Ambivalence towards a prospective pregnancy among contraceptive users
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Ambivalence towards a prospective pregnancy among contraceptive users
- 1. Ambivalence towards a prospective pregnancy among contraceptive users Ilene Speizer, PhD LailiIrani, MD Janine Barden-O’Fallon, PhD Jessica Levy, MPH
- 2. Overview Analysisusing data from a one-year follow-up study with reversible method users conducted in Honduras, 2006-2007 The study was funded by USAID and implemented by MEASURE Evaluation in collaboration with Programaspara el Desarollo de Infantes y Mujeres (PRODIM)
- 3. Introduction Inconsistent fertility motivations and contraceptive use is common among contraceptive users and non-users Estimates of unintended pregnancies and unmet need for contraception do not account for these inconsistencies towards a future pregnancy
- 4. Objectives of this study To determine women’s stated reasons for reporting inconsistencies between fertility motivations and contraceptive use behaviors Examine changes in fertility desires over a one-year period among women using contraceptives predominantly to space birth
- 5. Study Sites
- 6. Data- Panel study collected in 2 rounds Baseline exit interviews with 800 women aged 15-44, attending a FP appointment in selected health facilities in which they received the injectable, IUD, or oral contraceptive pill Women were both new and continuing users There were no quotas by type of method Follow-up interviews completed with 671 (84%) 1 year later
- 7. Methodology At baseline and follow-up, women asked how much of a problem it would be if they got pregnant in the next few weeks: big problem, small problem, no problem At follow-up, women gave reasons for why they had responded as they did
- 8. Analysis Sample at baseline (n=633) Young (<30 years old) Married/in union (94%) Urban residents (80%) Parity </= 1 (44%) 72% injectables, 22% IUD, 7% pills
- 9. How much of a problem would it be to get pregnant?
- 10. Responses to problem question and contraceptive use, at follow-up Contraceptive users: 53% gave a response of “no problem” Non-users: 52% gave a response of “big”/”small” problem, indicating unmet need
- 11. Common reasons for why women responded “no problem,” among users
- 12. Common reasons for why women responded “small”/ “big” problem, among non-users
- 13. Strengths of the study This study demonstrates inconsistencies in fertility motivations and contraceptive behaviors Includes novel question asking how much of a problem it would be if women became pregnant soon Gain a better understanding of women’s strength of motivation to avoid pregnancy Fertility desires are measured over time
- 14. Limitations of the study Cannot compare the reasons women gave over time Cannot determine why women expressed inconsistent attitudes and behaviors The reasons reported were the first reasons women stated, not necessarily the most important Might have been using hormonal method to control menstrual problems and not for contraception
- 15. Discussion Inconsistent fertility attitudes and use are common Fertility attitudes can change over time, even though contraceptive use is continued FP counseling on adherence behavior may address attitude of inevitability towards pregnancy Child spacing important issue; useful for advocacy
- 16. Thank you MEASURE Evaluation is funded by the U.S. Agency for International Development and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States Government.
Editor's Notes
- The study was conducted in 4 urban areas of Honduras: Honduras is a small country in Central America- it has a population of about 7.2 million; a TFR of 3.3, and a CPR of 65%. The most common method of contraception in the country is sterilization (33%), followed by injectables (21%), oral contraceptive pills (17%); and the IUD (10%).The cities included in the study are Tegucigalpa (capital, most populous), San Pedro Sula (large, industrial city in the north); and two regional cities, Santa Rosa de Copan and Gracias (in the Western, less developed region of the country)
- This table provides results for acomparison between baseline and follow-up responses to the problem question. Roughly half of all women gave different answers at the baseline and follow-up interview. Women giving the same answers at both time points are shown in the L to R diagonal of the table.At baseline, a total of 463 women said that it would be a small or big problem if they got pregnant. At follow-up, 212 of these women, or 46%, switched their response to “no problem”. (shown in the circle)At baseline, a total of 170 women said that getting pregnant in the coming weeks would not be a problem. At follow-up, 52 of these women, or 31%, had switched to either a big or small problem. (shown in the oval)Women giving the no problem answer at baseline were the most likely to give the same response at follow-up (69%).
- This table presents information for women using contraception at the time of follow-up who alsoresponded “no problem” to the problem question (that is, for women we consider to have responses inconsistent with their contraceptive behavior).Here we see that the most common responses to why they said a pregnancy in the next few weeks would be “no problem” were because they felt they had no other option, that is what it means to be human, that is what it means to be a woman, and they accept that pregnancy can happen.The other common response dealt with their religious beliefs- a pregnancy would be no problem for them because it was “sent by God” or “what God wants” and therefore they could not reject it. Non-users responding “no-problem” were also most likely to express acceptance, but also a pregnancy would be no problem because they were planning a family, or felt that their last child was old enough.
- This table presents information for women who were not using contraception at the time of follow-up but who responded “small” or “big” problem to the problem question (again for women we consider to have responses inconsistent with their contraceptive behavior).Here we see that the most common response to why women said a pregnancy in the next few weeks would be a small or big problem had to do with child spacing issues- their last child was still too young. Pregnancies would also be problematic because the women were not living with their husband/partner, could not afford another child, were not in stable relationships, or would expect a negative response from their extended family.Users who reported a pregnancy would be a “big” or “small” problem were slightlymore likely to mention child spacing (30%), followed by a bad economic situation (16%), and the opportunity costs of another child due to missed study or work (13%).