1Contraceptive practices among married women of reproductive

age in Bangladesh: a review of the evidence

Fauzia Akhter Huda 1 2, Yolande Robertson 3, Sabiha Chowdhuri 4, Bidhan Krishna Sarker 1, Laura
Reichenbach 5, Ratana Somrongthong 6

Affiliations expand

 PMID: 28587619

 PMCID: PMC5461624

 DOI: 10.1186/s12978-017-0333-2

Abstract

Background: Bangladesh has experienced a sevenfold increase in its contraceptive

prevalence rate (CPR) in less than forty years from 8% in 1975 to 62% in 2014. However,
despite this progress, almost one-third of pregnancies are still unintended which may be
attributed to unmet need for family planning and discontinuation and switching of
methods after initiation of their use.

Methods: We conducted an extensive literature review on contraceptive use among

married women of reproductive age (MWRA) in Bangladesh. A total of 263 articles were
identified through database search and after final screening ten articles were included in
this synthesis.

Results: Findings showed that method discontinuation and switching, method failure,
and method mix may offset achievements in the CPR. Most of the women know of at
least one contraceptive method. Oral pill is the most widely used (27%) method,
followed by injectables (12.4%), condoms (6.4%), female sterilization (4.6%), male
sterilization (1.2%), implants (1.7%), and IUDs (0.6%). There has been a decline in the use
of long acting and permanent methods over the last two decades. Within 12 months of
initiation, the rate of method discontinuation particularly the short-acting methods
remain high at 36%. It is important to recognize the trends as married Bangladeshi
women, on average, wanted 1.6 children, but the rate of actual children was 2.3.
 Conclusions: A renewed commitment from government bodies and independent
organizations is needed to implement and monitor family planning strategies in order to
ensure the adherence to and provision of the most appropriate contraceptive method
for couples.

Keywords: Bangladesh; Contraceptive practices; Family planning; Married women of

reproductive age.

Huda FA, Robertson Y, Chowdhuri S, Sarker BK, Reichenbach L, Somrongthong R.

Contraceptive practices among married women of reproductive age in Bangladesh: a
review of the evidence. Reprod Health. 2017 Jun 6;14(1):69. doi: 10.1186/s12978-017-
0333-2. PMID: 28587619; PMCID: PMC5461624.

2Childbearing and the use of contraceptive methods among

married adolescents in Bangladesh
S M Mostafa Kamal 1

Affiliations expand

 PMID: 22242676

 DOI: 10.3109/13625187.2011.646014

Abstract

Objectives: To investigate the socioeconomic determinants of childbearing and

contraceptive use among married adolescents in Bangladesh.

Methods: The study used the Bangladesh Demographic and Health Survey 2007 data.
Both bivariate and multivariate statistical analyses were used to examine the association
between the socioeconomic factors and childbearing and contraceptive use among
married female adolescents.

Results: Overall, 69% of the married adolescents initiated childbearing and 25% of the
most recent pregnancies were unintended. The current contraceptive prevalence rate
was 42%. The multivariate logistic regression yielded a significantly increased risk of
childbearing among adolescents with no formal education, those who were married-off
before age 16, the poor and those who had ever used any contraceptive method. Inter-
 spousal communication on family planning (FP) appeared as the most single significant
determinant of any contraceptive use. Number of living children, working status and
visitations by FP workers are also important determinants of contraceptive use among
the married female adolescents.

Conclusions: Early childbearing, lower use rate of contraceptive methods and

unintended pregnancies are common among married adolescents in Bangladesh.
Expanded schooling and reproductive health programmes in Bangladesh should
promote increased communication about FP within the couples in order to achieve
successful contraception and better reproductive outcomes, particularly among
adolescents.

Mostafa Kamal SM. Childbearing and the use of contraceptive methods among married
adolescents in Bangladesh. Eur J Contracept Reprod Health Care. 2012 Apr;17(2):144-54.
doi: 10.3109/13625187.2011.646014. Epub 2012 Jan 15. PMID: 22242676.

3Women's attitudes and beliefs towards specific contraceptive

methods in Bangladesh and Kenya
Kazuyo Machiyama , Fauzia Akhter Huda , Faisal Ahmmed , George Odwe , Francis Obare , Joyce N
1 2 2 3 3

Mumah , Marylene Wamukoya , John B Casterline , John Cleland

4 4 5 6

Affiliations expand

 PMID: 29739429

 PMCID: PMC5941610

 DOI: 10.1186/s12978-018-0514-7

Abstract

Background: Missing 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).

Methods: In 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.

Results: While 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.

Conclusions: High 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.

Keywords: Attitude; Bangladesh; Belief; Contraception; Contraceptive methods; Kenya;

Satisfaction.

PubMed Disclaimer

Machiyama K, Huda FA, Ahmmed F, Odwe G, Obare F, Mumah JN, Wamukoya M,

Casterline JB, Cleland J. Women's attitudes and beliefs towards specific contraceptive
methods in Bangladesh and Kenya. Reprod Health. 2018 May 8;15(1):75. doi:
10.1186/s12978-018-0514-7. PMID: 29739429; PMCID: PMC5941610.
 4Contraceptive Method Attributes and Married Women's Intention to Use
the Pill or the Injectable in Rural Bangladesh
Fauzia Akhter Huda 1, John B Casterline 2, Faisal Ahmmed 3, Kazuyo Machiyama 4, Hassan
Rushekh Mahmood 5, Anisuddin Ahmed 6, John Cleland 7

Affiliations expand

 PMID: 31381499

 DOI: 10.1363/44e7118

Abstract

in English, Spanish, French

Context: The factors underlying contraceptive method choice are poorly understood in
many countries, including Bangladesh. It is important to understand how Bangladeshi
women's perceptions of a method's attributes are associated with their intention to use
that method.

Methods: Data on 2,605 married women aged 15-39 living in rural Matlab were taken
from a baseline survey conducted in 2016. Conditional logit analysis was used to
examine associations between 12 method attributes and intention to use the pill or the
injectable among the 583 fecund women not currently using a method. Method
attributes included those relating to ease of obtainment and use, efficacy, health effects,
husband's approval, the experiences of the respondent and the experiences of women
in the respondent's social network.

Results: Women tended to perceive the pill more positively than the injectable. For
example, greater proportions of women reported believing that the pill is easy to use
(90% vs. 72%) and does not cause serious health problems (75% vs. 38%). The likelihood
that a woman intended to use a method was positively associated with her perception
that it is easy to use (odds ratio, 2.9) and does not cause serious health problems (1.7) or
affect long-term fertility (2.9). Satisfied past users of a method were more likely than
never users to report intending to use the method (5.2). Intention to use the pill rather
than the injectable was positively associated with education (2.0-3.6) and having a
migrant husband (1.7).
 Conclusions: Negative beliefs not supported by evidence, particularly about the
injectable, are associated with women's intention to use a contraceptive method. The
results may be useful in improving contraceptive care, counseling and training.

PubMed Disclaimer

Huda FA, Casterline JB, Ahmmed F, Machiyama K, Mahmood HR, Ahmed A, Cleland J.
Contraceptive Method Attributes and Married Women's Intention to Use the Pill or the
Injectable in Rural Bangladesh. Int Perspect Sex Reprod Health. 2018 Dec 1;44(4):157-
165. doi: 10.1363/44e7118. PMID: 31381499.

5Practice and Intention to use long acting and permanent contraceptive

methods among married women in Ethiopia: Systematic meta-analysis
Yonatan Moges Mesfin 1, Kelemu Tilahun Kibret 2

Affiliations expand

 PMID: 27329147

 PMCID: PMC4915059

 DOI: 10.1186/s12978-016-0194-0

Abstract

Background: The long acting and permanent contraceptive methods (LAPCMs) has not
used unlike that of short-acting methods in Ethiopia. Ethiopia is the second most
populous country in Sub Saharan Africa with a high total fertility rate, and high maternal
and child mortality rates. This study summarized the evidence of practice and intention
to use long acting and permanent family planning methods among women in Ethiopia
using systemic review and meta-analysis.

Methods: A systematic review and meta-analysis of the published and unpublished

observational studies were conducted. Original studies were identified using databases
of Medline/Pubmed, and Google Scholar. Heterogeneity across studies was checked
using Cochrane Q test statistic and I(2)test. The pooled proportion of intention to use
 and the practice of long acting and permanent contraceptive methods were computed
using a/the random effect model.

Results: Based on the ten observational studies included in the meta-analysis, the
pooled prevalence of intention to use long acting and permanent contraceptive
methods among married women according to the random effect model was 42.98 % (95
% CI 32.53, 53.27 %). On the other hand, the pooled practice of long acting and
permanent methods of contraceptive among the study participants was 16.64 % (95 %
CI 12.4 to 20.87 %).

Conclusion: This meta-analysis revealed that women's intention to use LAPCMs is

generally good but their utilization is low. It is recommended, therefore, that LAPMCs
must be made more readily available and accessible to women at the lower level of
health service delivery who are in need of it.

Keywords: Ethiopia; Intention; LAPCMs; Meta-analysis; Practice; Systematic review.

Mesfin YM, Kibret KT. Practice and Intention to use long acting and permanent
contraceptive methods among married women in Ethiopia: Systematic meta-analysis.
Reprod Health. 2016 Jun 21;13(1):78. doi: 10.1186/s12978-016-0194-0. PMID: 27329147;
PMCID: PMC4915059.

6Women's Sexual Empowerment and Its Relationship to Contraceptive Use

in Bangladesh: Findings From a Recent National Survey
Nishi Khatun 1, Sihab Howlader 1, Md Mosfequr Rahman 1

Affiliations expand

 PMID: 37927388

 PMCID: PMC10620289

 DOI: 10.3389/ijph.2023.1606143

Abstract
 Objectives: This study aimed to assess the relationship between women's sexual
empowerment and contraceptive use among married Bangladeshi women from a
nationally representative sample.

Methods: Secondary data analysis was conducted using the Bangladesh Demographic
and Health Survey (BDHS) 2017-18. The investigation covered a total of 14,515 married,
non-pregnant women who were residing with their spouses. Multivariable logistic
regression analysis was fitted to assess the relationship between the variables of
interest.

Results: A unit increase in the sexual empowerment scale increases the odds of
contraceptive use by 13%. While increasing age, being Muslim, having a spouse who is
older by more than 10 years, and living in rural areas are associated with lower odds of
using contraceptives than their respective counterparts, secondary or higher levels of
education, having more living children, exposure to TV or radio, and employment are
associated with higher odds of using contraceptives.

Conclusion: The study's findings point to the need for addressing women's perceptions
of their right to sexual and reproductive health and equity in order to further efforts to
achieve universal access to reproductive health services.

Keywords: contraceptive use; decision-making; empowerment indicators; sexual

empowerment; women’s empowerment.

Khatun N, Howlader S, Rahman MM. Women's Sexual Empowerment and Its

Relationship to Contraceptive Use in Bangladesh: Findings From a Recent National
Survey. Int J Public Health. 2023 Oct 19;68:1606143. doi: 10.3389/ijph.2023.1606143.
PMID: 37927388; PMCID: PMC10620289.

