Issue 28 | MARCH 2011
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Factors that influence contraceptive use

C-Channel 28 presents six articles that address communication and decision-making on contraceptive use and the influence of social networks, spousal communication, and mass media campaigns.

Of Interest…

In the Democratic Republic of the Congo, C-Change is strengthening the social and behavior change communication capacity of Search for Common Ground (SFCG) to further their work on HIV prevention.
C-Change is also working with SFCG to incorporate messaging on HIV prevention into popular radio and TV programs. More information can be found here.

The first article looks at how contraceptive decision-making in Cambodia is influenced by husbands, peers, and elders. The second examines the role of social networks of young Latinas and African American women, and the third reports on people and factors influencing contraceptive decision-making among couples in rural Myanmar. The fourth article outlines research on spousal communication in Islamic areas of northern Nigeria that produced findings that challenge conventional wisdom.The final two articles describe mass media campaigns that increased contraceptive use: one in Pakistan promoting condom use and one disseminating family planning messages among Garo people in Bangladesh.

A C-Change peer education program in Albania among young university students living on four urban campuses increased their awareness and use of modern contraceptives. A recent report found that students exposed to the trained peer educators were twice as likely to use a modern contraceptive method as students who were not exposed to the program. The survey also found that students exposed to both the peer education program and C-Change’s concurrent mass media campaign were more than four times more likely to be able to identify three or more modern contraceptive methods. The report and more details about C-Change’s work in Albania are on the website. Materials used in the mass media campaign are available on C-Hub.


In this issue

Factors influencing decision-making on contraceptive use

1. Social support and parity in Cambodia

2. Social networks of Latina and African American women

3. Spousal communication, attitudes, and knowledge in rural Myanmar

4. Gendered interests in Islamic areas of Nigeria

Two mass media campaigns with impact

5. Campaign on condom use in urban Pakistan

6. Family planning campaign in rural Bangladesh

Factors influencing decision-making on contraceptive use

1. The role of social support and parity in contraceptive use in Cambodia

Authors: Samandari G 1; Speizer IS 1; O'Connell K 2
Institutions: 1 University of North Carolina, Chapel Hill, USA; 2 Population Services International, Washington DC, USA
Source: International Perspectives on Sexual and Reproductive Health Sep 2010; 36(3): 122-31.

CONTEXT: In Cambodia, unmet need for contraception is high. Studies suggest that social support and parity each play a role in contraceptive decision making.
METHODS: A representative sample of 706 married women aged 15-49 from two rural provinces in Cambodia who wished to delay childbirth were interviewed about their contraceptive use and their perceptions of their husband's, peers' and elders' support of contraception. Multivariate analyses examined associations between support measures and women's current use of modern methods, among all women and by parity.
RESULTS: Overall, 43% of women were currently using a modern method. Women who believed that their husband had a positive attitude toward contraception were more likely than those who did not to use a method (odds ratio, 3.4), whereas women who were nervous about talking with their husband about contraception were less likely than others to use a method (0.6); these associations remained in analyses by parity. Among all women and high-parity women, those whose husband made the final decision about contraception were less likely than other women to use a method (0.6 and 0.4, respectively). Perceiving that most of one's peers practice contraception was strongly associated with method use among low-parity women (4.4). Among all groups, women who agreed that one should not practice contraception if an elder says not to had decreased odds of method use (0.5 each).
CONCLUSIONS: To promote contraceptive use, family planning programs should focus on increasing men's approval of contraception, improving partner communication around family planning and bolstering women's confidence in their reproductive decision making.

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2. The role of the social network in contraceptive decision-making among young, African American and Latina women

Authors: Yee L 1; Simon M 2
Institutions: 1 University of California, San Francisco, USA; 2 Northwestern University Feinberg School of Medicine, Chicago, USA
Source: Journal of Adolescent Health Oct 2010; 47(4): 374-80. [Epub before print]

PURPOSE: Understanding reasons for contraception decisions is critical to improving our ability to reduce rates of unintended pregnancies. We used an in-depth qualitative approach to examine the contraceptive decision-making process, with special attention to the role of the social network, among a group of young, postpartum urban minority women.
METHODS: Brief surveys and semi-structured interviews were conducted with 30 consenting postpartum women. In-person one-on-one interviews were then reviewed for themes using an iterative process. Qualitative analysis techniques identifying emergent themes were applied to interview data.
RESULTS: In this cohort of African American (63%) and Hispanic (37%) women (median age, 26), 73% had unplanned pregnancies. The social network, including friends, mothers, and partners, were key sources of contraception myths, misconceptions, and vicarious experiences. Women also utilized media, including the internet, as an additional source of information. Information relayed by the social network had a direct influence on contraceptive decisions for many women.
CONCLUSIONS: The experiences and opinions of the social network influence contraceptive decisions in this population of young, minority women. The social network, including friends, family members, and media sources, is a key source of contraceptive information for many women. Comprehensive contraception counseling should explore the experiences and opinions of the patient's social network to the extent possible.

