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.     

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.     

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.     

四川省农村育龄妇女避孕方法知情选择干预项目研究报告

目的:评价开展避孕节育知情选择活动对四川省农村育龄妇女的避孕节育知识和知情选择的知识、能力、态度和避孕行为等影响。方法:在四川省兴文县的2个乡开展持续1·5年的、以社区为基础、20~49岁的已婚育龄妇女为对象的干预性研究,干预活动包括组织社区宣传活动、发放宣传资料、播放录像带、组织讲座、面对面的宣传和开展同伴教育,分析干预效果。结果:干预组育龄妇女对避孕方法的使用、原理、优点、缺点得分明显高于对照组,且在干预后避孕方法使用率及使用避孕套的比例均高于干预前;避孕方法使用的最终决定者由干预前计划生育服务人员转变为干预后为本人。结论:集知识、信息、咨询与服务为一体的社区避孕节育知情选择干预项目的实施,可显著提高农村育龄妇女的避孕节育知识水平和她们选择避孕方法的能力。     

World population, family planning and development]

The 1991 world population report of the UNFPA projects a world population of 8.504 billion by 2025. The prevalence of the use of modern contraceptives increased from 9% in previous years to an average of 51% at the present time: to 70% in East Asia, to 60% in Latin America, but only to 17% in Africa. 20% of pregnancies are unwanted, the prevention of which would reduce the expected population by 2.2 billion people in 2100. Without birth control programs today there would be 412 million more people in Asia, Latin America, and Africa; and in 2100 1.48 billion would live on Earth instead of 10 billion forecast by the World Bank. The aim of UNFPA is to increase contraceptive prevalence form 51% to 59% by 2000: from 381 million users in 1991 to 567 million acceptors. Only 15% of men use contraceptives, although the prevention of sexually transmitted diseases especially AIDS makes the use of condoms highly advisable. In the report scant mention is made of breast feeding as a family planning method, although the Bellagio Consensus of 1988 states that if a woman almost exclusively breast feeds during lactation amenorrhea a more than 98% protection against pregnancy is offered during the 1st 6 months postpartum. During this period no additional contraception is necessary until the 1st menstruation occurs. Women in Bangladesh taking an oral contraceptive after delivery had shorter birth intervals than women exclusively relying on breast feeding. The Working Group of Medical Development Association issued guidelines concerning contraceptive methods including subdermal implant of levonorgestrel, although excessively strict standards can foil the contraceptive needs of the Third World. Their reproductive mortality is mainly determined by an extremely high maternal mortality rather than by complications from contraceptive use.     

Abortion and fertility control in Korea

Findings are presented from a detailed study that used data from the 1974 Korean National Fertility survey to evaluate the impact of abortion on fertility and to investigate the interrelationships of abortion, contraceptive use, and contraceptive effectiveness in Korea. The relative effectiveness of contraception is low, the best being 76% effectiveness for women aged 30-34 in urban areas. Among women using contraception after abortion, the effectiveness is even lower. After the 1st abortion, 85% of the women aged 25-29 become pregnant with 2-5 years. 74% of women who use contraception after abortion become pregnant in this time compared to 92% of women who do not. Contraception when added to abortion achieves intervals that are twice as long as those for abortion alone. By using contraception, the interval from abortion to pregnancy is lengthened on average by 10.3 months for women aged 25-29, 11.5 months for those aged 30-34, and 9.3 months for those aged 35-39. The average number of abortions needed to avert a live birth in Korea is lower than the figure of 3.3 Potter estimated for societies with prolonged lactation. When contraception is not used, at least 1 abortion is needed each year to avert 1 live birth. With contraceptive use, the number of abortions needed to avert 1 live birth is between 0.55 and 0.62. The number of abortions needed in this case is greatly reduced when contraception is practiced more effectively. Comparing the actual level of contraceptive effectiveness in Korea in 1974 with a possible 95% effectiveness shows that this latter high level would have the same effect on fertility with approximately 6 fewer abortions throughout a woman's reproductive life. The actual reduction in numbers would be 5.8 in the 25-29 age group, 5.9 in the 30-34 age group, and 8.2 in the 35-39 age group. This reduction in the number of abortions necessary with 95% effective contraception as compared with actual contraceptive use, suggests considerable potential for reducing the need for additional abortions with improved contraception. The current situation has improved since 1974, due to the success of the sterilization program.     

