IMPACT OF WOMAN S STATUS ON FERTILITY AND CONTRACEPTIVE USE IN BANGLADESH: EVIDENCE FROM BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY,

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1 IMPACT OF WOMAN S STATUS ON FERTILITY AND CONTRACEPTIVE USE IN BANGLADESH: EVIDENCE FROM BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY, M. ALAMGIR KABIR, M.M.H. KHAN, M. KABIR, MOHD. MUZIBUR RAHMAN AND MD. FAZLUL KARIM PATWARY INTRODUCTION Bangladesh gained independence on March 26, 1971 after a war of liberation from Pakistan. Though this country is very small in terms of area (only 147,570 in square kilometer), it was the ninth most populous country in the world in 2001 with an estimated population of around 123 million (male 62.7 million, female 60.4 million), whereas the population was only 42 million in According to census data, both fertility and mortality rates have been declining since For instance, the total fertility rate (TFR) has declined dramatically from 6.3 children per woman in to 3.3 in , a decline of 48% over a 25-year period. Crude death rate has fallen dramatically from about 19 per 1,000 people in 1975 to 8 in Infant mortality rate declined from 105 per 1,000 live births during to 66 per 1,000 live births during , an average rate of decline of nearly 4 infants per 1,000 live births per year. Maternal mortality declined from 6.2 deaths per 1,000 births in 1982 to 4.4 in About 80% of the people are still living in rural areas, 9 in 10 people are Muslims, and agriculture is the main sector of the nation s economy which accounted for 30% of the gross domestic product. 1 Women s status is multidimensional 2,3 which can be indicated by education, occupation/employment 2,3,4 respondents discussion of family planning with their partners 4 decision making, freedom of movement 5 age at marriage, political representation, and legal rights. 3 Kawachi M. Alamgir Kabir Assistant Professor, Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh, M.M.H.Khan, Department of Public Health, Sapporo Medical University, Sapporo, Japan, M. Kabir, Professor, Department of Statistics, Jahangirnagar University, Dhaka, Bangladesh, Mohd.Muzibur Rahman, Department of Environmetrics and Biometrics, Hiroshima University, Japan and Md. Fazlul Karim Patwary, Assistant Professor, Computer and Information Technology Institute, Jahangirnagar, University Savar, Dhaka, Bangladesh.

2 et al 6 mentioned that women s status can be assessed by four composite indices measuring women s political participation, economic autonomy, employment and earnings, and reproductive rights. Women s status is an important determinant of fertility 7 and all of its dimensions can play a crucial role in influencing their fertility. 8 It is also significantly associated with other outcomes such as contraceptive use 4 and mortality. 9 For instance, (i) the increasing status of women represented by education and occupation significantly decreases the number of children, (ii) the increasing status of women represented by education, occupation and discussion with partner significantly increases the ever-use of contraceptive method, and (iii) the increasing status of women represented by discussion with partner significantly increases the current use of contraception in Kazakhstan. 4 Lasee and Becker 10 showed that husband-wife communication, particularly the wife s perception of her husband s approval of family planning, was highly (odds ratio=4.2) associated with current contraceptive use. Number of living children and couple s educational level were also significantly related with contraceptive use. Chaudhury 11 found in Uganda that secondary or higher education, discussion of family planning with partners, and urban residence strongly influenced contraceptive use. In Pakistan, several factors including husband-wife communication showed significant influence on contraceptive use. 12 Salway 13 based on the 1988 Ghana Demographic and Health Survey, reported that the wife s attitude towards family planning and discussion of family planning between spouses have significant independent effects on current contraceptive use. According to Tawiah, 14 the three most important variables affecting contraceptive use among currently married women were approval of family planning, discussion of family planning with their partners, and level of education. Respondents who approved family planning, who discussed family planning with their partners and who had higher education (at least secondary level) were 3-4 times more likely to be current contraceptive users as compared to their reference categories. Some more studies also reported that women who talked about family planning with their partners/ husbands were 2.1 times 15 and 1.5 times 16 more likely to currently use contraceptives than those who did not. Using the data of 1989 Bangladesh Fertility Survey, Ullah and Chakraborty 17 identified 12 important determinants of contraceptive use among women of reproductive age, of which women s education emerged as the most important factor, followed by women s participation in making decisions about family planning practice. According to Chaturvedi et al 18 in India, mother s education made the significantly largest contribution in decreasing the number of children. Larsen and Hollos 19 reported that declining fertility in Tanzania was associated with the factors that are related to the status of women, including women s education. Examining the impact of women s status through education, labour participation, and age at marriage on fertility in Pakistan, Sathar et al 20 found education as the most important factor for decreasing fertility. United Nations 21 has also observed a negative relationship between education and fertility in Pakistan, although the greatest effects were observed among women with post-primary education. The differences in fertility in Pakistan were mainly attributable to variation in marriage patterns by education. Uddin et al 22 reported that in rural Bangladesh more educated women and women who were employed with cash payment were more likely than other

