Number of participants: 315
Number of participants' countries: 52
Number of contributions: 31
% of contributions from developing countries: 65%
Number of countries contributing: 10 countries
Contributing countries:
Democratic Republic of Congo, Egypt, India, Jordan, Kenya, Pakistan,
Peru, Philippines, Uganda, USA
Summary:
Jordan. Twelve focus group discussions were conducted in Northern and
Southern regions of Jordan, each with 8-9 respondents. In each region 2
focus groups were conducted with currently married women of
reproductive age not currently using contraception, 2 focus groups with
fathers, and 2 focus groups with “positive deviant” women. Women
classified as “positive deviants” were those who expressed interest in
birth intervals greater than 2 years and who were currently using
contraception. The focus group discussions covered the following areas:
fertility aspirations and age of marriage, birth spacing and attitudes
towards contraception.
The main findings of the study follow:
Fertility aspirations and age of marriage:
- There is a trend towards delaying marriage due to the high
cost of living and changes in women’s education and career aspirations.
- Couples feel pressure to conceive and have babies as soon
as they are married. This pressure is due to the combination of late
age of marriage and the cultural importance placed on fertility.
- Fertility seems to give women a higher status in society
and problems with fertility are considered the woman’s responsibility.
- In cases where a man has more than one wife, there is
competition between the two wives to produce children.
- There is a growing awareness that couples should “enjoy
life” and “each other” before starting a family.
- Some women expressed the hidden motivation to have more
children in order to exert greater control and gain more attention from
the husband.
- There is high social and family pressure to have a male
child.
Birth spacing:
- Most respondents favored the term birth spacing over family
planning.
- Respondents emphasized the challenges to space between the
first children.
- The ideal age between siblings is considered to be 2-3
years.
- The high cost of living is a main reason for the acceptance
longer intervals and smaller families.
- Main sources of information are friends, relatives and
health providers
Attitudes towards contraception:
- There is no religious taboo to using contraception as long
as it is to space, and not limit, births.
- The majority of respondents had limited knowledge of
contraception, were misinformed and afraid.
- Contraception is considered in the realm of the woman.
- Barriers against contraceptive use include:
- Large family norms
- Family and community pressure
- Conservative mindset
- Importance of fertility and desire for male heirs
- Late marriages
- Information gap and lack of proper knowledge on
contraceptive methods
Uganda. The overall objective of the study was to explore the attitudes
and beliefs of women and men towards birthspacing and further
understand the individual and social factors that serve as motivators
or barriers. The focus group discussions were carried out in two
districts of Kampala in the central region and Iganga in the eastern
part of Uganda. The participant selection criteria were the same as for
the Jordan study summarized in yesterday’s discussion.
The main findings of the study are as follows:
- Childbearing is the number one expectation from and by
couples and is the primary reason for marriage.
- Fertility is the woman’s responsibility and any delay or
failure is blamed on the woman; however fertility decisions such as the
number of children are the preserve of the man.
- Delayed pregnancy can threaten the marriage relationship
and can lead to early separation, divorce or extra marital
relationships.
- Urban couples are more likely to achieve their ideal birth
intervals due to access to family planning services and methods. Rural
women have limited options and the subsequent pregnancies are left to
God to determine
- Late age of marriage and ideal number of children
overshadow any aspirations for longer spacing. Urban couples who have a
choice calculate their spacing intervals based on the ideal age by
which they want to have completed childbearing.
- Polygamous marriages breed competition among women for a
higher number of children and gender mix.
- There is still a clear preference for males as heirs and
propagators of the family name, however most families want a gender mix.
- The health status of a previous child influences the birth
spacing interval.
- Women are more likely to think about birthspacing then men.
Men, on the other hand, consider the required number of children and
view birthspacing as an automatic occurrence.
- Too short and too long intervals are not desirable in the
community.
- While there is universal basic awareness of family
planning, there are still widespread myths and biases.
- One advantage of short birth intervals is the ability to
compress childbearing and rearing into a few years and avoid advanced
maternal age.
- Disadvantages of short birth intervals are the financial
and time resource stress related to child rearing. Although health
risks to the mother and child are acknowledged, there does not seem to
be strong conviction among the population.
- Most participants noted that birthspacing is more
appropriate for people living in rural settings where women get married
at a younger age and household income is limited.
- It is interesting to note that there are striking
similarities between these results and those from the Jordan
qualitative study. Some of these similarities include:
- Couples want (and are pressured) to have their first child
as soon as possible after marriage.
- Infertility is assumed to be the woman’s fault, one more
reason to have the first child early.
- In case a couple does not have children, pressure is often
put on the husband to remarry or have extramarital affairs in order to
have children.
