Changes in contraceptive use and fertility: Panama, 1976 to 1984.

PIP: From 1976 to 1984 important demographic changes occurred in Panama. The total fertility rate declined from 4.5 to 3.7, and contraceptive use among married women 20-44 years of age increased from 55% to 63%. However, using data from 3 national level reproductive health surveys which were conducted in Panama in 1976, 1979, and 1984, we found that most of the changes took place between 1976 and 1979. Since 1979, overall contraceptive use and fertility have remained virtually unchanged, although there has been an important method-mix shift toward an increase in the use of contraceptive sterilization and IUD's, with an accompanying decline in the use of oral contraceptives. Although the singulate mean age at marriage remained relatively constant, the average duration of breastfeeding rose 23% during the period. Further gains in contraceptive prevalence and reduction in unplanned fertility in Panama will largely depend on enhanced program efforts 1st begun in the early 1970's by the Panama Ministry of Health. Future program efforts especially should be directed toward encouraging young couples to space their children more effectively by using temporary methods of contraception. The surveys used for this analysis were the 1976 Panama National Fertility Survey of the World Fertility Survey program, the 1979 Panama Contraceptive Prevalence Survey (Westinghouse), and the 1984 Panama Maternal-Child Health/Family Planning Survey.^ieng

[Use of contraceptives and fertility in Panama]. / Uso de anticonceptivos y fecundidad en Panama.

PIP: The 1984 Maternal-Child Health and Family Planning survey of Panama was the first to achieve nationwide coverage by including 2 provinces with large indigenous populations that were excluded from the 1976 Panama Fertility Survey and the 1979 Contraceptive Prevalence Survey. The 1984 survey indicated a total fertility rate 4.0 children/woman or 3.7 excluding the 2 provinces not included in the previous surveys. The total fertility rate was estimated at 4.5 in 1976 and 3.9 in 1979. In 1979, rural women had 2.5 children more than urban women, but by 1984 the difference was reduced to 1.3. Including the 2 predominantly indigenous provinces, the total fertility rates were 5.0 children for the rural population and 3.2 for the urban population. The 1984 there were wide regional variations in fertility. The total fertility rate was 6.3 in the predominantly rural and indigenous provinces, 4.3 in the predominantly rural nonindigenous provinces, and 3.2 in urban areas. 10% of women stated that their most recent birth had been unwanted. The proportion of women giving birth within the previous 2 years who stated they had breast fed their babies increased from 80% in 1979 to 93% in 1984 and the average duration of breast feeding increased from 9.5 to 10.3 months. Between 16-79, contraceptive usage among currently married women aged 20-44 years increased from 53% to 63%, with 10% increases in both rural and urban areas. Between 1979-84, the level of contraceptive usage remained about the same and even showed a slight decline in urban areas. The proportion of women sterilized increased from 32.3% in 1979 to 36.8% in 1984, the proportion using pills declined for 18.9% to 12.2%, and the proportion using IUDs increased from 3.8% to 6.4%. Changes in use of rhythm, condoms, and other methods were slight. 58.2% of currently married women aged 15-44 used a contraceptive method in 1984, with use increasing with age to over 70% among women aged 35 or more. Pills are the most used method among men aged 15-19 and 20-24, but sterilization is the most popular method for women 25 or over. Over 80% of women aged 35 or over who use a method are sterilized. Among women in union aged 15-44, 43.2 in rural indigenous provinces, 56.7% in rural nonindigenous provinces, and 63.7% in the urban province used a method. The level of use varied from 52.7% of those with less than primary educations to 65.9% of those with university educations. 75% of married, fertile women who did not want additional children stated they would be interested in sterilization, but over 1/4 of them had been denied sterilization services by physicians because they were too young or had too few children. An estimated 61,400 Panamanian women, or about 13% of women aged 15-44 years, are in need of family planning services. The unmet need for services is especially high in rural areas, among women aged 20-34, among the less educated, and in the indigenous population.^ieng