Contraceptive Use among Married Women in Chuadanga District, Bangladesh

Md. Mizanur Rahman1, Shamima Akter2, and Dr. Md. Nazrul Islam Mondal3

1. Md. Mizanur Rahman
Lecturer
Dept. of Population Science and Human Resource Development
University of Rajshahi, Bangladesh
E-mail: mmr_f@yahoo.com

2. Shamima Akter
Department of Population Science and Human Resource Development,
University of Rajshahi,
Rajshahi-6205, Bangladesh
E-mail: samimarub@yahoo.com

3. Dr. Md. Nazrul Islam Mondal
Assistant Professor
Department of Population Science and Human Resource Development
University of Rajshahi, Bangladesh

Correspondence to:
Md. Mizanur Rahman
Lecturer
Department of Population Science and Human Resource Development
University of Rajshahi, Bangladesh
E-mail: mmr_f@yahoo.com

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ABSTRACT This study examines the use of contraception among married women of reproductive age in Chuadanga District, Bangladesh in 2005, with particular focus on the extent to which socio-economic and demographic factors exert independent influence on contraceptive use. The result of the study supports the hypothesis that place of residence, women's education and television watching are the most important significant factors which influence the use of contraception positively. Among the demographic and socioeconomic factors, women's age, the religion of the respondent, husband's education and couple's occupation were not found to have any significant net effect on use of contraception. Key words: Family planning, socio-economic and demographic factors, logistic regression model, odds ratio.

Family planning has been considered an effective way to improve the health of mother and child and enables a couple to decide freely and responsibly the number and spacing of their children. An expert Committee, defined and described family planning as follows: Family planning refers to practices that help individuals or couples to attain certain objectives: to avoid unwanted births, to bring about wanted births, to regulate the intervals between pregnancies, to control the time at which births occur in relation to the ages of the parent, and also to determine the number of children in the family (Park, 1997, WHO, 1971).

Bangladesh is a country of 1, 47,570 square kilometers and around 140 million people with the highest population density (839 per sq. km.) in the world (US, 2004). The practice of contraception is increased gradually over the last two decades in Bangladesh. With a population of 147.3 million in 2006, Bangladesh is the seventh most populous country in the world and will continue to grow by 2.0 percent annually during 2000-2010 (US Census Bureau, 2005).

The total fertility rate (TFR) has decreased from about 6.3 in the mid-1970s (MOHPC, 1978:73) to 3.3 in 1999-2000 and then to 3.0 in 2004 (BDHS, 2004). The contraceptive prevalence rate (CPR) was 8 percent in 1975, 40 percent in 1991, and 53.8 percent in 2000 and rose to 58.1 percent in 2004 (BDHS, 2005). Demographers have attributed this change in TFR to a decline in marital fertility and the success of the family planning programme rather than rising age at marriage (Huq and Cleland, 1990).

In 1976 the Government of Bangladesh identified population as the country's number one problem. Two years later, important measures were taken to strengthen the family planning programme. The invention of grassroots-level female family planning workers, i.e., family welfare assistants (FWAs) and establishment of health care centers in 1978 caused a dramatic shift in the CPR. Health care centers provided basic reproductive health services such as IUD insertion and injectable contraceptives and FWA providing free contraceptive pills, condoms etc.

Bangladesh has managed to achieve a steep decline in fertility in spite of its unremarkable socio-economic development in the past decade. The researchers have found that decline in the TFR due to increased use of contraception, which in turn has been credited to strong and successful family planning programme in the country (Kamal and et al, 1996).

Ullah, S.M et al (1993), found a persistent, strong relationship between women's education and contraceptive use but education makes less difference to contraceptive use where family planning programmes are strong. Schuler, R.. S. et. al. (2006) proposes a framework which indicates the relationships between family planning use and multiple domains of women's lives, in a context where external factors can affect both (see Figure 1).

The starting point of the framework is women's experiences with family planning. This includes contraceptive use and non-use, childbearing and pregnancy, family planning programs and other reproductive health services. Under this rubric, researchers asked women about their perceptions of method availability and variety, method efficacy, quality of services, and decisions to start or stop contraceptive use.

The main purpose of this study is to assess the quality of service provision, particularly as it was related to access for removal of the implants. The specific objectives are as follows:

• To examine the differentials of contraceptive practice among married women by different demographic and socio-economic characteristics;
  
• To investigate the factors influencing female participation in family planning.
  

