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A person's quality of life depends not only on good health and physical well-being, but
on a variety of other circumstances. These include family stability and harmony, the
welfare of children, and freedom to enjoy various activities including leisure, education
or community pursuits.
Family planning can influence nearly all of these aspects of quality of life, according
to FHI's Women's Studies Project (WSP) research conducted in 10 countries. The degree to
which family planning has an impact, however, is often influenced by beliefs and practices
that define gender roles, religious norms that may discourage contraceptive use, and
economic and political conditions.
For example, a woman whose in-laws want many grandchildren and whose husband has other
wives bearing his children may define a good life as having many children herself. In
contrast, a woman may think quality of life means having only one or two children to
ensure that each is well-fed and educated. Or, another woman may value time to pursue
educational or professional goals.
The many ways family planning use influences quality of life range from those that are
strictly personal, such as an individual's health status, to factors that are shaped by
relationships with others.
Health benefits
Family planning offers women clear health benefits. In developing countries,
complications related to pregnancy and childbirth are a common cause of death. By allowing
adequate spacing between pregnancies, preventing pregnancy very early or late in women's
reproductive lives when risks are greater, and avoiding unintended pregnancies that may
lead to illegal and dangerous abortions, family planning can protect women's health.
Research shows that many women recognize these benefits. In Mali, where less than 5
percent of married women of reproductive age use a modern contraceptive method, new users
of modern contraception in Bamako said they chose to contracept primarily because they
wanted to restore or maintain their health. "I want to have a rest," said one
woman in a WSP study of 55 contraceptive users. "It is the first time that I have
weaned a baby before having another pregnancy." Another explained: "The woman
who has close pregnancies is exhausted. But when you space your children, you are in
peace. It avoids sicknesses."1
In an FHI study of about 800 women in Lampung and South Sumatra, Indonesia, women with
only one or two children reported feeling greater vitality (defined as having no health
problems and "feeling okay") than those with more than two children. Women also
reported feeling more attractive. "If we always give birth, our body will
shrink," explained one Indonesian woman. "It gets skinnier fast, older
fast."2
Relief from the burden of childbearing and rearing also was seen as having
psychological benefits. In focus group discussions with more than 130 women and men from
Mashonaland East province, Zimbabwe, both men and women defined quality of life as peace
and happiness in the home, and said family planning was an important element of quality of
life. Women particularly valued having time to nurture their families.3
Studies of contracepting women in El Alto and Cochabamba, Bolivia, showed that modern
contraceptive methods were associated with increased sexual enjoyment, possibly because
they reduced fear of pregnancy.4 However, contraception
appeared to reduce libido for other women. Contraceptive side effects, as well as the fear
of pregnancy, can reduce a woman's sexual desire.
All too often, unintended pregnancy occurs because contraception was used incorrectly
or inconsistently, discontinued early or the method chosen was not effective. In a WSP
study conducted from 1995 to 1998 in collaboration with Xavier University researchers, 31
percent of about 1,250 Filipino women who had ever used family planning reported a
pregnancy while using contraception, primarily IUDs or pills.5
In contrast, a survey of 236 women in Campinas, São Paulo, Brazil, who had undergone
tubal ligation, found overwhelming (90 percent) satisfaction with this highly effective
method. Because sterilization is permanent, however, it may not be the best choice for
some men and women, especially those who are very young, since their decisions about
having children may change later in life. In the Brazilian study, women younger than 25
years old at the time of the ligation were more likely than older women to later regret
having been sterilized.6
Service delivery influences
How contraceptive services are delivered influences the way couples perceive the
benefits of family planning, thus affecting their quality of life.
Many clients in El Alto, Bolivia, were dissatisfied with the treatment they received at
clinics, including long waiting times, short consultations, discrimination against women
who wore the traditional female dress of the Altiplano, and lack of access to reversible
contraception.7 Throughout Indonesia, women complained about
services, particularly the great distance between home and service site, long waits,
unfriendly providers and unavailability of desired methods.
In addition, distress with side effects was exacerbated when systems of referral were
poor. In Bangladesh, women complained that door-to-door contraceptive distribution meant
help was seldom available when side effects occurred.8
Even women who recognize the health benefits of family planning complain that they do
not get enough information about contraceptive side effects. Many women say that providers
typically minimize side effects. Unexpected side effects later cause them to stop using
contraception.
Side effects are a serious concern for women who use contraception. In FHI's Lampung
and South Sumatra, Indonesia, study, 31 percent of contracepting women reported
experiencing a "major" problem related to their method. A frequent complaint was
headaches, most commonly experienced by users of the pill, injectables and implants.
Menstrual irregularities often disturbed users of injectables or IUDs, and could reduce
quality of life for Moslem women whose religion teaches that a menstruating woman should
not fast, pray, have sex or touch holy books.
Adequate counseling about side effects also helps to address misconceptions, which can
discourage women from using family planning. In Cochabamba, Bolivia, 95 percent of
approximately 600 couples interviewed in a WSP study were satisfied with their current
contraceptive method (generally IUDs or condoms), but about 15 percent believed various
myths associated with pills, tubal ligation, IUDs or condoms.9
Family harmony
Women often equate their own happiness with that of their families; thus, the impact of
family planning on their household is critical.
