness and cost as reasons for sporadic contraceptive use. The study results highlight the need to deepen understanding of how relational processes and couple dynamics contribute to pregnancy avoidance or conception.     

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples’ negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women’s and couples’ negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or on the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male dominated reproductive decision making and women’s agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.     

Concordance and discordance of couples living in a rural Pakistani village: perspectives on contraception and abortion--a qualitative study

In Pakistan, fertility rates and intended family size have fallen, but contraceptive use remains low. This has led to a high prevalence of unintended pregnancies, a large proportion of which result from disagreement between spouses about how to confront them. This study aims to understand how Pakistani couples view family planning, and how they communicate and make decisions surrounding fertility regulation. In-depth interviews were conducted with five couples and an additional five women and two men. Two focus groups--one for males and one for females--were also conducted. Family planning methods were more favoured by women than their husbands. Women reported the largest barrier to contraceptive use to be men's opposition to family planning or reproductive choices more generally, as well as fear of side effects of contraception. Abortion was viewed unfavourably except in situations of economic difficulty, having several young children or women's health problems. Couples reported rarely communicating about fertility intentions until later in childbearing after an unintended pregnancy. Discussions about family planning were largely initiated by women, although some felt unable to approach their husbands regarding this topic. Concordant intentions and communication between spouses led to desired pregnancy outcomes. In cases of discordance, women's intentions tended to determine actions and outcomes. Spousal communication, or the lack thereof, is an obstacle to effective contraceptive use, and strategies to improve couples' communication would undoubtedly enable them to achieve their reproductive intentions.     

A decade of Nepal's family planning program: achievements and prospects

Knowledge and practice of family planning in Nepal increased considerably from mid-1976 through mid-1986, with significant improvements in the availability of and accessibility to contraceptives. However, a proportionately larger share of the achievements were made during 1976-81 than in 1981-86. The impact on fertility of contraceptive use during the decade was minimal. Knowledge and use of reversible contraceptive methods remained very low, primarily because of the continued strong emphasis on sterilization in Nepal's family planning program. Consequently, the welfare of many couples who may be in need of contraception for spacing births, but not necessarily for terminating childbearing, does not appear to be adequately addressed by the program. A more balanced emphasis on reversible methods of contraception does not necessarily imply that a substantially higher level of contraceptive prevalence would be required to reach the fertility target. Several steps to improve program performance and contraceptive method mix are suggested.     

我国5城市已婚育龄妇女节育状况及影响因素分析

目的 :了解我国城市已婚育龄妇女节育状况及其影响因素。方法 :根据 2 0 0 2年 5城市已婚夫妇计划生育问卷调查资料 ,进行流行病学调查分析。结果 :5城市已婚育龄妇女综合节育率为 95 92 % ,机关妇女低于企业妇女 ,且存在不同地区间差异。各种避孕方法中 ,以宫内节育器使用率最高 ,达 4 1 17%。地区、年龄、妊娠次数、丈夫职业、丈夫学历、丈夫原生活地影响机关组已婚育龄妇女节育率 ,地区、年龄、职业、丈夫原生活地影响企业组已婚育龄妇女节育率。结论 :我国城市已婚育龄妇女的避孕节育情况较好 ,但不同地区、不同社会学特征的育龄妇女间存在差异 ,不同职业已婚妇女节育率的影响因素有所不同。     

Patterns of fertility preferences and contraceptive behaviour over time: change and continuities among the urban poor in Nairobi,Kenya

The main objective of this paper is to investigate the association between fertility preferences and contraceptive use among 15–49-year-old women living in Korogocho and Viwandani, informal settlements in Nairobi, Kenya. We draw on longitudinal data collected under the Maternal and Child Health project conducted between 2006 and 2010 in the two settlements. There is substantial regularity and stability but also unusual instability in reported fertility preferences over time among women living in these settings. Younger women, aged 15–24 years, are likely to change their preferences over time, passing from limiting to wanting additional children. But women aged 35–49 are likely to change their preferences from desiring more children to limiting their childbearing. The desire to limit childbearing is strongly associated with the use of modern and long-acting contraceptive methods. Findings have major implications for the success of family planning programmes in informal settlements where access to and knowledge about contraception may be limited.     

