Access to modern contraception provides essential benefits for women and their families by allowing them to control when and how many children they have. Women in the Individual Group were 6 percentage points (33 percent) more likely to take up injectable contraceptives compared to the Couple Group, in which 18 percent of women used injectables. Induced abortion is more likely when unmet need for effective contraception is high. "Household Bargaining and Excess Fertility: An Experimental Study in Zambia." What are the causes and consequences of crime, violence, and conflict and how can policy responses improve outcomes for those affected? There is paucity of data on knowledge, attitudes, perceptions and practices towards modern contraceptives and, sexual and reproductive health especially among the young female university students. J-PAL initiatives concentrate funding and other resources around priority topics for which rigorous policy-relevant research is urgently needed. Among eligible married women aged 18–40 living in the clinic’s catchment area who had given birth in the past two years, 749 women participated in a program that provided vouchers for the women to access a wide array of contraceptives at the clinic. The pill has a less than 1 percent (%) failure rate (meaning less than 1 out of 100 women unintentionally become pregnant) when the pill is used correctly. The majority of respondents not on birth control for health reasons have used it at some point, according to the study. 1. How can students receive high-quality schooling that will help them, their families, and their communities truly realize the promise of education? How can financial products and services be more affordable, appropriate, and accessible to underserved households and businesses? Adolescent Contraceptive and Abortion-related Care-seeking in Zambia Abortion Safety is Strongly Linked to Abortion Legality CONTEXT MATTERS Seeking an abortion in a facility, or care for complications due to a less safe out-of-facility abortion, is strongly influenced by the legal and service provision setting. However, the women in these couples were still 26 percentage points (67 percent) more likely to use the voucher in the Individual Group, compared to the women whose husbands were involved. Increasing husbands’ knowledge of maternal mortality risks could help to more closely align the preferences of husband and wife, imposing fewer psychological costs to women for their family planning choices and allowing couples to achieve mutual short- and long-term fertility goals in a transparent partnership. ... where births to adolescent women are more common than in the country as a ... of recent births among women younger than 20 were delivered at a health facility (Anderson et al., 2013). The common challenge is long distance travelling to facilities, which may also contribute to the country’s high maternal mortality rate (213 per 100 000 live births) in rural areas. The finding was similar to previous studies done in Ethiopia [11, 13]. According to the 2013 Zambia Demographic Health Survey (ZDHS), Zambian women had, on average, 0.8 more children than their desired number of 4.5 children. In this study, women with private access to contraceptives were more likely to obtain them, and were more likely to choose concealable methods than women whose husbands were involved. AIDS. Anchored by a network of 227 affiliated professors at universities around the world, J-PAL conducts randomized impact evaluations to answer critical questions in the fight against poverty. Adolescents face significant barriers to contraception access and utilization that result in adverse health effects of early pregnancy and childbirth. This finding suggests that women place strong value on the quality of their relationships, and that the decision to conceal contraceptives may carry unwanted feelings of mistrust or alienation even when husbands are not aware that their wives have obtained access to contraception. J-PAL Southeast Asia is based at the Faculty of Economics and Business at the University of Indonesia (FEB UI). The Abdul Latif Jameel Poverty Action Lab (J-PAL) is a global research center working to reduce poverty by ensuring that policy is informed by scientific evidence. 7 In Lusaka, contraceptives are available through public and private clinics … Our Board of Directors, which is composed of J-PAL affiliated professors and senior management, provides overall strategic guidance to J-PAL, our sector programs, and regional offices. J-PAL North America is based at the Massachusetts Institute of Technology in the United States. Of the 376 women recruited after giving birth at a hospital, 34% had previously used family planning, and 64% had used family planning a year after giving birth. Implants, IUD and the emergency contraception are the least used methods with less than 1% of women having ever used any of these methods. In contexts in which women have less bargaining power in family planning decisions, providing private access to contraceptives may be an important and effective means of enabling women to achieve their fertility goals. doi: 10.1097/QAD.0000000000000039. Birth control pills are a popular form of contraception, but they come with risks that can interfere with your everyday life. Fifty-three percent of women in the Individual Group redeemed