Contraceptive users in Malaysia were significantly less likely than non-users to report
marital disruption, perhaps due to better communication between spouses.10
Contracepting couples in the Zimbabwe study described more peace and happiness in their
homes than couples who were not using contraception. In the Cochabamba, Bolivia, study,
current users of contraceptives were more likely than non-users to report better
relationships with their partners.
Nevertheless, in Mali, family planning use frequently caused disagreements. One study
found that the husband disapproved but the wife approved of contraceptive use in about 20
percent of couples.11
The reaction of other family members can be crucial to family planning decisions, and
how those decisions affect quality of life. Husbands, in-laws and others can hold strong
opinions against contraceptive use, seeing it as an obstacle to the extension of the
family lineage or a challenge to traditional views about family authority. In many
cultures, women gain status through childbearing. Also, having many children represents
security later in life, when children support their parents. In another Zimbabwe study by
FHI, most older women, particularly in rural areas, wanted their sons to have large
families not only to help with household chores, but to look after them in old age.12
Financial security influences family planning decisions in other ways. Some FHI study
participants pointed out that income, rather than family size, determined a family's
general welfare. In a WSP study conducted in Central and East Java, in collaboration with
the Population Studies Center, Gadjah Mada University, a 32-year-old Indonesian mother of
two children commented, "It does not matter how many children we have. All depends on
how hardworking we are in looking for a livelihood. It [many children] is not a problem if
one's income is large."13 Others, however, do associate
educational prospects with family size. Said a man from rural Chivi, Zimbabwe: "I
like the idea of using [a] family planning method because when I grew up we were so many
in our family, and this is partly why I could not further my education. So if you have one
or two children who are well spaced, you can at least manage to educate them."14
Education and work
One benefit clearly attributable to limiting family size is more free time for women,
which could be used to devote more attention to family, work or other interests. Of 871
contracepting women who were surveyed in the study in Central and East Java, Indonesia,
approximately 86 percent said family planning resulted in more leisure time. A study
conducted in the Philippines illustrates part of the reason why: Considering all children
under the age of 18, each child increased the women's domestic work by about 16 minutes
per day. The younger the child, the greater was the domestic burden, with infants
requiring more than two hours per day.15
Contraceptive use is clearly associated with gains in women's education. In a study
conducted in Mutare, Masvingo and Harare, Zimbabwe, many female students reported high
academic and vocational ambitions, but educational avenues often closed when young women
became pregnant. Of 27 girls in the study who became pregnant in primary or secondary
school, 67 percent dropped out; of 36 young women who became pregnant in college, 78
percent dropped out.16
In South Korea, where a family planning program was implemented in 1962 and
contraception is widely used, young women are far more educated than their mothers or
grandmothers. Women had an average of only three years of formal education in 1960,
compared with an average of more than eight years in 1990.17
Women's enrollment in secondary school in South Korea, Japan, Taiwan, Singapore, Thailand
and Indonesia increased markedly between 1960, when women had on average six children, and
1990, when women had on average two children or fewer.18
When women pursue more education, training, employment or professional advancement,
household income may increase. However, the ways in which family planning affects women's
work opportunities, income and power vary dramatically from place to place.
In a WSP study in Zimbabwe, most older women, whether rural or urban, said the number
of children did not affect a woman's ability to get an education. Mothers-in-law,
particularly those from rural areas, said they could care for grandchildren while
daughters-in-law continued their education or job training.19
But this same study also revealed that men often supported the idea of their wives
pursuing an education and their use of contraception to achieve that goal. "With the
current economic environment," said one urban man, "if a woman is educated, it
is good for her to get more education. If she doesn't go [to school], you will be letting
wealth rot."
Whether contracepting women have more influence in making household decisions than
those who do not use family planning varies widely. Often, decision-making is associated
with work status. In Egypt, for example, family planning employees said their work gave
them knowledge and experience that helped them make decisions with their husbands,
including decisions about their daughters' age at marriage and their own contraceptive
use.20 A WSP collaborative study with researchers at Central
Philippines University found that in Western Visayas, the Philippines, more family
planning users than non-users shared decision-making with their husbands on matters
regarding whether the woman could work outside the home, travel outside the community, use
family planning, and have another baby.21
However, in Zimbabwe, women, men and mothers-in-law were unanimous that the number of
children a woman had did not affect her ability to decide about household expenses. One
rural woman said: "Making decisions depends on one's intelligence and intelligence
has nothing to do with how many children a person has." A man from rural Chivi
pointed out that "it depends on how a couple gets along since they got married. If
you oppress your wife and do not allow her to make decisions in the household, it will
never change. So there would be no difference."22
Community life
Women repeatedly told researchers that their roles as mothers not only fulfilled them,
but earned them the respect and approval of families and peers. In Zimbabwe, tradition
links a woman's spiritual growth to childbearing. In Mali, children are considered social
wealth.
