DETERMINANTS. Sulekha Patel. October 1982

Transcription

1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized SI~I LANKA CURRENT USE OF -CONTRACEPTION: PATTERNS AND Sulekha Patel October 1982 DETERMINANTS PHN Technical Notes RES 3 * This paper is one of a series issued by the Population, * * Health and Nutrition Department for the information and * * guidance of Bank staff working in these sectors. The * * views and opinions expressed in this paper do not neces- * * sarily reflect those of the Bank. * ***********************************************

2 RES 3 A B S T R A C T This paper uses data from the World Bank and UNFPA sponsored survey on the Determinants of Fertility Decline in Sri Lanka. The multivariate analysis shows that whereas the traditionally strong influences on fertility, and hence contraceptive use, such as education, age and labor force participation still exist among the older women, changes in the nature of delivery of family planning services are making these socio-economic factors less salient among younger women, as well as among sub-groups of older women.

3 TABLE OF CONTENTS Page No. Introduction... 1 The National Family Planning Program... 4 Current Use of Contraception... 8 Multivariate Analyses Conclusion Appendix A Knowledge and Ever Use of Contraception Appendix B Multivariate Analysis of Type of Contraceptive -Method Used....@c References

4 List of Tables Page No. Table Table 1 Re-interviewed WFS Respondents and New Respondents by Socio-economic and Demographic Characteristics Percent Age Distribution of WFS and New Respondents, Sri Lanka... 3 Table 3 New Acceptors of Family Planning, Sri Lanka... 5 Table Table Table Table Table Table 4 Demographic Characteristics of New Acceptors, Proportion of Currently Married Women who are Sterilized, by Age of Respondent Percent of Women currently Using a Method of Contraception, by Type of Method Used Percent of Women Currently Using a Method of Contraception, by Age of Respondents Percent of Women Currently Using a Method of Contraception, by Parity of Respondents Percent of Women Currently Using a Method of Contraception, by Family Formation Status of Respondents Table 10 Table 11 Table 12 Table 13 Percent of Women Currently Using a Method of Contraception by Religion of Respondent Percent of Women Currently Using a Method of Contraception by Are of Residence of Respondent Percent of Women Currently Using a Method of Contraception by Education of Respondent Percent of Women Currently Using a Method of Contraception by Household Expenditure of Respondent

5 Page No. Table 14 Table 15 Table 16 Percent of Women Currently Using a Method of Contraception by Respondent's Employment Status Percent of Women of Respondents Currently Using a Method of Contraception by Education of Husband Description of Variables included in the Analyses Table 17a Standardised and Metric Canonical Discriminate Function Coefficients, WFS Respondents Table 17b Standardised and Metric Canonical Discriminate Function Coefficients, New Respondents Table 18 Table 19 Eigen Vector Summary and Canonical Correlation for the Derived Function Differentiating between Users and Non-Users Distribution of Observed-and Predicted Group Membership of Users and Non-Users Table A.1 Percent Distribution of Women by Number of Family Planning Methods Known before Probing, All Respondents Table A.2 Percent Distribution of Ever-Married Women by Methods Known and Age, All Respondents Table A.3 Percent Distribution of Ever-Married Women by Method Known and Education, All Respondents Table A.4 Percent Distribution of Ever-Married Women by Method Known and Parity, Al-l Respondents Table A.5 Distribution of Ever-Users by Methods and Age, All Respondents Table A.6 Distribution of Ever-Users by Methods and Education, All Respondents Table A.7 Distribution of Ever-Users by Methods and Parity, All Respondents... 36

6 Page No. Table B.1 Description of Variables Included in the Analysis Table B.2 Table B.3a Table B..3ib Table B.4 Table B.5 Descriptive Statistics (means) of Selected *Variables Included in the Analysis Standardized and Metric Canonical Descriminant Function Coefficients, WFS Respondents Standardized and Metric CanorLical Descriminant EFunction Coefficients, New Respondents Eigen Vector Summary and Canonical Correlation for the Derived Function Differentiating Between Users and Non-users Distribution of Observed and Predicted Group Membership of Users and Non-users

