1993 Contraceptive Prevalence Survey Jamaica Volume II Knowledge And Attitudes Towards Family, Contraception And AIDS

Publication date: 1994

1993 CO~TRACEPTIVE PREVALENCE SURVEY JAMAICA 1993 CONTRACEPTIVE PREVALENCE SURVEY JAMAICA VOLUME II KNOWLEDGE AND ATTITUDES TOWARDS FAMILY, CONTRACEPTION AND AIDS Carmen P. McFarlane, M.Sc. (Econ.) Jay S. Friedman, M.A. Leo Morris, Ph.D., M.P.H. NATIONAL FAMILY PLANNING BOARD, August, 1994 PREFACE The 1993 Jamaica Contraceptive Prevalence Survey (CPS) is the fifth in a series of periodic enquiries conducted by the National Family Planning Board (NFPB). The Survey seeks to update measures of fertility and contraceptive use among women aged 15-44 years and will, for the first time, include a special module for men aged 15-54 as well as for young adults (male and female) aged 15-24 years. The scope of the survey, as in earlier studies, is designed to gather information on a broad range of areas including knowledge, attitudes and practices in contraception; perceptions on the role of men and women, including views on sexuality, child bearing, child rearing and health care. This CPS, coming as it does in the last decade of the century, is of significance to the NFPB in particular and the wider com- munity in general, as it heralds the beginning of the twenty first century and the realization of the goals of Jamaica's National Population Policy. It also comes against the gradual phased withdrawal of contraceptive procure- ment by the major funding agency, the United States Agency for International Development (USAID), by a twenty percent (20 percent) annual decline over the period 1993-1998 under the Family Planning Initiatives Project (FPIP), as well as the phased diminution of funding from other donor agencies such as the United Nations Fund for Population Activities (UNFPA). This CPS is in fact one of two surveys to be conducted during the life of the FPIP. Against this background, the NFPB has many challenges ahead which are, inter alia, not only to maintain but also to increase contra- ceptive prevalence and to achieve further milestones by the inception of the twenty- first century, such as a population of not more than 2.7 million and replacement level fertility of two children per woman. For contraceptive methods and family life services to impact on fertility and contribute to the processes of national development, it is vital that programme effectiveness be evaluated. The reliable and current data collected from the-CPS will be of invaluable use in policy analysis and programme imple- mentation for administrators and planners, not only in health but in those areas which impact on population issues at the broader national level. The Final Report of the 1993 CPS is present- ed in the following five volumes: I Administrative Report II Knowledge Of and Attitudes Towards Family, Contraception and AIDS III Sexual Experience, Contraceptive Practice and Reproduction IV Sexual Behaviour and Contraceptive Use Among Young Adults V Profiles of Health Regions In addition, an Executive Summary, contain- ing a summary of the main findings of the Survey will be presented. Volume I - the Administrative Report, contains background information on historical, geographical, demographic and social features relating to Jamaica and its population as well as the relationship of the Survey data to the population policies and programmes being implemented by the Government. In addi- tion, the survey design and organization including the sample design as well as the outcome of the data collection are presented. - ii - Background variables used in the exposition of the data are also displayed. Finally, a summary report on the National Dissemina- tion Seminar together with recommendations made by participants are included. Volume II presents data on knowledge of and attitudes towards family, contraception and AIDS of women aged 15-44 years and men aged 15-54 years while Volume III contains information on their sexual experience, contraceptive practice and reproductive history. Volume IV is dedicated to young adults, female and male, aged 15-24 years and in particular to their sexual behaviour and contraceptive use. The last volume, Volume V, presents selected information at the health region level so as to assist planners to determine the success or otherwise of the programmes being provided in each of the four health regions. The 1993 CPS was funded by USAID and directed by Mrs. Carmen McFarlane, Survey Director, a former Director General of the Statistical Institute of Jamaica (STATIN), in collaboration with NFPB and the Ministry of Health, while field work and data entry were carried out by STATIN. Technical assistance was provided by the Division of Reproduct- ive Health, National Centre for Chronic Disease Prevention and Health Promotion, Centres for Disease Control and Prevention (CDC) in the areas of survey design and sampling, questionnaire development and training, data processing and report prepara- tion. STATIN and CDC were jointly res- ponsible for printing. The National Family Planning Board wishes to place on record its sincere thanks to all those organizations which participated in the planning of the Survey, the development of the questionnaire and the review of the various modules. Main participants were the Ministry of Health, the Statistical Institute of Jamaica, the Planning Institute of Jamaica and the Fertility Management Unit of the University of the West Indies. Special acknowledgements are due to Mr. Vernon James, Director General, STATIN, for his leadership and support of STATIN'S participation; Miss Isbeth Bernard, Director of Surveys, for supervision of the field work and data entry, Mrs. Valerie Nam, Director of Censuses & Related Studies and Mrs. Morville Anderson, Senior Statistician, for their assistance in training on the question- naires, all of STATIN; and to Ms. Margaret Watson and Mr. Daniel Wallace, computer specialists of CDC, for installation of the data entry/edit software and training of STATIN personnel in its use. The NFPB also wishes to thank all who participated in the development, implement- ation and finalization of the survey. Particular mention is made of Mrs. Carmen McFarlane, Survey Director; Dr. Leo Morris and Mr. Jay Friedman of CDC; Mrs. Betsy Brown, Director, Office of Health, Nutrition and Population and Mrs. Grace Ann Grey, Project Officer, both of USAID; Dr. Sheila Campbell-Forrester, SMO, Cornwall Regional Hospital, Dr. Beryl Irons, SMO/MCH, Drs. Peter Weller and Peter Figueroa of the Epidemiology Unit and Ms. Kristin Fox, Director, Health and Information Unit, of MOH; Dr. Olivia McDonald, Medical Dir- ector, Mrs. Eugenia McFarquhar, Family Planning Coordinator, Mrs. Ellen Radlein, Director, Projects & Research, Mrs. Janet Davis, Director, Information, Education & Communication, and Mrs. Marian Kenneally, Programme Co-ordinator, of the NFPB. Finally, to the more than 7,000 women and men who gave up their time to answer so many questions, we owe a debt of gratitude for this information, which we are sure will be useful in enhancing their lives. Beryl Chevannes, Executive Director. August, 1994. - iii - CONTENTS Page No. PREFACE. i TABLE OF CONTENTS. iii LIST OF TABLES. iv INTRODUCTION . 1 CHAPTER I - KNOWLEDGE OF METHODS 1.1 Knowledge of contraceptive methods . 3 1.2 Knowledge of menstrual cycle . 5 CHAPTER II - ATTITUDES TOWARDS FAMILY 2.1 Family preferences . 6 2.2 Beliefs relating to conception and upbringing of children . 8 2.3 Attitudes towards childbearing . 10 CHAPTER III - ATTITUDES TOWARDS CONTRACEPTION 3.1 Views on sterilization . 12 3.2 Views on injection use . 13 3.3 Attitudes and practices related to pill use . 14 3.4 Attitudes and practice related to condom use . 16 3.5 Attitudes towards the use of the intra-uterine device . 19 3.6 Views on possible side effects resulting from the . 19 use of contraceptives CHAPTER IV - KNOWLEDGE OF TRANSMISSION AND PREVENTION OF AIDS 4.1 Knowledge of AIDS . 22 4.2 Knowledge of how AIDS is transmitted. 23 4.3 Risk of contracting AIDS . 24 NOTES. 27 - iv - LIST OF TABLES Table No. Title Page No. 1.1.1 Percentage of all women aged 15-44 years who have knowledge . 29 of at least one effective method of contraception by current age and selected characteristics - 1993 1.1.2 Percentage of all men aged 15-54 years who have knowledge of. 30 at least one effective method of contraception by current age and selected characteristics - 1993 1.1.3 Percentage of all women aged 15-44 years with knowledge of . 31 specific contraceptive methods by current age - 1993 1.1.4 Percentage of all men aged 15-54 years with knowledge of. 32 specific contraceptive methods by current age - 1993 1.1.5 Percentage of all women aged 15-44 years with knowledge of. 33 specific contraceptive methods by method and residence - 1983. 1989 and 1993 1.1.6 Percentage of all men aged 15-54 years with knowledge of . 33 specific contraceptive methods by method and residence - 1993 1.1.7 Percentage of women and men with knowledge of specific contra- . 34 ceptive methods by method and education - 1989, 1993 1.2.1 "Correct" knowledge of menstrual cycle: percentage of women. 35 and men who know when a women is at greatest risk of getting pregnant - 1989, 1993 2.1.1 Average desired family size and excess of average desired over . 36 mean number of children ever born: All women aged 15-44 years by current age group and selected characteristics - 1993 2.1.2 Average desired family size and excess of average desired . 37 over mean number of children ever born: All men aged 15-54 years by current age group and selected characteristics - 1993 2.1.3 Average desired family size and excess of average desired over. 38 mean number of children ever born: All women aged 15-44 years by current age group and selected characteristics -1989 - v - Table No. Title Page No. 2.1.4 Decision making concerning family size: Percent of women and. 39 men who agree that God/man should decide how many children on should have by selected characteristics - 1993 2.1.5 Decision making concerning family size: Percent distribution of . 40 women and men by decision maker and contraceptive use - 1993 2.1.6 Decision making concerning family size: Percent distribution of . 41 women aged 15-44 years by decision maker and selected charac- teristics - 1993 2.1.7 Decision making concerning family size: Percent distribution of . 42 men aged 15-54 years by decision maker and selected characteristics - 1993 2.1.8 Decision making concerning family size: Percent distribution of . 43 women aged 15-49 years by decision maker and selected characteristics - 1989 2.1.9 Decision making concerning use of contraception: Percent distribu- …………… 44 tion of women aged 15-44 years by decision maker and selected character- istics - 1993 2.1.10 Decision making concerning use of contraception: Percent distri-. 45 bution of men aged 15-54 years by decision maker and selected characteristics - 1993 2.2.1 Role of women/men: Percent of women and men who agree with . 46 views on the role of women by selected characteristics - 1993 2.2.2 Role of women/men: Percent of women and men who agree with . 47 views on the role of men by selected characteristics - 1993 2.2.3 Women's virginity: Percent of women and men who agree with . 48 views on virginity of women by selected characteristics - 1993 2.2.4 Pregnancy: Percent of women and men who agree with views . 49 associated with pregnancy by selected characteristics - 1993 2.2.5 Sex education: Percent of women and men who agree with views . 50 associated with sex education of children by selected charac- teristics - 1993 - vi - Table No. Title Page No. 2.3.1 Childbearing: Percent distribution of women aged 15-44 years . 51 by age at which a woman is considered responsible enough to have her first child and selected characteristics - 1993 2.3.2 Childbearing: Percent distribution of men aged 15-54 years . . 52 by age at which a woman is considered responsible enough to have her first child and selected characteristics - 1993 2.3.3 Limiting families: Percent distribution of women aged 15-44. 53 years by views on reasons for limiting the number of children a woman can have and selected characteristics - 1993 2.3.4 Limiting families: Percent distribution of men aged 15-54 years . 54 by views on reasons for limiting the number of children a woman can have and selected characteristics - 1993 2.3.5 Spacing of births: Percent distribution of women aged 15-44 . 55 years by desired spacing between births and selected character- istics - 1993 2.3.6 Spacing of births: Percent distribution of men aged 15-54. 56 years by desired spacing between births and selected character- istics - 1993 2.3.7 Breastfeeding: Percent distribution of women aged 15-44 years . 57 by views on how old should a child be before the mother stops breastfeeding and selected characteristics - 1993 2.3.8 Breastfeeding: Percent distribution of men aged 15-54 years by . 58 views on duration of breastfeeding and selected characteristics - 1993 3.1.1 Percentage distribution of views on which Is better, tubal ligation . 