Effects of couples' characteristics on contraceptive use in sub-Saharan Africa: the Ghanaian example.

Using data from the 1988 Ghana Demographic and Health Survey, this study examines couples' demographic and socioeconomic characteristics in the context of their attitudes towards family planning, and the impact of these factors on the use of contraceptives. The characteristics of the husbands and their influence on wives' behaviour illustrate the role of intra-household relations between men and women and their effect on fertility-related behaviour in patriarchal African societies.

PIP: Compared to elsewhere in the Third World, Africa has one of the lowest contraceptive use rates. Recent studies suggest that gender relations in many parts of the continent may be responsible for such low use of modern contraception. The 1988 Ghana Demographic and Health Survey collected data on background characteristics, contraceptive knowledge and use, attitudes toward family planning, marriage, fertility, and fertility preferences from 4488 reproductive-age women and 1010 of their husbands. Relative to their spouses, men tended to be older, better educated, and more likely working in agriculture. 83% of men and 73% of women indicated their acceptance of mass media family planning messages, while 20% of husbands and 16% of wives reported using some form of contraception. A larger percentage of men and women over age 26 reported using contraception compared to respondents under age 26. The level of contraception use increased with the level of education for both sexes, although the level of use was inversely related to the difference in age between spouses. Periodic abstinence was the most widely used method, followed by oral contraception. Communication between spouses was an important predictor of family planning use.

Determinants of current contraceptive use among Ghanaian women at the highest risk of pregnancy.

This study uses data from the Ghana Demographic and Health Survey (GDHS) of 1988 to examine factors determining the continued low levels of contraceptive use in Ghana. The women currently using efficient contraception are those who have sexual intercourse regularly, who discuss family planning with their partner, whose husbands approve of the use of family planning, and who live in the northern sector of the country. The finding that husband's approval is an important determinant of efficient contraceptive use has significant policy implications for Ghana and other African countries, to motivate both husbands and wives to share fertility control responsibilities.

PIP: Researchers analyzed 1988 Ghana Demographic and Health Survey data on 1585 15-49 year old women to examine factors which may contribute to low levels of contraceptive use among women in Ghana at highest risk of pregnancy despite widespread knowledge of contraceptives. The term women at highest risk was defined as those who were either currently married or in a consensual union, not pregnant, not amenorrheic, and not practicing postpartum sexual abstinence. Only 7% of the women currently used an effective contraceptive method. An additional 10% currently used an ineffective method. The methods used most frequently included periodic abstinence (7.4%) and oral contraceptives (3.3%). Women who engaged in sexual intercourse at least once a week (parameter estimate of the odds=1.655), talked about family planning the most with their partner (2.079), whose partner approved of family planning (1.214), and had some education (1.543) were more likely to currently use contraceptives. Yet women who lived in Greater Accra were less likely to use any contraceptive method (0.806). On the other hand, women living in Greater Accra were more likely to use an efficient contraceptive (1.339), but women with some education were less likely to do so (0.990). Women who engaged in sexual intercourse at least once a week (1.342), talked about family planning the most with their partner (1.246), and whose partner approved of family planning (1.553) were more likely to also use efficient contraceptives. Since men play a key role in women's use of contraceptives, family planning programs in Ghana should also target education campaigns to men emphasizing the economic and health benefits to the family and the mother. These programs should encourage both men and women to be equally responsible for fertility control.

Sociodemographic correlates of breast feeding in Ghana.

This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to investigate breast feeding in Ghana and the factors that affect it. Using life table procedures, we found evidence that, when other factors are held constant, older cohorts, women with no schooling, those who work in the agricultural sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis, rural residents, residents of the Volta, Brong-Ahafo, northern, and upper regions, and low-parity women show longer durations of breast feeding. It is recommended that, along with other fertility reduction measures, prolonged breast feeding among all Ghanaian mothers should be encouraged to help reduce conception and to ensure healthy children.

