Transcript Male method choice in Bangladesh: Does it matter who makes the decision?

Male Method Choice in Bangladesh: Does It Matter
Who Makes The Decision?
Mohammad Amirul Islam
Sabu S. Padmadas
Peter W.F. Smith
Division of Social Statistics
University of Southampton, SO17 1BJ, UK
e-mail: [email protected]
British Society for Population Studies Conference, Southampton, UK, 18-20 September 2006
Outline of the presentation
Rationale
Objectives of the research
Data and methods
Determinants of the decision-making process in FP
Influence of the decision-making process in FP on male method
use against female method use
Conclusions
Trend in contraceptive prevalence rate
70
60
50
%
40
CPR
30
Male method use
Female method use
20
10
0
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Trend in total fertility rate (TFR)
3.5
3.4
3.3
3.2
3.1
3
2.9
2.8
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Trend in method discontinuation in last five years
50
45
40
35
For all reasons
Due to side effects
Due to husband's opposition
%
30
25
20
15
10
5
0
1993-94
1996-97
1999-2000
Demographic and health survey
2004
Method discontinuation due to side effects by method
100%
80%
Others
Withdrawal
Periodic abstinence
Condom
Injections
IUD
Pill
60%
40%
20%
0%
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Method discontinuation due to husband's opposition by method
100%
90%
80%
70%
Others
Withdrawal
Periodic abstinence
Condom
Injections
IUD
Pill
60%
50%
40%
30%
20%
10%
0%
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Trend in FP discussion with partner
80
70
60
%
50
40
30
20
10
0
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Trend in FP decision-making
90
Only by wife
Only by husband
Joint decision
80
70
60
%
50
40
30
20
10
0
1993-94
1996-97
1999-2000
Demographic and Health Survey
2004
Objectives
To explore the associated determinants of the decision-making process in
FP (decision taken by mainly wife, mainly husband and jointly).
To investigate the influence of the decision-making process in FP on male
method use against female method use
Data
The study uses the couple data set (N=2249) based on the 1999-2000
Bangladesh Demographic and Health Survey.
The couple data set is generated by linking spouses from the male data set
constituting a sample of 2556 currently married men aged 15-59 years and that
from females which has a sample of 10,544 ever married women aged 10-49
years.
In the DHS women data set, the respondents who started using a contraceptive
method after April, 1994 were asked the question, ‘Who is responsible for
deciding to use FP?’ The predefined responses were, ‘mainly respondent’,
‘mainly husband’, ‘joint decision’, and ‘other’. Hence the sub-sample for the
study was reduced to the size of 946.
Methods
A multinomial logistic regression model will be fitted to identify the
determinants of decision-making process in FP.
A binary logistic regression model will be fitted to understand the influence
of decision-making process in FP on couples’ method choice (male/female).
