No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Contraception in Historical and Global Perspective
Abstract
This chapter describes the rise in contraceptive practice and fall in fertility from around 1880 to the present day. Two main phases are identified: the first confined to European populations and involving methods of low efficacy, and the second embracing the whole planet involving modern methods. Today, sub-Saharan Africa is the only region where low levels of contraceptive use and high fertility persist. Nevertheless, nearly half of pregnancies worldwide are still unintended, and much scope remains for improvement in contraceptive protection. The main international priority is Africa, where demographic factors jeopardize the goals of reducing poverty and hunger.
... This transition began in northwest Europe pre-19th century and continues worldwide. [6][7][8] In pre-transitional societies, high fertility rates off set high mortality rates and population levels remained constant (fi gure 1A) because, on average, only two children per couple survived to adulthood. 7,8 The fundamental processes of demographic transition-which causes a population to move from high mortality and high fertility to low mortality and low fertility-are associated with a sustained decline in mortality leading to population growth and a decline in fertility leading to population ageing and urbanisation. ...
... [6][7][8] In pre-transitional societies, high fertility rates off set high mortality rates and population levels remained constant (fi gure 1A) because, on average, only two children per couple survived to adulthood. 7,8 The fundamental processes of demographic transition-which causes a population to move from high mortality and high fertility to low mortality and low fertility-are associated with a sustained decline in mortality leading to population growth and a decline in fertility leading to population ageing and urbanisation. ...
... Margaret Sanger, an early pioneer of family planning, was arrested in 1916 for opening a birth control clinic in New York. 7 By contrast, the contraceptive revolution in the late 20th century, which was closely linked to government policy driven by demographic and economic concerns, played a very important part in the reduction of fertility in developing countries. 7 The fall in mortality in the 1950s and 1960s, coupled with persistently high fertility, led to rapid population growth and implied that some countries would double in population every 20 years, for example, in Kenya. ...
Global health, population growth, economic development, environmental degradation, and climate change are the main challenges we face in the 21st century. However, because the academics, non-governmental organisations, and policy makers in these specialties work within separate communities, our understanding of the associations between them is restricted. We organised an international symposium in May, 2011 in London, UK, for academics and technical experts from population, developmental, and environmental science to encourage debate and collaboration between these disciplines. The conference provided the impetus for this Review, which describes, in historical context, key events and fundamental intercommunity debates from the perspectives of population, development, and climate change communities. We consider the interconnections between population, development, and climate change and their effects on health, including new analysis of longstanding debates, and identify opportunities for effective collaboration on shared goals.
... The Government of Rwanda promoted contraception starting in the 1990s, despite it being a dominantly Catholic country. Several countries have not instituted as aggressive an effort (Cleland, 2009). Nevertheless, contraceptive use has increased as access has grown, partly due to efforts to prevent HIV-AIDS with condoms, and birth rates have fallen in many countries leading to a slowing of the population growth rate. ...
... Research suggests that reducing the growth of population is one of the most effective ways of mitigating climate change (Wheeler and Hammer, 2010). The rapidity of the growth, combined with increased economic productivity will lead to increased CO2 emissions and accelerated climate change in East Africa and, indeed, globally well beyond the more optimistic projections (Cleland, 2009). ...
This document provides guidance regarding significant issues emergent from the current climate change, population, agricultural, and land use and cover change literatures.
... Yet, more than 50% of the world's population still lives in areas where fertility rates are higher than parental replacement (2.1), and almost 10% where they exceed 5, leading population projections to at least triple by 2100 in almost 50 developing countries (United Nations 2019). Moreover, some recent studies have reported that fertility reduction has stalled in most sub-Saharan African countries (Cleland 2009;Mayhew and Colbourn 2015;Guillebaud 2016). From 1.2 billion people today, Africa is expected to reach between 3 and 6 billion people by 2100 (United Nations 2019), which suggests that the population question is not completely on the way to solving itself. ...
... The role played by religions such as the Catholic Church has been important to global population growth, especially in poor developing countries in South America, Africa or South-east Asia. Promoting conservative ideas relating to procreation and the sacredness of human life has led, among other things, to the religious prohibition of modern birth control methods in many countries (Cleland 2009). In addition to the religious aspect, in some countries there is cultural and familial pro-natalism, where having a large number of children is seen as a status symbol (Kopnina and Washington 2016). ...
Nowadays, human activities are causing an important collapse in global biodiversity while also affecting the global climate considerably. Despite historical agreements on both biodiversity conservation and climate change, humanity keeps changing the face of the planet at an increasing rate. An undisputed factor in global change is the excessive and growing human consumption. On the other hand, it seems that linking humanity’s environmental impact with population growth has been quite controversial in the international debate, as if, somehow, biodiversity loss and climate change were unconnected to it. To this purpose, this paper reviews (1) the impacts of continuing human population growth on global biodiversity and climate through the examples of food and energy production, (2) changing perceptions about population growth and (3) the potential solutions that could be used to address this issue. Despite not the only factor, the research reviewed in this paper highlights that continuing population growth plays a substantial global role in the destruction of biodiversity and in climate change, and this role urgently needs more attention in scientific, policy and public circles. Both unsustainable population levels and excessive consumption are part of the equation and must be addressed concurrently in developing and developed countries. Several non-coercive strategies are possible to address the population question, mostly through access to education and contraception, in order to empower women through the basic human right to have children by choice. In any case, although limiting population growth may not be the only solution required to fix current environmental problems, ignoring it is likely to hinder any ecologically sustainable future.
... Child marriage is associated with adolescent pregnancy and substantial health risks [11]. In low and middleincome countries, complications of pregnancy and childbirth are leading causes of death among women and girls 15-19 years old, and mortality rates are 73% higher for infants born to mothers less than age 20 compared to those over age 20 [12]. ...
... In low and middleincome countries, complications of pregnancy and childbirth are leading causes of death among women and girls 15-19 years old, and mortality rates are 73% higher for infants born to mothers less than age 20 compared to those over age 20 [12]. Family planning to postpone first births to later maternal age is a cost effective strategy to greatly mitigate these risks [11], however, data on family planning among Syrian child brides is lacking. ...
Child marriage is associated with adolescent pregnancy, which increases maternal and child health risks and rates of child marriage have increased among families affected by the Syrian conflict. Although contraception reduces these risks, data about contraception practices among Syrian child brides is sparse. This cross sectional, descriptive pilot study examined contraceptive knowledge, attitudes, barriers, needs and practices among young Syrian brides. A convenience sample of female Syrian refugees aged 13-25 who had married before the age of 18 was recruited through a civil society organization in Lebanon. Among the 32 participants, there were significant knowledge gaps and negative attitudes towards contraception, with approximately one fifth of participants (18.8%) unaware of contraceptive methods and 84.4% unaware of emergency contraception. Negative attitudes towards contraception were common, including beliefs that it was physically harmful (47.0%), contradicted religious views (43.8%), and lacked support by husbands (50%). The majority of participants (53.1%) had never used contraception with the most common reason being fear of side effects (47%). Approximately one-third (30%) of participants with two or more children reported sub-optimal birth spacing of less than a year and almost one-quarter of participants (24.1%) reported a history of terminating a pregnancy. Notably, one-fifth of participants (20.8%) had an unmet need for contraception, and unwanted pregnancies were common among women who were currently (42.9%) or previously (48.1%) pregnant. Results from this small convenience sample of Syrian child brides in Lebanon identify an urgent need to further explore contraception use among this population and to inform interventions for increased contraception usage to decrease adolescent pregnancies and improve maternal and child health.
