Determinants of contraceptive switching behavior in rural Sri Lanka

This study examines the influence of a selected set of determinants of contraceptive method switching in rural Sri Lanka. Of interest is the question of how change in contraceptive practice at the individual level can account for patterns observed at the aggregate level. Based on calendar data on contraceptive use over a 3-year period, collected for more than 3,000 married women in a 1986 survey, the multivariate analysis shows that women who attain all or a significant proportion of their desired fertility tend to switch to more effective methods. Women who experience method failure tend to switch methods, usually to a type that is more effective. The woman's background determinants of age and education have small but significant effects on method switching, whereas the effect of household economic well-being is not significant. There is strong indication that rural couples are practicing contraception in a nonrandom fashion, switching methods in accordance with changes in their fertility motivations and contraceptive experience.

Efficacy of three variations of periodic abstinence for family planning in Indonesia

A prospective study to determine the efficacy of three alternative guidelines for the practice of periodic abstinence (PA) for family planning was conducted in Indonesia. The three methods studied were the Billings ovulation method, the Dorairaj modified mucus method, and a local version of the mucus method. For each method, the study encompassed a three-month learning phase and an additional 12-month effectiveness phase. Data from a total of 850 acceptors showed that, despite some variations in the sociodemographic characteristics of the acceptors, the Billings ovulation method had the lowest (10.4 per 100 women) and the local mucus method had the highest (26.5 per 100 women) overall life-table discontinuation rates in the effectiveness phase. One-year life-table unplanned pregnancy rates ranged from 2.5 per 100 women for the Billings method to a high of 11.5 per 100 women for the local method acceptors. Unplanned pregnancy was the main reason for termination.

Vasectomy reversal in Nepal

Data from 157 men in Nepal who had vasectomy reversal are analysed. Most sought reversal within 5 years of vasectomy. Half of the men sought reversal because of the death of a male child, and about one-fourth because of the loss of a female child. Re-marriage was the primary reason for only 10% of the men. Those having reversal because of the loss of a male child were generally younger, and for almost half of this group, the age of their last child at the time of their vasectomy was under 2 years. The results suggest that the demand for reversal could be considerably reduced by more careful screening of the potential vasectomy acceptors.

Breast-feeding in the modern health sector in Indonesia: the mother's perspective

This paper presents findings of a study of postpartum women in major hospitals throughout Indonesia. The objective was to assess the mothers' practices and attitudes regarding several key aspects of breast-feeding and 'rooming-in'. The study found that most of the women breast-fed their babies, with many believing infants should be breast-fed for 18 months or longer. However, many mothers lacked information about ideal infant feeding patterns and were unaware of how to solve problems that may arise. Only 38% recognized the value of feeding colostrum, and many feared the effect of breast-feeding on breast shape. They often gave supplementary formula. Almost none understood the importance of frequent suckling in promoting milk production. Only 50% of infants were kept in the same hospital room with their mothers for 24 hr a day, or full rooming-in. Women who kept their infants in the nursery (39%) were generally younger, better educated, primiparous, or had non-normal deliveries. They knew little about rooming-in, and if given more information to allay their doubts, they might consider rooming-in as a viable and safe arrangement. The results of this study reinforce the importance of identifying the perceptions and the knowledge of women concerning breast-feeding and rooming-in, so that hospital administrator, and health professionals can design programs and provide environments that encourage women to breast-feed their infants in optimal ways.

Potential acceptors of Norplant implants in comparison with recently sterilized women in Sri Lanka

This paper analyzes data from a population-based survey fielded in Sri Lanka, which showed that almost half of the women interested in using Norplant contraceptive subdermal implants were actually those who wanted to limit childbearing, a pattern also found in international Norplant clinical studies. A comparison between recently sterilized women and professed limiters of potential Norplant users showed the limiters to be socio-economically and demographically a significantly different group of women from those sterilized. Among several variables analyzed, the most important factor distinguishing the two groups was their relative economic status. Further comparison of the limiters with professed spacers interested in using Norplant showed that the spacers were yet another distinct category of women, the most important characteristic distinguishing between the two groups being the total number of living children. The preliminary results suggest that the Norplant implants system is not necessarily a substitute for sterilization; it appears potentially a popular method among those who want no more children but are not ready to accept sterilization. These findings that the potential Norplant implant users represent different gradients of women in the population have implications for provider counseling and user satisfaction as well as continuation.

To what extent does breastfeeding explain birth-interval effects on early childhood mortality?