Only the significant variables will be included in the final model
FP decision-making among couples
0.8
18.1
Only by wife
Only by husband
12.3
Joint decision
By others
68.8
Determinants of FP decision-making
Response variable: FP decision-making
Categories: only by wife, only by husband, jointly
The regression results are presented in terms of estimated probabilities
corresponding to the estimated coefficients
The estimated probabilities are calculated based on the reference couples’
characteristics
The characteristics of the reference couple:
Marital duration 5-10 years
From Dhaka division
From rural area
Husband has primary level education
Wife has primary level education
Husband does not have access to newspaper
Husband does not approve of FP
Wife does not approve of FP
FP decision-making by area of residence
50
Adjusted predicted probability (%)
45
Mainly wife
Mainly husband
Jointly
40
35
30
25
20
15
10
5
0
Urban
Rural
Area of residence
FP decision-making by husband's education
80
Adjusted predicted probability (%)
70
Mainly wife
Mainly husband
Jointly
60
50
40
30
20
10
0
No education
Primary
Secondary
Husband's education
Higher
FP decision-making by wife's education
60
Mainly wife
Mainly husband
Jointly
Adjusted predicted probability (%)
50
40
30
20
10
0
No education
Primary
Secondary
Wife's education
Higher
FP decision-making by husband's approval of FP
60
Mainly wife
Mainly husband
Adjusted predicted probability (%)
50
40
30
20
10
0
Yes
No
Husband's approval of FP
Jointly
FP decision-making
Mainly wife
Mainly husband
Jointly
50
Adjusted predicted probability (%)
45
40
35
30
25
20
15
10
5
0
Yes
No
Wife's approval of FP
Influence of decision-making process in FP on couples’
FP method choice
Study is restricted for couples where -
both the spouses are currently using FP method
both the spouses reported the same method use
wife in the couple is fecund
FP decision taken by either or both the spouses
Method use by type
28.3
Male method
Female method
71.7
Method choice by FP decision-making
100
Female method
90
Male method
80
70
%
60
50
40
30
20
10
0
Mainly by wife
Mainly by husband
FP decision-making
Joint decision
Method choice by wife's education
90
Female method
Male method
80
70
60
%
50
40
30
20
10
0
No education
Primary
Secondary
Wife's education
Higher
Method choice by husband's education
90
Female method
Male method
80
70
60
%
50
40
30
20
10
0
No education
Primary
Secondary
Husband's education
Higher
Method choice by FP approval by wife
90
80
70
Female method
Male method
60
%
50
40
30
20
10
0
Approves
Disapproves
Approval of FP by wife
Method choice by FP discussion
80
Female method
Male method
70
60
%
50
40
30
20
10
0
Discuss FP
Does not discuss FP
FP discussion
Method choice by area of residence
80
Female method
Male method
70
60
%
50
40
30
20
10
0
Urban
Rural
Area of residence
Method choice by number of children
90
Female method
80
Male method
70
60
%
50
40
30
20
10
0
No children
1 to 2
3 to 4
Number of children
5 and above
Influence of decision-making process in FP on couples’
FP method choice
A binary logistic regression model has been fitted
Response variable is:
Currently using male method v female method (reference category)
Coding of independent variables
FP decision: Mainly wife, mainly husband, joint decision
Husband’s Age: less than 25, 25-39, 40 and above
Wife’s Age: less than 20, 20-34, 35 and above
Number of living children: no children, 1-2, 3-4, 5 and more
Division: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet
Area of residence: urban, rural
Husband’s education: no education, primary, secondary, higher
Wife’s education: no education, primary, secondary, higher
Wife approves of FP: yes, no
Discuss FP with partner: yes, no
Husband’s occupation: Unemployed, professional/managerial/technical, agriculture selfemployed, agriculture employed, skilled manual, unskilled manual
Regression results
If the FP decision is taken only by husband the couple is more likely to use male
method, while the couple is more likely to use female method if wife alone takes
the FP decision.
Furthermore a couple is more likely to use male methods than female methods if -
husbands aged 40 years and above, wives aged 35 years and above, husbands
have education higher than secondary level, wives have education higher than
secondary level, husbands are engaged in un-skilled manual jobs, wife does not
approve of FP, and couple does not discuss FP.
Conclusion
One third of the couples are taking FP decision without reaching to a consensus with
their partners. This may lead to inconsistent and inefficient use of contraception and
some time lead to drop out of methods. Couples should be encouraged towards joint
FP decision.
Sylhet division is not performing well in terms of joint FP decision compared to other
divisions which requires administrative action.
It is not well understood why urban couples are lagging behind in terms of motivation
toward joint decision regarding FP. This needs further investigation.
Sex of the spouse who takes decision regarding FP is found to be associated with the
type of method in use (male/female). This indicates a serious state of unshared
responsibility in contraception which is against the couple perspective of the FP
programme.
To increase the use of male FP methods among couples male should be more
involved in the FP process.
Shifting the target of the FP programme from a women only approach to a couple
based approach may help improving the situation of FP decision-making process
toward shared responsibility in the overall process which may finally lead to more
uptake of male methods.