... Nevertheless, nearly half of pregnancies worldwide are still unintended, and much scope remains for improvement in contraceptive protection. The main international priority is Africa, where demographic factors jeopardize the goals of reducing poverty and hunger [198]. ...
... There has been a rise in contraceptive practice and fall in fertility from around 1880 to the present day. Two main phases are identified: the first confined to European populations and involving methods of low efficacy, and the second embracing the whole planet involving modern methods [198]. Modern contraceptive methods have a surprisingly short history and are dominated by the OC pill, which came on to the market in 1960. ...
This chapter presents implicit social cognition theory as a framework for understanding the structure and processes of implicit attitudes toward contraceptives. Implicit social cognition primarily involves processes and attitudes that are based on principles of implicit memory and automatic or nonconscious associations. This chapter first argues that implicit social cognition may shed light on the psychological processes outside of an individual's consciousness and awareness that underlie attitudes toward contraceptives. We then present the theoretical arguments and empirical evidence that establish the reliability of implicit social cognition methodologies to measure implicit attitudes toward contraceptives and their utility to predict sexual behavior. Second, we turn to the chapter's main goal - to demonstrate that two sources underlying implicit attitudes toward contraceptives (condoms and birth control pills) are self-image and group identity based motives. In one set of experiments from our laboratory, we demonstrate that affirming women's gender identity leads to relatively negative implicit (but not explicit) attitudes toward condoms and birth control pills. Moreover, this effect appears to be particularly robust among women who strongly identify with their gender ingroup. We argue that this may be the case because a gender affirmation activates the motivation to procreate, and therefore should heighten negative attitudes toward any contraceptive. A second line of research examines the important role of self- image in implicit attitudes toward contraceptives. Specifically, we establish that individuals who hold discrepant implicit and explicit self-esteem possess relatively strong implicit self-image ambivalence, which is a proxy for self- image concerns. When these concerns are exacerbated they increase negative implicit (but not explicit) attitudes toward contraceptives; in contrast, such attitudes are decreased once self-image concerns are alleviated. We end the chapter with the implications of this research for sexual behavior and a discussion on the cultural universality of the above research on the implicit social cognition of attitudes toward contraceptives.
... The Government of Rwanda promoted contraception starting in the 1990s, despite it being a dominantly Catholic country. Several countries have not instituted as aggressive an effort (Cleland, 2009). Nevertheless, contraceptive use has increased as access has grown, partly due to efforts to prevent HIV-AIDS with condoms, and birth rates have fallen in many countries leading to a slowing of the population growth rate. ...
... Research suggests that reducing the growth of population is one of the most effective ways of mitigating climate change (Wheeler and Hammer, 2010). The rapidity of the growth, combined with increased economic productivity will lead to increased CO2 emissions and accelerated climate change in East Africa and, indeed, globally well beyond the more optimistic projections (Cleland, 2009). ...
... Total fertility rate (TFR) in pre-modern societies typically ranged from 4.5 to 6.5 live births per woman, which offset high mortality. In countries with a steady decline in mortality and minimal change in fertility rates, such as northern Nigeria, rapid population growth poses a challenge to sustainable development 4 . ...
... Concerns about women's health related to maternal morbidity and mortality has made discussions on fertility intentions and contraceptive preferences paramount. Nearly half of pregnancies worldwide are unintended, and much scope remains to improve contraceptive coverage 4 . The goal is to avert adverse health outcomes associated with unintended pregnancies in order to increase chances of attaining the fifth Millennium Development Goal (MDG) of reducing maternal mortality by three quarters by the year 2015. ...
This study measured contraceptive knowledge, contraceptive use and fertility intentions among 1408 women of reproductive age in three communities in Kaduna state, Nigeria. Contraceptive knowledge was relatively high, with 64.6% of women having heard of at least one method. Radio and health facilities were the primary sources of information. The pill was most widely known (54.1%), followed by female sterilization (47.5%) and injectables (47.4%). Knowledge did not reflect use, however, as only 3.1% were current users of any method, among which injectables, pills and traditional waist bands were the most popular. Nearly 10% of non-users intended to begin using a method in the coming year, of whom 37.3% wished to use injectables. When asked about their last birth, 87% of women had desired to become pregnant and only 15% felt that their last pregnancy was mistimed. A sensitive and community-friendly approach is needed to reduce risks associated with high fertility while being respectful of community preferences (Afr. J. Reprod. Health 2010; 14[3]: 65-70). Résumé Intentions de fécondité, de connaissance du contraceptif et de l'emploi des contraceptifs chez les femmes dans trois communautés au nord du Nigéria. Cette étude a examiné la connaissance du contraceptif, l'emploi des contraceptifs et le désir de la fécondité chez 1408 femmes en âge de procréation dans trois communautés dans l'état de Kaduna, Nigéria. Le niveau de connaissance du contraceptif est relativement élevé, 64,6% des femmes ayant déjà entendu parler d'au moins une méthode. Les sources primaires de l'information étaient la radio et les établissements de santé. La pilule a été largement la plus connue (54,1%), suivie de la stérilisation féminine (47,55%) et des injectables (47,4%). Néanmoins, la connaissance n'a pas reflété l'emploi étant donné que 3,1% étaient des usagers courants de n'importe quelle méthode, dont les injectables, les pilules et les ceintures traditionnelles étaient les plus populaires. Presque 10% de non usagers avaient l'intention de commencer à employer une méthode dans l'année qui vient; parmi elles, 37,3% voulaient utiliser les injectables. Quand on leur a demandé leur dernier accouchement, 87% des femmes avaient voulu être enceintes et seules 15% ont pensé que leur dernière grossesse a été mal-calculée. Il faut une approche sensible et qui favorise les communautés pour réduire les risques liés à la haute fécondité tout en respectant les préférences des communautés (Afr. J. Reprod. Health 2010; 14[3]: 65-70).
... ¿A qué se refiere todo esto, y su conexión con lo que aquí discutimos? Hay cuestiones sobre las cuales hay sólo hechos, facticidad, una de ellas son las prácticas sociales identificadas en Europa mucho antes de la anticoncepción moderna que permitían con mayor o menor éxito regular su fertilidad a través de distintos métodos (24,25). Estos son hechos: las personas antes de consagrar, reconocer o nombrar los derechos reproductivos simplemente realizaban ciertas conductas. ...
Este trabajo busca establecer cómo la construcción de los derechos sexuales y reproductivos ha transitado desde las prácticas sociales hasta su manifestación en normas, políticas públicas o decisiones de órganos jurisdiccionales. El actual escenario es propicio para la incorporación de una multiplicidad de derechos en una eventual carta constitucional, entre ellos los derechos sexuales y reproductivos
... Contraception has economic and environmental ramifications based on its effects on family spacing and population growth (may limit or increase growth). 1,2 Good contraceptive practices help in alleviating poverty and hunger, maternal death 3 and child death. 3,4 Contraception also reduces the chances of unintended pregnancy and helps in child spacing. ...
