Changes in contraceptive use and fertility: El Salvador, 1978-88.

In El Salvador from 1978 to 1988, contraceptive use among married women 15-44 years of age increased from 34% to 47%, and the total fertility rate declined from 6.3 to 4.6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception.

Fertility on the US-Mexico border.

Using Bongaarts' model, the relative importance of the proximate determinants of fertility is explored in five populations on the US-Mexico border. For the groups closest to natural fertility (the two Mexican groups), lactation, use of contraception, and marriage all were moderately important in terms of their direct effect on fertility. For the group with lowest fertility (Anglo-American), contraceptive use was an important factor inhibiting fertility; marriage was important but not nearly as important as contraceptive use. For the two US Mexican-American groups, contraceptive use was an important intermediate variable, not as important as for Anglo-Americans, but more important than it was for the two populations in Mexico. The proportion married was a moderately important factor for the Mexican-American groups. For these five populations the principal differences in fertility rates result from substantial differences in the use of effective contraception. Bongaarts' model proved very useful as an analytical framework in this study.

PIP: The relative importance of the proximate determinants of fertility is explored in 5 populations on the US-Mexico border using Bongaarts' model. These are: Mexican nationals who do not live in the 6 northern states that border the US; Mexican nationals who live in those 6 northern Mexican states; Mexican-Americans who were born in Mexico but now reside in the 4 US states that border Mexico and who prefer to speak Spanish at home; Mexican-Americans who were born in the US, live in the 4 US states that border Mexico, identify themselves as Mexican-American or Chicanos, and prefer to speak English at home, and Anglo-Americans who were born in the US, have non-Spanish surnames, and live in the 4 US states that border Mexico. For the groups closest to natural fertility (the 2 Mexican groups), lactation, use of contraception, and marriage all were moderately important in terms of their direct effect on fertility. For the group with the lowest fertility (Anglo-American), contraceptive use was an important factor inhibiting fertility; marriage was important but not nearly as important as contraceptive use. For the 2 US Mexican-American groups, contraceptive use was an important intermediate variable, not as important for Anglo-Americans, but more important than it was for the 2 populations in Mexico. The proportion married was a moderately important factor for the Mexican-American groups. For these 5 populations the principle differences in fertility rates result from substantial differences in the use of effective contraception. Bongaarts' model proved very useful as an analytical framework in this study.

Contraceptive use and fertility in Paraguay, 1987.

In 1987, 38 percent of married Paraguayan women aged 15-44 were practicing contraception, with oral contraceptives being the most prevalent method. Fertility rates for the population were at corresponding levels, with an overall fertility rate of 5.4 births per woman. Fertility has not changed substantially for the nation as a whole since 1979, and contraceptive use has increased by only 6 percentage points. Findings from the present study are consistent with the lack of a public sector family planning program in the country. Pharmacies are the principal source of contraceptives in the country. Twenty-two percent of all women and one-third of married women are at risk of having an unplanned pregnancy. The greatest impact on contraceptive use can be made if new and continued program efforts focus n the interior of the Oriental region of the country.

PIP: In 1987, staff from the International Planned Parenthood Federation affiliate in Paraguay (CEPEP) with technical assistance from the US Centers for Disease Control (CDC) selected 1500 households in metropolitan Asuncion and the interior of the Oriental region (the Interior) to study contraceptive behavior and fertility. Eligible respondents to the survey consisted of women 15 to 44 years old, regardless of marital status. Researchers interviewed only 1 woman per household and completed 2224 interviews. The 1987 overall fertility rate of 5.4 births per woman did not change much since 1979 (4.9), and contraceptive use only increased from 32.1% to 37.6%. Metropolitan Asuncion reported the highest prevalence (more than 50%). In terms of methods to control family size, oral contraceptive (OC) led the list of contraceptive use at 13.5%, followed by native herbs called yuyos at 7.2% and intrauterine devices (IUDS) at 5.1%. After the Paraguayan MOH stopped providing family planning services through MOH facilities in 1979, pharmacies became the primary source of contraceptives (51%). Prior to 1979, the MOH supplied 45% of all contraceptives. Findings in the survey indicated that 22% of all women and 33% of married women are at risk of having an unplanned pregnancy. Also the women exhibited a strong interest in spacing or limiting family size, but because the public sector does not provide contraceptives women cannot do so.

Use of maternal-child health services and contraception in Guatemala and Panama.

PIP: This paper presents data from 2 recent maternal-child health (MCH) and family planning surveys in Guatemala and Panama and examines the extent to which the use of contraception is influenced by the use of MCH services as compared with the influence of an increase in parity. Fieldwork was initiated in July 1984 but not completed until April 1985. A total of 8240 women aged 15-49 years, of all marital statuses, completed interviews, representing 91% of households with eligible respondents. The findings suggest that utilization of MCH services and parity independently are associated with a woman's decision to use contraception. The study also found 2 groups that appear to be particularly in need of both MCH and family planning services: high parity women and Indians. Nonuse of MCH and family planning services may be due in part to their strong cultural beliefs. In both Guatemala and Panama, improved health care services for these 2 groups should be a priority. Contraceptive use in Panama was over twice as high as in Guatemala. However, method choice and residence-ethnicity patterns of use were similar in each country. In both countries and in all residence-ethnicity groups, female sterilization was the most prevalent method in use, followed by oral contraceptives, except for Panama rural Indians. In Panama, contraceptive use increases up to ages 30-34 and then declines, with a sharp decline for women 40-44. In Guatemala, contraceptive use is generally low for ages 15-24, then increases to a fairly constant level for ages 25-39.^ieng

Contraceptive use and fertility in Guatemala.