7Contraceptive practice and fertility in Thailand: results of the Third

Contraceptive Prevalence Survey
A Chamratrithirong, P Kamnuansilpa, J Knodel

 PMID: 3798491

Abstract

The Third Contraceptive Prevalence Survey in Thailand was conducted in 1984. Results
indicate a continuation of the rapid rise in contraceptive use among married couples
that has been taking place over the past 15 years. Prevalence levels are approaching
those common in economically advanced countries. Sterilization is now the most
common method, although a fairly broad range of other methods is also widely used.
Only modest levels of unmet need for contraception for either limiting family size or
spacing children now exist. Fertility rates have fallen since the previous survey, done
three years earlier, but to a lesser extent than would be expected from the increased use
of contraceptives. Family size preferences are concentrated at small family sizes. A
comparison between the Buddhist majority and Moslem minority, made possible
through a special sample design, reveals substantial differences between the two
groups. Contraceptive use is lower and fertility levels and preferences are higher among
Moslems than among Buddhists.

PIP: The 3rd Contraceptive Prevalence Survey (CPS-3) in Thailand was conducted in
1984, sampling 7,576 ever-married women aged 15-49. It was based on a weighted
sample scheme, interviewing approximately equal numbers in each of the 4 major
regions and in Bangkok, including the same 24 provinces as in the previous CPS-2, and a
supplementary population of southern Moslems. Results indicate a continuation of the
rapid rise in contraceptive use among married couples that has been taking place over
the past 15 years. Prevalence among currently married women has continued to
increase from 53% in 1978 to 65% in 1984; approaching rates common in developed
countries. Female sterilization is the most common method (23.5% of all married
women) although a range of other methods is also seen (pill, 19.8%, injectables, 7.6%;
IUD, 4.9%, male steralization, 4.4%; condom, 1.8%; and other, 2.6%). Low levels of unmet
need for contraception for either limiting family size or spacing children now exist.
National total fertility rates had fallen since the previous survey (from 3.68 in 1981 to
3.36 in 1984), but to a lesser extent than would be expected from the increased
contraceptive use. Family size preferences are concentrated in small family sizes, slightly
higher for rural women and women with 4 years' education, but with group averages
ranging from 2.3 (urban women currently married 5 years with 4 years' education) to 3.4
(all currently married rural women educated 4 years). A comparison between the
Buddhist majority and Moslem minority reveals that contraceptive use is lower and
fertility levels and preferences higher among Moslems than among Buddhists.
Contraception practice by region, racial/language group, work status; % having
undesired pregnancies by rural and urban residency; source of supply (government or
private); and method are also examined.

Chamratrithirong A, Kamnuansilpa P, Knodel J. Contraceptive practice and fertility in

Thailand: results of the Third Contraceptive Prevalence Survey. Stud Fam Plann. 1986
Nov-Dec;17(6 Pt 1):278-87. PMID: 3798491.
 8Contraceptive use and fertility in Guatemala
R S Monteith, J E Anderson, M A Pineda, R Santiso, M Oberle

 PMID: 4060213

Abstract

In 1983, one-quarter of married Guatemalan women aged 15-44 years were using
contraception, and female sterilization was the most prevalent method. Fertility rates for
the population were at correspondingly high levels, with an overall total fertility rate of
about six births per woman. Contraceptive prevalence varied by residence and ethnic
group; less than 5 percent of currently married Indian women and about 50 percent of
married women in the capital city area were using contraception. From 1978 to 1983,
prevalence increased overall by six percentage points, with surgical contraception
accounting for most of the increase. Findings of the study suggest that different
strategies need to be employed among Ladino and Indian women in order to increase
contraceptive prevalence in these subgroups.

PIP: A 1983 survey shows that Guatemala continues to have a relatively low level of
contraceptive use by Latin American standards. However, by comparing the results of
the 1983 survey with those of a similar survey conducted in 1978, it is clear that
contraceptive use has increased slightly. During the 5-year interval between these
surveys, the % of married women aged 15-44 years old who were using contraception
increased from 19 to 25%. Most of the increase in prevalence was in the use of
sterilization, which was found to be the most prevalent method in both surveys. This
report describes the results of the 1983 Family Planning and Maternal/Child Health
Survey conducted in Guatemala. Also discussed are trends in fertility, breastfeeding,
contraceptive use, source of contraception, and women at risk of unplanned
pregnancies since the 1978 survey. The 1983 data indicate that mean parity was higher
for Indian women than for Ladino women at every age above 20. The mean parity for all
women in the 1983 survey is slightly less than that of women in the 1978 survey, but of
generally the same magnitude. Overall, the mean duration of breastfeeding estimated
from the 1983 survey is 18 months. Postpartum amenorrhea averages about 12 months
for all groups. A comparison of duration of breastfeeding for respondents in the 1978
survey with those in the 1983 survey provides no evidence of a trend away from
breastfeeding in Guatemala. Overall, 1/4 of married women aged 15-44 were using
contraceptive methods at the time of the 1983 survey. The most prevalent method was
female sterilization (10%), which, together with male sterilization, accounted for 45% of
all contraceptive use. The 2nd most commonly used method, oral contraceptives, had a
relatively low prevalence of 5%, followed by rhythm, the IUD, injectables and vaginal
methods, and finally, the condom. Contraceptive use also varied by age, reaching a peak
 among married women 30-39 years old and was lowest for those 15-24. Use of
contraception was strongly related to education, being lowest among women with little
or formal education. Results in general suggest that contraceptive use is part of a larger
predisposition among women to use modern health care. Among Indians, the major
reason given for nonuse of contraceptives unrelated to pregnancy was lack of
knowledge of contraception or where to obtain family planning services. Among
Ladinos, the most frequently mentioned reason was fear of contraception or fear of side
effects. The methods of choice for nonusers desiring to use a method were oral
contraceptives (27%), sterilization (18%) and injectables (14%). The survey data indicate
that the family planning program in Guatemala should be oriented toward high parity,
married, nonworking women living in the interior, both Ladino and Indian, who have less
than a primary school education. Family planning efforts need to incorporate different
approaches for Ladino and Indian women.

PubMed Disclaimer

Monteith RS, Anderson JE, Pineda MA, Santiso R, Oberle M. Contraceptive use and
fertility in Guatemala. Stud Fam Plann. 1985 Sep-Oct;16(5):279-88. PMID: 4060213.]

9Family planning in Jordan: 1983 survey data

A Abdel-Aziz, J E Anderson, L Morris, P Wingo, B Shrydeh

 PMID: 3750361

Abstract

Data from the 1983 fertility survey in Jordan indicate that 26 percent of married women
were using contraceptives, reflecting a very small relative increase in use in the seven
years before the survey. Only 5 percent of nonusers stated that they desired to use a
method. Other data from the same survey suggest a potential demand for
contraception, for spacing as well as limiting births, among those not using. For
example, many recent pregnancies were reported to be unplanned. Also, among
nonusers who did not desire to use a method, many stated they did not desire to
become pregnant, yet were exposed to the risk of pregnancy. A pool of potential users
exists who can be considered in need of contraception (i.e., fecund, not pregnant or
desiring pregnancy, and not using contraceptives)--20 percent of all currently married,
childbearing-age women--who may become contraceptive users as attitudes toward
contraception change.
 PIP: The 1983 Jordan Fertility and Family Health Survey (JFFHS) utilized a sample of
6,068 housing units. Interviewing took place between August and October 1983. A total
of 3939 individual interviews was obtained. The individual questionnaire was addressed
to ever-married women aged 15-49, for information on a number of subjects, including
health and immunization status of children, symptoms exhibited by children who had
died, infant feeding practices, use of maternal and child health services, family planning,
and a complete birth history. 26% of married women were using contraceptives,
reflecting a very small relative increase in use in the 7 years before the survey. Only 5%
of nonusers stated that they desired to use a method. Other data from the same survey
suggest a potential demand for contraception, for spacing as well as limiting births,
among those not using contraceptives. Many recent pregnancies were reported to be
unplanned. Among nonusers who did not desire to use a method, many stated they did
not desire to become pregnant, yet were exposed to the risk of pregnancy. A pool of
potential users exists who can be considered in need of contraception--20% of all
currently married, childbearing-age women--who may become contraceptive users as
attitudes toward contraception change. For the most part, contraceptive supplies and
services are not obtained from government or other public programs in Jordan. Most
users receive supplies and services from private physicians, pharmacies, or rely on
methods such as rhythm or withdrawal. Contraception is available in public hospitals,
but is not actively promoted. Jordan's very short birth intervals apparently result from
modest levels of both contraceptive use and breastfeeding.

Abdel-Aziz A, Anderson JE, Morris L, Wingo P, Shrydeh B. Family planning in Jordan:

1983 survey data. Stud Fam Plann. 1986 Jul-Aug;17(4):199-206. PMID: 3750361.

10Contraception among adolescents in Bangladesh

M M Islam, M Mahmud

 PMID: 12319482

Abstract

PIP: Data from the 1989 Bangladesh Fertility Survey were used to investigate the
contraceptive behavior of married adolescents (age range: 10-19 years) in comparison
with that of married adults. Marriage occurs at an early age in Bangladesh and is almost
universal. Thus, adolescent fertility contributes substantially to overall fertility. The
11,906 women interviewed included 1922 (16.1%) adolescents. Knowledge of family
planning (FP) was almost universal among both groups, with specific knowledge about
methods slightly lower among adolescents. Ever use of a method was reported by 26.3%
 of the adolescents and 48.4% of the adults. The contraceptive prevalence rate was 15.3%
among adolescents (10.7% modern and 4.6% traditional methods) and 34.4% for adults
(10.5% female sterilization, 9.9% oral contraceptives, and 6.4% traditional methods).
Little difference was found in the attitudes towards contraceptives of adults and
adolescents. 83% of adolescents and 58% of adults indicated an intention to use a
method in the future. When attitudes about family size were indecisive, contraceptive
usage was very low. Logistic regression analysis revealed that increased education is the
most important factor having a positive effect on the contraceptive use rate for
adolescents, followed by participating in family decision-making, frequency of visits by
FP workers, region of residence, husband's occupation, and availability of electricity in
the household. The policy implication of these findings are that as women's status
improves with increased opportunities for education and employment, they will find
ways to meet their contraceptive needs. Also, the popularity of traditional methods
could be exploited by program managers, since traditional methods can be effective if
taught properly and used consistently. Adolescents need to become aware of the
negative consequences of early marriage, early pregnancy, and large family size, they
need information on the availability of FP methods and their use-effectiveness, they
need improved reproductive health care services which are readily available, and they
would benefit from programs designed to overcome the resistance of older family
members and husbands to FP.

PubMed Disclaimer

Islam MM, Mahmud M. Contraception among adolescents in Bangladesh. Asia Pac

Popul J. 1995 Mar;10(1):21-38. PMID: 12319482.