59 or vasectomy by selected characteristics: Women aged 15-44 years - 1993 3.1.2 Percentage distribution of views on which is better, tubal ligation . 60 or vasectomy by selected characteristics: Men aged 15-54 years - 1993 3.1.3 Percent distribution of women aged 15-44 years by views on effect- . 61 iveness of tubal ligation to prevent pregnancy and selected characteristics - 1993 - vii - Table No. Title Page No. 3.1.4 Percent distribution of men aged 15-54 years by views on effect- .…. 61 iveness of tubal ligation to prevent pregnancy and selected characteristics - 1993 3.2.1 Percent distribution of women aged 15-44 years by views on effect- …………. 62 iveness of injectables to prevent pregnancy and selected character- istics - 1993 3.2.2 Percent distribution of men aged 15-54 years by views on effect-.… 62 iveness of injectables to prevent pregnancy and selected character- istics - 1993 3.2.3 Percent distribution of women aged 15-44 years by views on ease ……………. 63 of use of injectables and selected characteristics - 1993 3.2.4 Percent distribution of men aged 15-54 years by views on ease of ……………. 64 use of injectables and selected characteristics - 1993 3.3.1 Percent distribution of women aged 15-44 who are currently using …………… 65 pills by current age group and person recommending pill use by brand of pill used - 1993 3.3.2 Percent distribution of women aged 15-44 by views on safety for . 66 women's health of taking the pill and selected characteristics - 1993 3.3.3 Percent distribution of men aged 15-54 by views on safety for. 67 women's health of taking the pill and selected characteristics - 1993 3.3.4 Percent distribution of women and men who agree that using the . 68 pill will protect against sexually transmitted diseases, including AIDS by age, residence and education - 1993 3.3.5 Percent distribution of women aged 15-44 years by views on effect- …………. 69 iveness of the pill to prevent pregnancy and selected character- istics - 1993 3.3.6 Percent distribution of men aged 15-54 years by views on effect- …………… 69 iveness of the pill to prevent pregnancy and selected character- istics - 1993 - viii - Table No. Title Page No. 3.3.7 Percent distribution of response of women aged 15-44 years to: . 70 "If a woman takes the pill correctly, how sure can she be that she will not become pregnant?" by selected characteristics - 1993 3.3.8 Percent distribution of response of men aged 15-54 years to: . 71 "If a woman takes the pill correctly, how sure can she be that she will not become pregnant?" by selected characteristics - 1993 3.3.9 Percent distribution of women 15-44 years by views on ease of . 72 use of the pill and selected characteristics - 1993 3.3.10 Percent distribution of men 15-54 years by views on ease of . 73 use of the pill and selected characteristics - 1993 3.4.1 Percent of women aged 15-44 years whose partners are using . 74 condoms by brand of condom used and selected characteristics - 1993 3.4.2 Percent of men aged 15-54 years who are using condoms by brand . 75 of condom used and selected characteristics - 1993 3.4.3 Percent distribution of women aged 15-44 years whose partners . 76 have used condoms by reasons for use and selected character- istics - 1993 3.4.4 Percent distribution of men aged 15-54 years who have used . 77 condoms by reasons for use and selected characteristics - 1993 3.4.5 Percent distribution of women aged 15-44 years whose partners. 78 have never used condoms by reasons for not using and current age - 1993 3.4.6 Percent distribution of men aged 15-54 years who have never . 79 used condoms by reasons for not using and current age - 1993 3.4.7 Percent distribution of women and men who agree that using a . 80 condom during sexual intercourse does not take away any pleasure from a woman, by selected characteristics - 1993 3.4.8 Percent distribution of women and men who believe that a condom . 81 can be effective on second use and selected characteristics - 1993 - ix - Table No. Title Page No. 3.4.9 Percent distribution of women aged 15-44 years whose current. 82 partner uses condoms by frequency of use and selected character- istics - 1993 3.4.10 Percent distribution of men aged 15-54 years who use condoms. 83 by frequency of use and selected characteristics - 1993 3.5.1 Percent distribution of women aged 15-44 years by views on. 84 effectiveness of the IUD to prevent pregnancy and selected characteristics - 1993 3.5.2 Percent distribution of men aged 15-54 years by views on . 84 effectiveness of the IUD to prevent pregnancy and selected characteristics - 1993 3.5.3 Percent of women aged 15-44 years by views on ease of use. 85 of the IUD and selected characteristics - 1993 3.5.4 Percent of men aged 15-54 years by views on ease of use of . 86 the IUD and selected characteristics - 1993 3.6.1 Percent of women aged 15-44 years who think that contra- . 87 ception can cause abnormal bleeding by method and selected characteristics - 1993 3.6.2 Percent of men aged 15-54 years who think that contraception . 87 can cause abnormal bleeding by method and selected character- istics - 1993 3.6.3 Percent of women aged 15-44 years who think that contraception . 88 can cause vaginal discharge by method and selected character- istics - 1993 3.6.4 Percent of men aged 15-54 years who think that contraception . 89 can cause vaginal discharge by method and selected character- istics - 1993 3.6.5 Percent of women aged 15-44 years who think that contraception . 90 is bad for blood circulation by method and selected character- istics - 1993 - x - Table No. Title Page No. 3.6.6 Percent of men aged 15-54 years who think that contraception . 91 is bad for blood circulation by method and selected character- istics - 1993 3.6.7 Percent of women and men who think that contraception can cause . 92 infertility if used for a long period, by method and selected characteristics - 1993 4.1.1 Percentage of women aged 15-44 years who have ever heard of . 93 HIV/AIDS by selected characteristics - 1989, 1993 4.1.2 Percentage of men aged 15-54 years who have ever heard of HIV. 94 and AIDS by selected characteristics - 1993 4.1.3 Percentage of women and men who agree that a person can be . 95 infected by the virus that causes AIDS and not have any signs or symptoms of the disease by selected characteristics - 1993 4.1.4 Percentage of women and men who agree that a person can . 96 contract AIDS from persons with the virus who do not have the disease by selected characteristics - 1993 4.2.1 Percent of women aged 15-44 years who have specified how a . 97 person can become infected with the virus which causes AIDS by selected characteristics - 1993 4.2.2 Percent of men aged 15-54 years who have specified how a person . 98 can become infected with the virus which causes AIDS by selected characteristics - 1993 4.3.1 Percent distribution of women aged 15-44 who have heard of AIDS . 99 by perception of the degree of personal risk of getting AIDS and selected characteristics - 1993 4.3.2 Percent distribution of women aged 15-44 years who have heard . 100 of AIDS by perception of the degree of personal risk of getting AIDS and selected characteristics - 1989 4.3.3 Percent distribution of men aged 15-54 who have heard of AIDS by . 101 perception of the degree of personal risk of getting AIDS and selected characteristics - 1993 - xi - Table No. Title Page No. 4.3.4 Percent distribution of women aged 15-44 who have heard of AIDS ………… 102 by perception of the degree of risk and condom use - 1993 4.3.5 Percent distribution of men aged 15-54 who have heard of AIDS . 102 by perception of the degree of risk and condom use - 1993 4.3.6 Percent of women and men who think that a person can get the . 103 virus which causes AIDS by possible modes of transmission - 1989, 1993 4.3.7 Percent of women and men who think that a person can get the . 104 virus which causes AIDS by possible modes of transmission by self-perceived risk of getting AIDS - 1993 4.3.8 Percent of women and men who responded affirmatively to specific…………. 105 precautions a person can take to reduce the risk of contracting AIDS - 1993 KNOWLEDGE AND ATTITUDES TOWARDS FAMILY, CONTRACEPTION AND AIDS INTRODUCTION One of the stated goals in Jamaica's National Population Policy has been to modulate the growth of the population such that it falls within a limit which allows for the realization of the policy goals, the improvement of the wellbeing of its people and their quality of life. Within this context, one of the targets set is to realize a population of not more than 2.7 million at replacement level of fertility at the inception of the year 2000. For these targets to be realized, there is need to increase contraceptive prevalence above the levels which now obtain. This will involve the broad participation of the bulk of the population, practicing contraception in a meaningful, effective way, thereby lessening the relatively high proportions of women who have been found to be in need of family planning services. This would not only achieve the desired objectives of limiting the population but would contribute to a further goal, that of improving the health of the Jamaican people. There are a number of determinants which affect fertility, including both physiological and psychological factors. The psychological factors can, among other things, be demon- strated in terms of family preferences which affect attitudes and as such may influence the eventual size of families. Such attitudes are therefore important to the study of fertility. This volume presents findings relating to knowledge and attitudes towards family as well as towards contraception. A supple- mentary subject to be covered will be know- ledge of and attitudes towards sexually trans- mitted diseases, with particular reference to the diseases known as Human Immuno- deficiency Virus (HIV) and Acquired Immune Deficiency (AIDS). The coverage of this subject is particularly relevant in the light of the effect which these diseases can have on overall fertility. The information is presented in four chapters as follows: Chapter I Knowledge of Methods Chapter II Attitudes towards Family Chapter III Attitudes towards Contraception Chapter IV Knowledge of Transmission and Prevention of AIDS. Section 1 of Chapter I deals with knowledge of contraceptive methods including of indivi- dual methods while Section 2 deals more generally with knowledge of the menstrual cycle, important to the practice of the natural contraceptive methods including rhythm or the calendar method as well as the billings method. The next two chapters, II and III, as indica- ted above, deal with attitudes towards family and contraception. The information explored in Chapter II includes that relating to family preferences in Section 1, beliefs associated with conception and upbringing of children in Section 2, and attitudes towards childbearing in Section 3. Chapter III, on the other hand, looks at views of the respondents as they relate to specific methods. In Section 1 of -2- this Chapter, the views of the respondents on sterilization are presented; Section 2 explores their perception of possible side effects which may result from the use of three of the most popular methods, the pill, the injection and the IUD; these are further elaborated on in Sections 3, 4 and 5, while attitudes and practices relating to condom use are explored in Section 6. There are three sections in Chapter IV. These include knowledge of AIDS in Section 1, knowledge of how AIDS is transmitted in Section 2, and perception of the risk of contracting AIDS in Section 3. Cross-classi- fications of perception of risk in relation to circumstance and behaviour, as for example, union status or the use of condoms are included in the presentation. A Socio-Economic Index has been developed to assist in the analysis of the 1993 survey results. The index has been developed to assess the impact of social, economic and cultural factors on the respondent population and is based mainly on the education and occupation of the head of the household. Its relevance has also been tested on elements pertaining to household density and access to media by household members. The items used in this latter examination are number of rooms occupied by household members, possession of radio and television, and readership of newspapers by household members. The trends observed were analy- zed on the basis of expected trends, taking into account the anticipated movement of each variable. Four ranks have been employed in the index: "high", "medium", "low" and "very low". 