7 CURRENT USE OF CONTRACEPTION: PATTERNS AND DETERMINANTS I. Introduction 1.01 The central concern of this chapter is to examine the patterns of contraceptive usage in Sri Lanka. The focus of the analysis is on the currerlt use of conventional methods of contraceptionl/, a measure that is appropriate for describing the contraceptive practice prevailing in a population at any given time. Ever-use of contraception, although important in its own right, lacks some of the characteristics of good measurement associated with current use. First, it does not reflect a woman's current status; second, and more fundamentally, it does not measure exclusively the probability of use by women who feel they need contraception 2 /. For comparative purposes, however, data on contraceptive knowledge anid ever-use are also analyzed and the results are presented in Appendix A Information on current use was obtained by routing the responses of currently married women, exposed to the risk of pregnancy (non-sterilized, fecund women) through the following questions: a. -Are you or your husband using a method to keep you from getting pregnant? If the response was affirmative, they were further asked: b. What method are you using? 1.03 The respondents in the study sample can be categorized into two subgroups. The first group consists of women who had participated in the World Fertility Survey conducted in 1975 and were declared eligible for the 1/ Use of sterilization for contraceptive purposes is analyzed separately. 2/ Ryder, Norman and Charles Westoff, Reproduction in the United States, Princeton University Press, Princeton, New Jersey, 1971, p. 1146

8 -2- present survey by meeting the age criteria. The second group is constituted of women who became eligible for interview either (1) by meeting the age and marital status criteria in the interim period; or (2) by change of residence to units that were targeted for interview in the World Fertility Survey The two sets of respondents differ systematically from each other in their socio-economic and demographic characteristics, as well as in their orientation toward family size (Table 1). The newer respondents are younger, (see also Table 2), married at older ages, desire smaller families, and are more educated than their reinterviewed WFS counterparts. However, fewer of them are currently in the labor force, and fewer have ever worked, either before or after marriage. In view of these differences it is not unreasonable to assume that the two groups of respondents are likely to differ in their contraceptive behavior also. It can further be assumed that the contraceptive behavior of the new respondents is indicative of the more recent pattern of contraceptive usage. The two groups are therefore treated separately in the analysis and, for the sake of convenience, are hereafter referred to as the WFS respondents and the new respondents (NR) The next section briefly examines the Family Planning Program. Section III discusses the differentials in current use of contraception by socio-economic and demographic variables identified by other studies as being relevant for t'he analysis of contraceptive use. Finally, the relative importance of factors that differentiate between users and non-users of conventional methods of contraception are identified within a multivariate framework.

9 -3- Table 1. Re-interviewed WFS Respondents and New Respondents by Socio-Economic and Demographic Characteristics WFS Respondents NR Mean Age (years) Mean Age at marriage (years) Desired family size (mean) Children ever born (mean) Children dead (mean) Wife's education (years) Husband's education (years) Average household expenditures (Rs) *% Currently in labor force % Ever Worked e.1 Table 2: Percent Age Distribution of the WFS andl New Respondents, Sri Lanka Age Respondents Group WFS New Total (N) (1765) (789)

10 -4- II. The National Family Planning Program 2.01 Family planning was initially made available in Sri Lanka by the Family Planning Association (FPA) as early as 1953 for protecting the health of mothers and children. In 1965, by a Cabinet decision the Government of Sri Lanka (GOSL) accepted family planning as an integral part of the Maternal and Child Health Services, and the Family Planning Bureau, now known as the Family Health Bureau was established within the Ministry of Health (now the Ministy of Family Health) with the responsibility of implementing family planning activities. The FPA continues to function, but mostly in research and promotional activities, directing its efforts to areas and groups outside the scope of the official program Table 3 illustrates the pattern of family planning acceptance in Sri Lanka during the period There was an increase in the number of acceptors from 1968 to 1975 and substantial increases in female sterilization during , a period distinguished by heightened family planning activity on the one hand, and by the lack of any policy movement towards anti-natal legislation on the other. This was followed by a decline in total acceptors in Thereafter, an increase was again observed, and in 1980 there were 153,553 new acceptors of family planning. Roughly this means that in 1980 approximately 42 out of every 1000 women of reproductive age were new acceptors of family planning, an Increase of 8 new acceptors per 1000 since / 2.03 Table 4 gives information on the demographic characteristics of new acceptors. Among acceptors of sterilization, there is a decrease in both 3/ Computed using acceptor statistics from Table 3 and estimates of women in reproductive ages.

11 -5- Table 3. New Acceptors of Family Planning, Sri Lanka Sterilization Year Male Female Total Orals IUD Condom Total ,011 16,014 20,615 4,3z75 43, ,947 25,284 19,537 5,207 54, ,971 26,889' 15,799 6,416 55, ,090 4,335 25,828 11,446 6,945 49, ,078 9,576 32,300 18,599 9,290 71, ,850 18,398 20,248 34,214 27,528 12,963 95, ,292 34,942 42,234 35,924 29,693 NA 107, ,034 33,130 39,164 37,720 32,755 NA 109, ,924 32,664 35,588 25,597 27,030 NA 88, ,302 17,752 19,055 27,514 21,321 NA 67, ,325 19,624 21,949 31,146 23,085 NA 76, ,586 27,740 33,326 29,022 18,878 NA 85, Oa/ 45, ,215 j 101,182 26,867 17,055 NA 153,553 a/ Provisional totals. Source: Reports on New Acceptors of Family Planning, Evaluation Unit, Family Health Bureau, Sri Lanka.