3 women to be ever users of contraception. Similarly according to Vural et al 23 increasing literacy level significantly increased both contraceptive use and the participation of husbands in family planning decision making. The study of Oheneba-Sakyi 15 revealed that the likelihood of women currently using contraceptives was 1.5 times higher among those who had some education. Schuler and Hashemi 24 reported that employment for women was positively associated with contraceptive use in Bangladesh, because economic roles give them more autonomy and more control over important decisions affecting them and their families. Shapiro and Tambashe 25 also found in Zaire that women s employment is strongly associated with contraceptive use. Mother s occupation in India revealed significant association with number of living children 18. Above-mentioned literature revealed that family planning discussion between husbands and wives, education of women, and their occupation could play an important role in influencing the use of contraception, which ultimately influences the family size. Since the association of women s status with number of living children and contraceptive use are poorly studied and understood in Bangladesh, this study assessed the following hypotheses concerning the relationships of women s status with fertility and contraceptive use: Hypothesis I: The higher the status of the woman, the lower the number of children the woman had. Hypothesis II: The higher the status of the woman, the more likely she was an ever user of contraception. Hypothesis III: The higher the status of the woman, the more likely she is a current user of contraception. The findings of the study would help policy-makers and program managers in designing proper strategies, in Bangladesh. DATA SOURCE AND METHODOLOGY The data for this study is from the Bangladesh Demographic and Health Survey (BDHS), and was based on responses from a sample of women aged 10 to 49. A total of 10,544 women were interviewed, of whom 9,696 were currently married. Details of the study design including questionnaire are to be found elsewhere. 1 Briefly, detailed information was collected concerning the socio-demographic characteristics of individual respondents, their contraceptive use and fertility preferences. Based on the above-mentioned hypotheses, three dependent variables were selected for analysis. These were: i) The number of living children among married women. ii) Whether the woman was an ever user of a (modern or traditional) contraceptive method. Answer was coded as either yes (1) or no (0). iii) Whether the woman was a current user of a contraceptive method. Answer was coded as either yes (1) or no (0). Ordinary Least Squares (OLS) and logistic regression techniques were used to estimate three models of the relationship between women s status and fertility and contraceptive use. Three independent variables, used to represent the status of women, were: Educational level of women This variable was coded into six categories: no education, incomplete