1 -3- CHAPTER I KNOWLEDGE OF METHODS As indicated, one of the goals of Jamaica's National Population Policy is to maintain a population of not more than 2.7 million by the year 2000. The annual growth rate of the population has in the intercensal years since 1844 2, been fluctuating up until 1921, after which it has been declining steadily thereafter. The declines over these years coincide quite closely with the introduction and promotion of family planning activity in Jamaica. It was near the end of the period of highest population growth that family plan- ning activity was introduced in the country (in 1939). This was mainly a private effort, however, and formal planning programmes were not promoted until the 1950s and some 17 years later, the National Family Planning Board, a statutory board was formed and family planning activity fully institutional- ized. The population of Jamaica, and women in particular, have thus been exposed to widespread contraceptive education and easy availability of supplies for some thirty to forty years. This must be taken into account in assessing the extent of knowledge of con- traception as well as the level of usage. I.1 KNOWLEDGE OF CONTRACEP- TIVE METHODS The encouragement of contraceptive use forms the core of the population control policy in Jamaica. Knowledge must, how- ever, come before usage and on this account, there has been widespread education on the use of contraceptive methods. The outcome of this education may be seen in the tables presented in this section. Tables 1.1.1 and 1.1.2 present the percentage of female and male respondents who have heard of at least one method of contraception. Here it can be seen that knowledge is almost universal, 99.7 percent of both females and males. The comparative percent for females in 1989 was 99.8 percent. 3 All women over 25 years in 1993 knew of at least one method; the low est level of knowledge was among those 15- 19 years followed by those 20-24 years but the differences were not statistically signi ficant (99.7 and 99.8 percent respectively). For the men, there were slight variations which, again, were not statistically signifi cant. There were also slight variations by age between 1989 and 1993 but again these were not statistically significant. Also, at these high levels of knowledge, variations over the different characteristics provide little meaningful indicators. As would be expected, knowledge of specific methods would be lower but even here, knowledge is still relatively high. Tables 1.1.3 and 1.1.4 show the percentages of respondents who have heard of specific methods: for women aged 15-44 years in 1989 and 1993 and for men aged 15-54 years in 1993. Over ninety percent of female respondents had heard of the four most well known methods and for male respondents, the corresponding levels exceeded 85 percent. Knowledge of the pill was 99.1 percent and 96.2 percent for women and men respectively; for the condom, it was 98.6 percent and 97.8 percent. 97.1 percent and 95.1 percent of female respondents knew of the injection and of female sterilization, that is tubal ligation. For men, the corresponding -4- percentages were 88.2 percent and 86.0 percent respectively. With respect to the other methods, although percentages of respondents' knowledge are lower, some, including withdrawal but excluding the other traditional methods, are still fairly well known. Of the other supplied methods, diaphragms, foaming tablets and creams and jellies, knowledge for women ranged from 58 per- cent to 65 percent; for men, the range was lower, from 29 percent to 41 percent. From the information provided in the 1993 survey, withdrawal was indicated as the most well known of the traditional family planning methods, known by 75 percent of female respondents and by 74 percent of males. Rhythm was known by 43.4 percent and 28.1 percent of females and males, respectively, while knowledge of the billings method was much lower, 10.7 percent of women and 6.8 percent of men. Male sterilization, that is, vasectomy, was known by a little more than half of the women and by 45 percent of the men. The newest method to be introduced into Jamaica, the Implant (or Norplant) was known by only ten percent of women and seven percent of men. The pattern of knowledge has varied little over time, comparing percentages for women between 1989 and 1993. The most signifi- cant movement was in respect of the tradi- tional family planning methods; knowledge of withdrawal increased from just under 60 percent in 1989 to 75 percent in 1993 and of the rhythm method from 35 percent to 43 percent over the same period. Looking at movement over the longer run, information is available for women aged 15- 49 who have ever been in a union. It may be seen that there were relatively high levels of knowledge even as far back as in 1975/76 of those methods which are well known today, with increasing knowledge of the four most well known methods. These apply to the pill, the condom, the injection, tubal ligation and IUD. In the case of the lesser known methods, knowledge of vasectomy and of rhythm also showed increases over the period as shown in the table below: For almost all of the methods, knowledge was indicated to be a function of age. Knowledge was lowest for the younger age groups and in general, higher in the middle age groups up to age 40, declining slightly thereafter. For some of the more recently introduced methods and particularly for men, the declines were observed earlier. With respect to place of residence, there was higher knowledge in urban areas. In many instances, however, differences were margin- al (Table 1.1.6). There were significant differences for both sexes for the diaphragm, vaginal methods, male sterilization, natural methods and the implant. For males, there was also a difference in knowledge of with- drawal. On the other hand, differences by -5- level of education were more marked both for women and men in 1993 and comparing knowledge among female respondents bet- ween 1989 and 1993. In all cases, except for the most well known methods, knowledge was lowest for respondents whose level of education was primary or lower and highest for those who had had some post-secondary education (Table 1.1.7). I.2 KNOWLEDGE OF THE MENS- TRUAL CYCLE Knowledge of the menstrual cycle is import- ant for those persons who rely on the natural family planning methods. Accordingly, it was considered important to assess correct knowledge of the cycle among respondents. Knowledge of risks of pregnancy was deter- mined in the 1993 survey as in 1989 by asking respondents a question concerning when it is most probable for a woman to become pregnant during the menstrual cycle ("What are the days during the month when a woman has to be careful to avoid becoming pregnant?"). Alternative answers were: 1. During her period 2. Right after her period has ended 3. In the middle of the cycle 4. Just before her period begins 5. At any time 7. Other 8. Don't know The answer "In the middle of the cycle" is considered to imply that the respondent has "correct" knowledge. The results in Table 1.2.1 show that while 30 percent of women surveyed in 1993 had "correct" knowledge, the corresponding per- centage of men was only 14 percent, and that there was a percentage movement upward in respect of women, from 20 percent in 1989. Knowledge of the fertile period was assessed across a variety of social and demographic factors in Table 1.2.1. In this table, the following may be observed: a) Differences in "correct"-knowledge of the fertile period between urban and rural women and men in 1993, representing a change from the pattern among women in 1989. b) In 1993, women over 30 years generally have greater knowledge of the correct method that those that are younger. This was somewhat different in 1989 where there was greater variation by age group. c) Men between ages 35 to 44 years in 1993, on the other hand, have the highest "correct" knowledge while, as in the case of women, the lowest "correct" know- ledge (9.9 percent) was in age group 15- 19 years. However, "correct" know- ledge has only an eight percentage point range and is relatively low for all age groups. d) In the case of women in both 1989 and 1993, and men in 1993, correct know- ledge was highest among those with post- secondary education. e) Those that attend church services report somewhat higher "correct" knowledge and levels are about twice as high for women than for men. f) No consistent pattern is seen by union status. -29- -30- -31 - -32- -33- -34- -35- -6- CHAPTER II ATTITUDES TOWARDS FAMILY Attitudes to family will be addressed in terms of family preferences as represented in three main areas. Section 1 deals with family preferences as expressed in terms of desired size of family and also their views on who should be the decision makers in determining family size. A third area relates to decision making concerning use by couples of contra- ception. Section 2 covers beliefs relating to concep- tion and upbringing of children. A number of views are covered. These include views on: a) the role of women in the home, b) women's virginity, c) perceptions relating to pregnancy, d) sex education taught to children. Section 3 covers views of respondents relat- ing to childbearing including the control of family size. The subjects included are: a) childbearing, b) limiting families, c) spacing of births, d) breastfeeding. II.1 FAMILY PREFERENCES Average desired family size as expressed by female and male respondents in the 1993 survey is shown in Tables 2.1.1 and 2.1.2. The mean number of children desired by both women and men increases with age. For women, those in the youngest age group (15-19 years) indicated that their mean desired number of children was 2.2, thereafter rising until in the oldest age group covered (40-44 years), the mean desired was 3.4 children. This is consistent with the youngest age group (15-19 years) for women in 1989 (Table 2.1.3). However, average desired family size was somewhat lower in all other age groups. A similar pattern to that of women in 1993, rising with the age groups, was observed in the case of male respondents. However, the mean number was some 0.4 to 0.6 higher over the range of age groups than for women, starting from 2.8 children for age group 15-19 years and rising to a mean of 3.9 children in the age group 40-44 years. It continued to rise so that in the last two age groups surveyed, the number desired was 4.5 children. Compared with mean number of children ever born, the desired number of children for women approaches the mean number born only at age group 35-39 years, falling behind thereafter at age group 40-44 years. In the case of males, desired number of children did not approximate to mean number born at the age group until age group 45-49 when the excess over desired was 0.2 children; by age group 50-54, the gap was 0.3 less children desired than those actually born. Patterns were, in general, not dissimilar over all of the special characteristics. For women, there was basically little difference based on residence; in the case of men, mean average desired was marginally higher in the rural than in the urban areas. However, for women, having more children than desired -7- was associated with lower educational status and/or a lower socio-economic status. These same trends are not evident in the male sample. How do respondents feel about determining family size? Table 2.1.4 explores answers to two questions: "God should decide how many children one should have"; and "The man is the one to decide how many children his wife/partner should have". With respect to the first question, the percent of women and men who considered that God should decide was similar for both women and men (37.8 percent and 37.2 percent re- spectively). Variations over all of the special characteristics show little variation with the exception of an inverse relationship with education. In relation to the second question, 14.6 percent of women agree that the male partner should be the one to decide the number of children a couple should have; in the case of males, the percentage is 30.8. Variations by age groups show little diver- sity; by place of residence, percentages of rural women and men were higher than those of urban women and men (8.6 and 24.8 per- cent of women and men respectively in urban areas and 17.9 and 33.6 percent in rural areas). Higher percentages were observed among women and men who have lower edu- cational levels. Variations by attendance at church services and current union status did not show any consistent pattern. Table 2.1.5 also addresses the views of women and men as to who should make the decision regarding family size, in this case, giving a number of options which include "husband/ partner", "wife/woman", "both", "mother-in-law" and "other". An alternative which was given in this question, as in the earlier set of two questions was "fate/up to God". The majority of both female and male respondents consider that the decision should be made by both partners (87.6 percent 85.6 percent of females and males, respectively). Of interest, however, is the percentage ascribed to the individuals in the partnership. In the case of women, 2.4 percent considered that the male partner should make the deci- sion compared with 8.1 percent who felt that it was the woman who should take the deci- sion. The opposite position is taken by men; 1.9 percent felt that the woman in the part- nership should take the decision while on