12 -6- Table 4: Demographic Characteristics of New Acceptors, Vasectomy Tubectomy IUD Pill 1976 Mean Age of Mother Mean Parity Mean Age of Mother Mean Parity Mean Age of Mother Mean Parity Mean Age of Mother N.A N.A. Mean. Parity N.A. N.A. N.A. - Not Available. Source: Service Statistics,

13 -7- the age and the parity at which sterilization is performed. The increase in the number of vasectomy acceptors in 1980, if maintained appears to bode well for the future of fertility decline in Sri Lanka, since the wives of vasectomy acceptors are at lower parities than women who themselves get sterilized. The pill and the IUD are favoured by younger women at lower parities, mainly for spacing purposes Much of this upsurge in contraceptive acceptance since 1978 can be attributed to initiatives in family planning that were implemented by the GOSL with a view to controlling population growth. Bonuses in excess of daily wages lost and out of pocket expenses incurred, as well as extra leave days were granted to any employed person voluntarily undergoing sterilization The success of the scheme, which has been in operation since May 1979 is reflected in the number of sterilization acceptors, both male and female, in It is the hope of the GOSL to extend a similar system of sterilization bonuses to the unemployed. 4 / Another move that is hoped will prove beneficial to the family planning program is that program administration and direction are decentralized, and have become the responsibility of the 24 districts. Such organisational decentralization is expected to ensure that motivation, provision of services and referral in each district is responsive to local conditions. 5 / 2.05 In recent years, attention has been focused on analysing the impact of the national faipily planning program on the decline in the crude 4/ Many public and private corporations, including the tea industry, which is Sri Lanka's largest single employer, already pay sterilization bonuses which are set to compete with generous maternity benefits. 5/ "UNFPA Assists Sri Lanka in its Drive to Lower Birth Rates", in Population, UNFPA Newsletter, Vol. 6, No. 1, January 1980.

14 -8- birth rate. It is generally agreed that up to 1970 the majority of the decline is attributable to an increase in the age at marriage. 6 / Since 1970 however, the effect of declining marital fertility has increased and, more recently, even matched the effect of increasing age at marriage. 7 / Although there is no direct evidence, the coincidence in the timing of the shift in the relative importance of the two factors 8 / in contributing to fertility decline and the increased emphasis accorded to the family planning program in general, and the promotion of services in particu'lar suggest a causal connection. III. Current Use of Contraception 3.01 Among the women interviewed for the Survey, sterilization is not only the most popu':arly known, but also the most frequently used method of contraception. Of all (4360) currently married women years of age, 14.3 percent or 624 women were protected against future pregnancies because either they, or their husbands, were sterilized. Table 5 shows that the proportion of women sterilized increases with age up to age group years; thereafter, the proportion sterilized declines steadily. This variation in the prevalence of surgical sterilization by age is not unusual for a terminal method of birth control. Use of sterilization is low at 6/ Fernando, D.F.S. "Fertility Trends in Sri Lanka and Future Prospects". Journal of Biosocial Science 8, January 1976, Cambridge, England. 7/ Alam, Iqbal and Cleland, John. "Illustrative Analysis: Recent Fertility Trends in Sri Lanka". World Fertility Survey Scientific Report No. 25, November, / Age structure is the third factor that affects the crude 'birth rate. In developing countries however, the age structure is generally conducive to a higher fertility because of past high fertility and improving health conditions which ensure a large proportion of the female population surviving to reproductive ages.

15 -9- younger ages because these women are still in the process of family formation; use is low among older women:-either because of biological reasons (they have become sub-fecund or biologically sterile), or because they are less aware of and receptive to innovation than their younger counterparts. Table 5. Proportion of Currently Married Women Who are Sterilized by Age of Respondent Age Group Percent Sterilized a/ Total 14.3 (N) (624) a/ Based on 4,360 currently married women in.the sample Of the remaining 3736 currently married women, 2762 women at risk of pregnancy are the focus of this analysis; 974 currently married women were declared ineligible because they reported fecundity impairments or considered themselves physically unable to have more children. Among those at risk, 35.1 percent of the WFS respondents and 30.2 percent of the new respondents were using a conventional method of family planning.at the time of the survey (Table 6) Overall, the proportion of women at risk using the more efficient conventional methods, namely the pill, IUD, or condom, is low, both for the WFS and the new respondents. Only 12 percent of all WFS respondents,