Fertility and contraceptive adoption and discontinuation in rural Kenya

A G Ferguson 1

Affiliations expand

 PMID: 1412598

Abstract

After a long period of slow progress, the recent uptake of contraceptive use in Kenya
has been dramatic. This report describes adoption of a method and method switching
and discontinuation among a cohort of married women aged 25-34 in two contrasting
rural areas. A retrospective "fertility diary" completed by each woman provided
information on spousal separation, reproductive status, and contraceptive use over a
period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both
areas, with significant net adoption of injectables in both areas and of IUDs in one only.
Method discontinuation was concentrated among users of pills, barrier methods, and
"natural" methods, and only one-third of all discontinuations were voluntary. The wide
differences between the two rural areas in contraceptive prevalence were not totally
reflected in recent fertility levels, and the contribution of other proximate determinants
of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.

PIP: In Kenya, researchers compared data on 377 25-34 year old women in rural Kisa
with data on 338 such women in rural Ena to determine changes in contraceptive
adoption, method switching, and method discontinuation and to examine the effects of
contraceptive use of fertility in relation to other determinants of fertility. Contraceptive
prevalence rose between 1987 and 1990 in both areas. It rose somewhat more quickly
and was greater in Ena than Kisa (35-50% vs. 12-20%). Similarly more women had ever
used a method in Ena than Kisa (76% vs. 35.5%). Women in Ena were more likely to use
natural methods than those in Kisa (77 episodes vs. 11 episodes). Adoption of
injectables was the contraceptive which showed the strongest net growth in both areas.
In Ena, adoption of the IUD also grew considerably. The contraceptive mix in Ena was
more balanced than it was in Kisa. In Ena, natural method users had fallen. The 3 main
methods were oral contraceptives (OCs), injectables, and IUDs. Injectables and OCs
predominated in Kisa. Few women used natural methods. Tubal ligation increased
among high parity women. Few women in either area used condoms. OCs, barrier
methods, and natural methods were used for short-term birth spacing. The major
reasons for discontinuation were wanting another child (34.3%) and method
failure/poor compliance (30.2%). Considerable male out-migration from Kisa (58% vs.
21% for Ena) and high infertility levels (untreated sexually transmitted diseases
transferred to wives from husbands who had out-migrated) may have kept fertility levels
relatively low. Most husbands had returned to Kisa during the Christmas holiday (80% of
couples together) resulting in birth seasonality with peaks in September-October.
Postpartum amenorrhea played a greater role in protecting women against pregnancy
in Kisa than it did in Ena (51% vs. 35%). Women of Kisa had higher number of live births
and age at 1st birth than women in Ena (4.4 vs. 3.6 and 18.6 vs. 19.8, respectively, p.001),
especially simultaneous postpartum amenorrhea and separation (15% vs. 2%).

PubMed Disclaimer

Ferguson AG. Fertility and contraceptive adoption and discontinuation in rural Kenya.
Stud Fam Plann. 1992 Jul-Aug;23(4):257-67. PMID: 1412598.
 11Factors affecting unmet need for contraception among currently married
fecund young women in Bangladesh
Ahmed Zohirul Islam 1, Md Golam Mostofa 1, Mohammad Amirul Islam 2 3

Affiliations expand

 PMID: 27676285

 DOI: 10.1080/13625187.2016.1234034

Abstract

Objectives: The aim of our study was to explore the factors associated with unmet need
for contraception among currently married fecund women under age 25, in Bangladesh.

Methods: This study utilised a cross-sectional data (n = 4982) extracted from the
Bangladesh Demographic and Health Survey (BDHS) 2011. Multinomial logistic
regression was used to identify the determinants of unmet need for contraception
among currently married fecund young women.

Results: The unmet need for contraception was 17% and contraceptive prevalence was
54% in this young group. Total demand for contraception was 71% and the proportion
of demand satisfied was 77%. The results suggest that region, place of residence,
religion, husband's desire for children, visits of FP workers, decision-making power on
child health care, reading about FP in newspaper/magazine and number of births in
three years preceding the survey were significant predictors of unmet need for
contraception.

Conclusions: The BDHS of 2011 found that unmet need for contraception among
currently married, fecund women under 25 years old is higher than the national level,
and hence different or more intensive programme initiatives are required for them than
for older women. The present study identifies important predictors of unmet need for
contraception among fecund married Bangladeshi women under age 25.

Keywords: Bangladesh; Unmet need; contraception; contraceptive demand; family

planning; multinomial logistic regression.
 Islam AZ, Mostofa MG, Islam MA. Factors affecting unmet need for contraception
among currently married fecund young women in Bangladesh. Eur J Contracept Reprod
Health Care. 2016 Dec;21(6):443-448. doi: 10.1080/13625187.2016.1234034. Epub 2016
Sep 27. PMID: 27676285.

12Determinants of contraceptive knowledge and family planning services in

Bangladesh
A J Sufian

 PMID: 12286603

Abstract

PIP: A multivariate analysis and logistic regression of data from the 1983 Bangladesh
contraceptive Prevalence Survey was conducted to determine factors associated with
contraceptive knowledge and family planning services. The analysis was limited to
currently married women. When the researcher controlled for other independent
variables, the factors which had a significant positive relationship with knowledge of
modern contraceptives were as expected: education (unstandardized coefficient = 1.39),
urban residence (1.15), current use (1.14), employment (0.45), and land ownership (0.23)
(p .001 for all variables). Unexpectedly, women visited by family planning workers knew
fewer modern contraceptive methods than those not visited by them (-0.16; p .001).
Muslim women knew more modern contraceptive methods than did non-Muslim
women (0.15; p .05). Standarized coefficients indicated that a change in educational
status would effect the greatest positive change in number of methods known by source
(0.27) followed by urban residence (0.2). Religion (0.02) would least effect change. The
computed probability of a women being visited by a family planning worker was close
to the actual percentage that were visited (about 30%). The logistic regression showed
that age, land tenure, education, religion, employment status, and number of deceased
children did not significantly affect the probability of being visited by a family planning
worker. The significant variables affecting probability of being visited by a family
planning worker were urban residence (coefficient = 0.53), number of methods
spontaneously mentioned or knowledge of greater number of methods with source
(0.52 and 0.2, respectively), current contraceptive use (-0.21), and family size (-.005).
these findings suggest that education and urban-rural residence variables require more
research than other variables which have been accorded much research (e.g.,
employment status, religion, land tenure).
 Sufian AJ. Determinants of contraceptive knowledge and family planning services in
Bangladesh. Genus. 1992 Jul-Dec;48(3-4):119-28. PMID: 12286603.

13Barriers to contraceptive use among women in Benin

Sophia Chae 1, Vanessa Woog 1, Cyprien Zinsou 2, Megan Wilson 2

Affiliations expand

 PMID: 26702466

Abstract

The Republic of Benin has made it a national priority to promote family planning as part
of its efforts to reduce maternal and child mortality rates. In addition to preventing
deaths, increased contraceptive use would help women and families achieve their
desired number of children and have greater control over timing births. It would also
help Benin meet its development goals, including reducing poverty and increasing
women's education and earning levels, children's schooling and GDP per capita. Key
Points. (1) Although Benin's government promotes family planning, more needs to be
done to meet the country's goal of increasing contraceptive prevalence to 20% by 2018.
(2) As of 2012, modern contraceptive use remains low. Only 7% of married women and
23% of unmarried sexually active women use modern methods. (3) Unmet need has
increased since 2006, from 27% to 33% among married women and from 35% to 50%
among sexually active unmarried women. (4) Among married women with unmet need,
the most commonly cited reasons for contraceptive nonuse are fear of side
effects/health concerns (22%) and opposition to use (22%). In contrast, never-married
women with unmet need cite not being married (42%), infrequent or no sex (21%) and
fear of side effects/health concerns (17%). (5) Among women currently using
sterilization, IUDs, implants, injectables or the pill, 57% report having been told about
side effects when they received their method; 88% of those who were told about side
effects were given instructions on how to deal with them. (6) Strategies to increase
contraceptive use include improving the availability and quality of contraceptive
services, increasing knowledge of family planning, and addressing social and cultural
barriers to contraception.

Chae S, Woog V, Zinsou C, Wilson M. Barriers to contraceptive use among women in

Benin. Issues Brief (Alan Guttmacher Inst). 2015:1-22. PMID: 26702466.
 14Young, low-parity women: critical target group for family planning in
Bangladesh
M Alauddin, M Vanlandingham

 PMID: 12315771

Abstract

PIP: After years of persistent low levels, contraceptive prevalence in Bangladesh is

beginning to rise, although slowly. Much of the increase in contraceptive prevalence in
recent years is attributable to higher rates of acceptance among relatively older, high-
parity couples. While rather high increases in contraceptive prevalence have been
achieved for women with 3 or more living children, the gain for families with 2 or fewer
living children have not been impressive. The importance of targeting young, low-parity
couples for family planning services cannot be overemphasized. Women 15-24 years old
make up 44% of all women of reproductive age. Also, there are large cohorts of girls just
below reproductive age that will soon begin having children. Recent studies show a
surprisingly high demand for contraception among younger couples. A complete
registration of eligible couples in each fieldworker's area must be completed.
Fieldworker and supervisor training must be adapted to focus on this target group. The
provision of maternal-child health services becomes increasingly important as more
young couples are brought into the program. Temporary birth control methods should
make up a larger proportion of the country's method-mix target. The current family
planning media campaign should highlight the health benefits for mother and child of
family planning used for spacing. The government should continue to promote the
small family norm. More effort should be made to influence community and religious
leaders and men in general. Immunization and other child survival activities should be
intensified.

Alauddin M, Vanlandingham M. Young, low-parity women: critical target group for

family planning in Bangladesh. Asia Pac Popul J. 1989 Mar;4(1):49-58. PMID: 12315771.

15Men in Bangladesh play a role in family planning

S B Ahsan

 PMID: 12317723

Abstract
 PIP: More and more men are convincing their wives to use family planning in
Bangladesh. In this conservative, Moslem country, women are not allowed to leave the
homes so husbands must go to buy methods especially rural areas. 70% of women who
use oral contraceptives (OCs), IUDs, or condoms report that their husbands obtain these
method for them. many couples are poor peasants. Contraceptive prevalence is not
23.2%. Female sterilization and OCs are the 2 most popular methods (9% each) followed
by condoms (2%), IUD (1.7%), and vasectomy (1.5%). The total fertility rate is 4.8 which is
higher than the goal of 3.5 Bangladesh hoped to reach by 1995. In 1975, 30% of women
believed fate determines family size but now only 8% think that. Attitude changes about
family size have occurred despite illiteracy and poverty. Traditional religious beliefs are
still prevalent in rural areas making it difficult for wives to speak to their husbands about
family planning. Husband-wife communication is more open among urban, middle class
couples. The long lasting hormonal implant, Norplant, holds promise as a means for
Bangladesh to reach its goal. About 4500 women now have Norplant and government
and nongovernment clinics plan to insert it into around 20,000 more women. A study of
2586 potential acceptors of Norplant at family clinics in Bangladesh 3 other developing
countries shows that counseling diminishes the anxiety women and their husbands
experience about Norplant and its side effects. A study in Bangladesh reveals higher
continuation rates of Norplant for women whose husbands underwent counseling than
for those whose husbands did not undergo counseling. Family planning advertisements
on the radio, TV, and in newspapers have convinced couples to use family planning, but
the advertisements tend to not explaining how to use family planning. Men are key to
the changes in attitude about family planning in Bangladesh.

