Motivational Intensity: A New Perspective on Family Planning Needs

Publication date: 2013

Motivational Intensity: A New Perspective on Family Planning Needs Bernice Kuang John Ross Elizabeth Leahy Madsen November 13, 2013 Addis Ababa, Ethiopia Background  Non-users of contraception—both those with and without unmet need—are diverse in their need for family planning and their intensity of interest in its use.  Unmet need does not tell us HOW MOTIVATED to use family planning women are.  Few studies of unmet need have examined how some sub-groups of non-users may be more motivated to seek and adopt family planning methods than others. Context Source: Ross, J., J. Stover, and D. Adelaja. 2005. Profiles for Family Planning and Reproductive Health Programs: 116 Countries. Glastonbury, CT: Futures Group. Not all women with unmet need intend to use in the future. A puzzle Unmet Need Intention to Use Unmet Need Ever Users Never Users Intent to use High Motivational Intensity Low Motivational Intensity No Intent to use Unmet need: motivational intensity Never Users Ever Users Source: Westoff, C. 2012. Unmet Need for Modern Contraceptive Methods. DHS Analytical Studies No. 28. Calverton, Maryland: ICF International. Research Question & Methodology Non-users vary in their motivation to use family planning—  Analyzing motivation can tell us more about potential users and family planning needs than unmet need alone  By evaluating motivation against demographic characteristics and fertility preferences, we can characterize a set of indicators that consistently identify interested potential users Hypothesis  Most recent DHS surveys from 23 sub-Saharan African countries were analyzed (2003–2011)  Unmet need coded according to DHS revised definition  No need  Sexually active and not seeking to avoid pregnancy, essentially, non-users without unmet need  Data analyzed using Stata 12 and checked against STATcompiler  Data weighted according to DHS instructions to account for survey design Methodology Sub group analysis of non-users High Motivation Low Motivation All Non-Users = Unmet Need + No Need Intent to Use No Intent to Use Ever Users Never Users Never Users Ever Users Results Source: Most recent DHS, various years. Motivation differs by socio- demographic characteristics Age (Median) % Rural % No Education % in Poorest Quintile High Motivation Intend to Use Unmet Need Ever Use 29.5 65.5% 31.4% 14.7% No Need Ever Use 27.6 63.5% 31.2% 13.8% Do Not Intend Unmet Need Never Use 31.3 79.3% 53.6% 28.5% No Need Never Use 26.8 82.6% 56.5% 33.6% Low Motivation Source: Most recent DHS, various years Motivation differs by fertility history and preferences Ideal Number of Children % Within 12 Months of Birth % Reported Last Birth Unwanted High Motivation Intend to Use Unmet Need Ever Use 4.7 28.7% 15.0% No Need Ever Use 4.9 26.9% 1.4% Low Motivation Do Not Intend to Use Unmet Need Never Use 6.2 30.4% 12.9% No Need Never Use 6.7 33.2% 0.8% Source: Most recent DHS, various years Motivation differs by fertility history and preferences Ideal Number of Children % Within 12 Months of Birth % Reported Last Birth Unwanted High Motivation Intend to Use Unmet Need Ever Use 4.7 28.7% 15.0% No Need Ever Use 4.9 26.9% 1.4% Low Motivation Do Not Intend to Use Unmet Need Never Use 6.2 30.4% 12.9% No Need Never Use 6.7 33.2% 0.8% Source: Most recent DHS, various years Motivation differs by fertility history and preferences Ideal Number of Children % Within 12 Months of Birth % Reported Last Birth Unwanted High Motivation Intend to Use Unmet Need Ever Use 4.7 28.7% 15.0% No Need Ever Use 4.9 26.9% 1.4% Low Motivation Do Not Intend to Use Unmet Need Never Use 6.2 30.4% 12.9% No Need Never Use 6.7 33.2% 0.8% Source: Most recent DHS, various years Motivation differs by fertility history and preferences % Unmet Need for Limiting % Reported Contact With FP Worker in Last 12 months % Reported Previous Termination Intend to Use Unmet Need Ever Use 37.3% 28.8% 18.8% No Need Ever Use N/A 28.7% 20.1% Do Not Intend to Use Unmet Need Never Use 36.7% 16.1% 13.9% No Need Never Use N/A 12.1% 14.3% High Motivation Low Motivation Source: Most recent DHS, various years Motivation differs by fertility history and preferences % Unmet Need for Limiting % Reported Contact With FP Worker in Last 12 months % Reported Previous Termination Intend to Use Unmet Need Ever Use 37.3% 28.8% 18.8% No Need Ever Use N/A 28.7% 20.1% Do Not Intend to Use Unmet Need Never Use 36.7% 16.1% 13.9% No Need Never Use N/A 12.1% 14.3% High Motivation Low Motivation Source: Most recent DHS, various years Motivation differs by fertility history and preferences % Unmet Need for Limiting % Reported Contact With FP Worker in Last 12 months % Reported Previous Termination Intend to Use Unmet Need Ever Use 37.3% 28.8% 18.8% No Need Ever Use N/A 28.7% 20.1% Do Not Intend to Use Unmet Need Never Use 36.7% 16.1% 13.9% No Need Never Use N/A 12.1% 14.3% High Motivation Low Motivation Does high motivation agree with other predictors of interest in FP? Indicator Agreement? Higher Education  Yes Higher Income  Yes More Urban  Yes Lower Ideal Family Size  Yes Recent Contact with FP Staff  Yes Previous Termination  Yes Last Birth Unwanted  Some Recently Postpartum NO Unmet Need for Limiting NO Summary & Conclusion Source: Most recent DHS, various years. High motivation – representation among unmet need and no need High Motivation  Intend to use  Ever User 0% 5% 10% 15% 20% 25% Unmet No Need East and Southern Africa Average West and Central Africa Average Source: Most recent DHS, various years. Motivation in East and West Africa Low Motivation  No Intent to Use  Never User High Motivation  Intend to use  Ever User 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% East and Southern Africa Average West and Central Africa Average  Targeting interested/motivated women who already desire smaller families may be an efficient way of increasing FP uptake, while broad-base outreach to whole populations continues.  How can we better find and serve motivated/interested women?  Counsel women seeking care in postpartum or postabortion facilities  Provide FP services in urban workplaces, where more educated women may be found  Identify women lost to follow-up (ever users who are no longer using) for counseling to find them the right method and encourage continuity of care  Provide comprehensive baseline information to all non-users, including those with no current need, since many of them intend to use in the future Unmet need alone is not enough for program planning www.healthpolicyproject.com Thank You! 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 (CEDPA is now a 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). Slide Number 1 Slide Number 2 Context A puzzle Unmet need: motivational intensity Slide Number 6 Hypothesis Methodology ������Sub group analysis of non-users� Slide Number 10 Motivation differs by socio-demographic characteristics Motivation differs by fertility history and preferences Motivation differs by fertility history and preferences Motivation differs by fertility history and preferences Motivation differs by fertility history and preferences Motivation differs by fertility history and preferences Motivation differs by fertility history and preferences ��Does high motivation agree with other predictors of interest in FP? Slide Number 19 High motivation – representation among unmet need and no need Motivation in East and West Africa Unmet need alone is not enough for program planning Slide Number 23

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