|
Many studies have examined how aspects of women's lives influence their use of family
planning. When FHI's Women's Studies Project (WSP) began in 1993, researchers reversed the
equation, exploring how family planning use affects various aspects of women's lives.
Whether women felt they had or had not benefited from family planning methods and
services, and if so, how, were central questions. In order to determine women's
perspectives on this issue, in-country researchers as well as FHI staff went directly to
the women themselves, asking them which research issues were important to study.
Twenty-six field studies were conducted in 10 very diverse developing countries, using
both qualitative and quantitative research methods. Women expressed their views on family
planning by completing surveys and by participating in focus group discussions and
in-depth interviews. Additional information was obtained from secondary analyses of data
from four countries as part of the project, which is supported by the U.S. Agency for
International Development.
The project sought to look beyond the narrow focus of the impact of family planning on
women's health. Studies also examined how women's family planning experiences -- their
contraceptive use and non-use, their pregnancies and childbearing, and their experiences
with family planning and reproductive health programs -- affected other aspects of their
lives, including their roles as individuals, as family members and as participants in the
larger community. Some studies interviewed women's relatives, including husbands or
partners, parents and in-laws, to determine how family interactions and power dynamics
influence contraceptive experience and use.
The variety of the project's research topics reflects the diversity of women's
concerns:
- the impact of men's views on women's contraceptive behavior (Bolivia)
- the impact of family planning on women's domestic lives (Indonesia)
- the impact of tubal ligation on quality of life (Brazil)
- the social and behavioral consequences of unintended pregnancy (Egypt)
- the effects of gender on adolescent views of sexuality (Jamaica)
- the impact of family planning on women's self-esteem and self-image (the Republic of
Korea)
- the impact of family planning use on women's participation in the work force (the
Philippines)
- family planning and women's participation in the development process (Zimbabwe)
- strategies developed by new users to cope with family and community opposition to
contraceptive use (Mali)
- generational differences in family planning use (China).
These topics and others were selected by colleagues who formed in-country advisory
committees (IACs) in participating countries. Researchers, policy-makers and providers,
and women's health advocates formed an IAC "triangle," which became a critical
component of the research process, in each emphasis country (countries that were the site
of more than one study). The IACs established the research agenda, monitored the research
process and planned dissemination of research results.
To guide research and data analysis, the project staff developed a conceptual
framework, based on previous models and research. This framework incorporated the complex
and multidimensional aspects of women's lives; considered the possibility that strong
external factors, such as gender norms and sociopolitical climates, influence women's use
and experience with family planning; and placed family planning in the context of women's
larger reproductive health needs.
Common issues emerge
The completed studies illustrate the differences in perceptions that exist between
women and men, and among women, due to age, culture, place of residence, socioeconomic
class, religion and gender norms. However, common issues emerged, which were formulated
into 16 crosscutting themes.
There were two general themes: that gender norms (the roles prescribed by society for
women and men) play a significant role in shaping women's family planning experiences and
that family planning affects multiple domains of women's lives -- domestic, economic and
community. The other 14 themes are more specific, and address benefits to women, costs to
women, barriers to contraceptive benefits and service delivery issues.
Benefits to women
- Most women are convinced that practicing family planning and having smaller families
provide health and economic benefits.
- Family planning can offer freedom from fear of unplanned pregnancy and can improve
sexual life, partner relations and family well-being.
- Where jobs are available, family planning users are often more likely than non-users to
take advantage of work opportunities.
- Family planning helps women in their roles as wives and mothers, but it is only part of
what women need to attain equal opportunity with men in society.
Costs to women
- Contraceptive side effects are a serious concern for many women.
- When partners or others are opposed, practicing family planning can increase women's
vulnerability.
- When women have smaller families, they may lose the security of traditional roles and
face new and sometimes difficult challenges.
Barriers to contraceptive benefits
- Social, political and economic barriers prevent women from benefiting from family
planning.
- The benefits of family planning for women are reduced when contraceptive methods are
ineffective, used incorrectly or inconsistently, or discontinued early (before pregnancy
is desired).
- For some adolescents, pregnancy is wanted.
- Family members -- particularly husbands -- play a critical role in women's experiences
with family planning.
- Family planning is often initiated late in reproductive life.
Service delivery issues
- Men often have a dominant role in family decisions but tend to be marginalized by family
planning programs.
- Women are generally satisfied with family planning services but want more female
providers, more emotional support, help with side effects, and more information on
contraceptive methods.
These themes are described in greater detail in the project's synthesis report, Women's
Voices, Women's Lives: The Impact of Family Planning .
One of the main purposes of the project was to encourage the use of research findings
to improve the quality of women's reproductive health services. Indeed, the results have
clear implications for health policies and programs.
For example, contraceptive counseling must take into account gender norms, the barriers
these norms may pose to family planning, and whether women benefit from family planning
use. Peer networks, in which experienced contraceptive users counsel new users about the
everyday realities of method side effects, should be established.
Men and other key family members need to be informed and educated about family
planning. Providers need better training on how to assist clients experiencing
contraceptive side effects. Counseling should emphasize the benefits of contraceptive use
beyond health and economics, including emphasis on improvement in marital relationships.
Family life education should begin early.
The project found that while women perceive numerous benefits of family planning use,
they also see negative consequences, such as family disapproval and method side effects,
which can discourage them from taking control of their fertility.
By understanding the intricate realities of women's lives and the factors that affect
their reproductive health, family planning programs can offer services that match women's
needs and ultimately can help improve the quality of women's lives.
By Nancy Williamson, PhD
Former FHI Women's Studies Project Director
Note: Dr. Williamson led the Women's Studies Project from its inception until
August, when she joined the Frontiers in Reproductive Health project, serving as global
operations advisor. FHI and Tulane University School of Public Health are partners with
the Population Council in the Washington-based Frontiers project.
For more information, visit Family Health International's Website at www.fhi.org
Go to FHI's Network
|
Copyright