16 Table 6. Proportion Currently Using A Method of Contraception, by Type of Method Used Respondents Method Used All WFS New Pill IUD Condom Subtotal Douche Withdrawal Rhythm Abstinence Subtotal Percent Using Percent Not Using TOTAL (N) (2,762) (1,765)/a (789)/a /a Do not add up to 2,762 because 208 eligible respondents were not classified as either WFS or new respondents. comprising 34 percent of all current users, were employing an efficient method of birth control. The proportion among new respondents is even lower: approximately 10 percent, comprising 32 percent of current users Withdrawal is the most popular among the conventional methods, used by 10.9 and 9.5 percent of the&wfs and new respondents respectively. The next in popularity is the IUD for WFS respondents and the pill for new respondents. The condom, used by 1.8 and 1.3 percent respectively of the WFS and new respondents, is the least popular method Tables 7 through 15 give details on current use of contraception by selected socio-economic and demographic characteristics. The relation-

17 ships between use of contraception with age and parity (Tables 7 and 8) take a typical inverted U shape, with relatively lower proportions of women in younger and older ages, and at lower and higher parities using a method of family planning. The pattern is not pronounced among the new respondents who are younger, and therefore concentrated at low parities. The fact that a higher proportion of the new respondents compared to the WFS respondents in the year age group and among women of low parity are current users suggests a significant emphasis on child spacing on the part of these new respondents. However, when we examine the respondents on the basis of their family formation status (Table 9) more WFS than new respondents who have current parities less than desired parities are using a method of contraception, thus indicating an interest in child spacing on the part of WFS respondents also. Among the respondents who had attained their desired family size, slightly more new respondents (41 percent) than WFS respondents (39 percent) were currently using a birth control technique Current use of contraception by religious denomination (Table 10) has the same distribution among both the WFS and the new respondents. Buddhists have the highest proportion using a method (46 and 39 percent respectively of the WFS and new respondents), followed by Christians (43 and 29 percent respectively). Use of family planning is lowest among the Hindus (18 and 16 per cent respectively). Rural-urban differentials (Table 11) are in the expected direction among both sets of respondents. Use of contraception is most frequent-in urban areas and least frequent among women on the Estates.

18 - 12 Table 7. Percent of Women Currently Using a Method of Contraception, by Age Respondents Age Group All WFS New (18.2) (33.3) (35.7) Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents. Table 8. Percent of Women Currently Using a Method of Contraception by Parity Respondent Parity All WFS New (4.0) (33.3) (38.7) (42.1) (15.4) (8.3) (33.3) Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents.

19 - 13 Table 9. Percent of Women Currently Using a Method by Family Formation Status Respondents Fertility Status* All WFS New P less than D P = D P greater than D (30.3) Total (N) (872) (623) (238) * P - parity D - Desired family size Note: ( ) indicates fewer than 20 respondents. Table 10.. Percent of Women Currently Using a Method of Contraception by Religion Respondents Religion Al WFS New Buddhist Hindu Muslim Christian Others (50.0) Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents.

20 Table 11. Percent of Women Currently Using a Method of Contraception by Area of Residence of Respondent Respondents Place of Resiceince All WFS New Urban Rural Estate Total (N) (872) (623) (238) Table 12. Percent of Women Currently Using a Method of Contraception by Education of Respondent Respondents Level of Education All WFS New None (19.4) Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents.

21 Similarly, differentials in use by education (Table 12) and household expenditures (HHE) are also in the expected direction. Use of contraception is lowest among women with no education (23 and 19 percent respectively) and highest among 'women with 10 or more years of education (51 and 42 percent respectively), implying that for women, the opportunity cost of children is positively related to education Contraceptive use is also positively associated with household expenditure 9 / (Table 13). As HHE increases, the proportion of women using a method also increases, from a low of 28 percent and 20 percent respectively for WFS and new respondents with a monthly expenditure less than 250 rupees, to a high of 44 percent and 41 percent respectively among women with a monthly expenditure of over 750 rupees. This pattern of acceptance seems to indicate that as expenditure increases, children compete with other consumption goods for a share of the total. expenditure Current use of contraception by respondents' current employment status (Table 14) follows the expected pattern for the WFS respondents, but not for their new counterparts. Among the former, 38 percent of the women who are currently working were using a method compared to 25 percent not working. Among the latter, more non-working women (31 percent) compared to working women (27 percent) were currently employing a method of birth control. Contraceptive use by the nature (farm, non-farm) and location (home, away) of employment also reveal a reversal of the usual pattern, namely, that since the "costs" of childbearing are generally assumed to belower for women working on the farms or at home, they tend to have a higher 9/ Information on HHE was obtained by asking respondents "How much money per month does it cost your family to live including the cash value of any food you raise yourself"?