The data used for the analysis is the results of the study of the causes of differentials of family planning participation among married women. The study was conducted in the district Chuadanga. It was conducted in two Thanas of one district in Bangladesh (Alamdanga and Chuadanga sodar Thana of Chuadanga district). Two Thana were selected purposively in this district. Afterward, two unions were chosen purposively in each selected Thana, one with the highest rate of female family panning participation (high union) and one with the lowest female family planning participation (low union). Data collection was carried out using a structured questionnaire. Besides, data collection was conducted through in-depth interviews and focus group discussions. Purposive sampling was done to select 500 study subjects, with households taken as the unit of sampling. The type of information collected in the study using a structured questionnaire involves information about a respondent's background characteristics (demographic, social and economic), knowledge, attitude and practice of family planning, family planning methods availability and family planning activities in study location.

To examine the differentials of factors influencing female participation in family planning using cross tabulation. A binary logistic regression model was used to investigate the factors influencing married women's participation in family planning. There are 8 demographic and socio-economic factors analyzed as independent variables in the model: the female's age, residence, couple education and occupation, religion and role of mass media.

Now the expression i is given by
i= E (Y_i= 1/ X₁₁=0, X₁₂= x_12, X₂₁= 0, X₂₂= x_22, X₂₃= x₂₃, X₃₁=0, X₃₂= x₃₂, X₄₁=0, X₄₂=x_42, X₄₃=x₄₃, X₅₁=0, X₅₂=x_52, X₅₃=x₅₃, X₆₁=0, X₆₂=x_62, X₆₃=x₆₃, X₇₁=0, X₇₂=x₇₂, X₇₃=x_73, X₈₁=0, X₈₂=x₈₂)

(Here the value of the variables corresponding to the reference category is considered as "0").
That is,

i=

And

1-i =

Therefore, =

Log_{e () =
0}+ ₁x₁₁+ ₂x₁₂+ ₃x₂₁+ ₄x₂₂+ ₅x₂₃+ ₆x₃₁+ ₇x₃₂+ ₈x_41
9x₄₂+ ₁₀x₄₃+ ₁₁x₅₁+ ₁₂x₅₂+ ₁₃x₅₃+ ₁₄x₆₁+ ₁₅x₆₂+ ₁₆x₆₃+ ₁₇x₇₁+ ₁₈x₇₂₁₉x₇₃+ ₂₀x₈₁+ ₂₁x₈₂.....

 Then from the equation, the model is

Log_{e () =
0}+ ₂x₁₂+ ₄x₂₂₅x₂₃+ ₇x₃₂+ ₉x₄₂+ ₁₀x₄₃+ ₁₂x₅₂+ ₁₃x53+ ₁₅x₆₂+ ₁₆x₆₃+ ₁₉x₇₃+ ₂₁x82.....

Where, p= probability that a female was currently practicing or practiced female contraceptive method or the probability of Y= 1, and _i is the parameter estimate for the intercept and independent variables.

Pattern and Differentials of Female Participation in Family Planning

The percentage of women based on the female FP participation status and the socio-economic and demographic factors is displayed in Table 2. The analyses results of the study shows that women with 34.5% in rural areas and 65.5% in urban areas practicing family planning (FP). Thus participation of FP is higher in urban area than in rural areas.

Table 2 observed that women with age <20 and 30+ yrs were practicing a lower percentage (i.e. 17.8% and 28.4% respectively) of FP than younger (20-30 years) women (53.8%). The table also shows that Muslim women are practicing a higher percentage (89.8%) of FP than Non-Muslim women (10.2%). As this study found, it can be seen that women with secondary and higher education have 48.5% and illiterate women have lower percentage (27.3%) of practicing FP.

Husbands with a higher education are more willing to practice a male FP. The results of this study shows that 22.3% for husbands who were illiterate, 16.3% for husbands with primary education and 61.4% for husbands with secondary and higher education were practicing FP method.

Table 2 show that couples who are engaged in service professions use a higher percent (90.2% female and 46.2% male) of contraception practice than other occupational categories. Women who watch TV practice contraception 57.8% and the rest do not watch TV. This Table 2 also indicates that 73.8% of the married women use a contraceptive method oral pill, 0.80% use IUD, 11.8% of married women applied a contraceptive method injection and 13.7% follow a natural process. Here the maximum number of women use the oral pill and the lowest, use IUD.

