Men and women who need family planning services often consider whether they can afford
them, given other household expenses.
They also weigh potential benefits of family planning against costs to obtain these
services, which may include purchasing methods and supplies, traveling time to a clinic,
child care during clinic visits and lost work time. And they should consider the future
costs of having more children.
Little research has been done on how couples make decisions about spending money on
healthcare. However, a study in the Philippines, supported by FHI's Women's Studies
Project, is exploring couples' decision-making, including decisions on family planning
expenditures.
Research in Cebu, located in the southern Philippines, found that women typically play
the major role in decisions about household expenditures, while decisions about health and
family planning are made jointly with other family members. For example, about two-thirds
of women in a survey consulted no one else in their decisions to buy shoes or children's
clothing, and 43 percent said they consulted no one when taking children to a doctor.
However, women tend to consult others -- primarily spouses -- about decisions that
involved larger expenditures. For example, 86 percent said they consulted spouses about
major purchases for the household; 90 percent about buying land; 75 percent about hiring
household help; and 84 percent about travel outside of Cebu. If conflicts arise, 82
percent of women said they and their spouse arrive at a mutual final decision, while only
12 percent said the husband's judgment prevails.
In decisions about whether to use family planning, most women said they consult others.
Only 12 percent of women said they made autonomous decisions about contraceptive use.
Unlike other decisions where the spouse was the primary person consulted, some 20 percent
of study participants said they talked with other adult females about family planning.
Among women who consulted their husbands about family planning, 25 percent of women
reported that, in case of conflict, the woman's decision prevailed. Only 7 percent
reported that their husband's choice prevailed.
The research was a recent follow-up to the 1983 Cebu Longitudinal Health and Nutrition
Survey, a 10-year survey of approximately 3,000 households on contraceptive use and child
spacing, as well as maternal diet and infant feeding patterns. The study was conducted by
the Office of Population at the University of San Carlos in Cebu and the U.S.-based
Carolina Population Center at the University of North Carolina, with support from FHI.1
To gather information for the follow-up study, interviewers named common household
decisions and asked women whether they consulted anyone when making these decisions, whom
they consulted, whose judgment prevailed in case of conflict, and what women do when they
disagree with a decision made by someone else.
Other studies have examined factors that influence couples' decision-making about
household expenditures and have found that price is often only one consideration that
affects family planning use. A study of rural women, also in Cebu, found that time spent
in obtaining contraceptives was an important factor in women's use of contraception.2 Research in Thailand found similar concerns about the costs
involved in obtaining methods.3
A small study, which surveyed 64 women in or near a fishing village in southern India,
found that contraceptive prevalence was influenced by women's autonomy rather than income.
In the village and surrounding rural area, contraceptive prevalence was 27 percent.
Although women living in the village had higher family incomes and better access to health
services, their use of family planning was the same as the rural women, who lived in a
caste community. Researchers found that the main reason women gave for not using family
planning was their lack of decision-making power. Women's age, family size, children's age
and birth order affected women's decision-making power and access to money.4
A recent study in Pakistan found that a higher level of wives' unearned income --
possessions that the wife owns and the husband does not control, such as household goods,
land or jewelry -- resulted in overall lower fertility for women in both urban and rural
areas. Researchers found that if unearned income for rural women increased by 25 percent,
compared to unearned income for men, the fertility rate would drop by one child per
couple. Researchers recommended that since Pakistan's fertility rate is high -- 5.4
children per woman -- government policies that put more financial resources in the hands
of women could ultimately help improve contraceptive use and lower fertility.5
-- Barbara Barnett
References
- Adair L, Viswanathan M, Polhamus B, et al. Exploring
the Complexity of Women's Lives: Family Planning, Children, Decision-making, Domestic Work
and Labor Force Participation in Cebu, the Philippines. Report prepared for FHI's Women's
Studies Project by the Carolina Population Center, UNC, and the Office of Population
Studies, University of San Carlos, Cebu, the Philippines. Chapel Hill, NC: Carolina
Population Center, 1997.
- Schwartz JB, Akin JS, Guilkey DK, et al. The effect of
contraceptive prices on method choice in the Philippines, Jamaica and Thailand. In:
Bulatao RA, Palmore JA, Ward SE, eds. Choosing a Contraceptive: Method Choice in Asia
and the United States. (Boulder, CO: Westview Press, 1989) 78-102.
- Schwartz.
- Ravindran TK. Users' perspectives on fertility
regulation methods. Economic and Political Weekly 1993;28(46-47):2508-12.
- Kress D, Winfrey W. Husbands, wives and family size
decisions in Pakistan: testing the neoclassical model of resource allocation. Presentation
at Population Association of America Meeting, Washington, March 27-29, 1997.
For more information, visit Family Health International's Website at www.fhi.org
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