22 Table 13. Percent of Women Currently Using a Method of Contraception by Household Expenditure of Respondent Respondents HHE All WFS New , Total (N) (845) (604) (230) Note: ( ) indicates fewer than 20 respondents. Table 14. Percent of Women Using a Method of Contraception by Respondents' Employment Status Respondents Employment Status All WFS New Currently employed Currently not employed Total (N) (872) (623) (238) Farm (27.8) Off-farm Total (N) (872) (623) (238) Off-farm: Home Off-farm: Away Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents.

23 fertility, 1 0 / and consequently a lower use of contraception. According to the survey data, for both sets of respondents, more women working on farms than off farms were using a method of family limitation; among those working off farm, more women who worked at home than away employed some form of contraception One possible explanation for this pattern of diffusion could be the family planning program itself. Until 1975, in spite of heightened family planning activity between 1972 and 1975, political support for the program was weak and acceptance of contracetption was largely determined by the socio-economic characteristics of the women. Since 1977, there was a steady policy movement on the part of the new government, elected in 1977, towards recognizing family planning as an essential component of population and health policies. Enhanced family planning.services and financial incentives were provided by the state. Consequently sub-groups previously not disposed to fertility control were now using a method of contraception. However, such an explanation leaves unanswered the question Qf why.a similar pattern of diffusion did not take place among estate women as well as among respondents with no education Besides the characteristics of the wives, husbands' education (Table 15) also has a ponitive effect on contraception. For both sets of respondents, the proportion of WFS and new respondents using a method increases from 27 and 20 percent respectiv-ely for husbands with no education to 48 and 37 percent respectively for husbands with 10 or more years of schooling. I-t is interesting to note that current use of contraception is much higher among WFS respondents whose husbands have no education than among WFS respondents who themselves have no education. 10/ Birdsall, Nancy. "Population and Poverty in the Developing World". World Bank Staff Working Paper No. 404, Washington, D.C. L-"y, pp

24 Table 15. Percent of Women Currently Using a Method of Contraception by Education of Husband. Respondents Level of Education All WFS 'Sew None (20.3) Total (N) (872) (623) (238) Note: ( ) indicates fewer than 20 respondents Broad conclusions drawn from the data presented above are summarized below: a. The popular use of traditional, inefficient methods completely overshadows the use of efficient methods, even among the younger, more educated, new respondents. b. The stronger and more consistent relationships between socio-economic variables (such as female education and HHE) and contraceptive use continue to hold for both sets of respondents.the relationship between current employment and use of contraception, namely, that use is higher among working women, does not hold for new respondents. Additionally, the data also reveal a reversal in the pattern of contraceptive use by nature and :location of employment for all respondents. As noted above, while it can be hypothesized that this pattern of diffusion may be due largely to a change in the nature of the family planning program and its service delivery, the selective pattern of the diffusion certainly warrants a further investigation.

25 c. Both WFS and new respondents appear to place emphasis on spacing of births. Among the latter, this desire for spacing is indicated by higher proportions of respondents using contraception at younger ages (20-24) and lower parities (2-3 children); among the former it is implied by a higher proportion of women with a current parity less than their desired family size using a method of birth control. The only difference between the WFS and new respondents is that of those respondents who had attained the family size desired, slightly more new respondents than WFS respondents were using a method of birth control. IV. Multivariate Analysis 4.01 In this section data are analyzed within a discriminant function procedure, which weights and linearly combines the variables on which the groups are expected to differ. Hence it is not only possible to determine the extent to which the groups differ from one another, but also to estimate the discriminating power of each variable The variables included in the analysis are defined in Table 16. Current use of contraception, because of its greater precision and more direct implications for fertility, is the dependent variable. In view of the cross-tabular results which showed that a larger proportion of women who work on farms or in the house (but not housework) are currently using a method of contraception, economic activity for this equation is represented by classifying respondents into broad categories of those who have ever worked or those who have never worked. Excluded from the explanatory variables are program-specific variables. The omission of these variables, such as access to and availability of family planning, the costs of contraception, etc., for

26 -20- which no information was available, subject the model to a large specification error The data were also analyzed separately to examine the relative importance of these same explanatory variables in differentiating between users of more efficient and less efficient methods of contraception. Included in the former were couples using the pill, IUD or condom, while the latter encompassed couples using rhythm, withdrawal, abstinence, etc. No Table 16. Description of Variables Included in the Analysis Variable Code Description Dependent 1. Current use of contraception (1) Currently using (0) Currently not using Independent 2. Age In single years 3. Age at marriage In single years 4. Children ever born Total number.of children, both dead and alive 5. Family formation status 1 / (1) Parity less than desired (2) Parity greater than desired 6. Education olf respondent. Highest grade achieved 7. Labour force participation (1) Ever worked (0) Never worked 8. Monthly household expenditure In Rupees 9. Education of husband Highest grade achieved 10. Religion 2 / (1) Hindus (2) Muslims (3) Christians 11. Area of Residence 3 / (1) Urban (2) Estates OmittS.d Categories: 1. Parity equal to desired 2. Buddhists 3. Rural