Factors Influencing Contraception Practice among Married Women

The results of the binary logistic regression analysis are presented in Table 3 in the form of parameter estimates, p-value for assessing the significance of the independent variables and the odds ratio. The analyzed result found that, only 3 independent variables out of 8 independent socioeconomic and demographic variables are statistically significant at 1%, 5% and 10% level. These significant predictors are type of residence, female education, and watching of television. The other 5 independent variables are statistically insignificant on practice contraceptive method.

From the results of the logistic regression analysis, it appears that place of residence is the most important factor affecting the use of contraception among married women. Large and statistically significant differences in contraceptive use, by place of residence, are observed despite having controlled for other variables. Table 3 shows that type of residence has a significant effect on use of contraceptive method at a 5% level. Women who live in urban area are more likely to use it 1.073 more times than those who live in rural areas. So women who live in urban areas are more likely to have access to these services than those who live in rural areas.

The results of the study found that women's age affects the risk of ever or currently practicing female contraception. Females with age 30+ years are less likely to use FP 0.536 times than those age <20 years. Thus the older the female, the lower the probability of being a user or non user of a female contraceptive method. Belief can affect the acceptance of modern practice including birth control practice. Those who believe that FP is against religious values might be less likely to practice FP. The result shows that Non-Muslim women are more likely to use 1.048 times contraceptive method than Muslim women.

* Significance at p<.01, ** Significance at p<.05, *** Significance at p<.10

The estimated binary logistic regression model is given by
Log_{e ()} 1.897 + 0.070x₁₂ - 0.578x₂₂ - 0.624x₂₃ + 0.047x₃₂ + 0.055x₄₂ + 0.613x₄₃
-0.179x₅₂ + 0.886x₅₃ + 0.055x₆₂ - 0.9766x₆₃
-0.306x₇₂ - 0.352x₇₃ + 1.043x₈₂

The results shown in Table 3 indicate that women's education significantly affects use of contraceptive at a 5% level. The risk of contraception practice among married women for primary and secondary and higher levels have 1.057 and 1.846 times higher than the illiterate women. The results of the analysis show that the women whose husband was secondary and higher educated have used contraception 2.425 times more than illiterate husbands. Educated women also may desire fewer children than their less educated counterparts because of the incompatibility between formal sector employment and child care (Choe and Tsuya, 1991).
It was hypothesized that a couple's occupation influences female FP practice (Samosir, B.O and et. al, 2005). The result of this study shows that women who engaged in a service profession have 1.056 times higher risk than who those who engaged in household. Similarly for husbands those who are engaged in agriculture have 0.736 times lower risk than those engaged in a service profession.

Mass media is an important factor that has influence on acceptance of FP method. Table 3 indicates that watching of television has a significant affect on practicing female FP method. Women who watch television have used contraception 2.852 times more than those who do not watch television.

The result of this study found that contraceptive use among married women is higher (65.5%) in urban areas than in rural areas (34.5%). Women with secondary and higher education practice contraception at a higher percent (48.5%) than other lower educated women. Contraception use among secondary and higher educated women is 1.846 times higher than the rest of the educational category. In women who engaged in a service profession the use of contraception practice is higher than those who are engaged in the household. Mass media is an important factor which can significantly influence use of contraception. Those who watch TV use FP 2.852 times more than those who don't watch this. So contraceptive practice differentials among married women are mostly type of residence, age, religion, education, occupation and watching of television.

The study contains a number of implications for policy purposes that could be useful in devising ways to increase the contraceptive prevalence rate among women and thus bring lower fertility in Bangladesh. The policies are as follows:

• Provide free contraceptive materials and to increase the frequency of visits by family welfare assistants among married women, particularly in rural areas.
  
• Provide education to and create more employment opportunities for women to increase their social status;
  
• Create awareness among married women about the negative health, social and economic consequence of early marriage, early pregnancy and large family size. This could be done through mass media, special information, education and communication (IEC) campaigns, regular home visits by family welfare visitors and family welfare assistants.
  
• Provide women with information on the availability of contraceptive methods and their use-effectiveness.