This article shows that in Nepal breastfeeding almost completely explains the effects of following birth interval on childhood mortality during the first 18 months of age and partially explains the effect of following birth interval on childhood mortality between 18 and 60 months of age. Breastfeeding does not explain the effect of preceding birth interval on childhood mortality. The analysis is based on application of hazard models to data from the 1976 Nepal Fertility Survey.

Ethnic differentials in early childhood mortality in Nepal

This paper investigates the association of early childhood mortality (between birth and second birthday) with ethnicity in Nepal, based on data from the 1976 Nepal Fertility Survey, which was part of the World Fertility Survey. The approach is through a series of hazard models, which incorporate ethnicity, year of birth, mother's illiteracy, father's illiteracy, rural-urban residence, region, sex, maternal age, survival of previous birth, previous birth interval, and breast-feeding as covariates. Ethnic differentials in early childhood mortality are not explained by the other socioeconomic and demographic covariates, except for a modest effect of illiteracy, but the remaining covariates explain a great deal of variability in early childhood mortality itself. Analysis using an improved specification of breast-feeding as an age-varying covariate indicates, on average, that breast-feeding, relative to not breast-feeding, reduces age-specific mortality risks during the first 2 years of life by 76%, a very large effect.

Breast-feeding and health professionals: a study in hospitals in Indonesia

This paper presents findings on knowledge, attitudes, and practices regarding breast-feeding management in the modern health sector in Indonesia. The methodology applied was a survey which was carried out in teaching hospitals in major cities throughout Indonesia. The results showed that although the perinatal health care providers' attitudes toward breast-feeding were very positive, there were many areas in which knowledge was incomplete and in which wide variation existed or incorrect advice given to breast-feeding mothers. The content of advice on breast-feeding was not always sound. Many thought that a wide range of illnesses were a contraindication to breast-feeding, nearly one in five thought that breast-feeding should follow a fixed schedule rather than the baby's needs, and only 54% thought that breast-feeding should be initiated immediately after delivery. Most of the providers did not seem to have the knowledge to cope with the common problem of insufficient breast-milk supply syndrome. Similarly, although support for the concept of rooming-in was strong, about one-third of respondents did not think the mother and infant should be together for the full 24 hr implied by true rooming-in. Fears about the possibility of increased risk of infection with rooming-in were expressed These and other misconceptions about rooming-in imply that a consistent, well-designed training program needs to be carried out in the modern health sector which will provide the necessary information to health care providers about this important aspect of early infant care.

A decade of Nepal's family planning program: achievements and prospects

Knowledge and practice of family planning in Nepal increased considerably from mid-1976 through mid-1986, with significant improvements in the availability of and accessibility to contraceptives. However, a proportionately larger share of the achievements were made during 1976-81 than in 1981-86. The impact on fertility of contraceptive use during the decade was minimal. Knowledge and use of reversible contraceptive methods remained very low, primarily because of the continued strong emphasis on sterilization in Nepal's family planning program. Consequently, the welfare of many couples who may be in need of contraception for spacing births, but not necessarily for terminating childbearing, does not appear to be adequately addressed by the program. A more balanced emphasis on reversible methods of contraception does not necessarily imply that a substantially higher level of contraceptive prevalence would be required to reach the fertility target. Several steps to improve program performance and contraceptive method mix are suggested.

Sociodemographic determinants of contraceptive method choice in Sri Lanka: 1975-82

The determinants of contraceptive method choice in Sri Lanka are examined during a period in which contraceptive prevalence increased by over 60% and involved substantial use of sterilization and traditional methods. Data are from the 1975 World Fertility and 1982 Contraceptive Prevalence Surveys. Polytomous logistic regression is used to model four current contraceptive choices: non-use, use of a traditional method, use of a modern temporary method and use of sterilization. The analysis shows, in 1975 and 1982, strong socioeconomic as well as demographic effects on whether any method is used. However, in both years the type of method chosen is primarily a function of demographic considerations related to the couple's family-building stage rather than social status, implying that in Sri Lanka there are few socioeconomic barriers limiting access to different contraceptive methods. The family planning programme, however, has emphasized sterilization rather than birth spacing methods.

Contraceptive method change among rural Sri Lankan women

Patterns of contraceptive method change and their association with reproductive motivation and contraceptive failure are examined using data from a 1986 survey of family planning behaviour of rural Sinhalese married women aged 15-44 in seventeen districts of Sri Lanka. A notable degree of rationality in contraceptive method changes occurs with family formation. The attempt to control unwanted fertility leads to more efficacious use of contraception, including traditional methods. Some methodological improvements to the analysis of contraceptive switching are indicated. Implications of the findings for programmatic emphasis on permanent versus non-permanent modern methods are discussed.