Childbearing in cohabiting unions: racial and ethnic differences

CONTEXT: Cohabitation provides a two-parent family union in which to have and raise children outside of marriage. Little is known, however, about the conditions under which cohabiting couples conceive and decide to have children. METHODS: The National Survey of Family Growth provides detailed data on the cohabitation and fertility histories of American women. Life-table techniques, event-history analyses and logistic regression were employed to understand the racial and ethnic differences in the timing of childbearing within cohabiting unions and whether childbearing within cohabiting unions is more acceptable to members of minorities than to whites. RESULTS: In multivariate models, Hispanic women were found to be 77% more likely than white women to conceive a child in cohabitation and black women were 69% more likely than white women to do so. Among women who became pregnant while cohabiting, Hispanic women were almost twice as likely and black women were three times as likely as white women to remain cohabiting with their partner when their child was born. In addition, children born to Hispanic women in cohabiting unions were found to be 70% more likely to be intended than were those born to cohabiting white women. CONCLUSIONS: In terms of fertility, cohabitation does not maintain the same place in the American family system for all racial and ethnic groups. These racial and ethnic differences in fertility-related behavior are not explained by socioeconomic differences. Based on levels of childbearing during cohabitation, relationship status at time of birth and intention status of children, it appears that cohabitation is a more acceptable arena for family building among Hispanic women than among whites or blacks.     

Family planning KAP survey in Gaza

This study explores the reproductive attitudes, contraceptive use, demand for family planning and related topics of a representative sample of the female population of reproductive age resident in a Refugee Camp in the Gaza Strip. A cluster sample of 841 resident women of reproductive age (15-49 years) was interviewed in their homes. Univariate and multivariate statistical analyses were performed using BMDP software. 98% of the interviewees favour family planning and 88% plan to use a contraceptive in the future. However, 52% of the women at risk do not use any contraception because of their husband's opposition, fear of side effects or lack of knowledge. The risk of having seven or more children is positively associated with a woman's low educational level and husband's desire for more than seven children. Despite favourable attitudes regarding family planning, there is ignorance and the prevalence of contraception use is low. There is a gap between fertility preference and achievement.     

The influence of perceptions of community norms on current contraceptive use among men and women in Ethiopia and Kenya

The paper uses data from Ethiopia and Kenya to examine how perceptions of community norms differentially shape contraceptive use among men and women. Women whose current number of sons is lower than their perception of the community ideal had lower odds of reporting contraceptive use, while women whose own personal ideal number of sons is lower than the community ideal had greater odds of reporting contraceptive use. Men and women in Kenya were influenced more by their perception of their social network's approval of family planning than by their own approval of family planning. Results highlight the importance of place, conceptualized as the place-specific perceptions of fertility ideals, when conducting reproductive health research. Identification of people who use contraception in the face of pervasive pronatalist community norms presents a point for future intervention.     

Factors influencing contraceptive use in Tehran

BACKGROUND: Despite reluctance to conceive, approximately 30% of couples do not use any method of contraception. Health concerns, side effects, failure of the method and some demographic issues such as education, age, residential region and number of living children have a major effect on contraceptive use. OBJECTIVE: The aim of the present study was to determine those factors which influence contraceptive use in Tehran. METHODS: Data from the project "The Study of the Effectiveness of Postpartum Consultation about Family Planning on Contraceptive Practice during 2 years after Parturition in University Hospitals of Tehran in 1996" were applied for the analysis of those factors which influence contraceptive use by Iranian couples. A total of 4177 women of reproductive age who gave birth in one of the 12 hospitals in Tehran during the 24 hours following the interview of the initial study and had at least one living child were enrolled in the present study. The questionnaire used included some questions about socio-demographic status, fertility history, knowledge of contraceptives and the source of this knowledge, and previous contraception practice and its effectiveness. RESULTS: Using a logistic regression model, it was found that age, women's level of education, their husbands' level of education and previous familiarity with contraceptive methods were the most significant factors influencing contraceptive use. CONCLUSIONS: It is suggested that health policy makers strengthen the family planning services through providing appropriate counselling in family planning clinics.     

Childbearing and Contraceptive Decision Making Amongst Afghan Men and Women: A Qualitative Analysis

Afghanistan has one of the highest maternal mortality ratios and lowest contraceptive prevalence rates globally. Limited information is known regarding Afghan men and women's attitudes toward childbearing, child spacing, and contraceptive use, which is essential for delivery of appropriate services. We conducted a qualitative study among postpartum couples enrolled at maternity hospitals in Kabul, Afghanistan. We identified important themes that highlight the complex inter-relationship between acknowledged risks of childbearing, desire for family planning, rationales for limited contraceptive use, and sociocultural barriers to contraceptive use. We offer practical recommendations for application of findings toward family planning and maternal mortality reduction programs.     