27 21 discernible pattern was obtained in the discriminate analysis, thus precluding a more substantive interpretation of the results. These are presented in Appendix B To determine the relative importance of factors that differentiate between users and non-users of contraception, we consider next the results of the discriminant function analysis. The standardized and metric coefficients associated with each of the variables in the canonical discriminant function are presented in Table 17. The former reflect the relative importance of each variable to the derived function; the latter facilitate the interpretation of the nominally scaled variables. The standardized coefficients are analogous to the partial betas in multiple regression analysis and hence lend themselves to similar interpretation. The signs associated with these coefficients are indicative of a "push atway from" or a "pull towards" a particular group. In Table 17, a negative sign denotes a pull towards contraceptive use; a positive sign reflects a push towards non-use of contraception. The metric coefficients reported for nominally scaled variablesll/ show the net effect relative to the grand mean of being in a particular category of a nominally-scaled variable. The corresponding interpretation of a metric coefficient for a continuous variable is the change in contraceptive status that is attributable to a unit change in the explanatory variable. 11/ These were derived using the following formula: K = - bipjj where K = bi = deviation of omitted group from the grand mean. unstandardised beta coefficient for variable i. Pi proportion of cases in group i. The estimated intercept for the omitted category is: (bo + K) where bo is the value of the intercept. For the ith group, the estimated intercept is: bo + (bi + K)

28 Table 17a. Standardized and Metric Canonical Discriminant Function Coefficients, WFS Respondents ^ Coefficient Variables'/ Standardized Metric 1. Religion Hindu Muslim Christian Buddhists 2 / Family formation status Parity greater than desired Parity less than desired Parity equal to desired 3 / Respondents education Age Labor force participation Ever worked Never worked a Husband's education Children ever born Monthly expenditure Area of Residence Urban Estate Rural 4 / Age at marriage r 1/ Variables are given in order of importance. Omitted catogories: 2/ Buddhists 3/ Parity = Desired 4/ Rural

29 Table 17b. Standardized and Metric Canonical Discriminant Function Coefficients, New Respondents Coefficient Variables'/ Standardized Metric 1. Religion Hindu Muslim Christian Buddhists 2 / Family formation status Parity greater than desired Parity less than desired Parity equal to desired 3!/ Monthly expenditure Area of Residence Urban Estate Rural 4!/ Respondent's education Children ever born Husband's education Age Labor force participation Ever worked Never worked Age at marriage / Variables are given in order of importance. Omitted catogories: 2/ Buddhists 3/ Parity = Desired 4/ Rural (Only non-sterlized, fecund women were used in the denominator.)

30 Based on the values and signs associated with the standardized and metric coefficients, the following conclusions emerge: 1. Religious affiliation is the most important predictor of contraceptive use among both the WS and new respondents. The Buddhists are the most likely and Hindus the least likely to use a method of contraception. Among the new respondents however, the difference between the Muslims and Christians is considerably less than their WFS counterparts. 2. For both the WFS and new respondents, family formation status emerges as another important predictor of whether or not a couple is currently using a method of birth control. For both sets of respondents, those who had attained or exceeded their desired family size were more likely to be currently using a method of contraception than their counterparts who were still in the process of family formation. It is however interesting to note that whereas among the WFS respondents, those who had exceeded their desired parity were more likely to be currently using a method of contraception than those whose parity equalled their desired family size, among the new respondents the opposite pattern prevails. 3. Insofar as the relative importance of the remaining variables is concerned, there is less in common between the WFS and the new respondents. Among the former, the traditionally strong and more consistent influences on fertility still exist. Respondents education, age and labor force participation have an appreciable effect in differentiating between use and non-use of contraception. The more educated a woman is, the more likely she is to use contraception, since education improves the likelihood that a woman