the other hand, 10.2 percent felt that it is the man who should take the decision. The views given in answer to these questions contradict those given to the earlier two questions. For example, 37 percent of respondents indicated in response to the latter question that the decision should be up to God or Fate compared with two percent in the case when the wider options were given. Also, the percentages of those who considered that the man in the partnership should be the decision maker (14.6 and 30.8 percent for women and men) is much higher than those given in the other set of questions (2.4 percent of women and 10.2 percent of men). The fact that questions with the wider option were asked after the earlier set of questions could have resulted in greater thought being given to replies to the later set. Accordingly, it is possible that answers to the latter reflect more accurately the true beliefs of respondents. The views given in relation to this latter set were cross-classified by contraceptive use of the respondents. They are fairly consistent regardless of the pattern of use of contra- ception and also, the type of method used, if any. In fact, where the contraception used is a female method such as tubal ligation and the pill, there is even more positive recog- -8- nition of the woman being the secondary decision maker after the still dominantly expressed view of "both partners" being the main decision maker. Looking at views based on specific character- istics of the respondents in 1993 (Tables 2.1.6 and 2.1.7), while the patterns found in the various groupings are fairly similar, there is an upward shift of answers in favour of "both partners" for female and male respon- dents based on levels of education; the highest percentage of the main decision maker as "both partners" were among those with post-secondary education and the lowest among those with primary or lower levels of education. There was only slight differences based on residence which were not statistic- ally significant. Religion, based on church attendance, appeared not to have had any significant impact on their views. Table 2.1.8, which gives where available, comparative information for 1989, provides for an assessment of changes among females over the four year period. The most signifi- cant change was that, although "both part- ners" was, in 1989 as in 1993, identified as the main decision maker, the percentages were lower in 1989. In that survey, 63.2 percent of women identified this category as the main decision maker, the corresponding percentage in 1993 was 87.6 percent. With this lower percentage, the proportion for the secondary decision maker (also the woman in the partnership) was significantly higher (30 percent in 1989 compared with 8 percent in 1993). The trends observed in 1993 in rela- tion to age and union status were not as consistent in 1989 although the influence of education was similar. Also, the difference between urban and rural areas was more marked in 1989 than in 1993. In all cases, however, as in 1993, the differences did not take away from the dominance of the belief that "both partners" should be the main decision makers. Tables 2.1.9 and 2.1.10 examine the views of respondents concerning who should be the main decision makers relating to the use of contraception. Here, as in the case of the determination of family size, it was found that for both female and male respondents, the view was that the main decision maker should be "both partners" (86.1 percent of females and 89.9 percent of males). As in the case of decision making on the size of the family, the female partner was overwhelm- ingly recognized by women as the second decision maker, with the next highest percentage being 11.8 percent for the female partner and only 1.3 percent for the male partner. In the case of men, selection of a second choice was not as pronounced, with 4.6 percent at the mean going to "the woman" and 4.2 percent to "the man". There were slight variations between urban and rural dwellers, with more males and females in rural areas favouring "both part- ners" than those in urban areas; differences are, however, not great. Differences by age show, in the case of the female respondents, a slight upward trend up to the age group 25- 29 years, varying thereafter; in the case of male respondents, there is more variation. This variation may also be observed in the case of union status. Education again seems to be significant in relation to the determin- ation of views for both women and men, with the choice of "both partners" being strongest among respondents with some post- secondary education and less strong for those with primary or lower levels of education. II.2 BELIEFS RELATING TO CONCEP- TION AND UPBRINGING OF CHILDREN In this section, matters related to the role of -9- women and men in relation to the care of and responsibility for children, on women's virginity, matters relating to pregnancy and to sex education for children are examined and analyzed. The topics were addressed through a series of nine questions based on which respondents were asked to agree or disagree. Provision was also made for the expression of uncertainty as well as for non- response. The first two of the nine statements related to the role of women in the household were: • Work in the kitchen is women's work. • Care of children is women's work. Table 2.2.1 presents the results. More than one third of women and men agreed with both statements (36.1 and 40.3 percent of women for questions 1 and 2, respectively, and 34.6 and 34.5 percent of men). There was no observable patterns in relation to age composition for both ques- tions. Higher percentages were observed for both women and men with respect to all two questions in rural than in urban areas. Also, there were marked differences based on edu- cational levels, with higher percentages among respondents with lower levels, mov- ing consistently to lower percentages, the more advanced the level of education. No observable patterns were evident in the case of women, based on classifications by church attendance and union status. In the case of male respondents, some consistent pattern was observed in relation to church attend- ance, where percentages were lower, the more regular was the attendance at church. This was observed in the case of both statements. A third statement relating to care of children was put to respondents for the expression of their views relating to their agreement: • Men should always have financial responsibility towards their children. Here, in Table 2.2.2, almost all of the respondents agreed with the statement (95.3 percent of women and 95.8 percent of men. Variations by the selected characteristics were not statistically significant. The next series of statements were associated with women's virginity, and were related to morality and to myths. The associated ques- tions asked related to the following state- ments: • A woman should be a virgin when she marries. • Sex with a virgin can cure gonorrhoea. Some 34 percent of women and 29 percent of men agreed with the first statement, reflecting slight differences between the sexes and possibly changing values relating to sexual morality. Perhaps the most marked variation has been in relation to religion where, on the basis of attendance at church services, the expressions of morality appear to have been influenced by regularity of attendance, with the highest percentages observed for those women and men who attend church regularly and the lowest from those who declared "no religion". Also, those with no steady partner or with a steady friend in a non-sexual relationship are more likely to support a woman being a virgin at marriage. These persons are also most likely to be teenagers who also reported the highest percentage of any age group. With respect to the second statement, this has been a popular myth which had in the past resulted in a number of instances of serious - 10- child molestation and abuse. From the results, it appears that this myth is now believed by only a few, with two and three percent of women and men agreeing with the statement. The next set of statements to be considered relate to the age at which a woman should prove her fecundity and the possibility of her becoming pregnant at first intercourse. The two statements are: • A woman should have a baby before she is twenty to prove she is not a mule. • A woman can become pregnant during her first sexual intercourse. With respect to the first statement, not many respondents agree with the sentiments (14.4 percent of women and 18.0 percent of men). The view was more strongly held in rural than in urban areas and, based on levels of education of respondents, the lower the level of education the more strongly was the view held. This applied to both women and men. It appears that, with respect to age, religion and union status there is no marked correla- tion. In relation to the second statement, almost all of the respondents agreed (94.2 percent of women and 92.0 percent of men). In this respect, their belief appears not to have been affected by any of the special characteristics identified. However, less than 90 percent of male young adults (aged 15-24) and males with no steady partner agreed with this statement. The last set of statements relate to attitudes towards sex education. These are: • Parents who provide their children with sex education encourage them to have sexual intercourse. • Sex education should/ be taught in schools. The first statement explored the view that sex education encourages children to have sexual intercourse. Here, very few respondents, both women and men, hold this view al- though it is more firmly held by men than women (7.6 percent of women and 11.6 per- cent of men). There is little pattern of change relating to the special characteristics, with the exception of education where there is an inverse relationship. Responses to the second statement confirms the views expressed in relation to the first statement. Almost all of the respondents, regardless of characteristic, agree to the statement that sex education should be taught in schools (94.3 percent of women and 93.4 percent of men). With the high level of agreement, there was little variation by the identified special characteristics. II.3 ATTITUDES TOWARD CHILD- BEARING AND BREASTFEEDING The final section in this chapter looks at views relating to childbearing. Four topics, represented in Tables 2.3.1 to 2.3.8, were covered: timing of first birth, limiting families and spacing of births; the fourth topic dealt with breastfeeding. The first topic, age at which a woman was considered responsible enough to have her first child is represented in Tables 2.3.1 and 2.3.2. The highest percentage for both female and male respondents was in the age group 20-21 years (32.9 percent for women - 11 - next highest for women was in age group 25- 29 (19.6 percent) while for men, the next highest was the age group 18-19 (15.1 percent). Other categories identified for women, in descending order of importance were: "when she matures or is in a union" (11.9 percent); "age group 22-24" (11.3 percent) and "age group 18-19" (9.7 per- cent); another 11.6 percent did not identify a specific age group but gave other reasons including "Don't know" as their answer. For men, the other categories, in descending order of importance were: "When she mat- ures or is in a union" (14.0 percent), age group 25-28 (13.4 percent) and age group 22-24 (11.2 percent). As in the case of the female respondents, 13 percent fell in the "Other" category including those who ans- wered "Don't know". For both women and men, the identification of age group 20-21 as the top choice applied to all classifications; in respect of other choices, there were no marked observable patterns with the exception of education and socio-economic status. Views were next sought on reasons for limiting the number of children a woman can have (Tables 2.3.3 and 2.3.4). The main reasons identified area: Health of mother Health of child Economic reasons Wellbeing of the family Should not limit For both women and men, the overwhelming reason given was "economic reasons" (76.1 percent for women and 67.7 percent for men); next was "wellbeing of the family" (12.9 percent for women and 12.6 percent for men. "Health of mother" was third, al- though more men (12.2 percent) gave this as a reason than women (6.3 percent). Percent- ages varied over the various characteristics but no discernible patterns were observed. Spacing of children was the next topic examined. Only 6.5 percent of women and 11.3 percent of men responded that there should be less than two years between births. Most respondents gave a two to four year interval between births as ideal (Tables 2.3.5 and 2.3.6). Finally, with respect to breastfeeding, the enquiry into the desired age that a child should be before the mother stops breastfeed- ing indicated consistent results for both female and male respondents: " 12 months or more" was identified as the most desired