Further Analysis of Family Planning in Jordan (AB19) - Analysis Brief (English)

Publication date: 2020

Further Analysis of Family Planning in Jordan An Analysis Brief from The DHS Program Why do further analysis of contraceptive use in Jordan? Demographic and Health Surveys in Jordan between 1990 and 2017-18 have provided data on fertility and family planning use among women. The 2017-18 Jordan Population and Family Health Survey (JPFHS) unexpectedly revealed that while fertility has decreased steadily since 1990, family planning use declined between 2012 and 2017-18. The 2017-18 JPFHS was the first to interview men about family planning, and included refugee households. Descriptive statistics about family planning use, intentions, source of method, and unmet need for family planning are presented in the 2018-19 JPFHS final report. Stakeholders requested additional investigation to better understand the unique family planning context in Jordan. Further analysis papers confirmed that education, household wealth, and region of residence are associated with fertility preferences and modern method use among women and men (FA 139, 140, and 141). Additional tabulations have been prepared to respond to other key questions. They are summarized here. What are the key results? 1. Private-sector MOH sources of family planning most accessed in Amman, Zarqa, and Mafraq The 2018-19 JPFHS final report shows that just over half (51%) of modern method users get their method from a private-sector source. New tabulations explore MOH-supported sources (JAFPP, IFH, IRC, UNWRA, and UNHCR) by governorate. Among women who used JAFPP, IFH, or IRC for their current method, 58% were in Amman and 14% were in Zarqa. Similarly, UNRWA users were primarily in Zarqa (34%) and Amman (32%). UNHCR/other NGO source users were evenly split between Central and North Regions, with 42% in Mafraq, 22% in Amman, and 27% in Zarqa. Few women in the other governorates used MOH-supported private medical sector sources for contraceptives. 2. Desire to limit childbearing higher among contraceptive users than non-users Almost half (48%) of currently married women in Jordan say they do not want any more children (JPFHS 2018-19 final report). New tabulations indicate that this percentage is much higher among contraceptive users (63% of modern method users and 59% of traditional method users want no more children) than non-users (only 32%). Conversely, 8% of modern method users say they would like to have another child soon (within 2 years) compared with 27% of non-users. In which governorates are women visiting private-sector sources for contraception? Percent distribution of women using private-sector source for contraception JAFPP, IFH, IRC UNRWA UNHCR/ Other NGOs 58 32 22 14 34 27 Zarqa Amman Other Mafraq42 15 21 3 9 4 11 2 7 Irbid How does desire for another child di�er by use of contraception? Percent of married women 15-49 by fertility preferences All married women Modern method users Traditional method users 48 Want no more children 5963 18 Have another later 2015 17 Have another soon 128 Non-users 32 19 27 3. Almost 70% of married women in Jordan have ever used a method of contraception The 2018-19 JPFHS found that just over half (52%) of married women in Jordan are currently using a method of contraception – 37% use a modern method and 14% use a traditional method. IUDs are the most common currently used method (21% of married women). New tables explore ever use of contraception: 69% of all women in Jordan have ever used any method of contraception (modern or traditional). Ever use of contraception generally increases with age and education. Ever use of any contraception is highest in Irbid, Ajloun, and Jarash (about 75%) and lowest in Ma’an (57%). Need for Modern Contraception Percent distribution of currently married women age 15-49 Met need: using for limiting 26% Met need: using for spacing 11% No need 34% Unmet need for spacing 12% Unmet need for limiting 17% Family Planning: Current and Ever Use Percent of currently married women age 15-49 who used a modern contraceptive method Norplant Injectable IUD Pill <1 <1 8 21 Male condom 5 LAM (lactational amenorrhoea) 1 16 27 2 7 <1 3 Ever use in past 5 years Current use (at interview) 4. 29% of married women have an unmet need for modern contraception According to the 2018-19 JFPHS, 14% of currently married women have an unmet need for family planning – that is, they want no more children or want to wait at least two years before their next birth but are not currently using contraception. The standard definition of met need includes users of both modern and traditional methods. Because such a large proportion of family planning users in Jordan use a traditional method of family planning, it is also interesting to analyze unmet need for modern contraception only. The unmet need for modern contraception in Jordan is 29% - 17% for limiting births and 12% for spacing births. Ever Use of Contraception by Governorate Jordan 69% Percent of currently married women age 15-49 who have ever used any method of contraception Mafraq 73% Zarqa 72% Balqa 56% Madaba 66% Irbid 76% Amman 67% Jarash 75%Ajloun 75% Karak 65% Ta�ela 70% Ma’an 57% Aqaba 60% Data on the specific method used in the past is limited to the 5 year period before the survey through the contraceptive calendar. These retrospective data indicated that in the five years before the survey, 27% of married women had ever used IUD, 16% had ever used the pill, and 7% had ever used male condoms as a contraceptive method. 