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Contraceptive knowledge and practices in Ilorin, Nigeria: 1983-88.

This report describes changes in knowledge and use of contraceptives in Ilorin, Nigeria between 1983 and 1988, a period marked both by dramatic changes in Nigeria's economic climate, as a result of the decline in the value of oil exports, and by considerable increases in public programs aimed at promoting the use of family planning and reducing fertility. The report is based on the analysis of two surveys of married women aged 15-35 years who lived in the city of Ilorin. By 1988, knowledge of modern methods of contraception had become virtually universal in Ilorin, even among women with no education and among those living in the poorest areas of the city. Current use of contraceptives had also increased considerably since 1983, reaching prevalence rates of 15 percent among women with primary education, 20 percent among those with secondary education, and 40 percent among those with postsecondary education. Each of these groups of women experienced at least a doubling of contraceptive prevalence between 1983 and 1988. Although use among uneducated women was still low in absolute terms (prevalence of 4.5 percent), these women also experienced a substantial relative increase in use.

Adolescent↗

Contraceptive use and fertility decline in Chogoria, Kenya.

This article describes the results pertaining to fertility and family planning from a 1985 survey conducted in the catchment area of Chogoria Hospital in central Kenya. Current contraceptive prevalence was found to be quite high, 43 percent as opposed to 17 percent for Kenya as a whole. The total fertility rate of 5.2 births per woman was 2.5 births lower than the national rate. Very few women reported wanting to have large numbers of children or thinking that fate or God should determine family size. Although these data cannot conclusively demonstrate that the family planning program operating in the area has been responsible for reduced fertility there, they do provide some support for this hypothesis.

Adolescent↗

[Fertility and health in Mexico].

Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.

Family Planning Services↗

Contraceptive discontinuation among married women in the United States.

Using data from the 1982 National Survey of Family Growth (NSFG), this analysis reports differentials in contraceptive discontinuation among married women aged 15-44 years in the United States. The total discontinuation rate is broken down into change to no method (termination) or to a different method (a method switch), and rates are obtained for specific methods. In addition, sociodemographic differences in risks associated with each type of discontinuation are shown. Discontinuation rates are compared to use-failure rates to provide a more comprehensive understanding of the implications of discontinuation for contraceptive efficacy.

Actuarial Analysis↗

U.S. women's contraceptive attitudes and practice: how have they changed in the 1980s?

Between 1982 and 1987, favorable opinion of the pill increased steadily among American women (from 65 to 76 percent), and favorable opinion of the condom rose sharply (from 38 to 60 percent). Approval of the IUD dropped during the period (from 26 percent to 19 percent). During the five years, the proportion of married women aged 18-44 who were exposed to the risk of unintended pregnancy remained the same (78 percent), but the proportion among unmarried women rose significantly (from 64 percent to 69 percent). This change was primarily the result of an increase--from 68 percent to 76 percent--in the proportion of never-married women who had ever had intercourse. The overall level of contraceptive use among 18-44-year-olds who were exposed to risk remained stable over the period, at about 93 percent, but use of the most effective methods (sterilization, pill and IUD) went up, from 68 percent to 71 percent. All of the net increase in effective-method use, however, was limited to married women, among whom reliance on both sterilization and the pill increased (from 46 to 51 percent and from 17 to 22 percent, respectively). Pill use also rose among unmarried women (from 43 to 48 percent), but there was no change in the level of sterilization. The prevalence of IUD use declined among both married and unmarried women (to three percent in each case). Condom use remained steady among married women, at about 15 percent, but among the unmarried it increased markedly, from nine to 16 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Project Redirection: evaluation of a comprehensive program for disadvantaged teenage mothers.

An evaluation of Project Redirection, a two-year demonstration program designed to help pregnant teenagers and teenage mothers, shows that teenagers from a comparison group, who were not enrolled in the demonstration program, were significantly more likely than project participants to experience a repeat pregnancy after one year, but that after two years the difference was small and nonsignificant. Likewise, at 12 months into the program, the project participants proved more likely to be using contraceptives, but by 24 months the comparison group had caught up. After one year of participation, the project teenagers were more likely than the others either to be in school or to have graduated (56 and 49 percent, respectively). However, this differential also disappeared by 24 months. Nonetheless, even at that point, project teenagers who had dropped out prior to joining the program and those who had had a repeat pregnancy were more likely to be in school or to have completed school than were similar comparison teens. Project teenagers also were somewhat more likely to have held a job during the two-year period than were teenagers not enrolled in the program. All in all, the evaluation demonstrated that teenagers who participated in the project and remained in it for more than a year had consistently better outcomes in education, employment and repeat pregnancy than any other group had. Comparison teenagers who had never participated in any special program for pregnant teenagers, on the other hand, demonstrated consistently poorer outcomes than any other group.

Adolescent↗

Maintaining family planning acceptance levels through development incentives in Northeastern Thailand.

The results of a two-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984.

Contraception Behavior↗

Contraceptive prevalence in the slums of Rio de Janeiro.

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.

Adolescent↗

Contraceptive use and fertility in Guatemala.

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.

Adolescent↗

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

Bangladesh↗

Adolescent contraceptive use and communication: changes over a decade.

Sexual experiences of 186 adolescents in 1979 were compared to those of 215 adolescents in 1989 who were recruited from the same university to determine if there was an increase over the decade in "safe sex" practices. Self-reported condom use increased between 1979 and 1989 for very first intercourse as well as first intercourse with current partner, although condom use was still far from universal. For other behaviors, there were sexual career changes (i.e., changes from first to current partner) but not decade changes. The percentage of respondents using any method of contraception and the percentage who discussed contraception with their partner increased from first to current partner, but did not increase between 1979 and 1989. The very first intercourse with first partner remained especially troubling since contraceptive use was very low and discussions about contraception prior to sex were very infrequent.

Acquired Immunodeficiency Syndrome↗

Credit programs, women's empowerment, and contraceptive use in rural Bangladesh.

This article presents findings of research addressing the question of how women's status affects fertility. The effects on contraceptive use of women's participation in rural credit programs and on their status or level of empowerment were examined. A woman's level of empowerment is defined here as a function of her relative physical mobility, economic security, ability to make various purchases on her own, freedom from domination and violence within her family, political and legal awareness, and participation in public protests and political campaigning. The main finding is that participation in both of the credit programs studied, those of Grameen Bank and Bangladesh Rural Advancement Committee (BRAC), is positively associated with women's level of empowerment. A positive effect on contraceptive use is discernible among both participants and nonparticipants in Grameen Bank villages. Participation in BRAC does not appear to affect contraceptive use.

Adolescent↗

The long-term demographic role of community-based family planning in rural Bangladesh.

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.

Adult↗

Trends in contraceptive use in the United States: 1982-1995.

CONTEXT: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS: Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS: The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS: The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women.

Adolescent↗