male method choice in bangladesh: does it matter who makes the decision? mohammad amirul islam sabu...

Male Method Choice in Bangladesh: Does It Matter Who Makes The Decision?

Mohammad Amirul Islam Sabu S. Padmadas

Peter W.F. SmithDivision of Social Statistics

University of Southampton, SO17 1BJ, UK e-mail: islam@soton.ac.uk

British Society for Population Studies Conference, Southampton, UK, 18-20 September 2006

Outline of the presentation

Rationale

Objectives of the research

Data and methods

Determinants of the decision-making process in FP

Influence of the decision-making process in FP on male method

use against female method use

Conclusions

Trend in contraceptive prevalence rate

0

10

20

30

40

50

60

70

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

% CPR

Male method use

Female method use

Trend in total fertility rate (TFR)

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

Trend in method discontinuation in last five years

0

5

10

15

20

25

30

35

40

45

50

1993-94 1996-97 1999-2000 2004

Demographic and health survey

%

For all reasons

Due to side effects

Due to husband's opposition

Method discontinuation due to side effects by method

0%

20%

40%

60%

80%

100%

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

OthersWithdrawal

Periodic abstinenceCondom

InjectionsIUD

Pill

Method discontinuation due to husband's opposition by method

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

OthersWithdrawalPeriodic abstinence

CondomInjectionsIUD

Pill

Trend in FP discussion with partner

0

10

20

30

40

50

60

70

80

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

%

Trend in FP decision-making

0

10

20

30

40

50

60

70

80

90

1993-94 1996-97 1999-2000 2004

Demographic and Health Survey

%

Only by wife Only by husband Joint decision

Objectives

To explore the associated determinants of the decision-making process in FP (decision taken by mainly wife, mainly husband and jointly).

To investigate the influence of the decision-making process in FP on male method use against female method use

Data

The study uses the couple data set (N=2249) based on the 1999-2000

Bangladesh Demographic and Health Survey.

The couple data set is generated by linking spouses from the male data set

constituting a sample of 2556 currently married men aged 15-59 years and that

from females which has a sample of 10,544 ever married women aged 10-49

years.

In the DHS women data set, the respondents who started using a contraceptive

method after April, 1994 were asked the question, ‘Who is responsible for

deciding to use FP?’ The predefined responses were, ‘mainly respondent’,

‘mainly husband’, ‘joint decision’, and ‘other’. Hence the sub-sample for the study

was reduced to the size of 946.

Methods

A multinomial logistic regression model will be fitted to identify the

determinants of decision-making process in FP.

A binary logistic regression model will be fitted to understand the influence

of decision-making process in FP on couples’ method choice (male/female).

Only the significant variables will be included in the final model

FP decision-making among couples

18.1

12.3

68.8

0.8

Only by wife

Only by husband

Joint decision

By others

Determinants of FP decision-making

Response variable: FP decision-making

Categories: only by wife, only by husband, jointly

The regression results are presented in terms of estimated probabilities corresponding to the estimated coefficients

The estimated probabilities are calculated based on the reference couples’ characteristics

The characteristics of the reference couple:

Marital duration 5-10 years

From Dhaka division

From rural area

Husband has primary level education

Wife has primary level education

Husband does not have access to newspaper

Husband does not approve of FP

Wife does not approve of FP

FP decision-making by area of residence

0

5

10

15

20

25

30

35

40

45

50

Urban Rural

Area of residence

Ad

jus

ted

pre

dic

ted

pro

ba

bili

ty (

%)

Mainly wife Mainly husband Jointly

FP decision-making by husband's education

0

10

20

30

40

50

60

70

80

No education Primary Secondary Higher

Husband's education

Ad

jus

ted

pre

dic

ted

pro

ba

bili

ty (

%)

Mainly wife Mainly husband Jointly

FP decision-making by wife's education

0

10

20

30

40

50

60

No education Primary Secondary Higher

Wife's education

Ad

jus

ted

pre

dic

ted

pro

ba

bili

ty (

%)

