Does choice make a difference to contraceptive use? Evidence from east Java

Abstract

This study investigates sustained use of contraceptives among women in East Java, Indonesia. Interest is focused on the effect of whether the client's choice of contraceptive method was granted or denied, and the interaction between whether choice was granted or denied and husband-wife concurrence concerning method choice. Data were collected twice in a panel survey. The first round was conducted in family planning clinics among women initiating contraceptive use; the second was a follow-up household survey carried out 12 months later. Whether the user was granted her choice of method was found to be a very important determinant of sustained use of contraceptives. The interaction between whether choice was granted and whether there was husband-wife concurrence on method choice was also important. The highest rate of discontinuation occurred when method choice was denied in the presence of husband-wife agreement on method choice, and the lowest rate occurred when method choice was granted in the presence of such concurrence. The results imply that contraceptive continuation can be enhanced either when family planning workers pay more attention to the stated desires of their clients, or when policy is instituted allowing clients to use their method of choice.

PIP: A retrospective study of contraceptive discontinuation (CD) among a sample of 1945 women who were new government family planning (FP) clients in 1987-88 from 6 east Java regencies (Blitar, Jombang, Magetan, Malang, Pamekasan, and Pasurum) and the city of Surabaya, Indonesia is reported. Clients were interviewed initially and 1 year later. Discontinuation was defined as a report of no use of contraception after a year. 341 were discontinuers, which did not include those who became pregnant within the 12-month period but who were using contraceptives at the end of 12 months. This definition deviates from prior research. 2 hypotheses were examined: 1) denial of method of choice by the FP workers has a positive effect on CD and 2) husband/wife concurrence has a negative effect on CD or there is interaction between denial of method of choice and husband/wife concurrence. Husband/wife agreement reduces CD when desired method is approved. Choice granted was differentiated by those where the FP worker agreed or disagreed with the method of choice. Choice denied was determined by those that coincided with the FP worker's suggestion and those that did not. 13.7% were in the choice denied group at follow up, whereas 27% reported choice denied in the initial interview. It is possible though unlikely that selection bias was involved. Desired contraceptives were the pill, condom, IUD, injection, implant, and sterilization. The results indicated that there were large differences between and IUD suggested by the FP worker and the actual number used (70.9% vs. 32.8%), and the pill and injection (33.6% and 30.9%, respectively, vs. 8.4% and 14.7%). When the IUD was the method of choice, the method usually coincided with the FP worker, while the pill, condom, or injection were the chosen method which the FP worker did not suggest. 71% of all husbands concurred with the method of choice initially and after 12 months. 62.1% had concurrence and choice granted, and 24.3% had nonconcurrence and choice granted. 9% had choice denied and concurrence, and 4.7% had choice denied and nonconcurrence. The univariate analysis indicated that 72.2% of discontinuers had choice denied, and only 8.9% for choice granted. When choice is granted, husband/wife concurrence had little effect on CD, but when choice was denied, husband/wife concurrence increased CD. Logit linear modeling showed a strong and highly significant relationship between choice granted and sustained use, as well as the positive effect of concurrence and negative effect of nonconcurrence. If choice had not been denied, 91.1% of women would still be users compared with the actual 82.5%. Reciprocal rather than hierarchical relationships between FP workers and clients facilitates contraceptive usage. Give the people what they want is also supported by the Chairman of the National Family Planning Board.