age of the child (37.6 percent for women and 36.9 percent for men) with second most desired age being "6 to 9 months" (26.7 per- cent for women and 23.6 percent for men). These choices were consistent for all of the selected categories (Tables 2.3.5 and 2.3.6). -36- -37- -38- -39- -40- -41 - -42- -43- -44- -45- -46- -47- -48- -49- -50- -51 - -52- -53- -54- -55- -56- -57- -58- - 12- CHAPTER III ATTITUDES TOWARDS CONTRACEPTION Chapter III is, perhaps, the most important chapter in this Volume. It explores attitudes of female and male respondents towards five of the most well known and used contracept- ive methods, including possible side effects. The six sections in this chapter deal with: • Views on sterilization • Views on injectables • Attitudes and practice related to pill use • Attitudes and practices related to condom use • Attitudes towards the use of the intra- uterine device • Views on possible side effects assoc- iated with the use of contraceptives These six sections are supported by related tables. III.1 VIEWS ON STERILIZATION The first topic examined in this section deals with views on sterilization and takes the form of identifying which method of sterilization the respondents "think is better" - tubal liga- tion or vasectomy, identifying reasons for their choice. The relevant information is given in Tables 3.1.1 and 3.1.2 and should be reviewed in the context that not one man in the male sample reported having had a vasectomy nor was any partner of a female respondent reported to have had a vasec- tomy; in the 1989 survey, there was only one partner who was reported to have had a vasectomy. It is not surprising, therefore, that only 12 percent of women and three percent of men responded that "vasectomy is better". Almost one-quarter (22 percent) of women and one-quarter (26 percent) of men had no opinion. This was particularly true for younger women, teenage men, women and men with lower educational background or with no children. Men in the lowest socio- economic category and/or those who do not use contraception were also more likely to not have an opinion. Almost two-thirds (65 percent) of women and 71 percent of men think that tubal ligation is "better" or that neither is better and the two are "equal". Older women, those with prim- ary or lower education, with three or more children, and/or lower socio-economic status and women who already have a tubal ligation favour female sterilization more strongly. For men, results are less consistent except for men whose partners have had a tubal ligation - 73 percent say "tubal ligation is better". Most women and men who favour tubal liga- tion said that it eliminated the future possi- bility of childbearing (43 percent and 37 per- cent respectively) and one-third (34 percent) of women and 28 percent of men said that it is safer than vasectomy, which is not supported by medical literature. Of those who favoured vasectomy, the reasons were essentially the same plus 12 percent or men and two percent of women said that vasectomy is cheaper. - 13- One question which was asked related to per- ceptions as to the effectiveness of tubal ligation, presented in Table 3.1.3. Only two-thirds of women considered tubal liga- tion to be a very effective means to prevent pregnancy. In this context, more men than women considered it to be a very effective method (67 percent of women and 74 percent of men). About 15 percent of both women and men considered it to be an ineffective method or indicated that they did not know how effective it is. There were little discern- ible patterns in the percentages identified in the various specified categories. III.2 VIEWS ON USE OF INJECTABLES The next topic explored was related to views on injectables, information relating to which is presented in Tables 3.2.1 to 3.2.4. Table 3.2.1 presents data on the percentage distri- bution of women by views on the effective- ness of injectables while the corresponding presentation for men is shown in Table 3.2.2. Over 45 percent of both women and men considered injectables as a very effective contraceptive method, with 55 percent of women and 48 percent of men considering it very effective. Again, only a small propor- tion (4 percent) of both women and men considered the method ineffective, with 16 and 18 percent indicating that they did not know. Of those reporting "don't know", the highest percentage (about 25 percent) were among the 15-19 year olds. This percentage decreased significantly thereafter for women, ranging from 13 and 14 percent except in the oldest age group (40-44) where the percent- age was 16 percent. For men, the percent- age still remained high for the 20-24 year olds (over 20 percent), falling thereafter to comparable levels with females until after age 44 when the levels of "don't know" again was higher than 20 percent. The level of education of the respondents did not appear to have had any significant impact on perceptions of effectiveness among res- pondents. How did the respondents rate ease of use of the injectables? Answers are presented in Tables 3.2.3 and 3.2.4. Some 58 percent of women and 51 percent of men considered that the injection as a contraceptive method was very easy to use while a further 20 percent of both women and men regarded it as somewhat easy to use. Seven to nine percent indicated that they did not think it would be easy to use. Sixteen percent (approximately the same percentage as indicated not knowing as to effectiveness) said that they did not know. Again a similar pattern among those who reported not know- ing in relation to effectiveness was observed here. Those women reporting use of the injectables to be very easy increased with age from the youngest age group, 15-19, up until age group 30-34 and falling thereafter. In the case of the men, the percentages increased up until age group 40-44, with the falling off taking effect after age 44. More rural women considered the injection very easy to use than did urban women (62.6 percent compared with 50.6 percent). The difference based on place of residence for men was not significant. With respect to levels of education, for women, the lower the level of education, the higher was the percentage indicated for those who consider- ed it very easy. There were no discernible patterns observed for both women and men for classifications based on union status nor in relation to socio- economic status and men had no association with educational attainment. - 14- III.3 ATTITUDES AND PRACTICES RELATED TO PILL USE Pill use remains the most preferred con- traceptive method among women in Jamaica and is the second most used among partners in the male survey. Accordingly, a number of habits being practiced and attitudes towards pill-taking were explored during the survey. Areas represented are: 1. Brands of pills being taken, period over which they have been taken continuously and person recommend- ing the brand. 2. Views on safety for women's health by pill takers. 3. Views on whether or not using the pill will protect against sexually transmitted diseases. 4. Effectiveness of the pill to prevent pregnancy. 5. Views concerning taking the pill correctly. 6. Ease of use of the pill. Data presented on brands of pill used are restricted to those reported by female respondents since the incidence of "don't know" in the reporting of male respondents was too high to obtain meaningful results on this topic. The information is presented in Table 3.3.1. Perle is reported to be the most preferred brand used by women (43 percent reported that they used this brand). It should be noted, however, that there are some women who do not know the difference between brands and regard "Perle" as synonymous with "pill"; accordingly, the reporting on Perle could be exaggerated on this account. Lo Femenal was the second most preferred brand (with 28 percent of women reporting that they used this brand). Ovral and Nordette were the two other brands with usage above the acceptable numbers for classification (with 11 and 3 percent respect- ively). The Nurse is by far the professional who most often makes the recommendation for use. In analyzing these percentages, however, account has to be taken of the following factors: a) Whether the pills are obtained from a government or private health facility. b) If from a government health facility, whether or not there is a choice of pills. Often, there is only one brand available in the health facility providing the pill. c) Whether or not problems were experien- ced prior to using the present brand, requiring intervention of a higher level professional. It should be noted that as stated above, the pattern of use of Ovral and Nordette is different to that of Perle and Lo Femenal and that in the case of these two brands, the percent ascribed to "doctor recommending" is comparatively higher. One view which has been of concern to some members of the public is what degree of safety there is for women's health for those taking the pill and this is covered in Tables 3.3.2 and 3.3.3. A relatively low percentage of both female and male respondents (15 percent of women and 13 percent of men) considered that it was completely safe in relation to a woman's health. A higher proportion (44 percent of women and 38 - 15- percent of men) felt that there was only a slight risk; approximately one quarter felt that it was unsafe while some 16 percent of women and 24 percent of men indicated that they did not know. The proportion of respondents regarding the pill as safe, either completely or with a slight risk, increases with age up until the age group 30-34 for women and 40-44 for men, falling thereafter. Meanwhile, a higher proportion in urban areas consider taking the pill to be safe than those in rural areas. Also, education and socio-economic status show definite patterns, with the more educated and those in the higher socio- economic category showing greater confidence in the degree of safety of taking the pill than those with lower statuses. What do persons believe about getting protection from sexually transmitted diseases by taking the pill. The statement put was: "Using the pill will protect you against sexually transmitted disease including AIDS. Do you agree, disagree or are you uncertain". As might be seen in Table 3.3.4, very small percentage of respondents (2.7 percent of women and 3.9 percent of men) wrongly agreed with the statement. A slightly higher proportion of rural men and women agreed and the level of education appeared to influence those who agreed in that the lower levels of agreement were found in those with the higher levels of education. The next area explored related to views on effectiveness of the pill to prevent pregnancy. As is shown in Tables 3.3.5 and 3.3.6, approximately half of the women and over 40 percent of the men considered the method very effective; a further 37 percent of women and 39 percent of men felt that it was sometimes effective; some ten percent and 14 percent of the women and men surveyed did not know; and only a small percent (four percent) of both women and men considered it not effective. Percentages considering it effective, either completely or sometimes, were not significantly different in urban versus rural areas while there was little discernible pattern in levels of education. A number of pill failures is due to incorrect use of the pill. Thus, a more specific ques- tion was put to respondents to identify their views. "If a woman takes the pill correctly, how sure can she be that she will not become pregnant?" Answers given were: 1. Completely sure 2. Slight risk of pregnancy 3. Some risk of pregnancy 4. Don't know The answers are presented in Tables 3.3.7 and 3.3.8. The same proportion of women as those who considered the method effective (50 percent) considered it to be a completely sure method to prevent pregnancy if taken correctly; a lower percentage of men than those considering it a very effective method (33.5 percent compared with 43 percent) regarding it as a completely sure method if taken correctly. Lower percentages were also recorded by both women and men for those who felt that there was a slight risk of pregnancy if the pill was taken correctly compared with those who considered the method sometimes effective (20.7 and 24.2 percent for women and men respectively compared with 36.6 and 37.7 percent). In addition, 14.6 percent of women and 18.0 percent of men considered that there was some risk of pregnancy even if the pill is taken correctly. These figures highlight the importance which all respondents place on taking the pill correctly. In answer to this question, the remaining 14 percent of women - 16- and 24 percent of men answered that they did not know. As in the case of views on effectiveness, age does not appear to be a factor in their determination; neither is residence or the level of education. The final topic explored in respect of the pill is ease of use, data for which is presented in Tables 3.3.9 and 3.3.10. Over half of the women and men surveyed indicated that they considered the pill