Background: The Kingdom of Swaziland, following the introduction of the National Family Planning Programme in 1973, has witnessed insufficient scientific publications on the contraceptive practices in the country despite documented high fertility rates and low contraceptive prevalence rates. This study was conducted to understand the practices and potential determinants of contraception among Swazi women who requested emergency contraception.Methods: The data were collected over a period of one month and analysed using simple descriptive analysis to summarise the data and bivariate analysis to determine relevant factors associated with the use of contraception.Results: The majority of participants (79%) use contraceptives. Reasons given for not using contraception previously ranged from medical conditions to not being sexually active. Widely used contraceptives are male condoms, injectable hormones and combined oral contraceptives while the least popular are implants, and post-coital pills. Knowledge of contraceptives came mainly from the health facilities, peers and mass media while parents are the least consulted sources. A high percentage (97%) are aware of sexually transmitted diseases (STDs) and that male and female condoms are the best forms of protection against STDs. Demographic and socio-economic variables are not significantly related to the use of contraceptives.Conclusion: The study established that the majority of the participants used some form of contraception and they also delayed their sexual debut up to the age of 18–20 years. The observed changes of increased contraceptive use and later age of sexual debut could be associated with increased levels of education of the participants and the predominant relaxed approach by Protestants and Zionists who are usually tolerant of contraception. The recommendations, based on the findings of this study, would assist with the planning and implementation of future family planning programmes for which this study serves as a foundation.
... Contraception has economic and environmental ramifications based on its effects on family spacing and population growth (may limit or increase growth). 1,2 Good contraceptive practices help in alleviating poverty and hunger, maternal death 3 and child death. 3,4 Contraception also reduces the chances of unintended pregnancy and helps in child spacing. ...
Background: The Kingdom of Swaziland, following the introduction of the National Family Planning Programme in 1973, has witnessed insufficient scientific publications on the contraceptive practices in the country despite documented high fertility rates and low contraceptive prevalence rates. This study was conducted to understand the practices and potential determinants of contraception among Swazi women who requested emergency contraception.
... Consequently, demographers diagnose Sub-Saharan Africa as the only region in the world where low levels of contraceptive use and high fertility still persist (Cleland, 2009). According to the most recent DHS surveys on Sub Saharan African countries, the contraceptive prevalence rate is still very low at an average of 20% and the total fertility rate is still very high at 5.0. 3 The slow development in some Sub Saharan African countries has motivated demographic research to speculate whether in some countries the fertility transition stalled in mid-transition and whether the demand for contraceptives have leveled off (Bongaarts, 2006). ...
This study presents a novel theory on the interaction of social norms, fertility, education, and their joint impact on long-run economic development. The theory takes into account that sexual intercourse is utility enhancing and that the use of modern contraceptives potentially conflicts with prevailing social norms (religious beliefs). The theory motivates the existence of two steady states. At the traditional steady state, the economy stagnates, fertility is high, education is minimal, and the population sustains a norm according to which modern contraceptives are not used. At the modern steady state, the population has abandoned traditional beliefs, modern contraceptives are used, fertility is low and education and economic growth are high. Social dynamics explain why both equilibria are separated by a saddlepoint-equilibrium (a separatrix), i.e. why it is so hard to transit from the traditional regime to the modern regime. Enhancing the value of education is identified as a promising policy to encourage contraceptive use and to initiate the take-off to long-run growth.
... Of these 90%, more than half of them used non-hormonal contraception methods. Compared with those in other countries worldwide, this is a very high percentage [1]. The non-hormonal contraception methods, such as male condom, interuterine device (IUD; copper containing only) and the rhythm method (i.e. ...
Non-hormonal contraception methods have been widely used, but their effects on colonization by vaginal lactobacilli remain unclear.
To determine the association between non-hormonal contraception methods and vaginal lactobacilli on women's reproductive health.
The cross-sectional study included 164 healthy women between 18-45 years of age. The subjects were divided into different groups on the basis of the different non-hormonal contraception methods used by them. At the postmenstrual visit (day 21 or 22 of the menstrual cycle), vaginal swabs were collected for determination of Nugent score, quantitative culture and real-time polymerase chain reaction (PCR) of vaginal lactobacilli. The prevalence, colony counts and 16S rRNA gene expression of the Lactobacillus strains were compared between the different groups by Chi-square and ANOVA statistical analysis methods.
A Nugent score of 0-3 was more common in the condom group (93.1%) than in the group that used an interuterine device(IUD) (75.4%), (p = 0.005). The prevalence of H2O2-producing Lactobacillus was significantly higher in the condom group (82.3%) than in the IUD group (68.2%), (p = 0.016). There was a significant difference in colony count (mean ± standard error (SE), log10colony forming unit (CFU)/ml) of H2O2-producing Lactobacillus between condom users (7.81±0.14) and IUD users (6.54±0.14), (p = 0.000). The 16S rRNA gene expression (mean ± SE, log10copies/ml) of Lactobacillus crispatus was significantly higher in the condom group (8.09±0.16) than in the IUD group (6.03±0.18), (p = 0.000).
Consistent condom use increases the colonization of Lactobacillus crispatus in the vagina and may protect against both bacterial vaginosis (BV) and human immunodeficiency virus (HIV).
... Microfinance (MF) and family planning (FP) are important interventions in the promotion of human development and in the fight against poverty (Daley-Harris, 2002; Littlefield, Morduch and Hashemi, 2003; UNCDF, 2005; Cleland, Bernstein, et al, 2006; Cleland, 2009). MF is not just about credit; it encompasses other services such as savings, insurance, and remittances, and non-financial services such as financial literacy training (Armendáriz de Aghion and Morduch, 2005) and it is now often combined with other interventions, for example providing information and advice about contraception and fertility (Leatherman et al, 2011). ...
Microfinance (MF) and family planning (FP) are thought to be very important interventions in the promotion of human development and it has been suggested that MF has significant beneficent impacts on contraceptive adoption and fertility. Thus, several authors, e.g. Amin, Hill and Li (1995), Amin et al (1994 and 2001); Schuler, Hashemi and Riley (1997); Hashemi, Schuler and Riley (1996); Schuler and Hashemi (1994), using naive methods find that MF in Bangladesh increases contraceptive use and reduces fertility at the individual level, largely because MF empowers women. Pitt et al (1999) – henceforth PKML), however, using instrumental variables (IV) estimation find that MF is associated with decreases in contraceptive use especially when females borrow, and male borrowing decreases fertility, perhaps because fertility increasing income effects of MF outweigh substitution. Steele et al (2001), also using data from Bangladesh from around the same time as the PKML study, come to conclusions closer to the orthodoxy, arguing that PKML use an inappropriate metric for MF programme participation. In this paper we apply matching methods to our reconstruction of the PKML data to test whether other methods reproduce their results. We find that female borrowing substantially increases contraceptive use but has mainly no effects on fertility, while male borrowing has no effect on contraceptive use or on fertility; this contradicts some of the findings of PKML. Our results are shown to be vulnerable to unobservables, but there is no reason to believe that results on IV based methods are more reliable.