Ahsan SB. Men in Bangladesh play a role in family planning. Netw Res Triangle Park N C.
1992 Aug;13(1):18-9. PMID: 12317723.

16Rapid Contraceptive Uptake and Changing Method Mix With High Use of
Long-Acting Reversible Contraceptives in Crisis-Affected Populations in
Chad and the Democratic Republic of the Congo
Jesse Rattan 1, Elizabeth Noznesky 2, Dora Ward Curry 2, Christine Galavotti 2, Shuyuan
Hwang 3, Mariela Rodriguez 2

Affiliations expand

 PMID: 27540125

 PMCID: PMC4990162
 DOI: 10.9745/GHSP-D-15-00315

Abstract

The global health community has recognized that expanding the contraceptive method
mix is a programmatic imperative since (1) one-third of unintended pregnancies are due
to method failure or discontinuation, and (2) the addition of a new method to the
existing mix tends to increase total contraceptive use. Since July 2011, CARE has been
implementing the Supporting Access to Family Planning and Post-Abortion Care
(SAFPAC) initiative to increase the availability, quality, and use of contraception, with a
particular focus on highly effective and long-acting reversible methods-intrauterine
devices (IUDs) and implants-in crisis-affected settings in Chad and the Democratic
Republic of the Congo (DRC). This initiative supports government health systems at
primary and referral levels to provide a wide range of contraceptive services to people
affected by conflict and/or displacement. Before the initiative, long-acting reversible
methods were either unknown or unavailable in the intervention areas. However, as
soon as trained providers were in place, we noted a dramatic and sustained increase in
new users of all contraceptive methods, especially implants, with total new clients
reaching 82,855, or 32% of the estimated number of women of reproductive age in the
respective catchment areas in both countries, at the end of the fourth year. Demand for
implants was very strong in the first 6 months after provider training. During this time,
implants consistently accounted for more than 50% of the method mix, reaching as high
as 89% in Chad and 74% in DRC. To ensure that all clients were getting the
contraceptive method of their choice, we conducted a series of discussions and sought
feedback from different stakeholders in order to modify program strategies. Key
program modifications included more focused communication in mass media,
community, and interpersonal channels about the benefits of IUDs while reinforcing the
wide range of methods available and refresher training for providers on how to insert
IUDs to strengthen their competence and confidence. Over time, we noted a gradual
redistribution of the method mix in parallel with vigorous continued family planning
uptake. This experience suggests that analyzing method mix can be helpful for
designing program strategies and that expanding method choice can accelerate
satisfying demand, especially in environments with high unmet need for contraception.

Rattan J, Noznesky E, Curry DW, Galavotti C, Hwang S, Rodriguez M. Rapid

Contraceptive Uptake and Changing Method Mix With High Use of Long-Acting
Reversible Contraceptives in Crisis-Affected Populations in Chad and the Democratic
Republic of the Congo. Glob Health Sci Pract. 2016 Aug 18;4 Suppl 2(Suppl 2):S5-S20.
doi: 10.9745/GHSP-D-15-00315. PMID: 27540125; PMCID: PMC4990162.
 17Fertility and its proximate determinants in Bangladesh: evidence from
the 1993/94 Demographic and Health Survey
M M Islam, A Al Mamun, R Bairagi

 PMID: 12321906

Abstract

PIP: This study examined determinants of fertility in Bangladesh. Data were obtained
from the 1993-94 Bangladesh Demographic and Health Survey among a nationally
representative 2-stage sample of 9640 ever-married females aged 10-49 years. Findings
indicate that the age-specific marital fertility rate was highest among women aged 15-
19 years. The total fertility rate was 3.44 births/woman in 1993-94 and 5.12
births/woman in 1989. The interval between marriage and first birth declined more for
younger cohorts. The proportion of women who had a child within 5 years increased.
Over 60% were married under the age of 14 years. The proportion currently married has
remained stable since 1981. The number of those never married has increased,
especially among women aged 15-19 years. 44.6% of currently married women used
family planning; 36.2% used modern methods and 8.4% used traditional ones.
Prevalence was highest for the pill, followed by female sterilization. 48% of infants were
breast-fed on the first day. Breast-feeding duration averaged 30 months. Duration of
postpartum amenorrhea averaged 12 months. 0.5% reported induced abortion. Analysis
of proximate determinants indicates that contraception accounted for 39.0% of fertility
decline; lactational infecundability accounted for 34.7%. Marriage patterns accounted
for 23.9%. The fertility inhibition of contraception varied by religion. Contraception had
the highest impact among higher educated, upper class, urban, and non-Muslim
women. Lactational infecundability had the highest impact among poor, nonworking,
illiterate, and non-Muslim women.

Islam MM, Al Mamun A, Bairagi R. Fertility and its proximate determinants in

Bangladesh: evidence from the 1993/94 Demographic and Health Survey. Asia Pac Popul
J. 1998 Sep;13(3):3-22. PMID: 12321906.

18Contraceptive prevalence among adolescent married women in rural

Bangladesh
S Ahmed 1, S Nahar

Affiliations expand

 PMID: 18285730
 Abstract

Although contraceptive prevalence rate (CPR) has increased over the last decade it has
not yet reached the desired level. This cross sectional study aimed at exploring the
current use of the modern methods of contraception and some related issues among
the adolescent married girls residing in two rural areas of Faridpur district. A total of 426
girls were interviewed. The mean age of marriage was found to be 15.5+/-1.5 years
among the respondents and 57.5% of them had secondary level education. Majority of
the women (97.7%) were housewives and 41% of the households had a monthly income
of Taka. 2001-4000. It was found that only 41% of the couples were currently practicing
a modern method of contraception, oral pill being the most popular method (69.9%). In
seventy one percent of the respondents, husband and wife jointly took the decision
regarding contraceptive use. The main reasons for use were for spacing purpose (50.3%)
and for delaying of first pregnancy (42.2%). Increasing female literacy rate, improving
their socio economic condition and providing family planning services at the doorstep
could help in improving the situation.

Ahmed S, Nahar S. Contraceptive prevalence among adolescent married women in rural

Bangladesh. Mymensingh Med J. 2008 Jan;17(1):42-5. PMID: 18285730.

19Factors associated with contraceptive practices of married women in

Bangladesh with respect to their employment status
M S Laskar 1, M H Mahbub, Kenjiro Yokoyama, Masaiwa Inoue, Noriaki Harada

Affiliations expand

 PMID: 17056454

 DOI: 10.1080/13625180600759854

Abstract

Objective: There might be a difference between non-working and working women in

their perception of rights and privileges which may influence their contraceptive
behavior. The purpose of this study was to examine contraceptive behavior among non-
working and working women in Bangladesh determining associated factors.

Method: Analysis was based on data from the 1999-2000 Bangladesh Demographic and
Health Survey which employs nationally representative sample.
 Results: The prevalence of current contraceptive use (any method) was 58.2% among
non-working women and 65.5% among working women. Both rates are still low for the
country. Some factors, such as discussed family planning with husband, husband
approves family planning, desire for more children, and husband lives together, were
influential determinants of lower contraceptive prevalence among the non-working
women.

Conclusion: The results indicate a necessity for social activities promoting husband-wife
communication and women's participation in employment to enhance the use of
contraceptives among Bangladeshi women, especially non-working women.

Laskar MS, Mahbub MH, Yokoyama K, Inoue M, Harada N. Factors associated with
contraceptive practices of married women in Bangladesh with respect to their
employment status. Eur J Contracept Reprod Health Care. 2006 Sep;11(3):220-7. doi:
10.1080/13625180600759854. PMID: 17056454.

20 Unmet contraceptive need in Bangladesh: evidence from the 1993/94

and 1996/97 Demographic and Health Surveys
Barkat-e-khuda, N C Roy, D M Rahman

 PMID: 12349402

Abstract

PIP: Unmet contraceptive need is defined as the percentage of currently married

women in their reproductive ages who do not want additional children and yet do not
practice contraception. This analysis examined the extent of unmet need in Bangladesh
and differentials in unmet need by selected characteristics of the respondents. Data
were obtained from the 1993-94 and 1996-97 Bangladesh Demographic and Health
Surveys (BDHS), which employed nationally representative, two-stage samples of 8842
(7510 rural ad 1332 urban) and 8306 (6995 rural and 1311 urban) currently married
women of reproductive age. In this analysis, the dependent variable "unmet need"
includes pregnant women whose pregnancy was mistimed, amenorrheic women whose
last birth was mistimed, and women who were neither pregnant nor amenorrheic and
who were not using any method of family planning. In addition, several independent
variables were also considered in the analysis. According to the BDHS data, 1 out of
every 6 women in Bangladesh has an unmet need--8% each for spacing and limiting the
birth of children. The extent of unmet need was found to be higher in rural than in
urban areas, and was higher in Sylhet and Chittagong divisions compared to the
country's other divisions. The main predictors of unmet need were found to be ever use
 of family planning, husband-wife communication on family planning matters, number of
living children, and place of residence. Furthermore, unmet need was slightly lower
among women with some secondary schooling than among those with little or no
education.

Barkat-e-khuda, Roy NC, Rahman DM. Unmet contraceptive need in Bangladesh:

evidence from the 1993/94 and 1996/97 Demographic and Health Surveys. Asia Pac
Popul J. 1999 Jun;14(2):37-50. PMID: 12349402.

21Trends in contraceptive use and determinants of choice in China: 1980-

2010
Cuntong Wang 1

Affiliations collapse

Affiliation
1
 School of Social Development, Central University of Finance and Economics, Beijing, China.
wctpku@gmail.com

 PMID: 22176789

 DOI: 10.1016/j.contraception.2011.10.014

Abstract

Background: In China, contraception is the most commonly used practice adopted by

couples seeking to limit their number of children and to determine the time interval
between births. Since 1980, the implementation of mandatory contraceptive strategy
has reduced the fertility rate. Using large-scale data from national statistics and
nationally representative sample surveys, the current study aims to assess Chinese
trends in contraceptive use and determinants of choice from 1980 to 2010 among
married women and men aged 20-49 years.

Study design: Since 1980, national data on contraceptive methods utilization have been
gathered by the National Population and Family Planning Commission of the People's
Republic of China (NPFPC). Additionally, data from three roughly representative
decennial samples (1988, 1997, 2006) of Chinese women of aged 20 to 57 years have
been gathered by the NPFPC through the National Family Planning and Reproductive
Health Surveys in China.
 Results: A relatively stable Chinese mode of contraception has been established and
maintained since the 1980s. This is characterized by long-term contraceptive use which
is still dominant in current China. In addition, China's total contraceptive prevalence
rates remain at the highest level across the globe from 1980 to 2010. However, the
overall method composition of contraceptive use within China has changed since the
mid-1990s. Over the study period, the prevalence rate of sterilization increased from
30.21% in 1980 to 46.47% of married women of reproductive age (20-49 years) in 1994
and then declined to 31.7% in 2010. At the same time, intrauterine device usage
increased (39.83% in 1980 to 48.15% in 2010), as did oral contraception (0.3% in 1980 to
0.98% in 2010) and condom usage (2.35% in 1980 to 9.32% in 2010). The results from
the multinomial logit model show that an individual's contraceptive choice depends not
only on individual characteristics, including ethnicity, age, education level, household
registration, region, number of living children and sex of the last living child, but also on
the strength of family planning policies. A positive coefficient indicates that the looser
the strength of family planning policies is, the more likely the individual is to choose
condoms or another short-term contraceptive method.

