https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/121 Mon, 31 Oct 2016 11:28:26 +0000 Contraceptive prevalence rate (CPR) is lower while the fertility is higher among rural married women aged 15-29 in Bangladesh. Thus, this comparative study attempted to identify the socio-economic and cultural determinants of contraceptive use in different rural settings. In this primary data based cross sectional study, a  semi-structured questionnaire was applied to women aged 15-29 years in two rural areas who had at least one live birth on/before 20 December, 2006. The study areas were identified by multi-stage random sampling technique. Results showed that CPR was slightly higher in Dariadaulat (43.4%) than that of Chardigoldi union (41.6%) while the mean duration of use was slightly higher in Chardigoldi compared to Dariadaulat (5.04 v. 4.59 mo). Regression model for Dariadaulat (38.7% with P<0.001) better explained the use of contraception than that of Chardigoldi (30.0% with P<0.001). Among the determinants in Dariadaulat the most explanatory variable was mass media exposure (15.8%) while it was desired number of children in Chardigoldi (12.6%). Among others, joint decision of using contraception, familiarity with contraceptives before marriage, desired number of children, electricity, family interference and family size were found to have significant impact in Dariadaulat. On the other hand, the other explanatory variables in Chardigoldi were joint decision of using contraception, family interference and familiarity with contraceptives before marriage and age at present. It may be concluded that the CPR is markedly low in rural communities. The lack of accessibility to mass media, lack of joint decision with husband, premarital unawareness regarding contraceptive use, lack of post-marital planning and family interference are major contributory factors for the low CPR in the study population. Address for Correspondence: Dr. Housne Ara Begum, Assistant Professor, Institute of Health Economics, University of Dhaka, Dhaka 1000, Bangladesh, e-mail: drhousne@gmail.com   In spite of various socio-economic challenges, Bangladesh National Family Planning Programme has made remarkable strides toward a higher quality of life for its people. One substantial improvement is the increased contraceptive prevalence rate (CPR) from 7.7 percent in 1975 to 55.8 percent in 2007.1 During the same period, the total fertility rate (TFR) has declined from 6.3 to 2.7 births per woman. Different studies have shown that higher contraceptive use is associated with decreasing fertility.2-5   The primary data for this study was collected from women in two rural areas of Bangladesh. Study areas were identified through multi-stage random sampling technique. Two districts such as Brammanbaria and Narshingdi were selected from respectively Chittagong and Dhaka division and then two thanas namely Bancharampur and Narshingdi were chosen. At the final stage, one union from each thana was selected as study area (Dariadaulat from Bancharampur and Chordigoldi from Narshingdi). The subjects of this cross sectional survey were women within 15-29 years of age who had at least one live birth before December 20, 2006. From each union 250 eligible women were successfully interviewed with a structured questionnaire. Y= a + b1*X1…………………+ bk* Xk + e Y    =   dependent variable b    =   the regression coefficient K    =   end number of the series   Use of Contraceptives     Table 1 presents the results of bi-variate analysis of months of contraceptive use among women in two areas by different socio-economic, demographic and cultural factors. Duration of schooling was found to be positively associated with longer duration of use. The women aged 19 years or greater were found to use contraceptives for a longer period in both areas. The women with the facility of electricity, mass media exposure and smaller family size used contraceptives for a longer period in Dariadaulat than that observed in Chardigoldi (P<.01). Table-1: Mean comparison of contraceptive use in months among rural women aged 15-29 in Dariadaulat and Chardigoldi union     In order to identify the socio-economic, demographic and cultural determinants of months of contraceptive use, simple linear regression technique was used. Two separate models were analyzed for two regions. Variables significant at bi-variate analysis were included into the regression model. Between the models, model for Dariadaulat (38.7%) explained higher variation than that of Chardigoldi (30.0%).     Women with familiarity with contraception before marriage, electricity and larger family size were found to use contraceptive for longer time and respectively explained 6.1%, 2.2% and 1.6% variation. As expected, women’s desired number of children and family interference were found to have negative impact. Women with family interference and larger number of desiredchildrenwerelesslikely tousecontraceptive.     Women with familiarity with contraception before marriage and age at present were, similar to the model for Dariadaulat, found to have positively significant impact on months of contraceptive use. Family interference explained 5.1% of variation in month of contraceptive use. Similar to Dariadaulat, family interference in this model also indicates that women with such pressure were less likely to use contraceptive. Discussion It was found that promotion of family planning through radio or television can be an important means of raising awareness, improving knowledge and stimulating the use of modern contraceptive methods.6-8 However, mass media exposure had no universal impact on use of contraception in this study. But in Dariadaulat union, the impact of mass media showed significant explanatory power in determining the use of contraception since marriage to first live birth. Electricity provides the ground to utilize the mass media which is the access of rural people to the outer world. The electricity in this study was found to have significant positive impact on months of use of contraception only in Dariadaulat. This may be due to that in Dariadaulat union the household electricity was more prevalent than that of Chardigoldi union. Bangladesh is a traditional patriarchal society where women are expected to be guided by their husband’s decision in every sphere of life. Therefore, it is expected that husband’s approval or disapproval determines the use of contraception by women in Bangladesh. However, in this study joint decision by husband and wife for using contraception was found to have significant positive impact on use of contraception in both areas which is similar to a study in Nepal.10 It is evident from the study that women aged 15-29 yrs were less likely to use contraceptives since marriage to first live birth in the study population. Moreover, mean months of use was also very low. However, an increase of CPR may be possible to a significant level if different socio-economic and cultural determinants are considered within the planned program.   1.  National Institute of Population Research and Training (NIPORT), Mitra Associates Measures DHS, 2007. Ministry of Health and Family Welfare, Macro International, Calverton, Maryland, USA (2007). Bangladesh Demographic and Health Survey, Preliminary Report 2007. 3.  Mauldin W Segal. Prevalence of contraceptive use in developing countries: A Chart Book. Rockefeller Foundation: New York, United Nations, 1986. 5.  Frank O, Bongaarts J. Behavioural and biological determinants of fertility transition in Sub-Saharan Africa. Stat Med 1991; 10(2): 161-75. 7.  Olaleye DO, Bankole A. The Impact of mass media family planning promotion on contraceptive behaviour of women in Ghana. Pop Res Pol Rev 1994; 13:         161-177. 9.  Islam M, Kane TT, Khuda B, Reza MM, Hossain MB. Determinants of contraceptive use among married teenage women and newlywed couples. ICDDR,B, 1998 (Work. Pap. no. 117). 2026 Ibrahim Medical College. All rights reserved.