INTERNATIONAL FAMILY PLANNING PERSPECTIVES

United States of America (New York) 76

MARCH 1998 - VOLUME 30, NUMBER 1

99.76.1 - English - Young Mi KIM, Adrienne KOLS, Center for Communication Programs, Johns Hopkins University, Baltimore, MD (U.S.A.), and Stephen MUCHEKE, Family Planning Association of Kenya, Nairobi (Kenya)

Informed choice and decision-making in family planning counseling in Kenya (p. 4-11)

Context: Family planning programs have long endorsed the principle of informed choice as a way of ensuring that clients select a method that best meets their needs. There, has been little research, however, that examines how, or whether, family planning clients make informed decisions.

Methods: Interactions between female family planning clients and clinic- and community-based providers at 25 service delivery sites in Kenya were audiotaped over a 9-15 day period. Transcripts of 176 counseling sessions were analyzed to identify key counseling behaviors and assess the completeness of information provided to the clients.

Results: Providers collected information about a new client's marital and reproductive history in 60% of counseling sessions, but asked women about their childbearing intentions in only 7%. In 55% of sessions with continuing clients, providers asked whether the woman was experiencing any problems with her current contraceptive method; providers raised the issue of switching methods in 27% of these sessions, and inquired about a continuing clients reproductive intentions in 17%. Providers discussed an average of four contraceptive methods with new clients, while with continuing clients they typically discussed fewer than two. Providers seldom tailored their discussion of contraceptive methods to the client's reproductive intentions, prior knowledge of family planning, contraceptive preferences, personal circumstances or health risks. In addition, while they emphasized a woman's right to make the final decision as to method choice, they rarely assisted women in fully weighing alternatives or ascertained that they understood completely the personal implications of their choices.

Conclusions: Family planning providers could enhance the quality of womens contraceptive decision-making if they took a more active role in contraceptive counseling -- for example, by relating information on specific methods to women's personal circumstances and helping clients weigh the advantages and disadvantages of various methods. (KENYA, FAMILY PLANNING PERSONNEL, CLIENTS, COUNSELING, CONTRACEPTION, INFORMATION, CHOICE)

99.76.2 - English - Charles F. WESTOFF, Princeton University, Princeton, NJ (U.S.A.), and Akinrinola BANKOLE, Alan Guttmatcher Institute, New York (U.S.A.)

The time dynamics of unmet need: An example from Morocco (p. 12-14)

Context: Data on fertility and family planning among a sample of women interviewed at two points in time can show whether women initially in need of a rnethod fulfill that need, and whether contraceptive use and fertility intentions are fulfilled over time.

Methods: Longitudinal data on unmet need for contraception and on fertility were compiled from a panel survey of Moroccan women interviewed for both the 1992 and 1995 Demographic and Health Surveys. Transitions into and out of categories of need (for limiting or spacing births) were examined, as well as how well women were able to fulfill their fertility and contraceptive intentions in the three years between the surveys.

Results: Unmet need declined by about 43% over a three-year period among a sample of women interviewed both in 1992 and 1995. While 29% of women in need were still in need three years later (mostly to limit births), 35% had adopted a method by 1995, and another 36% had moved into the 'other, no need' category, which includes women trying to get pregnant and infecund women. Religious objections or the husband's opposition were the obstacles to using contraceptives that were most difficult to overcome.

Conclusions: The results underscore the importance of studying unmet need in a longitudinal perspective, which is the only research design that permits evaluating transitions in planning status over time. (MOROCCO, LONGITUDINAL ANALYSIS, ATTITUDE, NEEDS, FAMILY PLANNING, CONTRACEPTIVE USAGE, FERTILITY)

99.76.3 - English - Akinrinola BANKOLE and Susheela SINGH, The Alan Guttmatcher Institute, New York (U.S.A.)

Couples' fertility and contraceptive decision-making in developing countries: Hearing the man's voice (p. 15-24)

Context: Family planning research, policy and programs in developing countries have traditionally given little attention to men's role in reproductive decision-making. Men's exclusion from family planning efforts may have ramifications for their preferred family size and attitudes toward contraceptive use.

Methods: Demographic and Health Survey data collecled in 18 developing countries between 1990 and 1996 were used to directly compare husbands' and wives' attitudes toward fertility and contraception. Logistic regression analyses were conducted to examine how these attitudes affect couples' contraceptive behavior.