Conclusions: Long-term contraceptive use is still dominant in China. In fact, over the
30-year period (1980-2010) and in comparative world perspective, China continues to
have the highest total contraceptive prevalence rate. Additionally, an individual's
contraceptive choice is jointly influenced by the strength of family planning policies and
individual characteristics.

Wang C. Trends in contraceptive use and determinants of choice in China: 1980-2010.

Contraception. 2012 Jun;85(6):570-9. doi: 10.1016/j.contraception.2011.10.014. Epub
2011 Dec 15. PMID: 22176789.

22Some observations on marriage, contraception and fertility in

Bangladesh
M N Islam, S Abedin

 PMID: 12347417

Abstract

PIP: Data from the 1983, 1986, 1989, and 1991 Bangladesh Contraceptive Prevalence
Survey are used to examine the trends in marriage patterns and to evaluate the impact
of contraception and marriage on fertility. Coale's nuptiality model is used to analyze
the pace of marriage, the proportion married, and the marriage age and the impact on
fertility. Bongaarts' model is used to evaluate the contribution of marriage and
 contraception to the total fertility rate (TFR). Findings indicate that TFR declined from
6.08 children/woman in 1983 to 4.63 children/woman in 1991: a decline of 24% in 8
years. Total marital fertility declined by 20.6% in 8 years. The contraceptive prevalence
rate increased about 21% in 8 years to 39.9%. The proportions of single women aged
15-19 years and 20-24 years increased greatly to 46.7% and 12.3%, respectively, in 1991.
Marriage has remained universal. The tempo of marriage increased about 24% in 8 years
to 0.58 in 1991. Over time, the tempo of marriage slowed, and the marriage age span
increased and did so with greater intensity during 1989-91. The marriage age span
increased from 18.80 years to 23.20 years during 1983-91. The age of spinsterhood
increased to 35 years. Findings from Bongaarts' and Coale's models show that
reductions in total fertility were much more a result of changes in marital reproductive
behavior and the use of contraception than the change in the marriage pattern. These
two indices reduced fertility by 32.8% in 1983 and 51.5% in 1991.

Islam MN, Abedin S. Some observations on marriage, contraception and fertility in

Bangladesh. Genus. 1996 Jan-Jun;52(1-2):201-7. PMID: 12347417.

23The long-term demographic role of community-based family planning in

rural Bangladesh
J F Phillips 1, M B Hossain, M Arends-Kuenning

Affiliations expand

 PMID: 8875733

Abstract

Experimental studies demonstrating the effectiveness of nonclinical distribution of

contraceptives are typically conducted in settings where contraceptive use is low and
unmet need is extensive. Determining the long-term role of active outreach programs
after initial demand is met represents an increasingly important policy issue in Asia,
where contraceptive prevalence is high and fixed service points are conveniently
available. This article examines the long-term rationale for household family planning in
Bangladesh-where growing use of contraceptives, rapid fertility decline, and normative
change in reproductive preferences are in progress, bringing into question the rationale
for large-scale deployment of paid outreach workers. Longitudinal data are analyzed
that record outreach encounters and contraceptive use dynamics in a large rural
population. Findings demonstrate that outreach has a continuing impact on program
effectiveness, even after a decade of household visitation. The policy implications of this
finding are reviewed.
 PIP: Longitudinal data were analyzed to determine the long-term impact of community-
based distribution of contraception in rural Bangladesh. Since 1978, the Family Welfare
Assistant initiative has grown to involve more than 40,000 nonclinical outreach workers
and supervisors. Debate has focused on the sheer scope of this undertaking and on its
potential, permanent impact on demographic transition, especially with the advent of
less expensive supply depots, satellite clinics, and social marketing outlets that now
blanket the country. This study provides an analytical framework for interpreting the
long-term role of service outreach as a determinant of contraceptive use. The framework
has pathways that connect to demographic, socioeconomic, and programmatic factors.
A typology is also developed to explain the interface of the costs of fertility regulation
and the demand for contraception. The Maternal and Child Health-Family Planning
Extension Project monitoring activities provided data for this analysis through a Sample
Registration System covering a 10-year period. A statistical model was developed to
analyze changes in the reproductive behavior and motives of 4236 respondents arising
from exposure to outreach activities. Results of the analysis indicate that 1) outreach
generates incremental contraceptive use that would not arise if underlying demand
were the sole determinant of use; 2) the outreach activities of male workers have no role
in maintaining use; 3) outreach continues to foster contraceptive use because of the
high frequency of encounters; 4) the outreach program is the single most important
component of program exposure in the study population; 5) outreach generates a small
but significant demand for contraception; and 6) sex preferences for offspring are
weakened, but not eliminated, by outreach. These results suggest that the outreach
program should be continued and that the male health assistant role should be revised
or phased-out. Without outreach, contraceptive prevalence would be 15 points lower
than the observed level of 40%. Even though outreach has a continuing demographic
role, this role should be reevaluated periodically, especially to determine how to employ
supporting communication strategies. These findings may also be extrapolated to
similar settings in other countries.

Phillips JF, Hossain MB, Arends-Kuenning M. The long-term demographic role of

community-based family planning in rural Bangladesh. Stud Fam Plann. 1996 Jul-
Aug;27(4):204-19. PMID: 8875733.

24Awareness of sexually transmitted disease among women and service

providers in rural Bangladesh
M A Khan 1, M Rahman, P A Khanam, Barkat-e-Khuda, T T Kane, A Ashraf

Affiliations expand

 PMID: 9363543
 DOI: 10.1258/0956462971919066

Abstract

Sexually transmitted disease (STD) in rural Bangladesh is currently a topic of great

concern. To date, little information is available in the literature regarding its prevalence.
It is now known, however, that the current level of STD awareness among the rural
population with regard to modes of transmission and means of prevention is
inadequate. In 1994, the MCH-FP Extension Project (Rural) of ICDDR, B surveyed 8674
married women of reproductive age (MWRA) in 4 rural thanas to examine their
awareness of STDs. The association between socio-demographic and programmatic
factors (variables which affect STD information availability) and awareness of STDs was
examined by both bivariate and multivariate analyses. Seven focus group discussions
were conducted among groups of government health and family planning workers and
paramedics to assess their knowledge of STDs and attitudes about their prevention.
Only 12% of the original group had even a basic understanding about STDs and how to
protect themselves from them. Twenty-five per cent of the women surveyed had ever
heard of either syphilis or gonorrhoea. Of these women, less than half could mention
specific mechanisms involved in the transmission of these diseases. Seven per cent
reported that syphilis and gonorrhoea are transmitted through sexual intercourse.
Thirteen per cent reported that the infections are transmitted from spouses to their
partners. Four per cent reported that STDs can be spread by having multiple sexual
partners. The results of logistic regression analysis indicate that awareness of STDs was
higher among relatively older women than among younger women. Awareness of STDs
was most strongly and positively associated with the education of both the women and
their husbands. Awareness of STDs was also found to be higher among women who
were more socially mobile (e.g. those who frequent cinemas or mothers' clubs). The
findings of focus group discussions indicate that family planning and health care service
providers have a moderate level of STD awareness. Modes of transmission and means of
prevention, however, were areas of weakness. It will, therefore, be necessary, whether to
prevent a potential STD epidemic or to combat current STD prevalence, to implement
culturally acceptable and affordable means of disseminating knowledge in rural areas of
Bangladesh. Training of health care providers will be an essential first step.

PIP: Both a 1994 survey of 8674 married women of reproductive age from four rural
thanas (Abhoynagar, Bagherpara, Keshobpur, and Sirajganj) of Bangladesh and focus
group discussions conducted among government health and family planning providers
in the same thanas revealed inadequate awareness of sexually transmitted diseases
(STDs) and their transmission. Only 12% of survey respondents were considered to have
 a basic understanding of STDs and how to protect themselves from infection. Even after
probing, only 25% of married women had ever heard of syphilis or gonorrhea; of these,
just half knew the mechanisms of disease transmission. In the logistic regression
analysis, awareness of STDs and their transmission was significantly associated with
older age, higher educational level, Muslim religion, attendance at a family health and
welfare center, current contraceptive use, and women's mobility outside the home.
Although service providers had moderate levels of STD knowledge, there were many
misconceptions (e.g., that STDs could be transmitted by wearing the clothes of an
infected person). Providers agreed couples should be counseled to use condoms and
avoid brothels. Awareness of AIDS was even lower than knowledge of syphilis and
gonorrhea among both married women and health care workers. Training of health care
providers is recommended as a first step in a national campaign aimed at disseminating
accurate, culturally acceptable knowledge about STDs throughout rural Bangladesh.

Khan MA, Rahman M, Khanam PA, Barkat-e-Khuda, Kane TT, Ashraf A. Awareness of
sexually transmitted disease among women and service providers in rural Bangladesh.
Int J STD AIDS. 1997 Nov;8(11):688-96. doi: 10.1258/0956462971919066. PMID: 9363543.

25Contraceptive failure, method-related discontinuation and resumption of

use: results from the 1995 National Survey of Family Growth
J Trussell 1, B Vaughan

Affiliations expand

 PMID: 10224544

Free article

Abstract

Context: Half of all pregnancies in the United States are unintended. Of these, half
occur to women who were practicing contraception in the month they conceived, and
others occur when couples stop use because they find their method difficult or
inconvenient to use.

Methods: Data from the 1995 National Survey of Family Growth were used to compute
life-table probabilities of contraceptive failure for reversible methods of contraception,
discontinuation of use for a method-related reason and resumption of contraceptive
use.
Results: Within one year of starting to use a reversible method of contraception, 9% of
women experience a contraceptive failure--7% of those using the pill, 9% of those
relying on the male condom and 19% of those practicing withdrawal. During a lifetime
of use of reversible methods, the typical woman will experience 1.8 contraceptive
failures. Overall, 31% of women discontinue use of a reversible contraceptive for a
method-related reason within six months of starting use, and 44% do so within 12
months; however, 68% resume use of a method within one month and 76% do so within
three months. Multivariate analyses show that the risk of contraceptive failure is
elevated among low-income women and Hispanic women. Low-income women are also
less likely than other women to resume contraceptive use after discontinuation.

Conclusions: The risks of pregnancy during typical use of reversible methods of

contraception are considerably higher than risks of failure during clinical trials, reflecting
imperfect use of these methods rather than lack of inherent efficacy. High rates of
method-related discontinuation probably reflect dissatisfaction with available methods.