In 1983, one-quarter of married Guatemalan women aged 15-44 years were using contraception, and female sterilization was the most prevalent method. Fertility rates for the population were at correspondingly high levels, with an overall total fertility rate of about six births per woman. Contraceptive prevalence varied by residence and ethnic group; less than 5 percent of currently married Indian women and about 50 percent of married women in the capital city area were using contraception. From 1978 to 1983, prevalence increased overall by six percentage points, with surgical contraception accounting for most of the increase. Findings of the study suggest that different strategies need to be employed among Ladino and Indian women in order to increase contraceptive prevalence in these subgroups.

PIP: A 1983 survey shows that Guatemala continues to have a relatively low level of contraceptive use by Latin American standards. However, by comparing the results of the 1983 survey with those of a similar survey conducted in 1978, it is clear that contraceptive use has increased slightly. During the 5-year interval between these surveys, the % of married women aged 15-44 years old who were using contraception increased from 19 to 25%. Most of the increase in prevalence was in the use of sterilization, which was found to be the most prevalent method in both surveys. This report describes the results of the 1983 Family Planning and Maternal/Child Health Survey conducted in Guatemala. Also discussed are trends in fertility, breastfeeding, contraceptive use, source of contraception, and women at risk of unplanned pregnancies since the 1978 survey. The 1983 data indicate that mean parity was higher for Indian women than for Ladino women at every age above 20. The mean parity for all women in the 1983 survey is slightly less than that of women in the 1978 survey, but of generally the same magnitude. Overall, the mean duration of breastfeeding estimated from the 1983 survey is 18 months. Postpartum amenorrhea averages about 12 months for all groups. A comparison of duration of breastfeeding for respondents in the 1978 survey with those in the 1983 survey provides no evidence of a trend away from breastfeeding in Guatemala. Overall, 1/4 of married women aged 15-44 were using contraceptive methods at the time of the 1983 survey. The most prevalent method was female sterilization (10%), which, together with male sterilization, accounted for 45% of all contraceptive use. The 2nd most commonly used method, oral contraceptives, had a relatively low prevalence of 5%, followed by rhythm, the IUD, injectables and vaginal methods, and finally, the condom. Contraceptive use also varied by age, reaching a peak among married women 30-39 years old and was lowest for those 15-24. Use of contraception was strongly related to education, being lowest among women with little or formal education. Results in general suggest that contraceptive use is part of a larger predisposition among women to use modern health care. Among Indians, the major reason given for nonuse of contraceptives unrelated to pregnancy was lack of knowledge of contraception or where to obtain family planning services. Among Ladinos, the most frequently mentioned reason was fear of contraception or fear of side effects. The methods of choice for nonusers desiring to use a method were oral contraceptives (27%), sterilization (18%) and injectables (14%). The survey data indicate that the family planning program in Guatemala should be oriented toward high parity, married, nonworking women living in the interior, both Ladino and Indian, who have less than a primary school education. Family planning efforts need to incorporate different approaches for Ladino and Indian women.

Contraceptive use and fertility in the Republic of Panama.

Panama has a high prevalence of contraception, with surgical sterilization being the dominant method. Use of contraception is fairly high even in rural areas. Seventy-one percent of users named a public sector source for their contraception. High use of contraception is part of an overall program of public sector maternal and child health services that also shows substantial penetration of rural areas. The high reliance on public sector sources in panama distinguishes it from other Latin American populations with comparable levels of contraceptive use, such as Sao Paulo state, Brazil, and Costa Rica. These populations also differ in that oral contraceptives are the most prevalent method of contraception. The survey results indicate that the risk of unplanned pregnancy is greatest for unemployed married women who have children. It is particularly important to expand program coverage in rural areas, where two-thirds of those at risk of unplanned pregnancies reside; risk of an unplanned pregnancy for rural women is more than twice that for urban women. While unmarried teenage women do not appear to constitute an important group by this definition, there are other compelling reasons, some supported by other results of the survey, for a special effort oriented toward teenagers. The experience of Panama may be unique in many ways. It shows that an integrated MCH-FP public sector program can meet a high demand for surgical contraception and achieve a fairly high level of contraceptive use. Finally, the results illustrate the value of periodic surveys to gauge the impact of public health programs by monitoring trends in contraceptive use, fertility, breastfeeding, and other aspects of reproductive health.

Contraceptive prevalence in Paraguay.

Contraceptive use, source of contraception, history of abortion, current pregnancy intention, and fertility rates are evaluated for a national sample of women using data from the Paraguay Contraceptive Prevalence Survey, conducted in 1977. The survey found that 15.5 percent of all women aged 15--44 and 23.6 percent of ever-married women were using effective contraceptive methods. The urban/rural difference in contraceptive use paralleled fertility differentials: over 40 percent of ever-married women were using contraception in Greater Asuncion and other urban areas compared with 15 percent in rural areas. Overall, the data indicate that high-parity rural women have the greatest need for family planning services in Paraguay.