... Despite the benefits of LARC methods (National Collaborating Centre for Women's Health, 2005; World Health Organization, 2008a), they continue to be used less frequently than user-dependent methods in many regions (Fig. 3;Trussell and Wynn, 2008;Cleland, 2009). LARC methods may be underused for several reasons, including (i) women's misperceptions and misinformation about these methods; (ii) higher initial cost (although the cost is generally lower over time); (iii) 'provider dependence', such as the requirements for specific clinical skills and facilities; and (iv) provider bias against the method (National Collaborating Centre for Women's Health, 2005). ...
Despite increasing contraceptive availability, unintended pregnancy remains a global problem, representing as many as 30% of all known pregnancies. Various strategies have been proposed to reverse this disturbing trend, especially increased use of long-acting reversible contraceptive (LARC) methods. In this review we aim to discuss the role of LARC methods and importance of contraceptive counseling in reducing unintended pregnancy rates.
References/resources cited were identified based on searches of medical literature (MEDLINE, 1990-2009), bibliographies of relevant publications and the Internet.
LARC methods-copper intrauterine devices (IUDs), progestogen-releasing intrauterine system and injectable and implantable contraceptives-are safe and effective contraceptive options (unintended pregnancy rates with typical versus perfect use: 0.05-3.0 versus 0.05-0.6%) that are appropriate for a wide range of women seeking to limit or space childbearing. Despite their safety and efficacy records, these methods remain underutilized; injectable and implantable methods are used by an estimated 3.4% and intrauterine methods by 15.5% of women worldwide. LARC methods require no daily or coital adherence and avoid the adverse events and health risks of estrogen-containing contraceptives. The copper IUD and progestin-only injections and implants have been shown to be more cost-effective than more commonly used methods, such as condoms and the pill (5-year savings: $13,373-$14,122, LARC; $12,239, condoms; $12,879, pill). Women who are considering use of LARC methods should receive comprehensive contraceptive counseling, as women who receive counseling before use demonstrate higher rates of after-use method satisfaction, continuation and acceptance than those who do not.
... 9 In France the decline in family size had begun almost 100 years earlier and this too is generally attributed to contraception (initially in the form of coitus interruptus). 10 Abortion is believed to have played a large part in the latter part of the 19th century in France 2 and it is now obvious that the same is true in England. ...
Abortion is mentioned in ancient medical texts but the effectiveness of the methods described is doubtful. Attitudes varied from apparent disapproval by Hippocrates to open approval in Ancient Rome. In mediaeval times abortion was practised by women in secret and this continued during the 19th and early 20th centuries. Despite being illegal in England induced abortion became more common in Victorian times as the population grew. At the same time the link between criminal abortion and maternal mortality became increasingly clear, and if a woman died after a procedure the abortionist (sometimes a midwife) could be sentenced to death. The law was more tolerant of abortions performed by registered doctors. In the 20th century pressure grew for its legalisation. At the time of the 1967 Abortion Act, abortion was the leading cause of maternal death in the UK but within fifteen years death from illegal abortion had been abolished.
... But funding for family planning is declining for reasons such as a premature sense that the overpopulation issue has been solved, criticisms of inept and sometimes coercive programmes in Asia, and displacement by HIV/AIDS programmes. 136 Family planning is a low-cost, safe, and acceptable intervention, with proven benefits that encompass health, education, and reduction of poverty and environmental degradation. ...
... Growing interest by many developing country governments to adopt national population policies between the late 1960s and mid 1990s was matched by phenomenal growth in international funding assistance for family planning programmes. Although only two developing country governments had official policies to support family planning programmes in 1960, this number had increased to 74 by 1975and 115 by 1996(Cleland 2009). Between 1971and 1985, international funding for family planning programmes grew from about $168 million to $512 million annually (United Nations Population Fund, UNFPA 1988). ...
We use data from the Demographic and Health Surveys to examine the patterns of stall in fertility decline in four Eastern African countries. Contrary to patterns of fertility transition in Africa that cut across various socio-economic and geographical groups within countries, we find strong selectivity of fertility stall across different groups and regions in all four countries. In both Kenya and Tanzania where fertility decline has stalled at the national level, it continued to decline among the most educated women and in some regions. While fertility has remained at pre-transition level in Uganda over the past 20 years, there are signs of decline with specific groups of women (especially the most educated, urban and those in the Eastern region) taking the lead. For Zimbabwe, although fertility has continued to decline at the national level, stall is observed among women with less than secondary education and those in some of the regions. We link these intra-country variations to differential changes in socio-economic variables, family planning programme environment and reproductive behaviour models. The results suggest that declines in contraceptive use, increases in unmet need for family planning, increasing preferences for larger families, and increases in adolescent fertility were consistently associated with stalls in subgroup fertility across all four countries. These results are consistent with models that emphasize the role of declines in national and international commitments to family planning programmes in the premature stall in sub-Saharan fertility transition.
Albeit the government efforts improving access to contraception through health extension programs in Ethiopia, gaps exhibited on experiences of the stakeholder about the basis on services provision. Therefore, perceptions about the enablers and rationale for contraceptive service were explored. Interpretative phenomenological design was employed to explore the lived experiences of stakeholders. Focus group discussions, individual in-depth interviews, and key informant interviews were employed for data collection. Data were analyzed using interpretive phenomenological analysis. The finding indicated that contraceptive service provision from the socio-economic perspectives was understood adequately, but the human rights-based rationale was shadowed. The contribution of the health extension program for contraceptive use has been remarkable. The improvement is attributed to the alignment of primary health care with the community organizations such as women development armies. The health extension program accelerated contraceptive service and given momentum for PHC. Women revealed encouraging involvement in the process of contraceptive service access and use. However, the bigger picture, and rationale for providing contraceptive services, the human rights approach, remained elusive at lower hierarchy. Hence, the study recommends that the disconnect in the broader premises of providing contraceptive services must be properly communicated across the stakeholders.
Research Article
Factors Infl uencing
Contraception Usage: A
Cross-Sectional Study among
Mothers Receiving Abortion
Services in Orotta Maternity
Hospital, Eritrea
Factors Infl uencing
Contraception Usage: A
Cross-Sectional Study among
Mothers Receiving Abortion
Services in Orotta Maternity
Hospital, Eritrea
This article examines the rites of passage for poor girls of Haitian descent living in the Dominican Republic. In the Dominican context, preparation for and the transition to wife and mother historically served as an important rite of passage to an adult identity. Industrialization and the global discourse surrounding young motherhood increasingly challenges this culturally sanctioned practice. No research has examined how perceptions around rites of passage to an adult female identity are evolving across generations within the Spanish Caribbean. The author conducted an ethnographic project that included the use of in-depth life history interviews with 42 participants. She interrogates the narratives of three generations of adolescent girls and women of Haitian descent using modified grounded theory to (a) describe current culturally acceptable pathways to becoming an adult woman and (b) examine shifts taking place across time regarding acceptable pathways to womanhood. Findings suggest that, increasingly, younger generations no longer perceive marriage and motherhood as the singular rite of passage to adulthood. Yet, additional skills and characteristics that the participants identified as important to effectively transition to an adult role are either very difficult for the poor to attain, or are acquired through the experience of marriage and motherhood.