as a contraceptive method easy to use and a further 25 percent of women and 19 percent of men felt that it was somewhat easy. Twelve percent of women and eight percent of men thought that it was not easy while 10 percent of women and 15 percent of men reported that they had no views on ease of use. Patterns were mixed among the various characteristics of respondents. III.4 ATTITUDES AND PRACTICES RELATED TO CONDOM USE The other major contraceptive used by male respondents and the partners of female respondents is the condom. Thus, it is important to identify the practices employed by both women and men with respect to its use as well as the views held by them in respect of their effectiveness and use. Thus, a number of questions were asked concerning these. Topics studied were: • Brands of condom used. • Reasons for use (for those who are using). • Reasons for not using (for those who are not using). • Frequency of use (for those who are using). • Perceptions regarding the pleasure derived when a condom is used. • Perception as to effectiveness on second use. The brand of condom used is considered to be important, particularly to men, since it is the view of some that specific brands can contribute to a man's macho image. Accord- ingly, the survey collected information on the brands used both by the men surveyed as well as the partners of the women who were sampled in the female survey. The informa- tion collected has been presented in Tables 3.4.1 and 3.4.2. Only 3 percent of men could not report on the brand being used; on the other hand, the percentage for brand unknown from among the women is 17.3 percent; this is not a totally unexpected result. A total of 24 brands were identified in the survey; however, only three of the main brands were identified as being used extensively. These are: Panther, Rough Rider and Sultan. As explained in the case of Perle, Panther being the first commercial brand offered under the auspices of the family planning programme, the name to many persons is synonymous with "condom". Accordingly, this should be taken into account when assessing the significance of the figures. Panther is sold in the commercial marketing programme supported by the National Family Planning Board, with the use of international funding; up until September 1993, Sultan was distributed directly by government through its health centres and clinics (it has since then been divested) while the other brands are distributed through normal - 17- commercial channels. Of the three brands identified by women as being most popular, Panther accounted for 31 percent of the condoms used in their partner- ship, Rough Rider for 21 percent and Sultan for 12 percent. Of the men, 38 percent reported using Panther, 31 percent, Sultan and 15 percent, Rough Rider. In the case of Panther, the percentages increased with age for women and for men up to the age 45-49. On the whole, however, Panther was in all age groups the preferred brand for women and men. The brand - Rough Rider appears to be favoured by partners of younger women. For men, the pattern has not been as consistent, rising and falling over the age groups. For the brand Sultan, the percentage of use by women has been generally down- ward over increasing age groups, broken only by the sharp increase at age 35-39. For the men, like the women it has been generally downward with increasing age. Panther is the preferred brand used by all respondents in both urban and rural areas. At the same time, there are higher percent- ages for users of Sultan by rural women and men compared with their urban counterparts. Patterns by the other characteristics vary although preference for Panther over the other brands is evident for those at lower economic levels. For women whose partners are users of condoms, as union status is less stable, Rough Rider appears to be preferred by a greater proportion of their partners. The reasons for use of condoms by current condom users were next examined. Categor- ies were: • Prevents pregnancy • Prevents sexually transmitted diseases • Prevents pregnancy and disease • Other Results are given in Tables 3.4.3 and 3.4.4. Twenty-nine percent of women and 34 per- cent of men indicated that they used the condom to prevent pregnancy; a small percentage (5.6 percent of women and 8.1 percent of men) reported that they were using the condom only to prevent sexually transmitted diseases while the majority of persons (65 percent of females and 58 percent of males) admitted using it for both purposes. It is possible that the relatively low percentage of persons reporting using the condom only to prevent sexually transmitted diseases could be higher because some respondents may have been embarrassed to admit that they were in fact using the condom for that purpose and accordingly reported that they used if for both purposes. It should also be noted that, whatever the reason given for use, once it is being correctly used, it will achieve the purpose not only of protecting against the sexually transmitted diseases but also against pregnancy. The most notable difference when the patterns of use are examined, based on the various characteristics, is in relation to union status where in the case of the stable unions, and particularly for married women and men, the percentages of those using it to prevent pregnancy is significantly higher than in the less stable unions. Even here, how- ever, the emphasis in expressed reasons is concentrated on those using it for both purposes rather than for protection against STDs exclusively. Very few men in the lower socio-economic group and/or those with no steady partner use condoms for pregnancy prevention only. For those partners who have never used con- doms, reasons were sought for non-use. A broad cross-section of answers were given, some of which were grouped together for this - 18- analysis. Thus, for example, the category "perceived medically unsafe" consisted of two sub-categories - "unsafe", and "fear of side effects". Thirty percent of women to whom this ques- tion was directed indicated that they have never used a condom because they were never sexually active. The corresponding percentage for men is 38 percent. A further 27 percent of women who, with their part- ners never used a condom, never used because their partners did not like them and 5.4 percent believed that using a condom diminished the pleasure or the spontaneity of sexual intercourse. At the same time, 5.4 percent considered that it was not effective and 2.5 percent did not use since they perceived it to be medically unsafe. For men, 10.5 percent did not use since they had one partner only and, accordingly, con- sidered themselves safe; 2.9 percent of male respondents and 10.5 percent of their partners did not like using condoms while a further 12.2 percent did not use because they perceived condoms to diminish pleasure or spontaneity in the performance of the sexual act. The degree of emphasis given to the various reasons varied with age, depending on the reason. As indicated above, one of the reasons given by both female and male respondents for not using a condom was that it diminished plea- sure and inhibited spontaneity in the perform- ance of the sexual act. In order to follow up on this view which is believed to be quite commonly held, the following statement was put to all respondents to determine the extent of their concurrence with this belief: "If a man uses a condom, it doesn't take any pleasure away from a woman". Results are shown in Table 3.4.7. Less than half (44 percent of women and 42 percent of men) agreed. The percentage agreeing var- ied according to age with no consistent pattern. Women and men in the higher socio- economic categories as well as those with higher levels of education showed higher levels of agreement than those at the lower levels; there were no statistical differences with regard to attendance at church services and residence. Those with no steady partner or a partner with no sexual relationship had lower levels of agreement. A further investigation of the view that a condom can be effective on second use show that virtually few persons hold this belief (see Table 3.4.8). A concern is the consistency with which this method is practiced. Is it being used con- tinuously and if yes, with all or only some partners. This question was also included in the survey. Six categories were allocated to this question. These were: • Every time. • Every time, with certain partners. • Most of the time. • Some if the time. • Occasionally. • Other. Tables 3.4.9 and 3.4.10 presents the results of the enquiry. The greater proportion of women (64 percent) reported that they and their partners used it every time. A much lower percentage of men (38 percent) report- ed use every time. For women, 19 percent reported use most of the time and 12 percent, some of the time while a further three per- cent indicated that they used it occasionally. Patterns of use by men is somewhat differ- ent: 36 percent (higher than for women) - 19- indicated use most of the time and 17 percent for some of the time; a similar three percent used it only occasionally. Patterns are fairly consistent over the various classifications. III.5 ATTITUDES TOWARD THE USE OF THE INTRA-UTERINE DEVICE The intra-uterine device (IUD) is one of the lesser used contraceptive methods, falling from 1.6 percent among women in 1989 to 1.1 percent in 1993 and only 0.4 percent reported among the partners of men in the 1993 survey. Nevertheless, the demand for IUDs has been reported by field service workers to be strong, particularly in rural areas. Accordingly, it was felt that it was important to solicit views on perceptions of effectiveness of the method as well as ease of use. Results of these questions are given in Tables 3.5.1 and 3.5.2. Only 28 percent of women and 30 percent of men viewed the IUD as a very effective contraceptive in preventing pregnancy. The remainder of the respondents said the IUD was somewhat effective (29 percent and 27 percent respectively), not effective at all (8 percent and 10 percent respectively) or didn't know enough to say how effective it is (35 percent and 34 percent respectively). Among women, younger women were more likely to know that the IUD was a very effective method. Age does not appear to influence responses of males and there is no relationship for either sex by education. It is probably safe to say that the majority of both women and men do not know that the IUD is a very effective contraceptive method. 4 What of ease of use of the method? As is shown in Tables 3.5.3 and 3.5.4, less than half of the women and men consider the method easy to use with only approximately one quarter indicating that they consider the method to be very easy to use; 17 percent of women and 19 percent of men said that, in their view, the method was not easy to use while over 30 percent (37 percent of women and 32 percent of men) said they did not know. If the IUD is to be more extensively used in Jamaica, there is an obvious need for greater education and communication on this method. III.6 VIEWS ON POSSIBLE SIDE EFFECTS RESULTING FROM USE OF CONTRACEPTIVES Views on possible side effects which may result from using a contraceptive method was canvassed in respect of four contraceptives - tubal ligation, the injection, the pill and the intra-uterine device. These side effects have been indicated by clients in clinics as causes for cessation of use of the method. The side effects relate to abnormal bleeding, vaginal discharge, problems relating to blood circula- tion and resulting infertility, all believed to be caused by use of the specified methods. With respect to the belief that contraception can cause abnormal bleeding, covered in Tables 3.6.1 and 3.6.2, the injection was seen as the most likely to lead to this side effect (58.7 percent of women and 42.9 per- cent of men). The pill was the next method likely to lead to this complication. The intra- uterine device was next (34.3 percent of women and 32.1 percent of men) while tubal ligation was regarded as least likely to cause abnormal bleeding; even so, more than one quarter of the respondents considered it a possibility (28.2 percent of women and 26.3 percent). With respect to the injection, the pill and the IUD, agreement was less among female ado- -20- lescents. There is no discernible pattern among either sex in the case of tubal liga- tion. Views based on residence are signi- ficantly different only for the pill. For both sexes, more rural respondents hold the view that the pill can cause abnormal bleeding than their urban counterparts. The difference for all other methods and between women and men is not statistically significant. Levels of education appear not to have had a significant impact on these beliefs. The next belief canvassed relate to the view that the use of selective contraceptive met- hods can cause vaginal discharge. Tables 3.6.3 and 3.6.4 present the findings of the inquiry. Three methods were focussed on - the injection, the pill, and the intra-uterine