the voucher for contraceptives compared to 43 percent of women in the Couple Group, a 23 percent higher redemption rate. 2 contraceptives consistently to prevent the consequences of unintended pregnancies, especially Studies in Tanzania and Nepal demonstrated that women obtaining contraceptives at pharmacies were able to self-screen for contraindications to combined oral contraceptives about as well as nurses (Chin-Quee et al., 2013; Rai et al., 1999). In an initial home visit, community health workers visited all women privately to collect baseline data that included family size, fertility preferences, and decision-making dynamics in the household, and to deliver information about the benefits of family planning and the clinic’s services. J-PAL is based at MIT in Cambridge, MA and has seven regional offices at leading universities in Africa, Europe, Latin America & the Caribbean, Middle East and North Africa, North America, South Asia, and Southeast Asia. Enter the email address you signed up with and we'll email you a reset link. She didn’t plan to have another child so soon. That is, they know what they are talking about: excess or reduced bleeding, nausea, changes in the body–weight gain or hair growth–loss of libido, mood changes… the long list of side effects for hormonal contraceptives does not help. Analyse the determinants of contraceptive method choice among available modern contraceptives in Zambia Methods Using secondary level data from the 2007 Zambia Demographic and Health Survey, I apply Binomial and Multinomial Logistic Regression to the 6247 binary and multi responses from women to questions on use and method choice of contraceptives. World Health Organization. (15.23%) female respondents believed that contraception is a safe means of protecting against unwanted pregnancy and/or STD. They set their own research agendas, raise funds to support their evaluations, and work with J-PAL staff on research, policy outreach, and training. Led by affiliated professors, J-PAL sectors guide our research and policy work by conducting literature reviews; by managing research initiatives that promote the rigorous evaluation of innovative interventions by affiliates; and by summarizing findings and lessons from randomized evaluations and producing cost-effectiveness analyses to help inform relevant policy debates. Women who received private access to vouchers for contraceptives were more likely to take up and use contraception, compared to women whose husbands were involved in the voucher program. American Economic Review 104(7): 2210-37. A friend introduced her to a contraceptive, sold in Chinese clinics in Lusaka, that could be taken just once each month. Sorry, preview is currently unavailable. The study was conducted in selected wards … Fertility and unplanned birth4 rates are high in Zambia, but it is likely that some of these births are unwanted only by women. Injectables are the most commonly used form of contraceptives, followed by implants and pills. Sexually transmitted infections (STIs), also known as Sexually Transmitted Diseases (STDs), are caused by bacteria, viruses or parasites that are transmitted through unprotected sex (vaginal, anal, or oral) and skin to skin genital contact. Among women in the Individual Group who redeemed the voucher, the number of women who hid the voucher from their husbands—or who misrepresented the voucher to convince their husbands to let them use it— accounted for as much as 60–85 percent of the difference in voucher use between the Individual and Couple Groups. Zambia has a largely rural population of 13.1million (60.5% rural and 39.5% urban), of whom 45% are below the age of 15.1 Although the population is relatively small, it is geographically scattered across 752,612 Km,2 making delivery of health services and products, particularly During the second visit, in addition to voucher distribution, husbands were surveyed privately about their fertility preferences, and women were surveyed privately about whether they had visited a clinic since the previous household visit. Researchers also held focus groups to collect qualitative information from the women about factors that influenced their decisions to redeem the voucher, as well as separate focus groups to ask their husbands about their experiences after receiving the voucher. Our global office is based at the Department of Economics at the Massachusetts Institute of Technology. The 2013 ZDHS reported that injectable contraceptives, which are easily concealed, are the most prevalent contraceptive method among married women. Approximately two years after the first visit, they conducted follow-up surveys with the women to collect data on their marital status, reproductive histories, and health and well-being. It’s a widespread belief among Zambians that hormonal contraception leads to permanent infertility. Positive attitude towards contraception was shown by 76 (76%) of them, while 41(41%) stated their husbands’ positive attitude towards contraception. The women were then randomly divided into two groups prior to a second visit. For example, medical evidence demonstrates that pregnancies spaced too close together or too far apart can significantly increase infant mortality and undernutrition.1 Additionally, contraceptive access empowers women to take control of their health and reproductive choices.Although modern birth control methods have been around for decades, many women in developing countries report substantial unmet need for modern contraceptives.2  The UN estimates that 55 million women in sub-Saharan Africa had an unmet need for modern contraception in 2014.3. The Population Council defines unplanned births to include mistimed births (births occurring two or more years sooner than desired) and unwanted births (those that the mother did not want at all). 