Contraception in women with severe medical conditions is a potential measure to reduce maternal mortality. We sought to determine the contraceptive use in women with medical conditions at the University Hospital of the West Indies (UHWI) in Jamaica to determine if there is room for improvement in contraceptive use. Participants were identified from the medical out-patient departments and questionnaires administered. Two hundred and sixty females between 18 and 44 years with varied chronic medical conditions were included. Those included were systemic lupus erythematosus (SLE), diabetes, hypertension (HTN), thyroid disease, cardiac and renal disease. The total current use of contraception was 58.4%, while 41.6% were not on contraceptives. The use of barrier methods and long-acting reversible contraceptives (LARCs) was 71% and 10%, respectively. The current use of contraception in patients with sickle cell disease (SCD) was 84% (p=.004) and in rheumatoid arthritis (RA), 14% (p=.028). Fifty-eight (58, 24.2%) of the women were using two or more methods of contraception. There is a role for improving contraceptive use among women with medical conditions as they are at increased risk of pregnancy complications.
• IMPACT STATEMENT
• What is already known on this subject? Women with medical comorbidities significantly contribute to both direct and indirect causes of maternal mortality. Contraception may play an integral role in reducing the risk of dying in chronically ill women; however, the use of contraception in this group is often suboptimal.
• What the results of this study add? This study adds to the literature that in this high-risk group, there is an underuse of long-acting reversible contraceptives, which is ideal for this population.
• What the implications are of these findings for clinical practice or further research? The results will provide evidence that this high-risk group of women should be targeted and counselled regarding their risk of morbidity and mortality in pregnancy as well as contraception use while their condition is optimised. From this evidence, services may be put in place in institutions, especially in low-resource settings.
Despite the increasing rate of diffusion of effective therapies, the battle against HIV/AIDS in Sub-Saharan Africa (SSA) is far from being over. Three main challenges are that the epidemics might paralyse or reverse the fertility transition, the expansion of the resources needed to finance the fight against HIV, and the emerging resistance to anti-retroviral treatments. This research proposes a UGT-like model showing the complexity of the interplay amongst the (macro)economy, the epidemics, their endogenous feedback on mortality and fertility and the central role of policy actions aimed to fight HIV. The disease-induced increase in adult mortality can hamper economic development by its upward pressure on the precautionary demand for children and downward pressure on education. This can dramatically reduce physical and human capital accumulation.
Cambridge Core - History of Medicine - Eponyms and Names in Obstetrics and Gynaecology - by Thomas F. Baskett
The growing popularity of levonorgestrel (LNG)-releasing intra-uterine systems for long-acting reversible contraception provides strong impetus to define immunomodulatory properties of this exogenous progestin. In initial in vitro studies herein, we found LNG significantly impaired activation of human dendritic cell (DCs) and their capacity to promote allogeneic T cell proliferation. In follow-up studies in a murine model of intranasal Chlamydia trachomatis infection, we analogously found that LNG treatment prior to infection dramatically reduced CD40 expression in DCs isolated from draining lymph nodes at 2 days post infection (dpi). At 12 dpi, we also detected significantly fewer CD4+ and CD8+ T cells in the lungs of LNG-treated mice. This inhibition of DC activation and T cell expansion in LNG-treated mice also delayed chlamydial clearance and the resolution of pulmonary inflammation. Conversely, administering agonist anti-CD40 monoclonal antibody to LNG-treated mice at 1 dpi restored lung T cell numbers and chlamydial burden at 12 dpi to levels seen in infected controls. Together, these studies reveal that LNG suppresses DC activation and function, and inhibits formation of pathogen-specific T cell immunity. They also highlight the need for studies that define in vivo effects of LNG use on human host response to microbial pathogens.
This study presents a novel theory on the interaction of social norms, fertility, education, and their joint impact on long-run economic development. The theory takes into account that sexual intercourse is utility enhancing and that the use of modern contraceptives potentially conflicts with prevailing social norms (religious beliefs). The theory motivates the existence of two steady states. At the traditional steady state, the economy stagnates, fertility is high, education is minimal, and the population sustains a norm according to which modern contraceptives are not used. At the modern steady state, the population has abandoned traditional beliefs, modern contraceptives are used, fertility is low and education and economic growth are high. Social dynamics explain why both equilibria are separated by a saddlepoint-equilibrium (a separatrix), i.e. why it is so hard to transit from the traditional regime to the modern regime.
This paper examines the impact of low fertility and early age at sterilisation on women’s formal education and skill development in South India. Multilevel ordered-logit modelling of pseudo-cohort data re-organised from the three rounds of National Family Health Survey, and thematic analysis of qualitative data collected from Tamil Nadu and Kerala states showed no evidence of women’s resumption of formal education or uptake of skill development training in the post-sterilisation and post-childcare period. While resuming formal education in the post-sterilisation and post-childcare period is harder to achieve for various individual, household, community and policy reasons, there is greater preparedness and support for women to undertake skill development training. As low fertility and early age at sterilisation are widely regarded as the emerging reproductive norm in India, post-sterilisation and -childcare women will be a significant population group both in number and in proportional terms. No government policies or programs have so far recognised this group. India’s new government should consider targeted skill development programs for post-sterilisation and -childcare women appropriate to their social, economic and educational levels. An important contribution of the family planning program, particularly female sterilisation, for the economic and social development of the family and the wider society will otherwise be lost.
Maria is a 23-year-old woman who lives in a rural area 3 h from Santiago, Guatemala. She has a 1-year-old daughter and recently had an uncomplicated miscarriage after an unplanned pregnancy. Although she desires another child in the future, she is interested in contraception and travels 1 h to a clinic staffed by volunteer clinicians.
Niniejszy artykuł ma na celu przedstawienie stanu badań nad transformacją płodności obserwowaną w populacji międzywojennej Polski oraz próbę powiązania ich z teoriami czy modelami usiłującymi wyjaśnić fenomen przejścia od płodności naturalnej do kontrolowanej. Zestawienie to pozwoli również na przedstawienie kilku postulatów badawczych, których realizacja może przyczynić się do pełniejszego zrozumienia procesu przemian płodności w ogóle, a szczególnie w regionie Europy Środkowo-Wschodniej i samej Drugiej Rzeczypospolitej.
This paper discusses the poverty-wealth impact on contraceptive use both at individual and community levels. A multilevel probit regression framework was set up to explain the use of contraceptive methods. We use data from the Indian 2005–06 National Family Health Survey (NFHS). It contains data on both the socio-demographic and health characteristics of Indian women, as well as an assembled measure of household wealth: the wealth index. The individual-level model confirms the association between contraceptive use and wealth. When controlling the community level, i.e. where the women live, the multilevel regression results show it has a significant effect on contraceptive use, explaining 19 % of the total variance. Finally, decomposing the wealth index at individual and community levels (average community wealth; individual centered wealth values), the effect of the community poverty-wealth level is significant and positive. To sum up, this framework of nested models reveals the significant effect of the community’s poverty-wealth dimension on each woman’s decision about contraception and suggests that the longstanding urban-rural differential in the contraceptive prevalence is mainly poverty-wealth driven.
Objective:
To determine the prevalence of contraceptive use and unmet need for family planning in Iran and to explore the public-health implications.