device. For all three methods, significantly more women than men considered that use of the particular contraceptive method can cause vaginal discharge. More than half of the women considered that the injection and the pill can cause vaginal discharge while 40 percent considered that using the IUD can result in vaginal discharge; for men, 38 percent identified the injection, 40 percent the pill and 33 percent the IUD as likely to cause vaginal discharge. For women, in the case of all three methods, the lowest percent- age was for women in the youngest age group (15-19 years); the pattern among the other age groups did not reveal a great deal of consistency. In men, on the other hand, the percentages increase from the youngest age group up to age group 35-39, falling thereafter. Examining the findings by place of resi- dence, a significantly higher percentage of rural women than their urban counterparts considered that vaginal discharge could be caused by using the pill. The same was true for men with reference to the injectables. SLess women with higher levels of education on a percentage basis believed that, by using injectables or the pill, such side effect were possible than those with lower levels of education. In the case of the IUD, the pattern is reversed. In the case of the men, the pattern is not as straightforward although with respect to the IUD, the pattern experienced by women is more or less maintained. Other classifica- tions seem not to have a significant impact on the development of these beliefs. For men, the most discernible pattern relates to opinions on the IUD as indicated by respond- ents on the basis of their levels of education; the higher the level of education, the higher is the percentage of respondents who acknowledge that they hold that view relating to this method. What of the view that the use of contra- ceptives is bad for blood circulation? This was explored with respect to the injection, the pill and the IUD and the results have been presented in Tables 3.6.5 and 3.6.6. Here, patterns of beliefs are very similar for both women and men; some one-third think that using the injection is bad for blood circulation (33.4 percent of women and 35.1 percent of men); approximately one-quarter (23.9 percent of women and 27.2 percent of men) consider taking the pill can lead to that result while less than 20 percent (18.8 per- cent of women and 16.2 percent of men) associate that side effect with the IUD. In all cases, there is no consistent pattern by age group. Finally, beliefs relating to the long term effects of continuing contraceptive usage was introduced. The question asked was: "Do you think [METHOD] can cause infertility if you use it for a long time, say five years?" Again, three methods were identified and the -21 - results are shown in Table 3.6.7. Slightly over half of both women and men (51 percent of women and 52 percent of men) think that long term use of injectables can lead to infertility. A significantly higher proportion of men (44 percent) than women (35 percent) think the long term use of the pill can result in infertility. Lower propor- tions of women (17 percent) and men (20 percent) believe this in relation to the IUD. Age and education do not significantly affect the proportions who report infertility as a possible problem. The extent of infertility varies among countries and among different populations within countries. Levels of infertility may be influenced by differences in prevalence of sexually transmitted diseases (STDs); access to adequate health care for STDs, abortion and childbirth. STDs are the leading cause of preventable infertility. s There is no data supporting infertility as a side effect to the long term use of the contraceptives mentioned above. Thus, there is considerable mis- information among women and men of repro- ductive age in Jamaica concerning this topic. Account must, however, be taken of the advice being given to patients by physicians in Jamaica concerning the desirability of a rest period from contraceptive use. In a recent study conducted among three hundred and sixty-seven private physicians who pro- vide family planning services in Jamaica, "more than one-half (53 percent) say they recommended a rest from the oral contracept- ives, followed by 40 percent indicating a rest from Depo-Provera and 29 percent recom- mending a rest from the IUD. Reasons listed for temporary discontinuation of the pill and Depo-Provera are similar; physicians worry about reactivating normal hormone flow and eliminating chemicals from the body after three years, and about reducing complications and bleeding. Reasons given to rest from the IUD are if the client has an infection (32 percent) and as a way to reduce the chance of Pelvic Inflam- matory Disease (PID) or infection (22 per- cent)". 6 Such recommendations would have contributed to some of the beliefs reflected in the survey findings. -59- -60- -61- -62- -63- -64- -65- -66- -67- -68- -69- -70- -71- -72- -73- -74- -75- -76- -77 - -78- -79- -80- -81 - -82- -83- -84- -85- -86- -87- -88- -89- -90- -91- -92- -22- CHAPTER IV KNOWLEDGE OF TRANSMISSION AND PREVENTION OF AIDS The deadly disease Acquired Immune Defi- ciency Syndrome (AIDS) still remains one of the most dreaded afflictions which the world faces today; it has a devastating effect on persons who are affected by it and is parti- cularly distressing when it attacks women who are pregnant since it may be passed on to babies born to these women. This disease will therefore not only result in increasing mortality rates in populations in which the prevalence is relatively high but will signi- ficantly lower the quality of life for those affected by the disease, their families and their associates. Since not a great deal was known about the reproductive age population's knowledge of the disease, a decision was taken to include some questions relating to knowledge of transmission and prevention in the 1989 Contraceptive Preva- lence Survey. Because of the close link bet- ween AIDS prevention programmes and fam- ily planning programmes, it was decided to broaden the scope of the information collec- ted, to also ask if respondents had heard of the virus which leads to AIDS, the Human Immuno Deficiency Virus (HIV). This chap- ter is devoted to presenting information on HIV and AIDS perceptions of risk, know- ledge of transmission and prevention, and the practices which respondents may be taking to reduce the risk of transmission. Coverage is presented in three sections: 1. Knowledge of HIV and AIDS; 2. Knowledge of how AIDS is transmitted; 3. Prevention and perceptions of risk of contracting AIDS. IV.1 KNOWLEDGE OF HIV and AIDS Knowledge of HIV and AIDS is represented by four tables, Tables 4.1.1 to 4.1.4. Table 4.1.1 identifies the percentage of women who have ever heard of HIV and AIDS in 1993, with comparisons in relation to know- ledge of AIDS in 1989. Knowledge of AIDS by women in 1993, as in 1989, was almost universal (99.6 percent in 1993 and 99.8 percent in 1989). The universality of the knowledge is evident in all of the character- istics presented. Knowledge of HIV is slightly less (94.1 percent) but still universal both on the average as well as for all of the characteristics. Knowledge by men of HIV and AIDS (Table 4.1.2) follow the same pattern as for women, with almost universal knowledge of AIDS (99.8 percent) and a slightly lower percentage for knowledge of HIV (93.0 percent). There were only three instances in which knowledge of HIV was below 90 percent - men aged 50-54 (89.6 percent), men with primary and lower levels of education (88.5 percent) and men with no steady partner (87.7 percent). In all other cases, knowledge exceeds 90 percent. Table 4.1.3 deals with the percentage of women and men who agree that a person can be infected with the AIDS virus (that is, the HIV virus) and have no signs or symptoms of the AIDS disease. Approximately four fifths of respondents (81.1 percent of women and 78.6 percent of men) agree that a person can be infected with the AIDS virus without any signs or symptoms of the AIDS disease. Knowledge is higher in urban compared with -23- rural areas for both men and women (p <0.05). For both sexes, there is a positive correlation with both education and the socio- economic index. Knowledge is lower for men who are not in unions. Finally in this section, the percentage of women and men who think that the AIDS virus can be contracted from persons with the virus who do not have the disease has been examined, by selected characteristics, in Table 4.1.4. Approximately three-quarters of both women and men accept this premise (78 percent of women and 71 percent of men). Percentages are significantly higher in urban than in rural areas for women and are progressively higher, the higher is the level of education and, to a lesser extent, the socio-economic category to which respond- ents belong. This is especially true for those with a post-secondary education or highest socio-economic category. Patterns among classifications by religion through the proxy, attendance at church services, and by current union status, are not as well defined, although for men in union, the percentages who agree are significantly higher. IV.2 KNOWLEDGE OF HOW AIDS IS TRANSMITTED Among the respondent population, how ex- tensive is the knowledge of how AIDS is transmitted? The information derived, as portrayed in Tables 4.2.1 and 4.2.2, was given spontaneously by respondents in answer to the question: "Can you tell me two different ways in which a person can become infected with the virus which causes AIDS?" The two main causes specified by respondents are transmission through sexual intercourse and transmission by blood transfusion. Data in the tables, represent an amalgam of the replies, that is, the percentage of respondents who mentioned a specific mode of transmission either first or second. The mode of transmission identified by almost all respondents (96.8 percent of women and 96.1 percent of men) is through sexual intercourse. This is supported by the messages which have been widely disseminated by the Epidemiology Unit of the Ministry of Health devoted to the control of AIDS. There appears to be high awareness of this means of transmission among both women and men in all age groups, in urban as well as in rural areas, at all educational levels and in all socio- economic groups. The next highest percentage reported is through blood transfusion (48.9 percent for women and 44.4 percent for men). On this matter, it should be noted that the survey was conducted after the mishap at the University Hospital of the West Indies whereby a patient, by accident, was transfused with blood which had been contaminated with the AIDS virus. Approximately half of the respondent population identified blood transfusion as a possible means of trans- mission. The age pattern showed no signi- ficant level of perception based on either youthfulness or aging. Perceptions of blood transfusion as a probable cause was higher for women in urban than in rural areas and this seemed to have been the only char- acteristic where any observable difference among the various specified characteristics was observed. Intravenous drug use was shown as having the third highest level of recognition (13.0 percent of women and 19.7 percent of men) Since this has been considered an important -24- mode of transmission of AIDS at both the local and international levels, mainly through the use of contaminated needles, this is an area in which the AIDS Unit will have to redouble its efforts to educate the public. Perceptions, though low on the overall, is higher among urban men than among their rural counterparts; there is also a higher perception of cause among respondents with higher levels of education and socio- economic status than among those where the level is lower. Another possible means of transmission is the transference of the virus from a mother who has either HIV or AIDS at the time of her pregnancy to her child; less than ten percent of respondents, however, recognized this among the two ways in which a person can become infected (7.3 percent of women and 8.7 percent of men). No distinct differences were observed except that the level of response was significantly higher in rural than in urban areas for men. Two other means of transmission were iden- tified by respondents. These were through the bite of a mosquito and by way of casual contact. Only a minimal number of respon- dents (1.0 percent for mosquito bites and 2.6 percent for casual contact among women and 2.1 and 2.9 percent, respectively, for the corresponding identified means among men) gave these as probable causes. These are positive findings, based on the state of medical technology existing today. About 13 percent of respondents specified a variety of other means of transmission which were not recoded. IV.3 RISK OF CONTRACTING AIDS The personal risk of contracting AIDS is the third topic which was examined, details of which have been presented in Tables 4.3.1 to 