31 has knowledge of and can use modern contraception; it also influences the speed with which a new method of birth control is accepted. with age. For the WFS respondents, use of contraception decreases This is not surprising since older women are less prone to use family planning. Interestingly enough, among the new respondents, although the relative importance of age in predicting contraceptive use or non-use is considerably less, the use of contraception increases with age. Finally, among the WFS respondents, women who have ever participated in the labor.force are more likely to use contraception. Such women have developed interests beyond family and childbearing, which they take into married life and which tends to moderate their fertility goals. Among their new counterparts, not only is labor force participation relatively unimportant in predicting contraceptive use but the relationship is not in the expected direction. In consistency with the cross-tabular results, women who have never worked are more likely to be using a method of contraception. It can therefore be concluded that the variables which traditionally influenced fertility and contraceptive use in the absence of strong family planning programs and convenient delivery systems are becoming less salient for the new respondents, among whom income-related variables and economic calculations appear to be assuming a greater significance. 4. For the new respondents, monthly household expenditure is positively associated with contraceptive use, and emerges as the third most important predictor of contraceptive use. Since parity is also a

32 relatively important predictor of use of contraception (the number of children ever born is positively associated with contraceptive use) it can be hypothesized that for new respondents children compete with other consumer goods. Where socio-economic conditions are improving, parents may also opt to trade quantity for quality in children, as in any other good or service'purchased. Area of residence also emerges as an important predictor of contraceptive use. Respondents residing in urban areas are more likely to use contraception; those living on the estates are the least likely to use contraception. Area of residence-may influence contraceptive use ia one of two ways: one, since family planning services are both easily available and more accessible in urban areas, the financial and psychologicral costs of using contraception are smaller; two, having and raising children may be more costly in urban than in rural areas. These costs may range from purchasing health and educational services to purchasing child care if both parents work. For the WFS respondents, area of residence is the least important predictor of contraceptive use, though it is interesting to note that among them, rural women are the most likely to use contraception and estate women the least likely. 5. It is instructive to examine the signs associated with some of the other variables in the analysis which have relatively little predictive power. Fnr the WFS respondents, the number of children is negatively associated with contraceptive use. This can only be explained by the fact that parity increases with age and older women are less likely to use family planning. Finally, for both the WFS

33 Table 18. Eigen Vector Sulmmary and Canonical Correlation for the Derived Fuanction Differentiating Between Users and Non-Users Function 0 Function 1 WFS Respondents Eigen Value.140 Canonical Correlation Wilks Lambda Chi Square* New Respondents Eigen Value.131 Canonical Correlation.341 Wilks Lambda Chi Square* * Degrees of Freedom = 14 and the new respondents, husband's education and age at marriage are positively associated with contraceptive use Selected statistical measures summarizing the success of the analysis are shown in Table 18. The value of the Wilk's lambda (.878 for the WFS respondents and.884 for the new respondents) and the associated chi square statistics indicate that the discriminating power in the variables examined is small, but statistically significant. The probability of obtaining square values of (for WFS respondents) and (for new respondents) with 14 degrees of freedom by chance is one in 10,000. The amount of variance existing in the variables included in the analysis is given by the eigen value The canonical correlation is a measure of association between the derived discriminant functioni and the dependent variable. The coefficient,

34 when squared, can be interpreted as the proportion of variance in the response groups explained by the discriminating variable. The data show that percent (for WFS respondents) and percent (for new respondents) of the variance between users and non-users is explained by the predictions in the analysis One of the purposes to which the derived canonical discriminant function can be put is to classify ex post facto the study sample based solely on values on the discriminating variables. Table 19 examines the observed and predicted group membership of users and non-users of contraception. For both sets of respondents the percent of couples accurately classified as users and non-users was approximately the same: 64.43% for the WFS and 65.78% for the new respondents. V. Conclusion 5.01 As has been noted, there have been changes in the provision of family planning services since The impact of these changes generally has been to make family planning both more attractive and available to groups previously not disposed to using contraception, and thereby making less salient the socio-economic factors that traditionally influenced fertility and contraceptive use. According to the results of the multivariate analysis, among WFS respondents, rural women were now most likely to use a method of contraception.1 2 / This is in contrast to the findings of the Sri Lanka Fertility Survey, which showed that urban women, or urban women who 12/ The cross-tabular results (Table 11) show slightly more urban women currently using a method of contraception. This discrepancy between the bivariate and multivariate results is due to the fact that, by definition, the former donot control for the effects of other variables. - t I w '- + i }.

