Tanvir Hossain1, Sumaiya Abedin2 and Md. Rafiqul Islam3

Institution and Affiliation
1 Research Fellow, 2 Assistant Professor, and 3 Associate Professor
Department of Population Science and Human Resource Development,
University of Rajshahi, Bangladesh.

Correspondence to:
Sumaiya Abedin
Assistant Professor
Department of Population Science & HRD
University of Rajshahi
Rajshahi-6205, Bangladesh
E-mail: abedins_pops@yahoo.com

 

ABSTRACT The aim of this study is to assess the knowledge and use of contraception of ever-married women of a district of Bangladesh namely Naogaon. The study uses data collected from some specific rural and urban areas of Naogaon district, Bangladesh. The information was collected from 800 ever-married women by interview method. Bivariate analysis and logistic regression analysis were adopted in evaluation of data and the analysis revealed that although the knowledge of contraceptive use has been conveyed to the majority of couples in Bangladesh, the current use rate of contraception is high enough (above ninety percent) and most of them currently are using modern methods. The most prevalent method of contraception is the pill. The level of current contraceptive use is higher in urban areas than in rural areas however, this gap is very narrow. Logistic analysis shows that education of both respondent and husband, visit of family planning workers, place of residence, desire for additional children, talking to husband about family planning and the number of living children have a nett significant effect on the current use of contraception. Key words: Ever married women, Contraception and Logistic Regression.

Nowadays the opulation problem is one of the burning questions in Bangladesh. Bangladesh strides hard to solve ubiquitous problems related to some population issues such as- fertility reduction, to achieve the replacement level, reproductive health and reproductive rights of women in terms of family planning etc. In this case, the family planning program has been considered as one of the successful programs in a setting without much socio-economic development that is considered a prerequisite for fertility decline in a broader sense and ensures the reproductive rights and health of a woman in the individual sense. Use of contraception is generally the main determinant influencing reduction in fertility in developing countries (Mitra et al; 1993). Any deliberate practice to avoid conception and to keep the family size small is the main motive of contraception. Although contraceptive prevalence among ever-married women of reproductive age is increasing rapidly, in many developing countries, the rate has not yet reached those of developed countries. Therefore, it is important to understand the levels and determinants of contraceptive use in order to formulate policies supporting proper strategies for raising contraceptive prevalence. Such considerations as desired family size and child-spacing influence contraceptive prevalence among married women at the individual level, while at the macro level, the laws and regulations and cultural norms are important factors that determine access to contraception. However, unwanted pregnancies resulting from lack of contraceptive use have led to an increasing number of abortions among women. Though the accepted contraceptive use rate has got its momentum, still there might exist differences in such use rate by rural-urban residence as well as regional difference. The present study is an attempt to assess the use of contraception of ever-married women of Naogaon district, Bangladesh.

In this study, the ever-married women of reproductive age in Naogaon district are the study population. The data was collected on fertility performance along with various socio-economic characteristics of the respondents from both urban and rural areas in Naogaon district. The number of respondents was 400 from rural and 400 from urban areas. To determine the contraceptive behavior of ever-married women of the study population, the percentage of married women has been analyzed by categories of several independent variables. The Logistic Regression Model is used for identifying the risk factors and for predicting the probability of success.
The general logistic model expresses a qualitative dependent variable as a function of several independent variables, both qualitative and quantitative (Cox, 1984).

If P is the probability of use of contraception, then

where b0 and b1 are the regression coefficients and X is a vector of covariates that affect the use of contraception. The general logistic regression model can thus be expressed as:

Logit (pi) =loge

which express the log odds of current users as a linear function of the independent variables.
In this analysis, the input data were matrices tabulating the current use status of contraception by independent variables. The logistic model is fitted by considering current use of contraception as the dependent variable, which have dichotomized by assigning 1 if respondents were using any method of contraception at the time of the survey and 0 for not using any method. In performing stepwise regression analysis for the determination of significant variables, 10 variables were initially selected for logistic regression analysis. If the odds ratio is greater than unity, the probability of being a current user is higher than that of being a non-user. The P value is used to identify the significant effects to assess the relative importance of the selected variables in the logistic regression model.

3.1 Knowledge of Contraception

In the 2004 BDHS survey, knowledge of contraceptive methods was assessed through a series of questions combining spontaneous recall and prompting procedures, as in the earlier BDHS survey. Information about knowledge was sought for six modern methods the pill, IUD, injection, condom, female sterilization and male sterilization as well as two traditional methods: periodic abstinence (safe period or rhythm method) and withdrawal. Today a desire for family limitation is noticeable everywhere. A relatively wide range of contraceptive choices is available to women ranging from short acting to medium term, long action and permanent methods. These methods are available through Government, Non-Government Organizations (NGOs) and private sector network.

