Factors Affecting Contraceptive Use among Young Fecund Women in Bangladesh

Abstract

Background: World population stood at 7.238 billion in 2014. South Asia accounts 1.806 billion of world population of which, Bangladesh, the third populous country in South Asia contributes 158.5 million people. More than half of the population of Bangladesh is young (32.3% are below age 15 and 18.8% are age 15-24). As this large cohort of young people enters the reproductive life span, their reproductive behavior will determine the growth and size of population of Bangladesh for decades to come. So, this study focused on the contraceptive use status of young women as contraceptive prevalence is the main determinant of fertility. Extensive research has been made to identify the factors influencing the uptake of contraceptives. However, existing studies neglected the importance of specifying the fecundity of women though fecund (those who are physically capable to bear children) women are at real risk of encountering unintended pregnancy. Therefore, this study aims to explore the determinants of contraceptive use among young fecund women. Methods: This study utilized a representative set of cross-sectional data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Out of 17,842 ever married women this study considered 4,982 who were young currently married fecund to analyse fertility, fertility preference and contraceptive use and to analyse demand for contraception. Moreover, 3,744 young currently married fecund nonpregnant non-amenorrheic women, who were in actual need of current contraceptive use, were selected to analyse current contraceptive use. Besides, 237 women who used traditional and folkloric contraceptive method were excluded from 3,744 women to analyse modern contraceptive use. Descriptive statistics, binary logistic regression and multinomial logistic regression were used for analyses. Results: It was observed that contraceptive prevalence (CP) was 54.4% among currently married fecund women but CP became 70.6% when we refined our sample by considering only currently married fecund non-pregnant non-amenorrheic women who were at actual risk of encountering pregnancy. We propose the later one as net contraceptive prevalence (NCP) among young fecund women. Women who wanted to have another child after two years of the survey out of them more than one-third did not use any contraceptive and were at risk of having mistimed pregnancy. Women who did not want child any more out of them 45% did not use any contraceptive which put them at risk of encountering unwanted pregnancy. In spite of having three or more children 11.6% and 2.3% among them respectively desired to have another child after two years and within two years of the survey. These proportions became 20% and 4% respectively among women with two children. One third of women having two children did not use contraceptive and almost half of the women who had three or more children did not use any method of contraception. The highest prevalence of contraceptive use was recorded in young women aged 23- 24 years, those who were educated, those who were non-Muslim, those who got married before age of 18 years, those who gave birth in early adolescent period, those who had two or more living children, those whose husbands were professional worker, those lived in Barisal division or resided in the urban area. Moreover, husband-wife joint decisions regarding respondents’ own health care, child health care, large household purchases and visiting to family members or relatives were found to be highest for using any contraceptive. In multivariate analysis, it was observed that age, age at marriage, number of living children, desire for more children, husband’s desire for children, husband’s education and occupation, region, place of residence (urban-rural), religion, visited by FP workers and decision making power on own health care and child health care were identified as the influential predictors of current contraceptive use. Use of modern contraceptive was found highest among young women aged 23-24 years, those who were educated, those who were non-Muslim, those who experienced child marriage, those who had two or more living children, those whose husbands were professional workers, those who lived in Barisal division or resided in the urban area, those who were visited by FP workers, those who desired no more children and those who jointly took decision with their husbands regarding their own health care, child health care, large household purchases and visiting to family members or relatives. Findings of binary logistic regression analysis indicated that age, age at marriage, number of living children, desire for more children, husband’s desire for children, husband’s occupation, region, place of residence (urban-rural), religion, visited by FP workers and person who decides on respondent's own health care, child health care and visiting family or relatives had significant effects on using modern contraceptives. It was observed from this study that total unmet need for contraception was 16.6% out of which 13.4% for spacing birth and 3.2% for limiting birth. Total demand for contraception was 71% and proportion of demand satisfied was 77%. Unmet need for contraception was highest in young fecund women who were adolescent (aged 13-19 years), those who were illiterate, those who were Muslim, those who gave 2 births during 3 years preceding the survey, those who gave birth in adolescent period, those who had more than two living children, those whose husbands were manual worker, those who did not know about their husbands’ desire for children, those lived in Chittagong division or resided in the rural area, those who belong to the poorest quintile of wealth, those who watched television less than once a week. Moreover, husband-wife joint decisions regarding respondents’ own health care, child health care, large household purchases and visiting to family members or relatives were found to be lowest for having unmet need and highest for having met need for contraception. Findings of multinomial logistic regression analysis elucidated that age, number of births during three years preceding the survey, region, place of residence (urban-rural), religion, husband’s desire for children, visited by FP workers, decision making power on child health care and read about FP in newspaper/magazine were significant predictors of unmet need for contraception relative to current contraceptive use. Conclusion: This study assessed net contraceptive prevalence and identified the factors affecting contraceptive use among young fecund women. Women who had two or more children and wanted another child after two years of the survey or wanted no more children but were not using contraceptive were at risk of having unplanned or unwanted pregnancy. Husband-wife joint decision making power was found to be a significant factor that influences contraceptive use. So, this study suggests that greater gender equality may encourage women’s participation in decision making. Additionally, family planning policies should also be tailored to address the specific needs of these young fecund women with varied geographical locations.