Is Effective Contraceptive Use Conceived Prenatally in Florida? The Association Between Prenatal Contraceptive Counseling and Postpartum Contraceptive Use

The objective of this study is to describe the prevalence of postpartum contraceptive use among women experiencing a live birth in Florida in 2004–2005. To examine the association between family planning counseling during prenatal care visits and the use of effective contraceptive methods among postpartum women. Matched data from Florida PRAMS and Vital Statistics were used (n = 3,962). Weighted logistic regression was used to determine the association between prenatal family planning counseling and effective postpartum contraceptive use. Odds ratios were adjusted for use of contraception prior to pregnancy, well-baby checkup, race, ethnicity, nativity, education, marital status, poverty level, stress before or during pregnancy, and parity. Women who reported discussing family planning with their prenatal care provider were more likely to use effective contraception postpartum (AOR: 1.5, 1.1–2.0) compared to women who did not report a discussion. Women who used contraception prior to pregnancy (AOR: 2.3, 1.7–3.2) and women who experienced no stress before or during pregnancy (AOR: 2.0, 1.2–3.4) were also more likely to use contraception in the postpartum period. A significant interaction was identified between family planning counseling during prenatal visits and maternal education. Stratum specific odds ratios for women who received prenatal family planning counseling were significant for women with less than high school education (AOR: 2.5, 1.3–5.1) and for women with high school education (AOR: 2.0, 1.2–3.4). Women reporting family planning counseling during prenatal care were more likely to use effective contraception postpartum. While women with high school or less than high school education levels benefited from prenatal family planning counseling, the greatest benefit was observed for women with less than high school education. Integrating family planning counseling into prenatal care may increase the use of effective contraceptive methods among postpartum women.     

Men’s perceptions of child-bearing and fertility control in Pakistan: insights from a PEER project

Abstract

Notions of masculinity, which promote the role of men as providers and decision-makers, alongside men’s opposition to modern forms of contraception, have long been assumed to be a barrier to women’s use of contraception in Pakistan. There has been little in-depth exploration of varieties of masculinity and how these may influence men’s views of child-bearing or fertility preferences. This study used Participatory Ethnographic and Evaluation Research to explore married men’s (aged 18 to 45 years) perceptions of marriage, child-bearing and fertility control. A total of 31 men were recruited as researchers in two provinces (Punjab and Khyber Pakhtunkhwa), who, in turn, each interviewed two male friends. Men overall supported a ‘smaller’ family size and use of contraceptive methods. Drivers of this preference included perceived economic constraints, the desire to invest in children’s education, and wider acceptability of contraceptive use. Limiting family size was associated with both the value of competent male providers taking care of their children, as well as being poor. Men wanted to have better access to information through a range of channels. Understanding the sociocultural contexts in which masculinities are constructed is essential before involving men in family planning programmes, so that gender inequalities are not reinforced.     

Accelerating India's fertility decline: the role of temporary contraceptive methods

This report summarizes findings from the 1992-93 National Family Health Survey of India, on fertility and contraceptive use. Fertility declined about 2 children/woman during 1972-92. The total fertility rate in 1992-93 was 3.4 children/woman. The average desired number of children among ever married women aged 13-49 years was 2.9 children/woman. Among the 41% of women who used contraception, 76% relied on sterilization. 27% of currently married women of reproductive age were sterilized, and 3% had husbands who were sterilized. 20% of women had an unmet need for family planning. 64% of all women currently using temporary methods wanted no more children. 11% desired more children after an interval of 2 or more years. 9% desired a stop to childbearing. Women not currently using contraception and intending to use in the future preferred sterilization (59%) or a temporary method (36%). Currently, 24% of contraceptive users rely on temporary methods. It is likely that meeting unmet need for temporary methods would substantially increase contraceptive use. Women who were not using any method averaged 2.7 children, while sterilized women had 4.0 children. Women who used traditional methods averaged 2.8 children. Women using temporary methods averaged 2.6 children. It is unlikely that sterilization would further reduce fertility much below levels already reached. Women sterilized before the age of 24 years tended to have modest sized families, but most women were sterilized at older ages. Currently, only 10% of married women use temporary methods, and only 6% use a modern method.     

Ethnic differences in contraceptive use in Sri Lanka

In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.     

