 Trends and Determinants of Contraceptive Method Choice in Kenya
Monica Magadi is a Senior Research Fellow at the Department of Social Statistics, University of Southampton, UK. At the time this study was conducted, she was a Research Fellow with the African Population and Health Research Center, Nairobi, Kenya. Siân Curtis is Project Director, MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, CB#8120 University Square East, Chapel Hill, NC 27516–3997. E-mail: sian_curtis@unc.edu. This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information. (Studies in Family Planning 2003; 34[3]: 149–159)
How Gender Roles Influence Sexual and Reproductive Health Among South African Adolescents
Christine A. Varga is Assistant Professor, HIV/STI Intervention and Prevention Studies (HIPS), Program in Human Sexuality, Department of Family Practices and Community Health, Medical School, University of Minnesota, 1300 Second Street #180, Minneapolis, MN 55454. E-mail: varga_christine@hotmail.com. Although the literature on Africa increasingly adopts a gendered approach to sexual and reproductive health issues, few studies have addressed adolescent pregnancy and parenthood in such a framework. This article examines links between gender ideology or gender roles and the social impact of adolescent childbearing in the lives of rural and urban adolescents in KwaZulu/Natal, South Africa. It employs a triangulated research methodology (focus-group discussions, narrative role playing and discussions, and questionnaires and in-depth interviews) to inform an analysis of adolescents’ notions of male and female gender ideals. This analysis forms the basis for an exploration of the potential influence of adolescent childbearing on young peoples’ lives and factors that shape their sexual and reproductive well-being. Results indicate that gender ideals are grounded in traits that reinforce poor sexual negotiation dynamics and behavioral double standards and that place adolescents at risk for early pregnancy and other sexual and reproductive health complications. Overall, adolescent parenthood is viewed negatively by participants of both sexes because it compromises personal, professional, and financial aspirations. Compared with its effect on boys, parenthood has a disproportionate (and highly negative) impact on girls that is directly linked to gender-based inequities. The article addresses the research and policy implications of these findings. (Studies in Family Planning 2003; 34[3]: 160–172)
Rural Indian Women’s Care-seeking Behavior and Choice of Provider for Gynecological Symptoms
Manju Rani is Director, Social Welfare Department, Indian Administrative Services, Government of Rajasthan, India. E-mail: manju_rani@hotmail.com. Sekhar Bonu is Special Secretary (Medical and Health), Government of Rajasthan, India. This study uses data from the India National Family and Health Survey–2 conducted in 1998–99 to investigate the level and correlates of care-seeking and choice of provider for gynecological symptoms among currently married women in rural India. Of the symptomatic women surveyed, 31 percent sought care, overwhelmingly from private providers (70 percent). Only 8 percent of women consulted frontline paramedical health workers. Care-seeking behavior and type of providers consulted varied significantly across different Indian states. Significant differentials in care-seeking by age, caste, religion, education, household wealth, and women’s autonomy suggest the existence of multiple cultural, economic, and demand-side barriers to care-seeking. Although socially disadvantaged women were less likely than better-off women to consult private providers, the majority of even the poorest, uneducated, and lower-caste women consulted private providers. Geographical access to public health facilities had no significant association with choice of provider, whereas access to private providers had only a moderately significant association with that choice. The predominance of use of private services for self-perceived gynecological morbidity warrants the inclusion of private providers in the national reproductive health strategy to enhance its effectiveness. (Studies in Family Planning 2003; 34[3]: 173–185)
ReportsFactors Influencing Young Malians’ Reluctance to Use Hormonal Contraceptives
Sarah Castle is Lecturer, Centre for Population Studies, London School of Hygiene & Tropical Medicine, 49–51 Bedford Square, London WC1B 3DP. E-mail: sarah.castle@lshtm.ac.uk. During a qualitative evaluation of three peer-education programs in urban Mali, young people stated that they were wary of using either the pill or injectable contraceptives because they believed that these methods would make them sterile. Unmarried women’s contraceptive decisionmaking was not primarily driven by a current need to limit fertility, but rather by a future need to maximize it in order to gain status through childbearing in their marital households. Further interviews explored notions of conception, menstruation, and the perceived action of hormonal methods on the reproductive system. Findings revealed that menstrual disruption (in the form of amenorrhea or prolonged bleeding) appeared to have dire repercussions, including accusations of witchcraft and immoral behavior that could result in a woman’s being divorced or in her husband’s acquiring an additional wife. The social consequences of side effects were perceived to be more important than their biological manifestations, and together with the fear of sterility, resulted in a preference for the condom. (Studies in Family Planning 2003; 34[3]: 186–199)
Inconsistent Reporting of Female Genital Cutting Status in Northern Ghana: Explanatory Factors and Analytical Consequences (PDF)
At the time this study was written, Elizabeth F. Jackson was Staff Associate at the Population Council. Patricia Akweongo is Research Officer, Evelyn Sakeah is Research Assistant, and Abraham Hodgson is Director of the Navrongo Health Research Centre in northern Ghana. Rofina Asuru is Principal Investigator of the Navrongo Community Health and Family Planning Experiment at the Navrongo Health Research Centre. James F. Phillips is Senior Associate at the Population Council. E-mail: elizabeth_f_jackson@unc.edu. Although many cross-sectional social surveys have included questions about female genital cutting status and correlated personal characteristics, no longitudinal studies have been launched that permit investigation of response biases associated with such surveys. This study draws upon the findings of a longitudinal study of women aged 15 to 49 in rural northern Ghana. The self-reported circumcision status of women interviewed in 1995 was compared with the status they reported when they were interviewed again in 2000 after the government began enforcing a law banning the practice and public information campaigns against it were launched. In all, 13 percent of respondents who reported in 1995 that they had been circumcised stated that they had not been circumcised in the 2000 reinterview; this inconsistency reached 50 percent for the youngest age group. Analysis shows that women who said they had not been circumcised are significantly younger, more likely to be educated, and less likely to practice traditional religion than are women who reported that they were circumcised. Factors that may explain these correlates of denial are discussed, and implications for research are reviewed. (Studies in Family Planning 2003; 34[3]: 200–210)
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