Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"The role of women's self-efficacy in promoting postabortion contraception: Evidence from India"
Rajib Acharya and Shveta Kalyanwala

Background
A large body of evidence is available that confirms the limited agency of women in India to exercise choice in their own life; in the area of contraception, many lack the self-efficacy or confidence to adopt contraception independently, without the permission or approval of their husband or senior family members. Although the lack of self-efficacy in matters relating to contraception is likely an important obstacle underlying unmet need for contraception, its role in influencing the practice of contraception—interval, postpartum or post-abortion—has seldom been studied in India. Indeed, few studies have made attempts to measure self-efficacy with regard to contraception.

Objectives
The objectives of this paper are twofold: to measure self-efficacy with regard to the practice of contraception among women who have recently undergone an abortion and to examine the extent to which self-efficacy plays a role in their post-abortion contraceptive practices.

Methodology
Data are drawn from a study undertaken in four reproductive health service clinics in two of the least developed states of India, Bihar and Jharkhand, to assess post-abortion contraceptive patterns. In all, 800 married and unmarried women were recruited in the study, equally divided among those undergoing surgical and medical abortion during November 2009 to May 2010. Of these, 631 women were re-interviewed 6–9 months after the first interview (82 clients were lost to follow-up and 87 clients accepted sterilization immediately following abortion and thus were not followed up). The present analysis was restricted to 603 married women for whom data are available from both the interviews. The dependent variable—adoption of a contraceptive method within 4 weeks of abortion—was computed from weekly fertility history data obtained for the inter-survey period and collected during the follow-up interview. In order to measure self-efficacy in making contraceptive choices, our survey posed 10 statements to women that included, for example, whether women were confident about their ability to negotiate with their husband whether or not to practice contraception and which method to use, to procure and use contraceptive methods on their own, and to visit a health facility to access services. Our main explanatory variable, self-efficacy in making contraceptive choices was constructed as a simple additive index by summing responses from these statements and normalizing the index (range 0–1). The index had a high Cronbach’s alpha value of 0.82. Other explanatory variables included the age and education of the woman, number of children and living sons, whether the woman had been counselled about contraception during the abortion, whether she wanted more children, previous abortion experience, gestational age at which the recent abortion was performed, and the timing of the first post-abortion menstrual cycle. Analysis was conducted using logistic regression models, controlling for different combinations of explanatory variables.

Results
Analysis is ongoing. Women were, on average, aged 27 years, with about 10 years of education and two children at the time of the abortion. Seven in ten respondents had adopted a non-terminal method of contraception within a month of their abortion, ranging from 86% among those who had undergone surgical abortion to 58% among those who had undergone medical abortion. The most popular non-terminal method of contraception adopted was the IUCD, followed by oral pills and condoms. Self-efficacy in matters relating to contraception was moderate: the average index value was 0.54, far below the maximum of 1. Indeed, just two-fifths of respondents reported that they could use contraception on their own, and three-fifths reported that they could access the financial resources needed to procure contraception. Preliminary results from multivariate logistic regression analyses indicate that after controlling for age, parity, post-abortion contraceptive counselling experience, desire for more children, previous abortion experience, duration of pregnancy at the time of abortion and the timing of the first post-abortion menstrual cycle, the odds of adopting contraception within one month of abortion increased with increasing contraceptive self-efficacy (OR: 2.0, CI: 1.00 – 4.05). However, when education is introduced into the model, self-efficacy loses its statistical significance. These findings clearly suggest a pathway from education to post-abortion contraception through self-efficacy.

Knowledge contribution
The current study is one of very few studies that have explored the relationship between self- efficacy and post-abortion contraception. Findings advance current understanding of factors that influence post-abortion adoption of contraception and the role that self-efficacy plays in shaping the demand for family planning. While findings suggest that self-efficacy in turn is influenced by educational attainment, they highlight that in settings such as Bihar and Jharkhand, in which educational attainment levels among women are limited, BCC and other programmes must focus on building self-efficacy to practice contraception.

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