PIP: This study computed life table probabilities of contraceptive failure, discontinuation
of use, and return to contraceptive use in the US. Data were obtained from the 1995
National Survey of Family Growth (NSFG) among a nationally representative sample of
6867 contraceptive use intervals contributed by women 15-45 years old who began use
or resumed use after discontinuation during 1991-95. Analysis was based on Kaplan-
Meier product-limit single decrement life table probability methods. Findings indicate
that the risk of failure during typical use of reversible methods was 9% within 1 year of
starting. Women with continuous lifetime use will experience 1.8 contraceptive failures.
Failure rates were 7% for the pill, 9% for the male condom, 8% for the diaphragm, 20%
for periodic abstinence, and 15% for spermicides. Failure rates reflect imperfect use. 31%
of women discontinued use within 6 months of starting use. 44% discontinued within 12
months. Women using reversible methods continuously will discontinue use nearly 10
times during the reproductive period. Most women resumed use shortly after
discontinuation. Low income women had higher risk of unintended pregnancy for all
methods and the pill and lower risk of resumption after discontinuation. Hispanics had a
higher risk of contraceptive failure for all methods and the condom. Black women had a
higher risk of discontinuation of oral pills and condoms.

Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and

resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann
Perspect. 1999 Mar-Apr;31(2):64-72, 93. PMID: 10224544.

26Contraceptive users in rural Bangladesh: a time trend analysis

S Bhatia
 PMID: 6836661

Abstract

An examination of the characteristics of contraceptive acceptors in a family planning

program in rural Bangladesh revealed trends of declining age and number of living
children among new acceptors. A time series analysis of the age-specific acceptance
rates confirmed the observation, indicating that over time the program succeeded in
attracting younger and low-parity women. The high use prevalence rates resulted in
fertility levels that were 25 percent lower in the program area than in the comparison
area. The decline in the fertility levels during the first program year was mainly due to a
large decline in fertility among women over age 35, but in the second year, the
contribution made by women 30-35 years old was substantial.

PIP: An examination of the characteristics of contraceptive acceptors in a family

planning program in rural Bangladesh reveals trends of declining age and numbers of
living children among new acceptors. A time series analysis of the age specific
acceptance rates confirms the observation, indicating that over time the program
succeeded in attracting younger and low parity women. The high use prevalence rates
resulted in fertility levels that were 25% lower in the program area than in the
comparison area. The decline in the fertility levels during the 1st program year was
mainly due to a large decline in fertility among women over age 35, but in the 2nd year,
the contribution made by women 30-35 years old was substantial. The family planning
program was sponsored by the International Centre for Diarrhoeal Disease Research in
70 villages of Matlab Thana beginning in 1977. Data for the analysis is drawn from a
survey of all married women of reproductive age (MWRA), 15-49 years, and from a
longitudinal record keeping system maintained by female village workers who visited
and recorded information on each MWRA fortnightly. In analyzing the data based on
husband's occupation, the survey reveals that at the start of the program all had low
contraceptive use levels; however, those in more skilled occupations and higher
socioeconomic levels showed greater initial acceptance rates. But as the program
developed, the use prevalence among the lower socioeconomic groups (boatmen,
cottage industry workers, unemployed, agricultural laborers) increased substantially,
indicating that the program was successful in catering to the needs of all socioeconomic
groups. 75% made the injectable contraceptive (DMPA) their method of choice; 50% of
the remainder chose the pill in the 1st year of the program. By the 2nd year, sterilization
was chosen by many of the previous DMPA users to make a total acceptance rate of
20%.

Bhatia S. Contraceptive users in rural Bangladesh: a time trend analysis. Stud Fam Plann.
1983 Jan;14(1):20-8. PMID: 6836661.
 27Contraceptive uses among married women in Bangladesh: a systematic
review and meta-analyses
Sorif Hossain 1, Tahmina Akter 2, Md Mohsin 3, Md Momin Islam 4, Promit Barua Chowdhury 5, Md
Mohsan Khudri 6

Affiliations expand

 PMID: 38233954

 PMCID: PMC10795415

 DOI: 10.1186/s41043-024-00502-w

Abstract

Background: Although Bangladesh's economy has shown significant improvement over

the past two decades, the high population growth rate has hindered development
efforts. This study aimed to review the prevalence of different contraceptive methods
used among women of reproductive age in Bangladesh, which could help control the
population growth rate.

Methods: We conducted an extensive literature review and meta-analysis of 82 articles,

identifying 20 articles for analysis. The analyses included heterogeneity and publication
bias in published papers.

Results: The pooled prevalence of various contraceptive methods was as follows:

condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices
(IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and
withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage,
while traditional methods constituted 8.79%. On average, only 1.95% of women opted
for the implant method. The overall prevalence of contraceptive method usage was
59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically
significant heterogeneity for all contraceptive methods used by women in Bangladesh.
The funnel plot and Egger's test showed no publication bias for any of the contraceptive
methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by
women in rural areas also showed publication bias (Z = -3.04, P = 0.0024).
 Conclusion: A renewed commitment from government bodies and independent
organizations is needed to implement and monitor family planning strategies to ensure
adherence to and provision of the most appropriate contraceptive method for couples.

Keywords: Bangladesh; Contraceptive use; Meta-analyses; Trends; Women.

Hossain S, Akter T, Mohsin M, Islam MM, Chowdhury PB, Khudri MM. Contraceptive uses
among married women in Bangladesh: a systematic review and meta-analyses. J Health
Popul Nutr. 2024 Jan 17;43(1):10. doi: 10.1186/s41043-024-00502-w. PMID: 38233954;
PMCID: PMC10795415.

28 Bangladesh: modern methods are well known but not widely used
No authors listed

 PMID: 12284771

Abstract

PIP: A follow-up to the 1985 Contraceptive Prevalence Survey, this 1988 study of
contraceptive use in Bangladesh revealed that although modern methods are well-
know, contraceptive prevalence is low. This study reinterviewed 2586 women living in
rural Bangladesh who had participated in the earlier survey. The study found a high level
of knowledge about modern contraception, with nearly 95% of the women able to
identify at least on modern method (94% mentioned oral contraceptives, 65% IUDs, 76%
condoms, 64% injectables, 89% female sterilization, and 74% male sterilization).
Concerning traditional family planning methods, only 40% could identify at least one.
Despite knowing about modern methods, most women did not identify the advantages
or disadvantages of the methods known, making informed choice problematic.
Additionally, only 21% of the women interviewed were actually using method at the
time of the survey. Contraceptive prevalence among women under 25 years of age and
among women with only one child were 2% and 10%, respectively. The study also found
that the level of the woman's education had a significant impact on her contraceptive
behavior, with 65% of women with 10 or more years of schooling using a method,
compared to 18% among women with no schooling. Among the women using
contraception, younger women opted for birth spacing methods, while older women
generally preferred sterilization. Over 90% of the women using contraception expressed
satisfaction with the method they were using. The report regards the high level of
contraceptive knowledge as a positive sign, adding that contraceptive prevalence could
be increased by bringing services closer to the user, having each women of reproductive
age visited by a family planning worker, and through careful follow-up.
 Bangladesh: modern methods are well known but not widely used. Prog Hum Reprod
Res. 1991;(19):1, 6-7. PMID: 12284771.

Rural-urban differential in contraceptive use status in Bangladesh

M M Uddin, M Kabir, S R Choudhury, T Ahmed, M R Bhuyan

 PMID: 12280829

Abstract

PIP: Data from the 1981 Contraceptive Prevalence Survey (CPS) in Bangladesh were
analyzed to identify and facilitate understanding of the factors responsible for urban-
rural differentials in contraceptive use. The information was collected from a nationally
representative sample of ever married women under 50 years. A 3-stage stratified
cluster sampling design was used. A total of 196 sample areas were considered of which
116 were rural and 80 urban. The total number of households in the sample was 7393 --
5455 rural and 1938 urban. 6269 rural and 2241 ever married eligible women were
interviewed. The level of knowledge of at least 1 traditional contraceptive method was
61% for urban and 55% for rural women. The level of ever use of any specific
contraceptive method was about 49% in urban and 34% in rural areas. The oral
contraceptive (OC) was the most popular method of contraception in both the urban
(26%) and in the rural (12.1%) areas. The popularity of other methods also varied
between urban and rural residents. The higher use of some specific methods in urban
areas possibly was a function of the greater avilability and accessibility of methods. The
percentage of women who have ever used contraception in urban areas ranged from
27.8% at the ages of 15-19 to 59.9% at the ages of 35-39. At the ages of 40-44, the
proportion of women who have ever used contraception declined by almost 14% from
ages 35-39 and by as much as 20% after 44. Women in rural areas also were found to
have ever used contraception at a lower rate than urban women at all age groups. In
general, younger and older married women were less likely to have ever used
contraception than women aged 20-39. In rural Bangladesh, more educated women and
women who were employed with cash payment were more likely than other women to
have ever used family planning. Women who never attended school were least likely to
practice family planning (34% in urban areas and 30% in rural areas). In the urban areas
more or less a U-shaped pattern was observed between the level of education and the
ever use rate. Differentials by employment status show that those who were not
employed had the highest use rate compared to those employed with or without cash.
The average number of methods ever used was 2.0 by urban women and 1.7 by rural
women. This difference may be explained in terms of accessibility and availability of
family planning methods. The rate of current users of any methods was estimated to be
 29.2% in the urban and 17.5% in the rural areas. The analysis shows that contraceptive
use was substantially higher in urban than in rural areas. The rural-urban differences
could be due in part to differences in educational attainment of the women in the 2
areas. Ever user rates have increased considerably in both areas compared to the 1979
CPS.

29Rural-urban differential in contraceptive use status in Bangladesh

M M Uddin, M Kabir, S R Choudhury, T Ahmed, M R Bhuyan

 PMID: 12280829

Abstract

PIP: Data from the 1981 Contraceptive Prevalence Survey (CPS) in Bangladesh were
analyzed to identify and facilitate understanding of the factors responsible for urban-
rural differentials in contraceptive use. The information was collected from a nationally
representative sample of ever married women under 50 years. A 3-stage stratified
cluster sampling design was used. A total of 196 sample areas were considered of which
116 were rural and 80 urban. The total number of households in the sample was 7393 --
5455 rural and 1938 urban. 6269 rural and 2241 ever married eligible women were
interviewed. The level of knowledge of at least 1 traditional contraceptive method was
61% for urban and 55% for rural women. The level of ever use of any specific
contraceptive method was about 49% in urban and 34% in rural areas. The oral
contraceptive (OC) was the most popular method of contraception in both the urban
(26%) and in the rural (12.1%) areas. The popularity of other methods also varied
between urban and rural residents. The higher use of some specific methods in urban
areas possibly was a function of the greater avilability and accessibility of methods. The
percentage of women who have ever used contraception in urban areas ranged from
27.8% at the ages of 15-19 to 59.9% at the ages of 35-39. At the ages of 40-44, the
proportion of women who have ever used contraception declined by almost 14% from
ages 35-39 and by as much as 20% after 44. Women in rural areas also were found to
have ever used contraception at a lower rate than urban women at all age groups. In
general, younger and older married women were less likely to have ever used
contraception than women aged 20-39. In rural Bangladesh, more educated women and
women who were employed with cash payment were more likely than other women to
have ever used family planning. Women who never attended school were least likely to
practice family planning (34% in urban areas and 30% in rural areas). In the urban areas
more or less a U-shaped pattern was observed between the level of education and the
ever use rate. Differentials by employment status show that those who were not
employed had the highest use rate compared to those employed with or without cash.
 The average number of methods ever used was 2.0 by urban women and 1.7 by rural
women. This difference may be explained in terms of accessibility and availability of
family planning methods. The rate of current users of any methods was estimated to be
29.2% in the urban and 17.5% in the rural areas. The analysis shows that contraceptive
use was substantially higher in urban than in rural areas. The rural-urban differences
could be due in part to differences in educational attainment of the women in the 2
areas. Ever user rates have increased considerably in both areas compared to the 1979
CPS.