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3. Factors influencing married youths' decisions on contraceptive use in a rural area of Myanmar

Authors: Myo-Myo-Mon 1; Liabsuetrakul T 2
Institutions: 1 Medical Statistics Division, Department of Medical Research, Lower Myanmar; 2 Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
Source: Southeast Asian Journal of Tropical Medicine and Public Health Sep 2009; 40(5): 1057-64. [free text]

This study aimed to describe the factors influencing the decision of married female youth and their husbands measured by self-rating on the magnitude and importance of each factor and person, and agreement between willingness to use and actual contraceptive use. A community-based cross-sectional study was conducted in Ayeyarwaddy Division, Myanmar. The decision to use contraception increased significantly due to motivation from a provider, friends, spousal communication, and benefits of contraception by multiple logistic regression. Influencing factors which attained the magnitude of >50% and importance of >5 scores for their decision were a couple's attitude, spousal communication, pregnancy susceptibility, couple's knowledge, and benefit of contraception. A fair agreement was found between willingness to use and actual use.

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4. Gendered interests and poor spousal contraceptive communication in Islamic northern Nigeria

Authors: Izugbara C; Ibisomi L; Ezeh AC; Mandara M
Institution: African Population & Health Research Center; Kenya
Source: Journal of Family Planning and Reproductive Health Care Oct 2010; 36(4): 219-24.

Relying on focus group discussions and in-depth individual interviews with men and women in Jigawa and Kano states in northern Nigeria, we investigated barriers to spousal contraceptive communication. While attitudes toward spousal contraceptive communication were generally positive, there was very little evidence that respondents engaged in it. Poor spousal contraceptive communication in northern Nigeria is, in many ways, driven by the ample incentives that husbands and wives have to keep having children. For wives, having many children stabilises their marriage. It prevents husbands from marrying additional wives and sustains their attention and investments even if they ultimately do. For husbands, having many children helps them to keep their wives from objecting to their taking other wives and to mollify them by showing their continued commitment to that relationship should they take other wives. Our findings clearly challenge conventional population, family planning and reproductive health programmes that view high fertility as disempowering for women, and contraceptive use as capable of redressing gender inequality. New norms of gender relations are key to promoting contraceptive uptake and smaller families in northern Nigeria.

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Mass media campaigns with impact

5. Impact of an advertising campaign on condom use in urban Pakistan

Authors: Agha S 1; Meekers D 2
Institutions: 1 Population Services International, Washington DC, USA; Tulane University, New Orleans, USA
Source: Studies in Family Planning 10 Dec 2010; doi: 10.1111/j.1728-4465.2010.00253.x

This study describes an assessment of the impact on condom use in urban Pakistan of the second phase of an intensive condom advertising campaign conducted as part of a social marketing program. Between April and June 2009, advertisements for Touch condoms appeared on private television channels and on radio stations. To assess the impact of the campaign, a nationally representative panel survey of men married to women aged 15-49 was conducted, collecting information on behaviors related to condom use and recall of contraceptive advertisements. We employed conditional change regression analysis to determine whether awareness of the Touch ad at follow-up was associated with improved attitudes toward condoms and condom use. Respondents with confirmed awareness of the Touch campaign experienced significant improvements in indicators related to condom use, even after controlling for region, socioeconomic and demographic characteristics, the values of the indicators at baseline, and exposure to the first phase of the campaign. They experienced increases in the following: perceived availability of condoms; discussion of family planning; approval of family planning; procurement of condoms; and ever use, current use, and consistent use of condoms with wife. The study indicates that condom advertising can be effective in increasing condom use in urban Pakistan.

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6. Determinants of exposure to mass media family planning messages among indigenous people in Bangladesh: A study on the Garo

Authors: Islam MR; Islam MA; Banowary B
Institution: Bangladesh Agricultural University, Mymensingh, Bangladesh
Source: Journal of Biosocial Science Mar 2009; 41(2): 221-9. [Epub before print]

This paper evaluates exposure to mass media family planning (FP) messages among the Garo, an indigenous community in Bangladesh. A sample of 223 currently married Garo women were selected purposively from two districts where most of the Garo population live. The analysis demonstrated that television was the most significant form of mass media to disseminate FP messages among the recipients - more so than radio and newspapers. About 80.6% of the respondents had heard of FP messages through television, while for the radio and newspapers the percentages were 55.3% and 22.7% respectively. The contraceptive prevalence rate is much higher (79.5%) in the study area than the national level (55.8%). A linear logistic regression model was employed to identify the confluence of different demographic and socioeconomic characteristics on mass media FP messages. Regarding exposure to FP messages, four independent variables out of six had significant effects on the exposure to FP messages through any one of the types of media, i.e. radio, television and newspapers. These independent variables were age, level of education, occupation and number of children.

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