4.3.9. Tables 4.3.1 to 4.3.3 look at the perception by respondents who have heard of AIDS of the degree of risk which they perceive in contracting the virus or the disease. Data are presented for women in respect of 1989 and 1993 and for 1993 only for men. A small proportion in 1993 (14.7 percent for women and 11.5 percent of men) considered themselves to be at great risk of contracting AIDS. A slightly higher percentage (19.3 percent for women and 16.7 percent for men) considered themselves at some risk while an even higher percentage (29.3 percent for women and 28.0 percent for men) felt that there was some but not much risk of them contracting AIDS; 36.7 percent of women and 43.9 percent of men considered themselves at no risk at all. There was no significant change in women considering themselves to be at great risk of contracting AIDS (14.7 percent in 1993 an 14.3 percent in 1989). However, there was a significant increase (p <0.05) in women saying that they had "some" or "some but not much risk", with a corresponding decline in those who said they had no risk at all. The proportion saying they had no risk at all declined from 52.6 percent to 36.7 percent (p <0.01). Thus, almost two-thirds of women of reproductive age in Jamaica think that they have a non-zero risk of contracting AIDS. In general, respondents at the youngest age group considered themselves at greater risk than those older than themselves; however, degrees of perception do not move markedly with increasing age; in the case of education and socio-economic status, respondents tend to perceive a higher degree of risk, the higher is their status or their level of education, but the differences are not statistically significant. Lower degrees of risk are perceived by women who are regular -25- church goers than those who rarely or never attend; also, female respondents who have boyfriends with whom they do not have sexual intercourse and those with no steady partner have, in general, lower perceptions of risk than those who are in unions or have a boyfriend with a sexual relationship. This appear true also for the pattern in 1989. Do patterns of condom use show any correla- tion with the perceived degree of risk. For women, the percentage of those who have never used condoms show no difference over those who have ever used, for those who consider themselves at great risk (Table 4.3.4). There are lower percentages, however, for those who consider themselves at some risk or at not much risk. Conse- quently, there are higher percentages for those who have never used condoms who consider themselves to be at no risk at all than for those who have ever used condoms. Does frequency of use for current users impact on their perception of risk? Those who use condoms all of the time are more likely to consider themselves at no risk while those who use condoms some of the time (women) or with certain partners are most likely to say they are "at great risk" (Table 4.3.5). Has there been any change in the perceptions as to how respondents think that a person can get the virus which causes AIDS since the 1989 survey and also, how do answers deri- ved after prompting compared the spontan- eous answers presented earlier? Table 4.3.6 gives data on these perceptions for women in 1989 and 1993 and men in 1993. In order to obtain the replies given in Table 4.3.6, a direct question was put to the respondent and a number of alternatives put to him or her. The question was: "In which of the following ways do you think a person can get the virus which causes AIDS?" The alternatives given were: • Shaking hands or hugging. • Being in the same room as a person who has the AIDS virus. • Sharing personal items like dishes, toilets, etc. • Sharing needles used for drugs. • Sexual intercourse between men. • Sexual intercourse between a man and a woman. • Giving a blood donation. • Receiving a blood transmission. • Being bitten by an insect that has bitten someone with the AIDS virus. The respondent answered "yes", "no" or "don't know" to each of the alternatives. It should be noted also, that this question was asked after the spontaneous response was solicited. Based on the findings derived from the prompted responses, more than ninety percent of women and men in 1993 indicated that they considered sexual intercourse, heterosexual or homosexual, to be a means of transmission for the AIDS virus (98.4 and 97.9 percent relating to heterosexual and homosexual intercourse, for women, the corresponding percentages for men being 98.0 and 97.7 percent respectively). Another mode of transmission which was identified by more than 90 percent of respondents was sharing needles used for drugs (92.4 percent of women and 93.3 percent of men). In addition, receiving a blood transmission was identified by more than ninety percent of -26- respondents (94 percent of women and 91 percent of men). The mode of transmission with the next highest percentage is giving a blood donation (70.1 percent of women and 68.7 percent of men), indicating that a high proportion of women and men are probably confusing receiving blood with donating blood. Being bitten by an insect that has bitten an AIDS carrier received a positive response by 40.3 percent of women and 39.3 percent of men; being in the same room with an AIDS carrier (6.9 percent of women and 8.9 percent of men); and shaking hands or hugging an AIDS carrier (2.4 percent of women and 4.8 percent of men). The findings from the responses to the ques- tion just described are consistent in some cases with the results of the spontaneous ans- wers discussed earlier. There was a strong consistency of answers that AIDS can be transmitted through sexual intercourse, either homosexual or heterosexual. There was some difference in respect of the emphasis given to blood transfusion as a possible cause. Whereas over 90 percent of both men and women indicated, when prompted, that receiving a blood transfusion could lead to the transmission of AIDS, less than 50 per- cent of respondents gave it as one of the two most important causes when asked to name two causes. Also, only 13 percent of women and 20 percent of men spontaneously named intravenous drug use as one of the two most important causes although more than 90 per- cent agreed that sharing needles used for drugs could lead to its transmission. Have the percentages derived from the prompted responses changed for women since 1989? Almost all women still agree that sexual relations, heterosexual or homosexual, is a mode of transmission for HIV/AIDS. There has been an increase in knowledge that the virus can be transmitted by sharing needles or receiving a blood transfusion. On the other hand, misinform- ation persists. There is a significant increase in the proportion of women who think that you can contract AIDS by donating blood and an important minority think that an insect bite (40 percent) or sharing personal items (20 to 26 percent) may transmit HIV/AIDS. In addition, seven percent of women and nine percent of men think that transmission is possible by being in the same room with a person with the AIDS virus and two and five percent, respectively, say that a handshake or hug can transmit the disease. Are beliefs regarding modes of transmission influenced by self-perceived risks of contract- ing AIDS? From Table 4.3.7, it appears that, overall, differences are not great although there is a tendency for those who think they are at some or great risk to identify the modes of transmission specified. Only for "bitten by insect that had bitten an AIDS carrier", do persons who perceive that they are at "some" or "great" risk have a significantly greater belief that transmission occurs. Since this possible mode of trans- mission has never been confirmed, misin- formation regarding mosquito bites may contribute to the proportion of women and men who think they have "some" or "great" risk. Respondents were also asked: "What can a person do to reduce the risk of getting AIDS?" First, all spontaneous replies were coded. For all the possibilities that are listed in Table 4.3.8, if there was not a spontan- eous response, the interviewer probed each respondent by asking directly for each pre- caution if the risk of AIDS would be reduced. Results are very similar for women and men with great differences between spontaneous and probed responses for most precautions. Spontaneously, more than 75 percent men- -27- tioned the use of condoms and a little over half mentioned that the risk would be re- duced by having only one sexual partner. With probing, almost all respondents agreed that the risk could be reduced for these two items. For all other items, less than one- fourth were mentioned spontaneously with less than 11 percent spontaneously mention- ing the last four items - "avoid relations with bisexuals/homosexuals", "sterilize needles", "ask partner to have blood tested for AIDS", and "avoid relations with prostitutes". However, when probed, the proportion agreeing that each precaution could reduce the risk jumped to at least 79 percent. The last table (Table 4.3.9) in this section displays the spontaneous responses on ways to reduce the risk of AIDS by self-perceived risk of getting AIDS. It was conjectured that a higher proportion of those with greater self- perception of risk would spontaneously mention ways to reduce risk. However, this does not seem to have been the case. There are very few differences by self-perception of risk. In fact, for women, significantly more women at "no risk" mentioned having only one sexual partner than those at "great risk". For men, the same is true for those at "some risk" or "not much risk" versus those at "great risk". Also, men who said that they had "great risk" were less likely to mention avoiding relationships with prostitutes than other men. NOTES 1. For a more detailed description of the Socio-Economic Index, see Administrative Report - Volume 1, 1993 JAMAICA CPS; Appendix II (1994). [One in a series of reports on the 1993 Jamaica Contraceptive Prevalence Survey, published by the National Family Planning Board]. 2. See Table 1.i at page 3 in Volume 1 - The Administrative Report. National Family Planning Board, Kingston, Jamaica. (1994). 3. C. McFarlane and C. Warren, 1989 Jamaica Contraceptive Prevalence Survey. National Family Planning Board; Jamaica. (1990). 4. Hatcher, R. et. al, Contraceptive Technology, Sixteenth Revised Edition. Irvington Publishers; New York, NY. 1994. 5. Hatcher, R.A., 1994. Ibid. 6. Bailey, W., MacDonald, O.P., Hardee, K., Clyde, M., Villinski, M.T., Family Planning Service Delivery Practices of Private Physicians in Jamaica: Final Report. National Family Planning Board, Kingston, Jamaica. 1994. -93- -94- -95- -96- -97- -98- -99- - 100- - 101 - - 102- - 103- - 104- - 105- Cover VOLUME II: KNOWLEDGE AND ATTITUDES TOWARDS FAMILY, CONTRACEPTION AND AIDS PREFACE CONTENTS LIST OF TABLES INTRODUCTION CHAPTER I: KNOWLEDGE OF METHODS I.1 KNOWLEDGE OF CONTRACEPTIVE METHODS I.2 KNOWLEDGE OF THE MENS-TRUAL CYCLE Tables Table I.(i) Tables II-1.1.1 Tables II-1.1.2 Tables II-1.1.3 Tables II-1.1.4 Tables II-1.1.5 Tables II-1.1.6 Tables II-1.1.7 Tables II-1.2.1 CHAPTER II: ATTITUDES TOWARDS FAMILY II.1 FAMILY PREFERENCES II.2 BELIEFS RELATING TO CONCEPTION AND UPBRINGING OF CHILDREN II.3 ATTITUDES TOWARD CHILDBEARING AND BREASTFEEDING Tables Table II-2.1.1 Table II-2.1.2 Table II-2.1.3 Table II-2.1.4 Table II-2.1.5 Table II-2.1.6 Table II-2.1.7 Table II-2.1.8 Table II-2.1.9 Table II-2.1.10 Table II-2.2.1 Table II-2.2.2 Table II-2.2.3 Table II-2.2.4 Table II-2.2.5 Table II-2.3.1 Table II-2.3.2 Table II-2.3.3 Table II-2.3.4 Table II-2.3.5 Table II-2.3.6 Table II-2.3.7 Table II-2.3.8 CHAPTER III: ATTITUDES TOWARDS CONTRACEPTION III.1 VIEWS ON STERILIZATION III.2 VIEWS ON USE OF INJECTABLES III.3 ATTITUDES AND PRACTICES RELATED TO PILL USE III.4 ATTITUDES AND PRACTICES RELATED TO CONDOM USE III.5 ATTITUDES TOWARD THE USE OF THE INTRA-UTERINE DEVICE III.6 VIEWS ON POSSIBLE SIDE EFFECTS RESULTING FROM USE OF CONTRACEPTIVES Tables Table II-3.1.1 Table II-3.1.2 Table II-3.1.3 Table II-3.1.4 Table II-3.2.1 Table II-3.2.2 Table II-3.2.3 Table II-3.2.4 Table II-3.3.1 Table II-3.3.2 Table II-3.3.3 Table II-3.3.4 Table II-3.3.5 Table II-3.3.6 Table II-3.3.7 Table II-3.3.8 Table II-3.3.9 Table II-3.3.10 Table II-3.4.1 Table II-3.4.2 Table II-3.4.3 Table II-3.4.4 Table II-3.4.5 Table II-3.4.6 Table II-3.4.7 Table II-3.4.8 Table II-3.4.9 Table II-3.4.10 Table II-3.5.1 Table II-3.5.2 Table II-3.5.3 Table II-3.5.4 Table II-3.6.1 Table II-3.6.2 Table II-3.6.3 Table II-3.6.4 Table II-3.6.5 Table II-3.6.6 Table II-3.6.7 CHAPTER IV: KNOWLEDGE OF TRANSMISSION AND PREVENTION OF AIDS IV.1 KNOWLEDGE OF HIV and AIDS IV.2 KNOWLEDGE OF HOW AIDS IS TRANSMITTED IV.3 RISK OF CONTRACTING AIDS NOTES Tables Table II.4.1.1 Table II.4.1.2 Table II.4.1.3 Table II.4.1.4 Table II.4.2.1 Table II.4.2.2 Table II.4.3.1 Table II.4.3.2 Table II.4.3.3 Table II.4.3.4 Table II.4.3.5 Table II.4.3.6 Table II.4.3.7 Table II.4.3.8

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