Uddin MM, Kabir M, Choudhury SR, Ahmed T, Bhuyan MR. Rural-urban differential in
contraceptive use status in Bangladesh. Rural Demogr. 1985;12(1-2):1-20. PMID:
12280829.

30Trends and differentials in knowledge, ever use, current use, and future
intended use of contraceptives in rural Bangladesh: evidence from three
surveys
R Amin, A G Mariam, R Faruqee

 PMID: 12315187

Abstract

PIP: Data were drawn from 3 major surveys conducted between 1968-77 in Bangladesh
to examine the trends and differentials in knowledge, ever and current use of
contraception, and future intended use of contraception among the rural population.
Logit analysis was used to estimate net effects of socioeconomic and demographic
factors. Data utilized covered "currently married" women from the Impact of Family
Planning Survey (IFPS) (n = 2522), the World Fertility Survey (WFS) (n = 4117), and the
Rural Fertility and Poverty Survey of 1975 (RFPS) (n = 1247). Since the RFPS data were
from rural areas, they were compared with corresponding data from rural samples in the
IFPS and WFS. The diffusion pattern of knowledge, current and ever use, and future
intended use of contraceptives by parity and age of respondents in rural Bangladesh are
given for the years 1968-77. There was a steady increase in knowledge and practice of
family planning over the years. Knowledge of contraceptives increased from 63% in
1968 to about 94% in 1977. Current use also increased from 3.6% in 1968, 1975, and
1977, ever, current, and future intended users and knowledge of contraceptives tended
to be positively and moderately related to respondents' educational levels,
nonagricultural occupation, and number of living children. The same also was true of
educational levels of respondents' husbands. No consistent relationship was found
between these factors and ideal family size, but overall ideal family size declined
 somewhat by 1977, reflecting a change in family size preference that prevailed across
sociodemographic groups. No major sociodemographic differences in the rate of
change in ever, current, and future intended uses of contraceptives appeared to emerge
between 1968-77. Table 3 shows the net results of the multivariate analysis of the
dependent variables by logit regression technique. The most important variables
associated with ever, current, and future intended uses of contraceptives were parity and
education level of the respondents. In 1968, 1975, and 1977, individuals with more
children or with higher educational attainment were more likely to seek fertility
limitation measures, but the effect of living children seemed to have decreased over the
years. This declining coefficient of living children suggested more increases in
contraceptive use and future contraceptive intent among younger or lower-parity
mothers.

Amin R, Mariam AG, Faruqee R. Trends and differentials in knowledge, ever use, current
use, and future intended use of contraceptives in rural Bangladesh: evidence from three
surveys. Pak Dev Rev. 1987 Summer;26(2):201-14. PMID: 12315187.

31Labor force participation and fertility: a study of married women in

Bangladesh
M M Miah, A N Mizan

 PMID: 12317936

Abstract

PIP: Most researchers support the notion that a direct negative relationship exists
between married women's labor force participation and fertility behavior, yet female
employment shows no consistent, general relationship with declining fertility at
individual and societal levels. Specific conditions under which employment lowers
fertility are therefore explored for the case of Bangladesh. The economic, sociological,
and world-system theoretical approaches to the relationship and empirical studies in
developing countries including Bangladesh are reviewed. 1975-76 Bangladesh Fertility
Survey data on births, deaths, nuptiality, and family planning knowledge and practice for
5772 currently married women of 6513 ever married women under 50 sampled are
subjected to multivariate analysis for the study. Analysis revealed that women's modern
and traditional occupation as well as higher and secondary education significantly lower
their fertility, and that higher age, Islamic religion, use of modern contraceptives, and
husband's occupation in transitional and modern sectors have significant positive effects
on fertility. The correlation between higher fertility and contraceptive use may be due to
women's delay in practicing family planning until reaching desired parity and/or high
 infant mortality driving women to cease practice in order to replace lost offspring.
Future research should be conducted with larger samples and also consider occupations
of both husbands and wives. Societal attitudes about women's education should be
reformed in support of opening rural schools for women. With 90% of women residing
in rural areas and women with traditional occupations having lower fertility, more
traditional sector opportunities for women in cottage industry and agriculture
production are also recommended, and would help balance skewed urban growth and
hypertrophication of the tertiary sector. Finally, motivational efforts should be focused
upon encouraging younger instead of older married couples to limit fertility.

Miah MM, Mizan AN. Labor force participation and fertility: a study of married women in
Bangladesh. Int J Sociol Fam. 1992 Autumn;22(2):69-82. PMID: 12317936.

32[Women's behavior and knowledge concerning family planning in the

region of the Park Health Center]
[Article in Turkish]

F Ozyurda, M Durmusoglu

 PMID: 12159442

Abstract

PIP: 1390 women aged 15-44 were surveyed between February-June 1988 in the vicinity
of the Park Health Education Center by the Ankara University School of Medicine,
Department of Public Health. Within this sample, the survey focused on the knowledge,
attitude and behavior of the 1082 married women, regarding birth control. Birth control
pills, IUDs, and condoms were classified as effective modern birth control methods.
Other less effective traditional methods were classified as ineffective. Analysis of the
data indicated 74.2% of the subjects resort to some form of birth control while 66.2%
use an effective modern method. Age, education, work status, number of children and
type and location of housing influence family planning decisions. In general, the women
using birth control are primary school graduates aged between 25-39, living in urban
areas for at least 5 years. Most have 2 to 3 children and have had an abortion. The most
frequently used method of birth control is the IUD. It is notable that 29.5% use the
ineffective withdrawal method. 58.62% of the women who do not use birth control,
avoid family planning because of their husbands. These women have 2 or more children
and are illiterate or primary school graduates between the ages of 25-35 when they are
most likely to become pregnant. Family planning services should be geared towards
educating these families, especially the husbands. Education services should also target
 families using the withdrawal method and the 35-44 age group of women who show a
low percentage of contraceptive use.

Ozyurda F, Durmusoglu M. Park egitim saglik ocagi bolgesinde kadinlarin aile planlamasi
konusundaki bilgi, tutum ve davranislari [Women's behavior and knowledge concerning
family planning in the region of the Park Health Center]. Nufusbil Derg. 1989;11:61-75.
Turkish. PMID: 12159442.

33Kenya: many women know about contraceptives, but few use them
No authors listed

 PMID: 12284508

Abstract

PIP: The 1989 Kenya Demographic and Health Survey found women to be well informed
about contraceptive methods, yet Kenya's population growth rate is higher than India's
where contraceptive knowledge is less universal. 89% of women surveyed in Kenya knew
of at least 1 modern method. Contraceptives are, however, used less than one would
expect given such high levels of contraceptive awareness and knowledge. A study of
contraceptive use dynamics was, therefore, conducted different districts. A total 982
currently or ever-married women were interviewed. 81% knew of at least 1 method; with
highest awareness of the oral pill at 71.4%, and lowest for traditional methods at 3%.
Health workers and friends were identified as the most important information sources.
While a full 51% were pregnant at the time of the study, only 34% had ever used
contraceptives. Those opting to use selected contraceptives did do on the basis of
perceived ease and safety, as well as from health worker recommendations. Most
acceptors began with a contraceptive method shortly after bearing the 1st child. While
varied reasons were cited for switching methods, unavailability of the 1st was the most
common. Non-users offered a range of reasons including health problems, ignorance,
personal and familial opposition, religion, and fatalism, among others. Steps suggested
to increase the use of modern contraceptives include providing better and more
education, improving living standards, information/education/communication targeted
to illiterate women in rural areas, improving contraceptive supply and service quality,
and providing better advice to clients regarding method suitability.

Kenya: many women know about contraceptives, but few use them. Prog Hum Reprod
Res. 1991;(18):5-6. PMID: 12284508.
 34Knowledge regarding family planning methods among rural women of
Faridkot district of Punjab
H P Kaur

 PMID: 12286548

Abstract

PIP: A researcher analyzed data on 60 married women of reproductive age living in the
villages of Kaoni and Assa Buttar in Faridkot District, Punjab state, India, to determine
their knowledge levels of various aspects of family planning methods. 80% of the
women could neither read nor write. About half lived in an extended family, while the
rest lived in a nuclear family. All the women knew about family planning. The women
considered the purpose of family planning to be limiting family size (80%), spacing
children (53.3%), and preventing conception of children (33.3%). Indeed 40% used a
family planning method to space their children, 33.3% to limit family size, and 26.7% to
cease childbearing. The leading known methods included the copper T IUD (100%),
tubectomy (93.3%), vasectomy (86.6%), and condom (86.6%). 60% of the women and
13.2% of their husbands used a contraceptive. The major methods ever used were
tubectomy (46.6%), condom (26.6%), the loop IUD (13.6%), oral contraceptives (13.3%),
and the copper T IUD (13.3%). Friends and relatives constituted the most frequently
reported knowledge sources for all family planning methods except jelly, cream, and
diaphragm which none of the women knew about. Husbands tended to be the leading
information source about condoms. Authorities were not major contributors to these
rural women's family planning knowledge. All the women trusted family planning and
believed it to be good for their health. 86.6% thought it was also good for their
children's health and that it allowed parents to provide a better life for their children.
The main reasons for stopping family planning use were 1) wanted a child (20%), 2)
physical discomfort (13.3%), and 3) method failure (6.6%). The leading reasons for not
using a family planning method at all included 1) wanted a child (20%) 2) unhappy
marriage (13.3%), and 3) high cost (6.6%).

Kaur HP. Knowledge regarding family planning methods among rural women of
Faridkot district of Punjab. Indian J Behav. 1991 Jul;15(3):49-55. PMID: 12286548.

35Women and contraception in Mali. Individual will to practice in conflict

with a pronatalist environment]
[Article in French]

K Ignegongba
 PMID: 12282449

Abstract

PIP: The 1987 demographic and health survey (DHS) of Mali indicated that 29% of
women aged 15-49 knew of a modern contraceptive method and 36% knew of a
traditional method. Urban women as expected had higher rates of knowledge. 16.5% of
women reported they wanted no more children, 33% wanted a child in less than 2 years,
32.4% wanted to wait at least 2 years, and 9.3% wanted a child at some undetermined
future date. Women not wanting more children were as numerous in rural as in urban
areas and were evenly distributed in all regions of Mali. Ethnic differences were found in
the desire to terminate childbearing. Illiterate women wanted fewer children than those
with primary educations, but those with secondary or higher educations wanted much
smaller families. Although around 16% of women in rural as well as urban areas wanted
no more children, only 4% of urban and 2% of rural women wanting no more children
stated they intended to use contraception. 58-65% of women in various regions
expressed a need for contraception for spacing births, but very low percentages actually
intended to use a method. Social pressures from a profoundly pronatalist society appear
to hinder actual use of contraception. 2.3% of rural women and 11.6% of urban women
use modern contraception. The contraceptive user in Mali tends to be an educated
urban woman who wishes to space births that are already numerous.

