Abstract

PIP: This case study illustrates that low contraceptive prevalence in the rural areas of Kondoa District in Tanzania is related to socioeconomic conditions that foster high fertility. These socioeconomic conditions include a subsistence level of production, the high value on children, early marriage, low educational levels, discrimination in the distribution of contraception, and the persistence of traditional norms and values. High contraceptive awareness is not sufficient to overcome the influence of the high demand for children. It is argued that contraceptive prevalence can be increased through changes in socioeconomic conditions that will reduce poverty and increase literacy. Analysis is based on survey data from 849 women aged 15 years and older in October 1992 among 9 randomly selected villages. Family planning services in the district study area are available only in the 1 district hospital, 4 health centers, and 42 public dispensaries that are not accessible to large segments of the population of 340,232. Distance to a facility may be 10 km or more. In 1991 contraceptive use was 16% of women of reproductive age. 6.8% of current users relied on modern methods, and contraceptive prevalence among respondents was 13.7%. 67.4% were aware of at least one method of contraception. The pill was the most widely used modern method and the most widely known method. Women with 9 or more years of education were the most knowledgeable about contraception. Reasons for nonuse included disapproval by their husbands (13.3%), fear of side effects (5.8%), and a high demand for children (12.8%). Many women with no education or a primary education indicated husband's objection and lack of demand as reasons for nonuse. Only 2.6% of women had an education higher than the primary school level. The mean desired number of children was 6 children. The mean number of children ever born was 5 children. The total fertility rate was 7.1 children.