5. Pregnancy outcome data underline additional pregnancy risks for older and high parity women In the JPFHS, women provide information on their pregnancy status for each of the 60 months prior to the survey as part of their reproductive calendar. Each pregnancy recorded ends with either a birth or a termination (a stillbirth, spontaneous abortion/miscarriage, or induced abortion). An analysis of the births and terminations in the 2018-19 calendar data shows that there were 159 terminations for every 1,000 live births in the 5 years before the survey. This ratio varies by women’s background characteristics and is highest in the expected high-risk categories of age and parity. For example, the ratio of terminations to births is highest among women who age 45-49 and among women who have had 5 or more children. There are fewer terminations to births among women with higher levels of schooling and among women from wealthier households. The termination to birth ratio is highest in Irbid (211 per 1,000) and lowest in Aqaba (103 per 1,000). 6. Modern method use sometimes precedes sterilization or traditional method use Overall, 30% of contraceptive use episodes were discontinued within 12 months (2018-19 JPFHS). While more than half of discontinuation is due to the desire to become pregnant, concerns about the method (that it was inconvenient, failed, or that a more effective method was desired) were often frequently cited reasons for discontinuation. New tabulations explore earlier use of modern methods among women who then used a traditional or sterilization method. Among women who ever used a traditional method, 20% discontinued a modern method at some time before adopting the traditional method. Nineteen percent of women who used a sterilization method discontinued a modern method before sterilization. Overall, 23% of women who either used a traditional or sterilization method during their calendar had previously discontinued a modern FP method. This is most common among women between the ages of 25-39, and least common among the youngest and oldest women. Discontinuation of modern methods prior to traditional method use or sterilization, by age Percentage of women who discontinued a modern method at some time before using a traditional or sterilization method 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15 22 28 27 28 18 11 TOTAL 23 Jordan 159 Mafraq 170 Zarqa 166 Balqa 108 Madaba 110 Irbid 211 Amman 140 Jarash 183Ajloun 157 Karak 149 Ta�ela 139 Ma’an 141 Aqaba 103 How do pregnancy terminations vary by governorate? Number of pregnancy terminations per 1,000 live births How do pregnancy terminations vary by women’s age? Number of pregnancy terminations per 1,000 live births 15-19 20-24 25-29 30-34 35-39 40-44 45-49 206 157 131 120 171 269 686 This brief summarizes additional analysis of the 2018-19 Jordan Population and Family Health Survey published as Jordan Family Planning Questions, DHS Other Documents No. 79. Funding was provided by USAID/Jordan through The DHS Program implemented by ICF. The opinions expressed here are those of the authors and do not necessarily reflect the views of USAID and other cooperating agencies. For the full report or more information about The DHS Program, please visit www.dhsprogram.com. 7. Fertility is higher among women with health insurance According to the 2018-19 JPFHS, the total fertility rate (TFR) in Jordan is 2.7. The 2018-19 JPFHS also reports that more than half (58%) of women age 15-49 have some type of health insurance coverage. New tabulations explore possible associations between fertility and health insurance. Overall, insured women have slightly higher TFRs than uninsured women (2.9 versus 2.5). In general, fertility follows the same age pattern for insured and uninsured women. Additional analysis was done to construct fertility rates for all women (not just ever-married women) and disaggregate the results by insurance type. Women with MOH insurance have the lowest fertility rate, at 2.1 children per woman, while women with UNHCR insurance have the highest fertility rate, at 6.4 children per woman. How does TFR vary by insurance coverage? Total fertility rate among ever-married women Total Insured Uninsured 2.7 2.9 2.5 How does TFR vary by type of insurance? Total fertility rate among all women Total Insured Uninsured 2.7 2.1 3.1 MOH Royal/ Military 2.9 6.4 2.9 UNHCR Other

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