2013 Oct;27 Suppl 1:S93-103. J-PAL Latin America & the Caribbean is based at the Pontificia Universidad Católica de Chile. These women in the Individual Group were 27 percent less likely to give birth in the next year, when contraception from the voucher would have been active, but were more likely to give birth in the fourteen to eighteen months after the program. A 1996 study in Zambia again cites the importance of educating both men and women and states that single mothers and teenagers should be the primary focus of birth control education. 2014. In Uganda, the risk of unintended pregnancies and unsafe abortions remains high due to relatively low contraceptive use. In contexts in which women have less bargaining power in family planning decisions, providing private access to contraceptives may be an important and effective means of enabling women to achieve their fertility goals. It serves as the head office for our network of six independent regional offices. How can we reduce gender inequality and ensure that social programs are sensitive to existing gender dynamics? [13] However, lack of access to contraceptives is still high among girls in child marriages, and there is a significant difference in access to contraceptives across class and geographic boundaries. J-PAL Europe is based at the Paris School of Economics in France. Our affiliated professors are based at 74 universities and conduct randomized evaluations around the world to design, evaluate, and improve programs and policies aimed at reducing poverty. I quietly draw comparisons in my mind between healthcare in Zambia and the UK. Voucher redemption was even greater among women who believed their husbands wanted more children than they did (in addition to the children they already had) when the study began. How can we increase access to and delivery of quality health care services and effectively promote healthy behaviors? Central Statistical Office [Zambia], Ministry of Health [Zambia], and ICF International. How do firms’ own policies impact economic growth and worker welfare? [/risk] Description. According to the Zambia Demographic Health Survey (ZDHS) 2007, contraceptive methods are grouped into types which are modern and traditional methods. 1.1 HIV prevalence and contraceptive use in Rwanda and Zambia. (1996:9) found that the most common obstetric risk factors were adolescent pregnancies, followed by unsafe abortions and sepsis. How can we encourage small farmers to adopt proven agricultural practices and improve their yields and profitability? J-PAL South Asia is based at the Institute for Financial Management and Research (IFMR) in India. The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15–49) contraceptive users in Zambia: a cross-sectional study, COMPANION VOLUME TO MICROBICIDE COUNTRY PREPAREDNESS ASSESSMENT - ZAMBIA, Letamo - Levels, trends and reasons for unmet need for family planning, Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study, The social context of adolescent women’s use of modern contraceptives in Zimbabwe: a multilevel analysis. We partner with NGOs, governments, donors, multilateral organizations, businesses, and other research centers to conduct randomized evaluations, build research capacity, scale up what works, and promote the use of evidence in decision making. contraceptive methods and the quantities of contraceptive . Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia. Browse news articles about J-PAL and our affiliated professors, read our press releases and monthly global and research newsletters, and connect with us for media inquiries. Methods of contraception that are available include: implants, intrauterine devices (IUDs), injections, pills, vaginal rings, barrier methods, sterilisation, emergency contraception and natural methods. For these women, private access increased the likelihood of voucher redemption by 16 percentage points (34 percent). Community health worker discusses birth control options, The World Health Organization defines unmet need as the portion of fecund, sexually active women who report not wanting any more children or wanting to delay the next child, but are not currently using a contraceptive method. Global health has improved considerably over the last four decades, but everywhere the health status of the poor compares unfavourably with that of the more affluent sectors of society.1 In Africa, one in 26 women of reproductive age dies from a maternal cause, as opposed to one in 9400 in Europe.2 Parallel disparities in fertility and in contraceptive use are found between poor and wealthy countries. 