Methods:
A nationwide cross-sectional study was conducted by interviewing 2120 married women aged 15-49 years. The sample population was enrolled in 6 large Iranian cities (Tehran, Mashhad, Tabriz, Isfahan, Shiraz, and Ahvaz) and 2 small cities (Zahedan and Kerman) from September 22 to December 20, 2011.
Results:
The overall contraceptive prevalence rate was 81.5% and the unmet need for any method of contraception was 2.6% (95% confidence interval, 2.0%-3.3%). Given the frequency of women who used traditional contraceptive methods (22.3%), the unmet need for modern methods was estimated as 17.4%. The main reasons given for unmet need for family planning were low perceived risk of pregnancy (41.8%) and family opposition (21.8%). Unwanted pregnancy was reported by 30.7% of the participants.
Conclusion:
A high rate of unmet need for modern contraceptive methods might potentially lead to increased rates of unwanted pregnancies and induced abortions. Healthcare policymakers should, therefore, be warned against a sense of complacency that family planning in Iran does not need their support.
This study measured contraceptive knowledge, contraceptive use and fertility intentions among 1408 women of reproductive age in three communities in Kaduna state, Nigeria. Contraceptive knowledge was relatively high, with 64.6% of women having heard of at least one method. Radio and health facilities were the primary sources of information. The pill was most widely known (54.1%), followed by female sterilization (47.5%) and injectables (47.4%). Knowledge did not reflect use, however, as only 3.1% were current users of any method, among which injectables, pills and traditional waist bands were the most popular. Nearly 10% of non-users intended to begin using a method in the coming year, of whom 37.3% wished to use injectables. When asked about their last birth, 87% of women had desired to become pregnant and only 15% felt that their last pregnancy was mistimed. A sensitive and community-friendly approach is needed to reduce risks associated with high fertility while being respectful of community preferences (Afr. J. Reprod. Health 2010; 14[3]: 65-70). Résumé Intentions de fécondité, de connaissance du contraceptif et de l'emploi des contraceptifs chez les femmes dans trois communautés au nord du Nigéria. Cette étude a examiné la connaissance du contraceptif, l'emploi des contraceptifs et le désir de la fécondité chez 1408 femmes en âge de procréation dans trois communautés dans l'état de Kaduna, Nigéria. Le niveau de connaissance du contraceptif est relativement élevé, 64,6% des femmes ayant déjà entendu parler d'au moins une méthode. Les sources primaires de l'information étaient la radio et les établissements de santé. La pilule a été largement la plus connue (54,1%), suivie de la stérilisation féminine (47,55%) et des injectables (47,4%). Néanmoins, la connaissance n'a pas reflété l'emploi étant donné que 3,1% étaient des usagers courants de n'importe quelle méthode, dont les injectables, les pilules et les ceintures traditionnelles étaient les plus populaires. Presque 10% de non usagers avaient l'intention de commencer à employer une méthode dans l'année qui vient; parmi elles, 37,3% voulaient utiliser les injectables. Quand on leur a demandé leur dernier accouchement, 87% des femmes avaient voulu être enceintes et seules 15% ont pensé que leur dernière grossesse a été mal-calculée. Il faut une approche sensible et qui favorise les communautés pour réduire les risques liés à la haute fécondité tout en respectant les préférences des communautés (Afr. J. Reprod. Health 2010; 14[3]: 65-70).
Purpose:
Unintended pregnancy is a significant public health problem among young people worldwide. The purpose of this study was to explore and better understand the reasons for the apparent underuse of emergency contraceptive pills (ECP) in young people in coupled relationships. THEORETICAL RATIONAL: In postmodern explications of grounded theory, social construction of realities and the influence of subjectivities on the meanings of experiences lead to the development of partial truths that may change with time, context, and situation.
Methods:
Grounded theory methods guided semi-structured face-to-face interviews and data analysis. Twenty-two couples aged 18 to 25 years old were recruited through public notices.
Findings:
Four salient and interrelated conditions were constructed to help explain the complexities involved in young couples decision making regarding ECP use: (a) the shifting locus of responsibility for contraceptive decision making: in a perfect world versus biological reality; (b) relationship power: control-vulnerability continuum; (c) a woman's autonomy over her own body; and (d) conflicting views on ECP.
Conclusions:
Healthcare professionals whose practice includes young people need to be aware of possible couple dynamics when discussing contraception. Clients in supportive relationships should be encouraged to engage in open communication with their partners about their contraception needs, including possible ECP use.
Clinical relevance:
The results of this study contribute to the body of knowledge with regard to decision making related to ECP use in young adults.
Major depression is a frequent complication of the postpartum period. Untreated postpartum depression increases the risk of maternal suicide and can impair parenting capability with resultant adverse effects on offspring development. A number of factors influence a woman's vulnerability to postpartum depressive episodes. This article summarizes processes for assessing these risk factors and implementing primary preventive interventions, and summarizes methods of early detection to promote secondary and tertiary prevention.
Mechanical barriers, specifically male condoms, command renewed interest and are used today by more people. The worldwide prevalence rate of male condoms was about 6% in 2007 corresponding to 65 million cohabiting couples. The prevalence of female barrier methods, including diaphragms, cervical caps and female condoms has declined to less than 1% of women in North America and in north-west Europe. Even smaller percentages use female barriers elsewhere. First-year life table pregnancy probabilities of mechanical barrier methods range from 4 to 19 per hundred in clinical trials. The male condom is the only proved preventive tool against several sexually transmitted infections (STIs), especially HIV. The effectiveness of the diaphragm and cervical caps in this regard appears limited. Further research is needed to measure the efficacy of female condoms in disease prevention. Sponges are not known to protect against STIs. Because of their ease of use and availability, low short-term costs, relative freedom from side effects, and usefulness in combating STIs, mechanical barrier methods, especially condoms, will continue to be used on a large scale. For our literature search we used personal files, search engines such as Popline, Medline, PubMed and Google, and data bases of WHO, FHI and Cochrane Library.
This paper challenges the widely held and influential view that the fertility transition is largely the consequence of changing parental demand for children brought about by changes in the economic costs and benefits entailed in childbearing. Using evidence from both historical and contemporary populations we argue that demand theories do not offer a plausible explanation of the fertility transition. Instead, we propose that ideational, rather than structural, economic change lies at the heart of the transition. In particular, we suggest that attitudes to birth control, broadly defined, play a crucial role.
The evidence in the demographic and family planning literature of the range and diversity of the barriers to fertility regulation in many developing countries is reviewed in this article from a consumer perspective. Barriers are defined as the constraining factors standing between women and the realistic availability of the technologies and correct information they need in order to decide whether and when to have a child. The barriers include limited method choice, financial costs, the status of women, medical and legal restrictions, provider bias, and misinformation. The presence or absence of barriers to fertility regulation is likely an important determinant of the pace of fertility decline or its delay in many countries. At the same time, barriers inhibit women's ability to avoid unintended pregnancy. Problems of quantifying barriers limit understanding of their importance. New ways to quantify them and to identify misinformation, which is often concealed in survey data, are needed for future research.
Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.
Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission.
We did a secondary analysis of public-access data sets in 18 African countries (132,800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location.
Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy.
Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified.
