Characterizing Motivational Intensity of Need for Family Planning Among Non-Users in Sub-Saharan Africa
Publication date: 2014
INTRODUCTION As a group, non-users of contraception differ greatly in their likely motivation to adopt a method or resume use. This study, conducted under the USAID-funded Health Policy Project, presents a new approach by defining high- and low-motivation groups among current non-users according to Stated intention to use Past use Unmet need By evaluating the demographic characteristics and fertility preferences of these subgroups, we can identify consistent correlates of motivational intensity. This information can be used to guide family planning policies and implementation. Fertility History and Preferences Six proxies for the likelihood of adopting family planning were examined in conjunction with the constructed high- and low-motivation groups (Figures 3 and 4). RESULTS Socio-Demographic Profile The low-motivation non-users, compared to the high- motivation ones, are more rural, less educated, and closer to poverty (Figure 2) and may tend to have less access to public services. These differences between the low- and high-motivation groups hold true regardless of unmet need status, suggesting similarities between the no-need and unmet-need groups. Characterizing Motivational Intensity of Need for Family Planning Among Non-Users in Sub-Saharan Africa HEALTH POL ICY P R O J E C T HEALTH POL ICY P R O J E C T The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. PRESENTED BY Bernice Kuang John Ross Elizabeth Madsen Health Policy Project/ Futures Group 2014 Population Association of America Annual Meeting May 1–3, 2014 Boston, MA Figure 1: Defining High and Low Motivation Ever Users Intent to Use No Intent to Use Never Users Ever Users Never Users High Motivation Low Motivation ALL NON USERS [Unmet Need + No Need] CONCLUSION By identifying high- and low-motivation groups according to past use, intention to use in the future, and unmet need, large and consistent differences between the high- and low-motivation groups were discovered. Because these groups differed substantially and consistently in fertility histories and preferences, with some women in the low-motivation group having no interest at all in contraception, those with higher motivational intensity would benefit more from prioritization in certain program strategies, especially those related to reducing supply barriers. METHODOLOGY The most recent (2003–2011) Demographic and Health Surveys data from 23 sub-Saharan African countries were used to categorize subgroups of women with varying motivational intensities to adopt contraception in the future. Data were analyzed using Stata/SE 12. The analysis was restricted to married/in union women who were not using any contraceptive method. A yes/ no division grouped all these non-users by intention to use, unmet need, and ever use (see Figure 1). (In these 23 countries, those who intend to use a method and those who do not are about equally represented.) The no-need group includes fecund married/in union women who want a child within two years, women whose current pregnancy is wanted and properly timed, and postpartum amenorrheic women whose last birth was wanted and properly timed. 0 20 40 60 80 100 % In Poorest Quintile % No Education% RuralAge (median) Pe rc en t ( M ed ia n fo r A ge ) Figure 2: High- and Low-Motivation Groups by Socio-Demographic Characteristics Do Not Intend to Use, Never Use, No Need Do Not Intend to Use, Never Use, Unmet Need Intend to Use, Ever Use, No Need Intend to Use, Ever Use, Unmet Need High Motivation Low Motivation Do Not Intend to Use, Never Use, No Need Do Not Intend to Use, Never Use, Unmet Need Intend to Use, Ever Use, No Need Intend to Use, Ever Use, Unmet Need High Motivation Low Motivation 0 5 10 15 20 25 30 35 % Last Birth Unwanted% Within 12 mo. of BirthIdeal # Children Pe rc en t ( M ed ia n fo r A ge ) Figure 3: High- and Low-Motivation Groups by Fertility and Preferences 0 5 10 15 20 25 30 35 40 % with Pregnancy Terminations % Contact with FP Worker in Last Year % Unmet Need for Limiting Pe rc en t ( M ed ia n fo r A ge ) Figure 4: High- and Low-Motivation Groups by Need, Family Planning Contacts, and Pregnancy Terminations Ideal number of children: The ideal number of children is higher in the low-motivation group. This also applies to both the unmet-need group and the no-need group. Recent birth: More low-motivation women had given birth in the preceding 12 months than high-motivation women; this is a strong correlate to the prevailing fertility rate within each group, especially since these women are comparable in age. Unwanted births: Women with unmet need are more likely to have recently had an unwanted birth, since unmet need is partly based on whether the last birth was wanted. Almost none of the members of the no-need groups, mostly younger women who are still building their families, stated that they did not want their recent births. Unmet need for limiting births: If unmet need for limiting dominates (i.e., is a substantial proportion of all unmet need within a subgroup), this suggests stronger motivation to use a method. However, the two motivation groups were nearly identical in the distribution of limiting versus spacing objectives. Recent contact with a family planning health worker: Women were asked whether they were counseled on family planning by a healthcare worker at a health facility in the last 12 months. The low-motivation groups reported the least exposure to family planning counseling. Termination of pregnancies: The high-motivation groups, comprised of women who were more urban and better educated, reported more terminations. This was likely due to induced abortions, although the data are limited. CONTACT US Health Policy Project One Thomas Circle, NW Suite 200 Washington, DC 20005 www.healthpolicyproject.com email: email@example.com Tel: +1.202.775.9680 Fax: +1.202.775.9684
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