Declines in the age and family size of family planning program acceptors: international trends

Social changes are encouraging couples to inititate contraception at younger ages, practice spacing, and in general reduce fertility. The personal characteristics of acceptors in the family planning programs of 23 developing countries were accumulated with concentration on the age and number of children by contraceptive method. The findings indicate that the ages and family sizes of acceptors decline with little relation to available family planning programs or contraceptive method. Contraceptive methods must fit the needs of younger couples; therefore, services for sterilization must still be maintained while new services are added which take into account age distributions of married women and age-specific acceptance rates.     

Fertility and contraception in the Marshall Islands

Data on fertility and contraception in Micronesian women in the Marshall Islands were collected during a women's health survey in 1985. High total fertility rates were found. The reproductive pattern of many Marshallese women is one that has been associated with adverse health consequences: pregnancies in teenagers and in women over 39 years, high parities of four or more births, and short birth intervals. The practice of breastfeeding is declining in younger women. The prevalence of contraceptive use is low, and the availability of reversible methods is limited. Most contraceptive nonusers would like to practice contraception, but are inhibited by the lack of information about family planning. It is suggested that more attention needs to be given to family planning services in the Marshall Islands, in particular to improving the availability of reversible methods of contraception and of information about family planning. Further research is also needed on how family planning services might best be organized to maximize participation by women and their partners who wish to use such services.     

Birth-based approach to family planning: an empirical justification

Amid persistently high population growth rates in developing countries, people have questioned whether the recent change from a fertility-reduction oriented family planning program strategy to a reproductive health-oriented and meeting-unmet-needs based program of contraceptive services will slow the pace of fertility decline, exacerbating population problems and developmental issues in developing countries. The authors consider the question and suggest reorienting program strategy such that both the microlevel needs of couples and the macrolevel objective of fertility reduction are simultaneously and efficiently met. A birth-based approach to family planning program is proposed in which efforts will be made to identify all pregnant women and recently delivered mothers and provide services to them. This approach would comprise a key component of a reproductive health program. The authors empirically test the hypotheses that the unmet needs of contraception for birth spacing and limiting are relatively higher among recently delivered mothers than among all women of comparable age and parity, and that recently delivered mothers are self-selected for their higher fertility.     

Fertility and contraceptive use among young adults in Harare, Zimbabwe

In 1986, a survey of young adults aged 14-24 in Harare, Zimbabwe obtained information about their knowledge, attitudes, and sexual behavior. Most adolescent childbearing took place within marriage, although sexual intercourse was generally initiated before marriage. Knowledge of family planning was high, but contraceptive use lagged behind knowledge. Fewer than half of the respondents had talked to an elder about family planning, sex, or pregnancy. Fourteen percent of young women who were unmarried at the time of first intercourse used contraceptives, compared to 18 percent of young unmarried men. Current contraceptive use among sexually active unmarried youths was 36 percent among women and 29 percent among men. One consequence of low contraceptive use was a high number of unwanted premarital pregnancies. Twenty-nine percent of the women had been pregnant; those not married at the time they got pregnant generally got married soon after. Of the girls who got pregnant while in school, 90 percent had to drop out of school. A second consequence of low contraceptive use is an increased risk of transmission of STDs and AIDS among the youth of Harare.     

Do Ambivalent Women Have an Unmet Need for Family Planning? A Longitudinal Study from Bali,Indonesia

IntroductionFertility intentions often can predict contraceptive demand and fertility outcomes. Little is known about women reporting ambivalent fertility intentions, who are usually classified as having an unmet need for contraception. This study’s objectives were to determine 1) which fertility intention group ambivalent women more closely resemble and 2) whether ambivalent women seem to have an unmet contraceptive need.MethodsWe analyzed longitudinal data from 1,018 married Balinese women aged 15 to 45, of whom 33% desired more children, 52% wanted no more, and 14% were ambivalent. Ambivalent women were compared with those with definitive intentions using bivariate analyses. Regression analysis was used to determine the predictors of birth avoidance.ResultsAlthough ambivalent women were significantly older, and had less education and more children than women who wanted more children, ambivalent women were more similar in their contraceptive use to those who wanted more children than those who wanted no more. However, in terms of birth outcomes, ambivalent women resembled more the women who intended to avoid childbearing: After 4 years, 33% of ambivalent women had another birth compared with 29% of women who wanted no more and 57% of women who desired more children. Contraceptive use at baseline did not predict ambivalent women’s fertility outcomes, unlike the other groups.ConclusionDespite their relatively low rates of contraceptive use at baseline, ambivalent women generally avoided giving birth during the study period. This suggests that ambivalent women may not have a high unmet need for family planning.