Results: Men and women in these countries desire fairly large families; however, husbands tend to want more children than their wives and to want the next child sooner. The proportion of couples in which partners' ideal family size differs by two children, or more ranges from 30% (in Bangladesh) to 72% (in Niger). In most couples, either both spouses want more children or both want no more, but in 10-26%, their desires differ. Modern method use is low in most of these countries, but husbands are more likely than their wives to report such use. Combining each spouse's fertility intentions into a couple analysis, while controlling for their demographic characteristics, significantly predicts modern method use in 9 of 14 countries for which date are available; in 6 of these countries, the wife's fertility preference, has a greater impact then the husband's.

Conclusions: Spouses may have disparate reproductive goals, and data from both partners are necessary to ascertain these differences. Fertility and family planning programs and research must continue to expand their focus on men's attitudes and behavior. (DEVELOPING COUNTRIES, CONTRACEPTIVE USAGE, ATTITUDE, DESIRED FAMILY SIZE, COUPLE, SPOUSES, DECISION MAKING)

99.76.4 - English - Dale HUNTINGTON, Laila NAWAR, Population Council, Cairo (Egypt), Ezzeldin Osman HASSAN, Hala YOUSSEF, Egyptian Fertility Care Society, Cairo (Egypt), and Nahla ABDEL-TAWAB, Population Council, Cairo (Egypt)

The postabortion caseload in Egyptian hospitals: A descriptive study (p. 25-31)

Context: Despite international calls to recognize unsafe abortion as a serious health problem in developing countries, very little quantitative information exists on national levels of abortion activity, major health-related sequelae of unsafe abortion or the quality of routine medical care provided to postabortion patients in countries where induced abortion is legally restricted.

Methods: Researchers used random sampling procedures to select 569 public-sector hospitals in Egypt, and asked designated medical staff to complete a medical abstract form for each postabortion patient admission during a continuous 30-day period. Data were analyzed to assess the state of postabortion care in Egypt, and using data from the 1995 Egypt Demographic and Health Survey and other sources, to estimate the rate of induced abortion, in Egypt.

Results: Among the 22,656 admissions to the obstetrics and gynecology departments during the 30 dāy study period, approximately one of every five patients (19%) was a woman admitted for treatment of an induced or spontaneous abortion. Projections yielded an estimated induced abortion rate in Egypt of 14.8 per 100 pregnancies. The mean gestational age of the lost pregnancies was 10.8 weeks, and a large majority (86%) were lost at 12 weeks or less. 14% of the women arrived at the hospital suffering from excessive blood loss, 1% exhibited one or more signs of trauma and 5% had one or more signs of infection. Dilatation and curettage under general anesthesia was the principal surgical treatment provided.

Conclusions: Treatment for complications from unsafe abortion consumes substantial resources within the Egyptian health care system. Postabortion care could be improved if vacuum aspiration under local anesthesia were used as the primary postabortion treatment, and if adherence to antiseptic measures were increased. (EGYPT, ABORTION, POSTABORTAL PROGRAMMES, INDUCED ABORTION)

99.76.5 - English - Sohail AGHA, Population Services International, Washington, DC (U.S.A.)

Sexual activity and condom use in Lusaka, Zambia (p. 32-37)

Context: Condom social marketing is among the AIDS prevention strategies being attempted in Lusaka, Zambia, a country where women generally are of low socioeconomic status relative to men, and where the prevalence of sexuaIly transmitted diseases is high.

Methods: The 1996 Lusaka Sexual Behavior and Condom Use Survey gathered data on sexual activity in Lusaka from 806 respondents; multiple regression analysis was performed to identify factors that predicted men's and women's condorn use.

Results: Most respondents reported that their most recent intercourse was with their marital partner (62% of women and 43% of men) or with a regular partner (20% of women and 23% of men); almost one-quarter of men (24%), however, reported having last had intercourse with a casual partner. Overall, 17% of women and 24% of men had used a condom at last intercourse. Multivariate logistic regression analysis found that women whose Iast intercourse was with a regular or casual partner rather than a marital partner were significantly more likely (odds ratios, 2.8 and 3.1, respectively) to have used a condom, as were those who recalled hearing a social marketing advertising message for condoms (2.8). For men, use of condoms was elevated among those who were younger than 30 (odds ratios, 3.3-3.8), who had an education beyond the secondary level (2.2) and who had easy access to condoms (1. 9).

Conclusions: Because of gender inequity, programs directed at men are more likely to succeed in encouraging condom use than are those aimed at developing women's skills in negotiating condom use. (ZAMBIA, SOCIAL MARKETING, CONTRACEPTIVE USAGE, CONDOM, SEXUAL BEHAVIOUR, SEXUAL RELATIONSHIPS, MATE)

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