Contraceptive use among single women is often equated with immorality or promiscuity.
Researchers from the University of the West Indies and FHI found in focus group
discussions that Jamaican adolescents expressed positive attitudes about contraception and
agreed that its use indicated responsible behavior, but said contraceptive use also
implied sexual activity, which is forbidden for young adolescent girls.23
Religious, cultural or gender norms define community life and can influence decisions
about contraceptive use. Chinese youth, despite a long history of contraception in the
country, follow traditional gender norms and roles when talking about their future
spouses: Young Chinese women say a woman should have a career before marriage, because
housework and childcare are a wife's responsibility. In Bangladesh, women remained
subservient to men and socially isolated even after contraceptive use increased. In South
Korea, women have achieved significantly better educational and work opportunities, but
without changes in traditional gender roles that define men as breadwinners and women as
homemakers responsible for housework and nurturing children. In Indonesia, gender roles
are specified by law.
By giving women more time for activities other than childcare, family planning may
increase women's opportunities to take part in civic activities. But women's involvement
depends greatly upon cultural norms. For example, one WSP study in Zimbabwe found that
social pressures discouraged women from political participation. "No one will listen
to a woman leader," states a young woman with children from rural Chivi. "We are
always under men." Zimbabwean urban men generally tended to oppose married women
attending political meetings, believing they would be hard to control and more likely to
engage in extramarital affairs.
Even when women perceive contraceptive use as a way to improve the quality of their
lives, WSP studies show that family planning, and the resulting smaller family size, is
seldom viewed as an end in itself. Instead, controlling family size is simply one step on
a long continuum of social and economic factors that may improve the quality of life for
all family members.
-- Kim Best
References
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the Lives of New Contraceptive Users in Bamako, Summary Report for the Women's Studies
Project. Research Triangle Park, NC: Centre d'Etudes et Recherche sur la Population
pour le Développement and Family Health International, 1998.
- Irwanto, Poerwandari EK, Prasadja H, et al. In the Shadow of Men:
Reproductive Decision-Making and Women's Psychological Well-Being in Indonesia, Final
Report for the Women's Studies Project. Research Triangle Park, NC: Atma Jaya Catholic
University and Family Health International, 1997.
- Mutambirwa JM, Utete VL, Mutambirwa CC, et al. Consequences of Family
Planning on the Quality of Women's Lives in Zimbabwe, Summary Report to the Women's
Studies Project. Research Triangle Park, NC: Family Health International, 1998.
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Conocimiento, Actitudes y Comportamiento del Hombre acerca de la Regulación de la
Fecundidad en la Vida de las Mujeres en Cochabamba. Research Triangle Park, NC:
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Ordóñez E, et al. Impacto de la Regulación de la Fecundidad sobre la Estabilidad de
la Pareja, la Sexualidad y la Calidad de Vida. Research Triangle Park, NC: Proyecto
Integral de Salud and Family Health International, 1998.
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Planning Use in Southern Philippines, Final Report for the Women's Studies Project.
Research Triangle Park, NC: Xavier University and Family Health International, 1998.
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Project. Research Triangle Park, NC: CEMICAMP and Family Health International, 1998.
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de Anticoncepción de El Alto, Bolivia. La Paz: PROMUJER and Family Health
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International, Inc., 1996.
- Wekwete N. The Mediating Effects of Gender on Women's Participation
in Development, Draft Report for the Women's Studies Project. Research Triangle Park,
NC: Family Health International, 1998.
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Welfare and Women's Activities in Indonesia, Final Report to the Women's Studies Project.
Research Triangle Park, NC: Population Studies Center, Gadjah Mada University and Family
Health International, 1997.
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Nutrition Survey, Follow-up Study, Women's Studies Project Final Report. Research
Triangle Park, NC: Family Health International, Carolina Population Center and University
of San Carlos, 1997.
- Tshuma NM, Taruberekera N, Zvobgo R. Zimbabwe: Impact of Family
Planning on Young Women's Academic Achievement and Vocational Goals, Draft Report to the
Women's Studies Project. Research Triangle Park, NC: Family Health International,
1998.
- Lee H-S, Kong S-K, Cho H, et al. A New Look at the Korean Fertility
Transition: Its Impact on Women, Final Report Prepared for the Women's Studies Project.
Research Triangle Park, NC: Family Health International, 1998.
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southeast Asia. Asia-Pacific Popul Pol 1998;(44):1-4.
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- El-Deeb B, Makhlouf H, Waszak C, et al. The Role of Women as Family
Planning Employees in Egypt, Final Report Prepared for the Women's Studies Project.
Research Triangle Park, NC: Cairo Demographic Center and Family Health International,
1998.
- David FP, Chin FP. Economic and Psychosocial Influences of Family
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Project. Research Triangle Park, NC: Central Philippines University and Family Health
International, 1998.
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Women's Study Project Final Report. Research Triangle Park, NC: University of the West
Indies and Family Health International, 1998.
For more information, visit Family Health International's Website at www.fhi.org
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