Status of abortion in Japan

Recent information on induced abortion in Jan appears in a general review of Japanese family planning. The Eugenic Protection Law of 1948 greatly broadened the indications for legal abortion. There were two reasons for this. One was concern over the rising birth rate and the other was an attempt to protect women from the harmful effects of illegal abortion. Since 1952 abortion has been performed at the sole discretion of the doctor in charge of the patient, and most Japanese women now believe that an abortion can be procured from a doctor without any difficulty. Where contraception is practised, abortion is looked on as a safeguard against contraceptive failure. Even so, total reported abortions in Japan have been falling, from a peak of about 1.2 million in 1955 to about 900,000 in 1964. Many abortions go unreported, so these totals are probably very much higher. Abortions among primigravidae seem to be on the increase. Up to 1955 at least 70% of the decrease in the birth rate was due to abortion, and 30% to contraception and sterilization. At present abortion accounts for only 40-50% of total fertility control. Induces abortion was an important factor in the postwar economic recovery of Japan, which was helped by the large reduction in the birth rate. 2n the past few years many leaders of the community, including religious authorities, Government officials and civic leaders, have been concerned about the widespread use of abortion and its easy accessibility. Many women, although experiencing some remorse after an abortion, would rather undergo the operation than have an unwanted child. Other reasons given for the relatively high rate of abortion are "the inexpensiveness of the operation and the ready availability of designated physicans". Surveys have shown that few harmful effects follow legal induced abortions. It is suggested that conditions favouring the use of induced abortion will be eliminated if young couples age given better homes and if highly effective, free-from-failure contraceptive methods are introduced.     

新疆生产建设兵团已婚育龄妇女避孕现状调查分析

目的：了解新疆生产建设兵团已婚育龄妇女避孕现状。方法：采用分层、四阶段、整群、概率比随机抽样方法,共调查已婚育龄妇女6823人,对影响避孕方法选择的因素进行单因素分析。结果：兵团已婚妇女的避孕率为86．57％,避孕方法使用比例居前3位的依次是宫内节育器（51．92％）、避孕套（21．35％）、女性绝育（17．56％）,妇女居住地、年龄、民族、文化程度、活产生育次数等是避孕方法选择的影响因素。结论：进一步加大对基层计划生育工作力度,推行避孕节育优质服务,坚持以人为本,合理选择避孕方法,促进生殖健康。     

上海市流动人口节育模式的分析

１９９８年２月１６日至４月３日对上海市闵行区虹桥、梅陇两镇流动人口中育龄妇女的避孕节育现状、意愿进行了全面调查。研究结果表明,两地８４３例已婚育龄妇妇使用的避孕节育方法中宫内节育器居首位,占６８．１０％,绝育占２３．６０％,口服药占４．２％,其他避孕方法占４．００％,避孕率８８．６９％。已婚育龄妇女对现用避孕方法满意的占９４．３％,不同避孕方法的满意程度差别有显著性意义（Ｐ＝０．００１）,绝育、宫     

The impact of the family planning supply environment on contraceptive intentions and use in Morocco

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.     

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.     

Public-sector savings resulting from expenditures for contraceptive services

Almost one in four U.S. women who use a reversible method of contraception rely on a publicly funded source of care, either a family planning clinic or a private physician reimbursed by Medicaid. According to three scenarios of alternative contraceptive use patterns, if publicly funded services were not available, these women would have between 1.2 million and 2.1 million unintended pregnancies over one year--substantially more than the approximately 400,000 they currently experience. If these women relying on publicly funded services were using no method of contraception, they would be expected to have more than 3.5 million unintended pregnancies in one year. In FY 1987, federal and state governments spent $412 million on contraceptive services for women who otherwise might not have been able to obtain them. If these services had not been available, the additional public costs for medical care, welfare and supplementary nutritional programs during the first two years after a birth or for publicly funded abortions would have totaled $1.2-$2.6 billion. These savings represent an average of $4.40 saved for every dollar of public funds spent to provide contraceptive services.     

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.     

Epidemiology and determinants of induced abortion in the U.S.S.R

Since the mid-50s, induced abortion (IA) has been the principal method of birth control for as much as 80% of the U.S.S.R. population, with more than 9 million of terminations performed annually. After brief discussion of the general and specific reasons for a long-term IA dominance in family planning practices, data of the national statistics and local surveys on IA prevalence, contraceptive use and their determinants are critically reviewed. Although most couples are willing to use contraception, they have to rely on traditional methods with high failure rates (withdrawal, condom, rhythm/calendar). Due to many years of misleading information, population views on pros and cons of various birth control methods are severely biased. Public health implications of multiple IA are summarised.     