- High fertility increases a woman’s status in her family and
the society.
- There is a preference for male children.
- Men decide the number of children.
- The method to space births is a women’s business.
- Too short or too long birth intervals are not acceptable.
- Factors of pressure to have children include age of woman
at marriage, gender of first child, loss of a pregnancy or child,
multiple wives.
- In polygamous marriages, there is competition between wives
to have more (male) children than the other wives. This creates
pressure for short birth intervals and large families.
- Factors to delay childbearing include waiting until the
woman finishes school, financial burden / high cost of living, etc.
- Health of previous child can influence both ways. 1) It can
make a couple want to wait longer in fear that the next child will also
be unhealthy, or 2) it can pressure them into having another child as
soon as possible in hope of a healthy child.
- There is a poor knowledge of modern contraceptive methods.
Rumors and fear of side effects are undermining use.
Kenya. The Council of Imams and Preachers (CIPK) of Kenya is a
Garissa-based Islamic organization, which coordinates Mosque activities
in the 11 administrative divisions of Garissa District. CIPK’s major
mandate is to disseminate Islamic information to the Muslim communities
through the Imams. CIPK collaborated with the ESD Project to organize a
five day training on Child Spacing and Reproductive Health for 30
Muslim Religious Leaders in Garissa. The training was facilitated by
local and other Muslim RH and medical experts. Religious leaders shared
knowledge on Reproductive Health with special reference to the Islamic
view of healthy timing and spacing of births.
India. Promoting Optimal Inter-pregnancy Intervals in India through
Integrated Public Delivery Systems FRONTIERS Program of Population
Council is collaborating with the Ministry of Health and Family
Welfare, Office of the Integrated Child Development Services (ICDS)
scheme, and Lala Lajpat Rai Memorial Medical College (at Meerut, Uttar
Pradesh) to conduct a study that assesses the effectiveness of
promoting a three-year interval between births among pregnant women
with no or one child by increasing postpartum contraception. The key
intervention is an educational campaign for pregnant women during
antenatal check-ups and house visits. In addition, their husbands,
mothers-in-law and community opinion leaders were educated by community
level workers trained in counseling young couples on birth spacing and
postpartum contraception. Several IEC materials and educational aides
(pocket booklet, posters and wall paintings in Hindi) were developed on
delaying first birth, need to space births 3-5 years, correct practice
of LAM, and other spacing methods.
Number of
surveys completed 34
% who have
passed content to others 53%
% who have or
will use in their work 94%
% very
satisfied with forum content 61%
Suggestions
for improvement :
- The format in which the postings came out was not easy to
see who was responding/ posting to whose message.
- It was unfortunate that there was another online forum
going on at the same time and it was a challenge keeping up with all
the postings. The information was valuable, but I think the format for
the online discussions needs some reconsideration. Posting a series of
questions at the beginning of the week and then summarizing
contributions at the end of the week, with access to the actual
contributions online if desired, would be helpful. Daily postings are
too much - our inboxes are too cluttered with things to address this on
a daily basis.
- It would be great to reach out to more people- in addition
to the technical experts working on the issue- to participate in the
discussions.
- I do not have good ideas yet on how to achieve this- but it
seems like the forum could be enriched by a diversity of people with
different viewpoints and programming experiences.
Health Communication Partnership (HCP) and the INFO Project,
based at the Johns Hopkins Bloomberg School of Public Health/Center for
Communication Programs (JHU/CCP), ACCESS/FP Project, Extending Service
Delivery (ESD) Project, United States Agency for International
Development (USAID), World Health Organization Department of
Reproductive Health and Research (WHO/RHR)
Shea Rutstein, PhD, Technical Director, Macro International
Carla Schnell White, Senior Advisor Monitoring and Evaluation, Extending Service Delivery Project
Lina Qardan, MS, Mass. Comm, Senior Technical Advisor, Jordan Health
C Lina Qardan, MS, Mass. Comm, Senior Technical Advisor, Jordan Health
Communication Partnership Communication Partnership
Maureen Norton, Senior Technical Advisor, USAID
Ricky Lu, JHPIEGO
Maria Ofelia Ocana-Alcantara, MD, MPH, Consultant: Health Sector and Health Finance Health Care Perspective Inc. RH Link Inc
Cate Lane, Senior Youth Advisor, Extending Service Delivery (ESD) Project
Robin Anthony Kouyate from ACCESS-FP
Sheikh Hussein Mahad, Council of Imams and Preachers of Kenya
Mary Sebastien, Population Council, India
Robin Anthony Kouyate, ACCESS-FP
Dr. Judith Brown
Catharine McKaig, ACCESS-FP
Salvador-Davila, MD, CATALYST