Ignegongba K. Femmes et contraception au Mali. La volonte individuelle de pratiquer en

conflit avec un environnement pronataliste [Women and contraception in Mali.
Individual will to practice in conflict with a pronatalist environment]. Pop Sahel. 1989
May;(9):15-7. French. PMID: 12282449.

36[Prevalence of contraceptive use in Colombia: determinants and

implications]
[Article in Spanish]

L H Ochoa

 PMID: 12311014

Abstract

PIP: The principal findings of the National Contraceptive Prevalence Survey conducted
in Colombia in 1978 are presented. The report discusses the characteristics of the
sampled women; the levels of exposure to the risk of pregnancy and of contraceptive
use; methods used currently and changes since 1969; factors which contribute to
 contraceptive use, including sources of service and information, knowledge of methods,
regional differences in the desire for additional children, and patterns of limitation and
spacing; current fertility levels and recent changes; and policy implications of the
unsatisfied demand for family planning in Colombia. Of each 100 women of fertile age
in urban areas, 82 are protected from risk of pregnancy: 47 are not in unions, 7 are
already pregnant, and 29 use contraception. In rural areas only 63 of each 100 are not at
risk: 34 are not in unions, 10 are already pregnant, and 19 use contraception. Pills, IUDs,
and female sterilization are the most popular methods, used by 39% of women in urban
areas and 21% in rural areas. Regional differences in fertility levels in Colombia are
primarily the result of differential use of contraception. Although the prevalence of
contraceptive use is high in Colombia, the unsatisfied demand for family planning
measure as a percentage of women in unions varies from a low of 23% in Bogota to a
high of 33% in the Eastern Region.

Ochoa LH. Prevalencia del uso de anticoncepcion en Colombia: determinantes e

implicaciones [Prevalence of contraceptive use in Colombia: determinants and
implications]. Estud Poblac. 1980 Jul-Dec;5(7-12):66-94. Spanish. PMID: 12311014.

37Fertility differentials according to females' education, employment and

family planning adoption in rural Bangladesh
K C Bhuyan

 PMID: 12320794

Abstract

PIP: This study examines differential fertility in 16 contiguous villages of both Savar and
Dhamrai upazila in Dhaka district, Bangladesh. The sample includes 890 couples. Levels
of female education were positively correlated with family planning use. 50.6% of
housewives with a secondary or higher education used contraception. 59.8% of
employed women with a secondary or higher education used contraception. 21.6% of
illiterate women used contraception. Fertility declined with an increase in educational
level. Child mortality increased fertility regardless of educational level or contraceptive
usage. The average number of children ever born differed significantly between
contraceptive and noncontraceptive users who did not work. Fertility between working
and nonworking women did not differ significantly. Fertility was higher throughout the
life cycle among adopters and nonadopters who had husbands that were laborers.
Multivariate analysis reveals that fertility was highly significantly affected by duration of
marriage and desired number of children. Differences in fertility between working and
nonworking individuals was insignificantly related to differences in socioeconomic
 factors. The impact of socioeconomic factors on the fertility of adopter and nonadopter
women was significantly different. Regression findings show that duration of marriage,
desired number of children, and spouse's occupation had the strongest impact on
fertility. Significant changes in impacts were due to changes in female education and
contraceptive usage. Duration of marriage and desired number of children did not have
the same level of impact among educated women and illiterate women. Income had a
negative effect on the fertility of contraceptive users.

Bhuyan KC. Fertility differentials according to females' education, employment and

family planning adoption in rural Bangladesh. Nufusbil Derg. 1996;17-18:21-39. PMID:
12320794.

38[Some comments on the status of family planning in Colombia]

[Article in Spanish]

G Ojeda

 PMID: 12342357

Abstract

PIP: Colombia's rate of population growth of about 2%/year from 1938-51 increased to
over 3% between 1951-64 before dropping again to 1.8% in 1985. The total fertility rate
declined from 6.7 in 1969 to 3.2 in 1986, but the decline was not equal for all population
sectors. In 1986, the total fertility rate was 4.4 in the Atlantic Coast region, 2.7 in Bogota,
2.8 in urban areas, 4.9 in rural areas, 5.4 for illiterate women, and 1.5 for women with
higher educations. Knowledge of contraceptive methods is almost universal, with pills,
IUDs, and female sterilization the best known. The proportion of women in union using
contraception increased from 15% in rural areas and 45% in urban areas in 1969 to 53%
in rural areas and 70% in urban areas in 1986. Use of female sterilization increased
steadily to 19% of urban and 17% of rural women by 1985, while use of oral
contraceptives declined slightly from 20% of urban and 12% of rural women in 1978 to
18% of urban and 13% of rural women in 1986. 11% of women in union used IUDs in
1986. Use of contraception increased rapidly with age of the woman, from 57% of
women in union aged 20-24 to 76% aged 35-39. Rates of contraceptive usage in 1986
were 51% for illiterate women, 62% for those with primary educations, 72% for those
with secondary educations, and 81% for those with higher educations. The private family
planning organization PROFAMILIA is the contraceptive source for over 1/3 of family
planning users, with especially high rates for IUD and sterilization users. PROFAMILIA
sells over 1/2 of the pills, condoms, and vaginal methods used in the country.
Pharmacies supply 30% of users, with especially high rates for pills, injectables,
 condoms, and vaginal methods. Around 1988, there will be an estimated 7,889,242
fertile aged women in Colombia, some 4,212,855 of them in union and 2,814,187 current
users. Although PROFAMILIA is 1 of the most economical family planning programs in
the world, its need for financial support will inevitably increase as the number of clients
increases

Ojeda G. Algunos comentarios sobre la situacion de la planificacion familiar en

Colombia." [Some comments on the status of family planning in Colombia]. Profamilia.
1988 Dec;4(13):5-9. Spanish. PMID: 12342357.

39Low levels of family planning knowledge and use threaten Madagascar

population goals
No authors listed

 PMID: 12319376

Abstract

PIP: 1992 Madagascar Demographic and Health Survey (DHS) data indicate that
Madagascar has a long way to go in order to realize its 1990 National Population Policy
Law goal of reducing fertility from 6.1 to 4.0 by the year 2000. Madagascar DHS data are
based upon a nationally representative sample of 6260 women aged 15-49. Only 62% of
sampled women in union knew a modern method of contraception and 45% knew
where they could obtain one. 56% of rural women and 38% of women with no
education were similarly knowledgeable. Injection, the pill, and female sterilization are
the best known modern methods. The infrequent airing and limited reach of family
planning messages found only 6% of respondents reporting hearing a family planning
message on the radio or television in the month preceding the survey. An aggressive
and widespread information, education, and communication program is therefore
needed to increase the level of knowledge about modern contraceptive methods. There
is considerable unmet need for family planning in Madagascar. 40% of married women
in 1992 reported that they did not want to have any more children, while another 30%
reported wanting to space their next birth. Only 5% of married women, however, were
then currently using modern methods, and 12% were using traditional methods, mainly
periodic abstinence. As for maternal and child health, 163 children under five years old
die per 1000 births, with the level of mortality inversely related to the level of education
attained by the mother. The under-five mortality rate is 183/1000 in rural areas and
142/1000 in urban areas. In 1992, 78% of mothers received antenatal care from an
health professional, and an health professional was present at delivery for 57% of births.
Only 43% of children aged 12-23 months, however, have received all recommended
 vaccinations, such that childhood illnesses, particularly diarrhea, are common among
young children. More than 50% of children under five are stunted, and 40% are
underweight.

Low levels of family planning knowledge and use threaten Madagascar population
goals. Newsl Macro Syst Inst Resour Dev Demogr Health Surv. 1995;7(1):4-5. PMID:
12319376.

40Knowledge and attitudes of family planning in Khartoum Province,

Sudan
M Khalifa

 PMID: 12267407

Abstract

PIP: Data on contraceptive knowledge and attitudes, collected in a 1977 fertility survey
undertaken in the Khartoum Province of the Sudan by the Sudan Family Planning
Association, was presented. The data, collected from an urban sample of 1474 wives and
1036 husbands and a rural sample of 494 wives and 264 husbands was analyzed
primarily by constructing percent distributions. Knowledge of contraception was fairly
high. Among rural respondents, 99% of the wives and 97% of the husbands were aware
of birth control. Respective figures for the urban sample were 99% and 98%. Among the
2753 respondents who knew of at least 1 method of birth control, all except 7 rural
husbands were familiar with OCs. More than 3/4 of the rural women knew about
injectables, IUDs, and lactation. 86% of the rural women were also aware of female
sterilization; however, only 26% knew about male sterilization. Among the rural women,
knowledge of diaphragms, condoms, rhythm, abstinence, and withdrawal ranged from
32%-50%. Knowledge of specific methods tended to be slightly higher among urban
women than among rural women; however, only 44% of the urban women compared to
88% of the rural women were aware of lactation as a birth control method. Urban wives
were similar to rural women in that the proportion aware of female sterilization (90%)
was higher than the proportion aware of male sterilization (41%). In urban areas,
husbands were somewhat less knowledgeable about specific methods than wives, and
this same pattern was observed among rural respondents. Urban men tended to be
more knowedgeable about birth control than rural men. Despite the relatively high
knowledge levels, the use of birth control was disapproved of by many of the
respondents. Among the rural wives, 36% disapproved of birth control, 49% approved of
birth control, 12% approved of it only under certain circumstances, and 3% had no
opinion. Respective figures for urban women were 29%, 56%, 12%, and 3%. Respective
figures for rural men were 52%, 23%, 22%, and 3%, and for urban men they were 47%,
30%, 22%, and 1%. In both urban and rural areas, the level of approval was highest
among educated women, recently married women, and women of high socioeconomic
status. In urban areas, women who grew up in urban environments were more likely to
approve of birth control than women with rural backgrounds. For both urban and rural
men, the level of approval was highest among recently married men and among men
with high socioeconomic status. Among rural women who approved of birth control
only under certain circumstances, 83% approved of using birth control when maternal
health was endangered, 42% approved its use to prevent births under adverse economic
conditions, 29% approved its use to limit family size, and 38% approved its use for
spacing births. Respective figures for urban women were 56%, 42%, 37%, and 34%. The
respondents were asked why they approved or disapproved of family planning. Major
reasons for disapproving of birth control were that it was contrary to religious beliefs
and harmful to maternal health. Major reasons for approving the use of birth control
were that it made it possible to give better care to each child, it eased the financial
burden on the family, and it contributed toward maternal health. The reasons given by
male and female respondents were very similar. The major findings were presented in a
set of 8 tables.

Khalifa M. Knowledge and attitudes of family planning in Khartoum Province, Sudan.

Egypt Popul Fam Plann Rev. 1982 Jun;16(1):20-38. PMID: 12267407.