Despite identification in numerous studies of factors that influence the use of family planning, the translation of these research findings into interventions that increase contraceptive prevalence is not always successful. The reasons for this seeming discrepancy sometimes lie in the social environment in which women live or in the interaction between women and family planning providers. Three of the articles in this issue of International Family Planning Perspectives look at social, cultural and interpersonal factors that may act as barriers to adoption and continuation of contraceptive use.
In the lead article, "Women's Networks and the Social World of Fertility Behavior," Sangeetha Madhavan and her coauthors look at the relationships of selected household and social network characteristics to fertility and contraceptive use among Bamanan women in Mali [see article]. According to the results of their analysis, the odds that a woman had ever practiced contraception rose with the proportion of members in her social network who lived outside her village, but declined sharply as the proportion of conjugal kin in her network increased. Network effects for younger and older women varied: The odds of ever-use among women aged 30 or older were increased by the presence in their network of their mother-in-law, members of their own family and unrelated older women; for younger women, the odds increased with the proportion of network members who were nonkin or lived outside the village, and decreased with the proportion of network members who were relatives of the women's husbands.
Tiziana Leone and her colleagues examine another social factor that influences fertility and family planning use in many developing countries--the preference of couples for sons [page 69]. Using data from the 1996 Nepal Demographic and Health Survey, the authors find indications of substantial gender discrimination in sex-specific mortality rates among young children and in the sex ratio at last birth (the number of last-born males per 100 last-born females). The result for the latter measure (146 males per 100 females, compared with an expected ratio of 105 males per 100 females) provides evidence that many couples stop childbearing only after having a son. The authors' analysis indicates that the societal preference for sons decreases contraceptive prevalence by 24% and increases the total fertility rate by more than 6%. The authors predict that son preference will become an increasingly important barrier to lowering fertility as the desired family size in Nepal decreases.
Even if women encounter no resistance to family planning within their social environment, their interactions with family planning providers may discourage them from adopting or continuing use of a method. In "The Link Between Quality of Care and Contraceptive Use," Saumya RamaRao and colleagues find that use of any contraceptive and use of a modern method at follow-up rise with the quality of care women receive when they first adopt a method [see article]. In their study, which was conducted in the Philippines, women who had received all the necessary information about their contraceptive method (including how it worked, how to use it, potential side effects and how to handle problems) and had experienced good interpersonal relations with their provider (e.g., were treated in a friendly manner and with respect for their privacy, were permitted to ask questions and were given adequate answers) were significantly more likely to be using a modern method (or any method) 16-24 months later.
Also in This Issue
• In many developing countries, levels of knowledge about emergency contraception are low, despite high rates of unplanned pregnancy and abortion. In a study conducted in a sample of 880 female university students in Nigeria, Michael Aziken and colleagues find that 43% were sexually active, 39% had ever practiced contraception and 34% had had an abortion [see article]. Although 58% of the students reported knowing about emergency contraception, only 18% of that group knew the time frame during which it must be used in order to be effective.
• In the late 1990s, the Bangladeshi government began to integrate family planning services--formerly provided through doorstep delivery by fieldworkers--into a package of primary health care services offered at community clinics. Because this strategy appears to have led to a plateau in the decline in fertility and rise in contraceptive use experienced over the past two decades, the current government appears to be reconsidering a return to domiciliary services. Lisa Bates and colleagues examine possible reasons for the lack of continuing progress, and discuss areas that need to be addressed if the potential of the new service approach is to be reached [see article].