The design of the 1965 National Fertility Study is comparable to the 1955 and 1960 surveys and therefore makes it possible to examine the changes in fertility control methods during the previous 10 years. The proportion of couples reporting that they have ever used contraception and the number of methods per using couple rose steadily between 1955 and 1960 and between 1960 and 1965. The use of oral contraceptives increased while the use of rhythm diaphragm and condom decreased. Among Catholic women the major change was the decline of their reliance on rhythm. The most significant result of the study was the increase in the use of fertility regulation in general and the pill in particular a finding that holds for Catholics and non-Catholics alike.
Fertility remains high and stable throughout sub-Saharan Africa, and there is no certain evidence of any national fertility decline. The explanation is not solely lack of development or ineffectiveness of family planning programs; almost 20 years ago some countries were relatively well developed and had introduced national population programs. The explanation lies largely in a religious belief system and an accompanying social structure that have accorded both spiritual and economic rewards to high marital fertility. Because of the weakness of the conjugal link, men do not feel the full economic burden of their reproductive decisions, while women are ultimately so dependent on their children that they have good reason to fear having too few. This essay explores the context of high African fertility as well as signs of destabilization in this high-fertility system on both the individual and national level.
3.1 INTRODUC TION In this chapter data on contraceptive practice are brought together within a common framework of analysis from all of the national cross-sectional sample surveys carried out in Great Britain or in England and Wales prior to the 1980s. In addition, data from the two more recent enquiries - in 1983 and 1986 - are considered briefly later in the chapter. The main object is to examine trends in contraceptive practice; other purposes are to assess the consistency of the data and to see how well they fit the known facts about fertility. Apart from the cross-sectional surveys, there have been three national surveys of contraceptive practice based on samples of births' and one based on a sample of marriages2. Data from these enquiries are not included because of the difficulties of comparing them with the cross-sectional data. Details of the cross-sectional surveys are presented in Table 3.13. All except the first were based on probability samples. The criteria of eligibility for interview varied. However, in every case information on contraceptive practice is available for a sample of married or ever married women - and in one case of men too - and these samples form the basis of the present work. They are similar enough to permit comparisons between surveys. The fact that some enquiries covered Great Britain and others only England and Wales can be ignored: the population of England and Wales comprises such a large proportion of the population of Great Britain that the figures for the two areas tend to be very similar.4 In the case of the survey carried out in 1946-47 by the Royal College of Obstetricians and Gynaecologists (the background to which is given in the chapter by Grebenik) the overwhelming majority of respondents were patients in the general wards of hospitals. Although more than 11,000 women were interviewed, the survey report was based on only 3,281 cases. Women in hospital as a result of any gynaecological condition or for any reason connected with maternity were excluded; so were women under the age of 45 whose first marriage had ended and those over the age of 45 whose first marriage had not lasted at least until they were 45 years of age.5 The sample was not a probability sample and was biased in a number of respects. Sixty four per cent of the 3,281 women were interviewed in London or Glasgow, although only 21 per cent of married women in Great Britain lived in those cities. Sample women were, on average, more working class and married younger and had more children than women in general. Lewis-Faning believed that because of these biases, and women's reticence, the reported level of contraceptive practice was likely to be lower than the true level in the population.6 Glass and Grebenik carried out an assessment of the survey findings using data from the Family Census of 1946 and came to the same conclusion.7 The basic approach in the analysis is to show all the information from each survey for the same set of marriage cohorts, so that comparisons can be made. However, depending
Pakistan launched one of the first population control programmes in the 1950s, yet has lagged far behind other countries in
effectively implementing or developing its understanding of population programmes. This paper explores the policy-making process
which shaped the programme in Pakistan in terms of the political considerations of the various military and civilian regimes,
the role of religion in politics, the influences of Western donors (particularly USAID), and the effect of international development
ideology. The resulting instability of the population programmes is analyzed in terms of: a) the rivalry between the separate
population and health programmes within government; b) the politically charged problem of over-centralized federal control
over population; c) the unresolved and uneasy working relationship between government and non-government organizations. The
paper concludes that the conflicts in these areas are directly related to the larger policy context in which they have evolved,
and without addressing the latter, the population programme will remain victim to deep-rooted structural problems
Discontinuation of contraceptive use that is not immediately followed by resumption of use of another method while a woman is at risk is a common cause of unintended pregnancy.
We provide new estimates of discontinuation for the pill, injectable, male condom, withdrawal and fertility-awareness-based methods, and identify socioeconomic characteristics associated with discontinuation for the pill, male condom and withdrawal. We provide new estimates of resumption of use by prior method used and identify socioeconomic characteristics associated with resumption of use. Estimates are obtained using the 2002 National Survey of Family Growth, supplemented by the 2001 Abortion Patient Survey to correct for underreporting of abortion.
The fraction of method use segments discontinued for method-related reasons within 1 year was highest for the male condom (57%), withdrawal (54%) and fertility-awareness-based methods (53%), and lowest for the pill (33%), with the injectable in-between (44%). However, contraception was abandoned altogether in only 25% of cases. The probability of resuming use of a contraceptive was 72% in the initial month of exposure to the risk of an unintended pregnancy; this rose to 76% by the third month.
The risk of discontinuation of use of reversible methods of contraception for method-related reasons, including a change of method, is very high, but fortunately the risk of abandoning use of contraception altogether is far lower, and most spells of exposure to risk of an unintended pregnancy following discontinuation are protected from the start by a switch to another method.
This study investigates sustained use of contraceptives among women in East Java, Indonesia. Interest is focused on the effect of whether the client's choice of contraceptive method was granted or denied, and the interaction between whether choice was granted or denied and husband-wife concurrence concerning method choice. Data were collected twice in a panel survey. The first round was conducted in family planning clinics among women initiating contraceptive use; the second was a follow-up household survey carried out 12 months later. Whether the user was granted her choice of method was found to be a very important determinant of sustained use of contraceptives. The interaction between whether choice was granted and whether there was husband-wife concurrence on method choice was also important. The highest rate of discontinuation occurred when method choice was denied in the presence of husband-wife agreement on method choice, and the lowest rate occurred when method choice was granted in the presence of such concurrence. The results imply that contraceptive continuation can be enhanced either when family planning workers pay more attention to the stated desires of their clients, or when policy is instituted allowing clients to use their method of choice.
Using participant observation data on worker-client exchanges from Bangladesh, this article examines the interface between a government family planning program and the rural women it serves. Case material focuses first on the program function typically identified in the literature: meeting unmet demand for contraception by providing convenient supply. Functions that have been less recognized are then illustrated: (1) the worker's role in reducing fear of contraceptive technology; (2) her effort to address religious barriers, child mortality risks, and high fertility preferences; and (3) her role in mobilizing male support. The range of functions performed by the female family planning worker in the cases discussed here demonstrates that her role transcends the boundaries of what is conventionally implied by the concept of supply. She acts as an agent of change whose presence helps to shift reproductive decision-making away from passivity, exposing women long secluded by the tradition of purdah to the modern notion of deliberate choice.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
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.
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.
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.
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.