Mainly wife Mainly husband Jointly

FP decision-making by husband's approval of FP

0

10

20

30

40

50

60

Yes No

Husband's approval of FP

Ad

jus

ted

pre

dic

ted

pro

ba

bili

ty (

%)

Mainly wife Mainly husband Jointly

FP decision-making

0

5

10

15

20

25

30

35

40

45

50

Yes No

Wife's approval of FP

Ad

jus

ted

pre

dic

ted

pro

ba

bili

ty (

%)

Mainly wife Mainly husband Jointly

Influence of decision-making process in FP on couples’ FP method choice

Study is restricted for couples where -

both the spouses are currently using FP method

both the spouses reported the same method use

wife in the couple is fecund

FP decision taken by either or both the spouses

Method use by type

28.3

71.7

Male method

Female method

Method choice by FP decision-making

0

10

20

30

40

50

60

70

80

90

100

Mainly by wife Mainly by husband Joint decision

FP decision-making

%

Female method Male method

Method choice by wife's education

0

10

20

30

40

50

60

70

80

90

No education Primary Secondary Higher

Wife's education

%

Female method Male method

Method choice by husband's education

0

10

20

30

40

50

60

70

80

90

No education Primary Secondary Higher

Husband's education

%

Female method Male method

Method choice by FP approval by wife

0

10

20

30

40

50

60

70

80

90

Approves Disapproves

Approval of FP by wife

%

Female method

Male method

Method choice by FP discussion

0

10

20

30

40

50

60

70

80

Discuss FP Does not discuss FP

FP discussion

%

Female method Male method

Method choice by area of residence

0

10

20

30

40

50

60

70

80

Urban Rural

Area of residence

%

Female method Male method

Method choice by number of children

0

10

20

30

40

50

60

70

80

90

No children 1 to 2 3 to 4 5 and above

Number of children

%

Female method Male method

Influence of decision-making process in FP on couples’ FP method choice

A binary logistic regression model has been fitted

Response variable is:

Currently using male method v female method (reference category)

Coding of independent variables

FP decision: Mainly wife, mainly husband, joint decision

Husband’s Age: less than 25, 25-39, 40 and above

Wife’s Age: less than 20, 20-34, 35 and above

Number of living children: no children, 1-2, 3-4, 5 and more

Division: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet

Area of residence: urban, rural

Husband’s education: no education, primary, secondary, higher

Wife’s education: no education, primary, secondary, higher

Wife approves of FP: yes, no

Discuss FP with partner: yes, no

Husband’s occupation: Unemployed, professional/managerial/technical, agriculture self-

employed, agriculture employed, skilled manual, unskilled manual

Regression results

If the FP decision is taken only by husband the couple is more likely to use male

method, while the couple is more likely to use female method if wife alone takes

the FP decision.

Furthermore a couple is more likely to use male methods than female methods if -

husbands aged 40 years and above, wives aged 35 years and above, husbands

have education higher than secondary level, wives have education higher than

secondary level, husbands are engaged in un-skilled manual jobs, wife does not

approve of FP, and couple does not discuss FP.

Conclusion

One third of the couples are taking FP decision without reaching to a consensus with

their partners. This may lead to inconsistent and inefficient use of contraception and

some time lead to drop out of methods. Couples should be encouraged towards joint

FP decision.

Sylhet division is not performing well in terms of joint FP decision compared to other

divisions which requires administrative action.

It is not well understood why urban couples are lagging behind in terms of motivation

toward joint decision regarding FP. This needs further investigation.

Sex of the spouse who takes decision regarding FP is found to be associated with the

type of method in use (male/female). This indicates a serious state of unshared

responsibility in contraception which is against the couple perspective of the FP

programme.

To increase the use of male FP methods among couples male should be more

involved in the FP process.

Shifting the target of the FP programme from a women only approach to a couple

based approach may help improving the situation of FP decision-making process

toward shared responsibility in the overall process which may finally lead to more

uptake of male methods.