35 - 29 migrated to rural areas, were the most likely to use contraception. In addition, the results of the cross-tabular analysis showed that for all respondents, those working on farms or at home were more likely to be using a method of contraception. Such a pattern of diffusion, which is likely to have a beneficial effect on future fertility, may be attributed in large measure, to the program effect. Table 19. Distribution of Observed and Predicted Group Membership of Users and Non-Users Predicted Observed Non-Users Users Total WFS Respondents Non-users l0 (708) (429) (1137) Users (197) (426) (623) % of Total correctly classified: 64.43% New Respondents Non-users (362) (186) (548) Users (83) (155) (238) % of Total correctly classified: 65.78%

36 Appendix A Knowledge and Ever-use of Contraception Information on knowledge and ever-use of contraception was obtained by asking the following questions of all ever married women: (1) Do you know any methods which prevent or delay pregnancies? If the answer was affirmative, two further questions were asked: (2) What methods do you know? (3) Have you ever used (method)? The methods not mentioned were described to all respondents, and they were asked whether they had heard of them, and, if they had, whether they had ever used them. Knowledge of Family Planning methods. Eighty-five percent, or 4,091 ever-married women in the sample, without any prompting by the interviewer, knew of one or more methods of birth control, and 15 percent, or 738 women did not know of any method. After probing and describing the methods not mentioned the number of women who knew, or had heard of, at least one method of birth control increased to 4,669 or 97 percent of the sample. This indicates a six percentage point increase in knowledge over 1975 when 91 percent of all ever-married women knew of one or more methods of birth control. On the average, an ever-married woman knew of 2.7 methods of birth control (Table A.1). Female sterilization was the best known method, with 92 percent of the ever-married women claiming to know or to have heard of it. followed by the pill, known to 88 percent of the respondents. This was The condom and male sterilization, mentioned by 54 percent of the respondents, were the

37 Table A.1. Percent Distribution of Women by Number of Family Planning Methods Known Before Probing, All Respondents No. of Methods Known Percent of Women Total (N) (4892) Average 2.7 least known scientific methods. Among the traditional non-scientific methods, the best known mentioned by 36 percent of the ever-married women, was rhythm. This proportion indicates a decline over 1975 when 44 percent of the ever-married women knew, or had heard of, the method. Abstinence, known or recognized by 21 percent of women, was the next best known of the non-scientific methods. Knowledge about family planning method is highest among women years, at which age over 98 percent of the ever-married women knew about family planning and lowest at the two extremes. The overall pattern of knowledge by age is thus in the shape of an inverted U (Table A.2). Years of schooling is positively associated with knowledge of family planning (Table A.3). As the level of education increases, there is an increase in the percent of women who know about family planning. Whereas 7 percent of the ever-married women with no education had never heard of any

38 Table A.2. Percent Distribution of Ever-Married Women by Methods Known and Age, All Respondents Never Method Known Heard Age Sterilization All of any Group Pill IUD Condom Female Male Methods Method Total ' Total (N) (4,253) (3,247) (2,616) (4,444) (2,612) (4,669) (160) (4,829) Table A.3. Percent Distribution of Ever-Married Women by Method Known and Education, All Respondents Never Method Known Heard Educa- Sterilization All of any tion Pill IUD Condom Female Male Methods Method Total None , , Total (N) (4,253) (3,247) (2,616) (4,444) (2,612) (4,669) (160) (4,829)

39 family planning methods, less than one percent schooling had never heard of family planning. with 10 or more years of Thus education has a significant impact on knowledge about family planning. In contrast to the other variables, variation of knowledge by parity has no consistent pattern (Table A.4). Knowledge of family planning is highest among women with 4 and 8 children, where less than one percent of the women did not know of even one method of birth control. Except for women with no children, among whom 13 percent did not know of family planning, over 95 percent of the women at all other parities.knew about contraception. Ever-use of Contraception. Thirty-six percent of the ever-married women stated that they had ever-used a method of contraception. Rhythm, used by 18 percent of the women was the most popular method, followed by sterilization and abstinence, both used by 13 percent of women. Among the conventional efficietit methods, the pill, used by 9 percent of the ever-married women, is the most popular. Notwithstanding increases in knowledge of the more efficient methods and decreases in knowledge of the less efficient traditional methods, the latter continue to play a more significant role in the attempts of the Sri Lankan women to regulate their fertlity. Contraceptive use by age (Table A.5) exhibits the same pattern as knowledge of contraceptive methods by age: experience of use was lowest among the youngest age group (12 percent), relatively low among the oldest age group (26 percent) and highest among women aged years (43 percent). Women below age 30 favored the conventional methods of family planning, of which the pill was the most popular: among women 30 years of age and older, on the other hand, the terminal method of sterilization dominated.

40 Table A.4. Percent Distribution of Ever-Married Women by Method Known and Parity, All Respondents Never Method Known Heard Sterilization All of any Parity Pill IUD Condom Female Male Methods Method Total ' Total (N) (4,253) (3,247) (2,616) (4,444) (2,612) (4,669) (160) (4,829) Table A.5. Distribution of Ever-Users by Methods and Age, All Respondents Method Ever Used Sterilization Alla/ Never Age Pill IUD Condom Male & Female Methods Used Total Total ,829 (N) (443) (334) (258) (637) (1,751) (3,078) -