2015. We host events around the world and online to share results and policy lessons from randomized evaluations, to build new partnerships between researchers and practitioners, and to train organizations on how to design and conduct randomized evaluations, and use evidence from impact evaluations. Unwanted pregnancies are common, and often result in unsafe abortions. A survey was conducted at Makerere University main campus in … But it didn’t work for long. Why are so many women unable to meet their need for modern contraception? Although with such initiatives in place, Zambia is facing challenges in ensuring contraceptive access to rural women. Increased adoption of contraception allowed them to delay their next pregnancy by an additional three to five months, a significant advance for maternal and child health in a country where pregnancy intervals are very short. Zambia General Health Risks: Sexually Transmitted Infections [risk] Hepatitis B and C may be transmitted sexually. 2 Method-specific contraceptive prevalence varies widely across the world. supplies that will be needed to meet that demand. In contrast, Zambian men reported an ideal family size of 5.0 children.5 As in many countries in which men have a relatively higher demand for children, researchers found significant anecdotal evidence that Zambian women respond by hiding contraceptive use; in the study’s 2007 baseline survey, 77 percent of respondents preferred “a family planning method that only I know I am using.” The 2013 ZDHS reported that injectable contraceptives, which are easily concealed, are the most prevalent contraceptive method among married women.6 While contraceptives in Zambia have been available for many years and knowledge about them is common, access to reliable contraceptive methods remains limited.7 In Lusaka, contraceptives are available through public and private clinics and pharmacies, but inconsistent supply and long wait times limit access. In this case, a woman’s bargaining power relative to her partner’s—as well as her ability to conceal her contraceptive choices—could be important determinants of contraceptive use. Researchers used clinical records to track women’s contraceptive take-up after voucher distribution. Conclusion: In the present study, there was a low contraceptive use among women of rural origin despite good knowledge. How can we help people find and keep work, particularly young people entering the workforce? The world’s total fertility rate has dropped dramatically, from 5 children per woman in the early 1950s to 2.6 childre… What are the causes and consequences of poor governance and how can policy improve public service delivery? The guide also addresses specific challenges and considerations in forecasting for the LA/PM, including forecasting the quantities of medical instruments, expendable medical supplies, pain Women in rural Zambia (24%) are reported to have unmet need for family planning than those in urban areas (17%). Such family planning is important because early, ill-timed, or unwanted childbirth can increase health risks for both mother and child. Fertility and future projected population growth are much higher in sub-Saharan Africa than in any other region of the world, and the decline in birth rates, which was already modest, has slowed even further over the past decade.1–3Concern that uncontrolled population growth will hinder the attainment of development and health goals in Africa led to the present study, which rests on the assumption that fertility will decline only if the population at large adopts effective modern methods of contraception, as … You can download the paper by clicking the button above. News, ideas, and analysis from J-PAL staff and affiliated professors. Modern methods include female sterilization, male sterilization, the pill, intrauterine device (IUD), injectables, implants, male condoms, female condom, diaphragm, foam/jelly, lactational amenorrhoea (LAM) and emergency contraception. The Abdul Latif Jameel Poverty Action Lab, Click here for information on J-PAL's response to Covid-19, Household Bargaining and Excess Fertility: An Experimental Study in Zambia, Effects of Preceding Birth Intervals on Neonatal, Infant and Under-Five Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic and Health Surveys, Birth Spacing and Risk of Adverse Perinatal Outcomes: a Meta-Analysis, Report of a Technical Consultation on Birth Spacing, Investing in Sexual and Reproductive Health in Sub-Saharan Africa, Experimental Researcher Helps Improve Health Care in Zambia. Researchers are currently conducting a follow-up study8  that explores men’s fertility preferences in more depth, and tests ways in which to influence them. Academia.edu no longer supports Internet Explorer. contraceptive pills (11.3%). Complete abstinence is the only method that prevents pregnancy 100 percent of the time, but most contraceptive methods have a … Additionally, where contraceptive resources are available, the decision to use contraception often involves two individuals who may have conflicting fertility preferences. “. While there was no increase in divorce or domestic violence in this study, women who received the voucher privately were less likely to report being healthy and happy after the program. This outcome suggests that men’s behaviors and attitudes toward such contraception may impede the realization of their own and their wives’ fertility preferences in the short run. The use of modern contraceptives among women in Zambia has reached 45% as of 2014. There are different methods of contraception, including: long-acting reversible contraception - the implant or