In this essay, I suggest that the crisis in our understanding of fertility transitions is more apparent than real. Although most existing theories of fertility transition have been partially or wholly discredited, this reflects a tendency to assume that all fertility transitions share one or two causes, to ignore mortality decline as a precondition for fertility decline, to assume that pretransitional fertility is wholly governed by social constraints rather than by individual decision-making, and to test ideas on a decadal time scale. I end the essay by suggesting a perceptual, interactive approach to explaining fertility transitions that is closely allied to existing theories but focuses on conditions that lead couples to switch from postnatal to prenatal controls on family size.
This study reviews the major research and interventions concerning readiness and quality of care in family planning programs. It has three aims: to identify and describe the principal methodological research including conceptual frameworks, perspectives, and tools for measuring and improving quality; to describe the results from various intervention studies; and to assess what is known about the effect of such interventions. The review suggests that interventions that improve client-provider interactions show the greatest promise. Good quality of care results in such positive outcomes as clients' satisfaction, increased knowledge, and more effective and longer use of contraceptives. Rigorously documented evidence of the effects of interventions is sorely needed. The review indicates areas requiring additional research.
Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no 'ideal' method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.
In this article we survey variations in Chinas fertility policy as of the late 1990s in an attempt to describe local policy and the implications of the aggregation of local policies for national policy. Following a brief discussion of the politics of population policymaking in contemporary China we summarize fertility policy regulations within Chinas provinces. Our survey illustrates the intricacies and complexities of the population control process in China and serves as a background for our detailed analysis of the policy-stipulated fertility level in China based on local fertility policies. Using data collected on fertility policy for 420 prefecture-level units in China the administrative level below the province we estimate fertility levels that would obtain locally if all married couples had births at the levels permitted by local policy. Chinese birth control officials term this fertility level as "policy fertility" (zhengce shengyulu). We compute the average provincial and national policy fertility levels implied by policy fertility at the prefecture level and map the geographic and demographic distributions of policy fertility in China. This policy fertility level is a quantitative summary of Chinas current fertility policy informing what is pursued in terms of population control nationally on the basis of diverse local policies. Policy fertility serves as a reference for evaluating Chinas fertility policy implementation and as a starting point in evaluating the necessity and feasibility of continuing Chinas current fertility policy. (excerpt)
This study analyzes the practice of prenatal sex selection in rural central China. It examines the prevalence and determinants of prenatal sex determination by ultrasound scanning and subsequent sex-selective abortion. The data are derived from a survey of 820 married women aged 20-44 and from in-depth interviews with rural women and men, village leaders, family planning managers, and health providers, conducted by the author in one county in central China in 2000. Prenatal sex determination was a widespread practice, especially for second and higher-order pregnancies. Sex-selective abortion was prevalent and order of pregnancy, sex of fetus, and sex of previous children were major determinants of the practice. A female fetus representing a high-order pregnancy in a family with one or more daughters was the most likely to be aborted. Awareness among rural families that in the population at large a future marriage squeeze was likely did not diminish the demand for sex-selective abortion. Copyright 2001 by The Population Council, Inc..
El problema del aborto provocado en Chile
- Armijo
Armijo R & Monreal T. El problema del aborto provocado en Chile. Bol Oficina Sanit Panam 1966; 60: 39–45.
Non-use and use of ineffective methods of contraception Comparative quantification of health risks
- Collumbien M Gerressu
Collumbien M, Gerressu M & Cleland J. Non-use and use of ineffective methods of contraception. In Ezzati M, Lopez AD, Rodgers A et al (eds.). Comparative quantification of health risks. Geneva: World Health Organization, 2004, pp. 1255–1319.
Recent trends in abortion and contraception in 12 countries. Calverton: ORC Macro Demographic and Health Surveys Analytic Studies 8. *29 Family planning programmes and fertility Family planning: the unfinished agenda
- Cf Westoff
- J Cleland
- S Bernstein
- Ezeh
Westoff CF. Recent trends in abortion and contraception in 12 countries. Calverton: ORC Macro, 2005. Demographic and Health Surveys Analytic Studies 8. *29. Phillips JF & Ross JA (eds.). Family planning programmes and fertility. Oxford: Clarendon Press, 1992. *30. Cleland J, Bernstein S, Ezeh A et al. Family planning: the unfinished agenda. The Lancet 2006; 368: 1810–1827.
Emergence of the Indian family planning program
- Harkavy
Harkavy O & Roy K. Emergence of the Indian family planning program. In Robinson WC & Ross JA (eds.). The global family planning revolution: three decades of population policies and programs. Washington DC: The World Bank, 2007.
Our common interest: report of the commission for Africa. London: Commission for Africa
- Commission
- Africa
Commission for Africa. Our common interest: report of the commission for Africa. London: Commission for Africa, 2005. J. Cleland / Best Practice & Research Clinical Obstetrics and Gynaecology 23 (2009) 165–176
Sexual abstinence, contraception and condoms; trends in young single African women
- Cleland
Cleland J & Ali MM. Sexual abstinence, contraception and condoms; trends in young single African women. The Lancet 2006; 368: 1788–1793.
Fertility, biology and behavior
- J Bongaarts
- Potter
Bongaarts J & Potter RG. Fertility, biology and behavior. London: Academic Press, 1983.
Trends in contraceptive use in the United States: 1982–1995 United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use
- Lj Piccinino
- Mosher
Piccinino LJ & Mosher WD. Trends in contraceptive use in the United States: 1982–1995. Fam Plann Perspect 1998; 30: 4–10, 46. *13. United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use 2007. New York: United Nations, 2008.
United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use 2007
*13. United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use 2007. New York:
United Nations, 2008.
Department of Social and Economic Affairs, Population Division
United Nations, Department of Social and Economic Affairs, Population Division. World population policies 2003. New York:
United Nations, 2004.
United Nations, Department of Economic and Social Affairs, Population Division. Levels and trends of contraceptive use as assessed in 2002
*37. United Nations, Department of Economic and Social Affairs, Population Division. Levels and trends of contraceptive use as
assessed in 2002. New York: United Nations, 2004.
The stall in the fertility transition in Kenya. Calverton: ORC Macro, 2006. Demographic and Health Surveys Analytic Studies 9
- C F Westoff
- A Cross
Westoff CF & Cross A. The stall in the fertility transition in Kenya. Calverton: ORC Macro, 2006. Demographic and Health
Surveys Analytic Studies 9.
Recent trends in abortion and contraception in 12 countries. Calverton: ORC Macro
- C F Westoff
Westoff CF. Recent trends in abortion and contraception in 12 countries. Calverton: ORC Macro, 2005. Demographic and
Health Surveys Analytic Studies 8.
Our common interest: report of the commission for Africa
- Africa Commission
Commission for Africa. Our common interest: report of the commission for Africa. London: Commission for Africa, 2005.
Family planning programmes and fertility
- J Cleland
- S Bernstein
- A Ezeh
Phillips JF & Ross JA (eds.). Family planning programmes and fertility. Oxford: Clarendon Press, 1992.
*30. Cleland J, Bernstein S, Ezeh A et al. Family planning: the unfinished agenda. The Lancet 2006; 368: 1810-1827.
Sahin-Hodoglugil NN & Potts M. Barriers to fertility regulation: a review of the literature
*31. Campbell MM, Sahin-Hodoglugil NN & Potts M. Barriers to fertility regulation: a review of the literature. Stud Fam Plann
2006; 37: 87-98.
Television, telenovas and fertility change in north-east Brazil
- Faria