3.2 Current Use of Contraception

The term "current use" refers to the method that was being used by an individual client at the time of the survey. According to the BDHS-2004 report current use of contraception is defined as the proportion of women and men who reported that they are using a family planning method at the time of interview. Table 1 shows the percentage distribution of ever-married women by current contraceptive use status. The table show that about 93.9 percent women of the study area are currently using a contraceptive method. This current contraceptive use rate is higher in urban areas than in rural areas (about 96.5 percent vs. 91.2 percent) giving rise to almost 5% urban rural gap in contraceptive use. Among all methods, the pill accounted for the highest use (nearly about 51.0 percent). There has been a wide difference in the use of pill by rural-urban residence. The use rate of the pill in urban ares is 56% and in rural areas is 46.3%, a gap of nearly 10%. The use rate of condoms is higher in urban areas but the use rate of injections and male and female sterilization are higher in rural areas. Traditional methods are less widely used than modern methods.

3.3 Differentials in Current Use of Contraception

Although the current contraceptive use rate is still high (93.9 percent) among the women of the study area, there are positive variations in use among women with different socio-economic and demographic characteristics. The level of current contraceptive use is higher in urban areas than in rural areas. Contraceptive use is also higher among women aged 20-34 years than among women either younger or older. The level of education of both respondent and their husband seems to have a positive effect on the current use of contraception. The current use rate is found to be directly associated with the number of living children and age at first marriage. The women who have no children are less likely to use contraception. The current use rate is much higher among the non-Muslim women than Muslim women in the study area. Women who have talked to husbands about family planning are more likely to use contraception than women who have never talked to their husbands which indicates that discussions with husband is needed for applying any decision of contraception. Those who do not desire more children are more likely to be current uses than those who desire more children. Occupation of husband also has a strong effect on the use of contraception. Visits of family planning workers also have a positive impact on contraceptive use rate.

3.4 Multivariate Logistic Model for current use of contraception

The logistic model is fitted by considering current use rate of contraception as the dependent variable. The independent variables are considered as place of residence, religion of respondent, education of both respondent and husband, occupation of husband, age at first marriage, desire for more children, number of living children, talked to husband about family planning and visit of FP workers.

Place of residence and religion of respondent has a significant and positive influence on the current use of contraception. In Table 3, the odds ratio for place of residence shows that the women of urban areas are 2.3 times more likely to use contraception than women in rural areas. Non-Muslim women are 2.044 times more likely to use contraception than their Muslim counterparts. The effect of the respondent's education on current contraceptive use is found to be the most important one.

Women with secondary or higher education are found 79.7 percent more likely to use contraception as those who are illiterate (Table 3). This indicates that women's education is the most important factor; it is followed in importance by women's participation in family planning decision-making. Both influence the current use rate of contraception positively.

Note: (r) represent reference category;
: *** for P<0.01, ** for P<0.05, and * for P<0.1

Education of husbands also gives a significant and positive effect on current use of contraception. Occupation of husbands shows insignificant and negative results except the service category by use of contraception. The women whose husbands work in service are 1.356 times more likely to use contraception than the wives whose husbands work in the agriculture group (Table 3). Age at first marriage does not have much influence on current use of contraception. Desire for additional children is highly significant and a positive influence on current use of contraception. Table 3 shows that the women who want no more children are 2.261 times more likely to use contraception than women who want more children. No. of living children has a significant relationship with current use of contraception. The women who have 1-2 children are 2.221 times more likely to use than those who have no children. With an increment in the number of children, the likelihood of using contraception also increases. The women who talked to their husband about family planning are 3.05 times more likely to use contraception than those who never talked to their husband. This indicates that husband's opinion has a great influence on use of family planning methods. Visit of family planning worker is highly significant and appeared as the most important factor influencing the current use of contraceptive methods. In view of the likelihood that the visit of family planning workers can motivate the women by counseling family planning methods, efforts of family planning workers can increase the contraceptive rate.

The study reveals that nearly all women of the study area are aware of at least one contraception method. The current rate of contraceptive use in Bangladesh is still high (93.9 percent) and it has an increasing tendency day-by-day. This study found a persistent, strong relationship between women's education and contraceptive use, but education makes less difference to contraceptive use where family planning programs are strong, although female education should be encouraged particularly on the rural areas. The husband-wife discussion about family planning and a more equal status of women in family in terms of decision making about family planning are important for increasing the contraception use rate and also a husband's consent is required before his wife can accept a contraceptive method. Efforts should be made to encourage greater participation of women in all family decisions. The current use of contraception is more in urban areas. It is also being increased in rural areas to control the growth rate of Bangladesh. Improvement of the status of women in the family and society in general, and enhancement of contraceptive supply through visits by field workers to the individual level in particular, would make the family planning program more effective and successful in Bangladesh.

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