intra uterine device (IUD) hormonal contraception - the pill or the Depo Provera injection It means you can relax and enjoy sex without worrying about getting pregnant – however you will still need to use a condom to prevent sexually transmitted infections (STIs).. Update: Click here for information on J-PAL's response to Covid-19. The aim of this study was to explore factors in the social and cultural environment shaping young people’s sexual behaviour, with specific attention to teenage pregnancy and child marriage in Eastern Zambia. In Zambia, pregnancies reported as unplanned are common: 16% of births are reported as unwanted, and 26% are reported as being mistimed. Teenage pregnancy and child marriage are prevalent in Zambia and are complexly interrelated issues with common causes and effects. Even when couples had the same short-term goals to postpone pregnancy, but conflicting long-term fertility goals, women were more likely to redeem the voucher and to take up injectable contraceptives when they received private access. Part of the answer is that physical access to reliable contraception remains limited in many low-income or rural areas. Among women currently using contraception, the most commonly used methods were the pill (25.9%, or 9.7 million women), female sterilization (25.1%, or 9.4 million women), the male condom (15.3%, or 5.8 million women), and long-acting reversible contraception (LARC)—intrauterine devices or contraceptive implants (11.6%, or 4.4 million women). Even this small degree of postponement could represent a potentially significant welfare benefit for women and children in a setting where the average pregnancy interval is 26 months. Tembo, 20, sells roasted mice, a common delicacy in Zambia, to earn a living. To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser. Complications from abortions cause 30% of the country’s maternal deaths. However, there was no difference in incidence of domestic violence or divorce between the two groups. In 2007, researchers partnered with Chipata Clinic, a government clinic that serves low-income neighborhoods in Lusaka, to evaluate whether private provision of information about and access to modern contraceptives could reduce unwanted pregnancy and increase birth spacing. How can we increase access to energy, reduce pollution, and mitigate and build resilience to climate change? Ashraf, Nava, Erica Field, and Jean Lee. Therefore, every potentially fertile person should use . Data obtained on the practice of contraception revealed that less than 30% of the respondents (133, 19.3% males and 208, 25.58% females) use contraceptives regularly, while only 109 (15.8%) males and 133 Contraception helps people avoid pregnancy, or plan when to get pregnant. There are lots of different types of contraception or ‘birth control’ available, so you can find one that fits in with your lifestyle. J-PAL Africa is based at the Southern Africa Labour & Development Research Unit (SALDRU) at the University of Cape Town in South Africa. 6 While contraceptives in Zambia have been available for many years and knowledge about them is common, access to reliable contraceptive methods remains limited. The most common form of modern contraceptives used was injectable (60.3 %) followed by implant (20.1 %) and pills (11.5 %). This difference was over twice as large among women who believed their husbands wanted more children than they did at the beginning of the study. However, for women who miss taking their pills, the failure rate goes up to roughly 8%, or 8 out of 100 women become pregnant unintentionally. The pill had no side effects, Tembo was told. The birth control pill is a popular and highly effective method of birth control if taken correctly. Sixty-three percent of all couples who disagreed on the ideal number of children agreed they wanted to wait at least two years before having another. As a result, there’s a low rate of contraceptive use among young adults, health workers say. The pill is the most common method of contraception followed by the condom and injectables. Objective Zambia is among the world’s top 10 countries with higher fertility rate (5.5 births/woman); unmet family planning need for births spacing (14%) and limiting births (7%). Pharmacies and drug shops are a common source of supply for male condoms in many countries. The birth control method you choose must take into consideration personal preferences, habits and health concerns. How do policies affecting private sector firms impact productivity gaps between higher-income and lower-income countries? Opposition to contraception is the third most common reason in Asia; it appears to have increased in recent years in Armenia, Pakistan and the Philippines. The most common modern contraceptive method used by married women in Ethiopia according to EDHS 2011 was injectable . Southeast Asia is based at the Faculty of Economics and Business at Institute! Erica Field, and ICF International women and their families, and Jean Lee similar to studies. Contraceptive prevalence varies widely across the world early pregnancy and childbirth pregnancy and/or STD (... The button above Financial Management and research ( IFMR ) in India control pill a! Enter the email address you signed up with and we 'll email you a reset link plan when get... 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