PIP: Data from the Ghana Fertility Survey (GFS), 1978-80, is used to investigate the fertility levels and breast feeding behavior in Ghana. The stratified sample of 6125 women aged 15-49 years represents region and urban, large urban and rural sectors, of which a subsample of 4943 ever married women provides data of the last births within the preceding 5 years. Analysis is based on survival table procedures and accelerated failure time models to estimate the probability of breast feeding at various ages. The Weibull regression version of general accelerated failure time models was employed in estimating the effects of the independent variables on the median duration of breast feeding for selected maternal characteristics. The SAS statistical procedure, LIFEREG, was used to estimate maximum likelihood parameters with a Newton-Raphson algorithm. The dependent variable was the cumulative probability of breast feeding for children who were still breast feeding, those discontinuing, and those breast fed until their death. Independent variables were birth cohort (1930-39, 1940-49, 1950-54, and 1955-64), age at first marriage, formal education, occupation, religion, ethnicity, monogamous or polygynous marriage, residence, ratio of desired children to living ones, and parity. The results show that the median duration exceeds 12 months which is strongly related to birth cohort, .01 level of significance. Duration decreases over time. The youngest age cohort may perceive their breasts to be sex symbols and infant feeding formulas have become more available. Age at first marriage has little effect on duration, but increasing age at marriage shows a slight reduction in duration with controls operating. Babies are breast fed longer by less educated mothers, although the multivariate analysis indicated insignificance. Working mothers may have a conflict with breast feeding, but professional women have about the same duration as other women, perhaps due to the 3-month paid maternity leave. Agricultural workers tend to breast feed longer. Only traditional believers breast feed longer, longer by Christians by 4 months and by Muslims 2 months. Only the Mole-Dagbanis breast fed over 1.5 years. Women in polygynous marriages also breast feed longer. Urban women tended to have shorter durations, .05 significance level. Regional differences varied between 14-19 months. Women from Brong-Ahafo and Volta regions may breast feed longer because of inadequate health services. Greater parity is associated with shorter duration. The recommendation is that contraceptives be associated with shorter duration. The recommendation is that contraceptives be made more widely available because of the trend in shorter feeding and concomitantly shorter birth intervals, and that breast feeding be promoted.

Socio-economic and cultural differentials in contraceptive usage among Ghanaian women.

PIP: Data from the Ghana Fertility Survey of 2001 married women in 1979-1980 were subjected to logistic regression to determine the factors influencing contraceptive use. In this Ghanaian sample only 22 women and no men were sterilized, 11% used an efficient contraceptive method and 8% were using an inefficient method. The most prevalent methods were abstinence by 6% and pill by 5%. The variables analyzed were birth cohort, age at 1st marriage, education, occupation, religion, ethnicity, rural/urban residence, northern/southern residence and number of children desired number of living children. All these factors were dichotomized, e.g., cohort: born before or after 1950. Factors positively significant for contraceptive use were younger women (20% more likely), married at age 20 or older (82% more), education (150% for any method, 67% for an efficient method), professional occupations, protestants, urban residence, southern residence, desire fewer children. Factors negatively associated with contraception were agricultural work (50% as likely), non-Christian religion, both traditional and Moslems (75%), desiring more children and living in the north. Unexpectedly, living in the northern undeveloped region was strongly linked with use of an efficient contraceptive. A factor without significant effect was ethnicity, Akan or non-Akan. These results were discussed with a general review of the literature on determinants of contraceptive use.^ieng

Examining the relationship between age at first marriage, education and the timing of marital dissolution in Ghana.

"This study utilizes the family-life course perspective with survival tables and proportional hazard rate analysis to examine the timing patterns of marital dissolution in Ghana at various durations of marriage. Using data from the Ghana Fertility Survey (GFS) 1979/1980, this study has found evidence to support research from western industrial countries that young age at marriage compared to the cultural norm increases the probability of divorce.... It is found that for those with no education, divorce rates are not affected by age at marriage, while for those with some education, later marriage leads to lower dissolution rates."

Cohort shifts in the timing of births in Ghana.

PIP: A comparison of cohorts of ever-married Chanaian women suggests evidence of a fertility transition beginning among younger women and select subgroups. Ghana's crude birth rate declined from a high of 50/1000 population in 1970 to 38.8/1000 in 1985. To ascertain whether marital fertility is now being controlled through conscious attempts to lengthen birth intervals, World Fertility Survey data from 1979-80 on the timing of births among different birth cohorts were analyzed. It was hypothesized that, as a result of the influence of Western values that stress independence from parents and the introduction of compulsory education, cohorts of the mid-1950s and 1960s would be more likely to postpone childbearing, more active in the modern sector of the economy, and more accepting of modern contraceptive usage for birth spacing than women in the 1930-39, 1940-49, and 1950-59 cohorts. For the 1940-49 cohort, it took 10.8 months for 25% to have a birth following 1st marriage, 18.7 months for 50% to have a 1st birth, and 27.4 months for 75% to complete this step. By comparison, these figures for the 1955-64 birth cohort were 9.9, 16.7, and 20.5 months, respectively. The significantly shorter (p 0.01) interval between marriage and 1st birth found among younger women in part reflects rising age at marriage; mean age at 1st marriage was 17.9 years for the 1940 cohort and 21.6 years for the most recent cohort. After the birth of the 1st child, recent cohorts were more likely to wait longer for the 2nd birth. For women born in 1950-64, it took 21.8, 36.7, and 44.6 months for 25%, 50%, and 75%, respectively, to reach parity 2. This pattern of lengthened birth interval beyond the 1st birth was apparent at all parities in the youngest cohort and indicates increasing acceptance of contraception among those who have come of age during a period of rapid social change.^ieng