Breast feeding, birth spacing and their effects on child survival

It has long been known that breast feeding inhibits female fertility and that it is a factor in restricting population growth. But just how important is it?

Compensatory payments and vasectomy acceptance in urban Sri Lanka

This paper examines the effects of different levels of payment on the acceptance of vasectomy in urban Sri Lanka. Data from 496 vasectomized men are analysed by socioeconomic and demographic characteristics, post-operative problems encountered and attitudes towards vasectomy by amount of payment. The findings show that higher levels of payments have significantly enhanced the adoption of vasectomy, particularly among the low economic status group. The time of vasectomy in relation to the youngest child's age was influenced by the payment scheme. Higher monetary payments have not induced men to become sterilized who would be considered ineligible for the operation. A high level of satisfaction with the decision to have a vasectomy, regardless of payment level, was found. There was no systematic influence of payment levels on post-operative problems.

Evaluation of safety, efficacy, and acceptability of NORPLANT implants in Sri Lanka

This paper presents findings based on a one-year pre-introductory clinical investigation concerning safety, efficacy, and acceptability of the new contraceptive NORPLANT implants in Sri Lanka. The study is based on 400 acceptors of the implants at two clinics in Sri Lanka. Acceptors' mean age was 27 years, mean number of children was about two, and average educational attainment was eight years. Nearly half of the acceptors did not want to have another child. Follow-up was conducted at one, three, six, and twelve months. The one-year termination rate due to medical problems was very low, and the one-year life-table pregnancy rate was 0.5. Menstrual pattern disruption was the most frequently reported complaint with the implants. Amenorrhea increased in the first three months of use, and intermenstrual bleeding was common among those menstruating. In spite of these changes and some significant variations between the acceptors in the two study center, the overall degree of satisfaction with the implants was very high. The features most important to the acceptability of the implants were low risk of pregnancy, the long duration of action, and the convenience of use. The results of the study suggest that NORPLANT implants are safe, effective, and highly acceptable to Sri Lankan women.

Determinants of fertility in Nepal: applications of an aggregate model

Bongaarts' aggregate model of the proximate determinants of fertility is applied to data from the 1976 National Fertility Survey in Nepal. Breast-feeding is shown to be the most important limiting factor, resulting in a reduction of about six children per woman. Decline in the duration of breast-feeding by one-fourth would increase fertility by one additional child per woman. The temporary separation of spouses due to migration is conjectured to be the second most important fertility inhibiting factor, not explicitly accounted for in the standard model. Results are presented for the three major ecological regions, urban-rural residence and educational attainment of the women.

Infant mortality trends and differentials in Nepal

Infant mortality trends and differentials are estimated from the 1981 Nepal Contraceptive Prevalence Survey (NCPS) and compared with similar estimates from the 1976 Nepal Fertility Survey (NFS) and the 1981 Census of Nepal. The analysis indicates that infant mortality rates derived directly from the NFS maternity histories are the most accurate. Infant mortality rates derived directly from the NCPS maternity histories are severely underestimated and yield a strongly biased trend that is the reverse of the true downward trend. Indirect estimates of infant mortality trends derived from child survivorship data do not result in a consistent pattern. Infant mortality differentials, when expressed in relative rather than absolute terms, are generally consistent with findings from earlier studies. Possible reasons for data quality differences among the three data sources are discussed.

Awareness of sexually transmitted diseases (STDs) among married women of reproductive age group in Barahi, Chiraigaun, India

A survey was conducted using 139 rural married women to know awareness of sexually transmitted diseases (STDs) in Barahi, Chiraigaun, a rural primise in India. About one-fifth of the respondents were aware of STD, of which there was only one female who had heard of STD. Very few people sought for help from medical practitioners and less than one-fifth of the diseased people failed taking medicine regularly. Treatment cost ranged from Rs 10 to 5,000. Mass media like TV was not popular among rural people. Health workers were effective means of propagating knowledge and creating awareness. None of the diseased persons were using condom while 10% of non-diseased respondents used condom. No awareness program on health was conducted in the locality within a year. None of the respondents were able to tell whether STD’s and HIV were same or different. Key words: Sexually transmitted disease (STD); health worker; condom. DOI: 10.3126/jcmsn.v6i3.4068Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.8-14