Confidential reproductive health services for minors: the potential impact of mandated parental involvement for contraception

CONTEXT: Recent legislative efforts to implement mandated parental involvement for minor adolescents seeking family planning services threaten the rights of adolescents younger than 18 to access reproductive health care. METHODS: State and federal laws and policies pertaining to minor adolescents' rights to access services for contraception and sexually transmitted diseases are reviewed, and research examining issues of parental involvement among adolescents using clinic-based reproductive health services is synthesized. RESULTS: Attempts to mandate parental involvement for reproductive health care often focus on contraceptive services and are typically linked to federal or state funding. Studies of teenagers using clinic-based family planning services suggest that slightly more than one-half would obtain contraceptives at family planning clinics even if parental notification were required. Mandated parental involvement for contraception would discourage few teenagers from having sex, but would likely result in more teenagers' using the least effective methods, such as withdrawal, or no method at all. Family planning clinics encourage teenagers to voluntarily talk to their parents, but relatively little information is available about the extent to which activities to promote parent-child communication have been adopted. CONCLUSIONS: Mandated parental involvement for teenagers seeking contraceptive care would likely contribute to increases in rates of teenage pregnancy. Research that will help clinics implement and improve efforts to encourage voluntary parental involvement is urgently needed.     

广州市流动人口产后避孕宣教需求分析

目的：调查广州市流动人口避孕节育现状和产后生殖健康服务需求,探索针对流动人口的计划生育服务模式。方法：对广州市妇女儿童医疗中心的流动人口产后妇女进行调查,调查方式为匿名封闭式问卷调查。结果：调查对象平均年龄（28．50±4．00）岁;职业以公司职员和无业人员为主（59．7％）;文化程度以初中和高中为主（63．3％）;既往有人工流产史的占28．03％。研究对象产后愿意接受避孕宣教的时间前三位依次为产后42d体检时、婴儿体检或免疫接种时、产后访视时,希望产后避孕宣教的来源依次为网络、科普宣传和展览、医生,希望通过宣教了解的内容依次是避孕药具的优缺点、避孕方法种类和性传播疾病。结论：产后是落实避孕措施的关键时期,应根据流动人口的特点,提倡加强产后医务人员提供的避孕指导,以提高流动人口妇女生殖健康水平。     

Eight million women have unmet need for family planning in Uttar Pradesh

The 1992-93 National Family Health Survey sampled almost 90,000 women in India to find that 41% of currently married Indian women aged 13-49 use some form of contraception, ranging from 13% of women in Nagaland to 63% in Kerala. Uttar Pradesh is the country's most populous state, with a 1991 population of 139 million. With only 20% of reproductive-age women in Uttar Pradesh using contraception, the level of fertility in the state is higher than that of any other state in India. According to the survey, the rate of total fertility (TFR) in Uttar Pradesh is 4.8 children per woman, higher than the national TFR of 3.4, while the rate of infant mortality is 100 infant deaths per 1000 births. Total population size in Uttar Pradesh grew by 25% over the period 1981-91. 60% of currently married women who have a need for family planning are not having their need met. The level of unmet need is greatest among women who live in rural areas, are illiterate, are Muslim, belong to scheduled tribes, and are either of high or low parity. The government has launched an Innovations in Family Planning Services Project designed to increase contraceptive use in the state. The authors recommend that the family welfare program place greater emphasis upon birth spacing methods such as the condom and pill, while also ensuring that women are aware of their ability to opt for female sexual sterilization.     

易受孕期知晓法避孕的研究进展

易受孕期知晓法（FAMs）是自然计划生育法的一种,可用于指导妊娠或避孕。FAMs因其无需任何医疗介入、无毒副作用、不受文化宗教限制等原因,深受部分育龄人群欢迎,其避孕失败率为1%～5%。FAMs在中国的使用人群主要限于婚前性行为及新婚的育龄人群,然而中国育龄人群甚至妇产科医生对FAMs了解有限,导致有关FAMs的知识宣教不足或片面、不完整,从而导致FAMs使用不当、避孕失败率明显升高,严重损害了中国育龄女性的生殖健康。鉴于以上原因,综述了FAMs应用机制、常用方法分类、研究进展及未来研究方向和国内应用前景等方面,以促进中国育龄人群正确使用FAMs、减少非意愿妊娠发生,并推进中国生殖健康卫生事业的发展。     

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.