4 primary, complete primary, incomplete secondary, complete secondary, and higher education. Women s occupation Three categories (not working, unskilled occupation, skilled occupation) were used to measure the occupation of women. The women who engaged in agriculture, who were skilled and unskilled manual labor were considered as unskilled occupation. The women who were professionals, technicians, teachers, managers were considered as skilled occupation. Family planning discussion between husband and wife Since many studies used education of women, and their occupation as indicators of women s status, it was included in this study. However, the rationale of choosing family planning discussion with the partner as an indicator of women s status was that women who can discuss with, negotiate with, and influence their partner in the use of family planning and/or the number of children, they have would be considered of higher status. 4 Few more variables such as age (five year age groups from to 45-49), place of residence (urban, rural), region of residence (divided into 6 administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet), religion (Muslim, others), number of dead children, and age at first marriage were used as control variables either in ordinary least square (OLS) regression or logistic regression model. Each variable was included in the model because of its importance to the dependent variables, which was explained elsewhere. 4 For instance, the urban-rural place of residence was included in the model to see the effect of urbanization on women in Bangladesh. Similarly, the variable relating to the number of dead children was included in the model to determine its effect on the use of contraceptive methods, where the rationale was that if a woman lost a child due to death, she may not use contraception in order to have another child. RESULTS Table 1 revealed the background information for total married women as well as for women who were not pregnant and amenorrheic during the survey. According to information, about 78% of married women ever used any method of contraception. To calculate the current rate of contraceptive users, we excluded those women who were not likely to use contraception due to pregnancy or amenorrheic status at the time of survey. Approximately 75% of this sub-sample was currently using any method of contraception. More than 40% women were illiterate and the rate of higher education was found very low (about 6%). Occupational statistics indicated that more than 80% of the married women did not have any job (were not working), about 17% belonged to the unskilled job category, and only 2% belonged to the skilled job category. About 46% of the married women had discussed family planning methods with their partners. More than 70% of the women were living in rural areas. Among the 6 administrative regions, the most number of women (24%) were from the Dhaka region, followed by Rajshahi (20%), Chittagong (18%), and Khulna (18%) regions respectively. Majority of the women (about 87%) were Muslin by religion, followed by Hindu (12%). About 30% of the women had lost at least one child. Number of living children and woman s status Table 2 revealed OLS regression coefficients (standardized) of the number of

5 TABLE 1 Background characteristics of all married women and the women not pregnant or amenorrheic in Bangladesh All married women (n=9696) Married women excluding not pregnant or amenorrheic (n=6493) Variables n % Variables n % Ever use of any method Current use of contraceptive Never use No Ever use Yes Education Education No education No education Incomplete primary Incomplete primary Complete primary Complete primary Incomplete secondary Incomplete secondary Complete secondary Complete secondary Higher Higher Occupation + Occupation Not working Not working Skilled Skilled Unskilled Unskilled Discussed FP with partner Discussed FP with partner No No Yes Yes Age Age Place of Residence Place of Residence Urban Urban Rural Rural Religion Religion Islam Islam Hinduism Hinduism Christianity Christianity Buddhism Buddhism Other Other 1 0 Region Region Barisal Barisal Chittagong Chittagong Dhaka Dhaka Khulna Khulna Rajshahi Rajshahi Sylhet Sylhet No. of children who died No. of children who died None None One or more One or more Mean no. of living children 2.58 Mean age at first marriage n=9647, n=9682, n=6454, n=6482

6 living children according to selected variables. The table showed that the women who had secondary (incomplete or complete) or higher education had significantly fewer children than those who had no education. Women with high-level jobs had significantly fewer children than those who were not working. The significantly negative relationship between number of living children and discussion of family planning with partner meant that the women who discussed family planning with their partner had significantly fewer numbers of children than that of the reference category. Among the control variables, age was significantly associated. Rural women had significantly more children than urban women. The women who belonged to Hindu and other religions had significantly fewer children than Muslim women. The regional statistics showed that women in Khulna had significantly fewer children than those in other regions. The relation between number of living children and number of children who have died was also statistically significant. Women who had lost one or more children had more children than those who did not. Age at first marriage was significantly negatively associated i.e., higher age at marriage was characterized by fewer living children. TABLE 2 OLS regression of number of living children with selected background characteristics for all married women, Bangladesh Variable Standardized co-efficient Education No education (r) Incomplete Primary (-.107) *** Complete Primary (-.108) *** Incomplete Secondary (-.255) *** Complete Secondary (-.135) *** Higher (-.209) *** Occupation Not working (r) Unskilled (.009) ** Skilled (-.017) ** Discussed FP with partner No (r) Yes (-.097) *** Age (-.156) *** (-.311) *** (-.174) *** (r) (.147) *** (.218) *** (.296) *** (.350) *** Place of residence Urban (r) Rural (.076) *** Religion Islam (r) Christian (-.041) *** Hinduism (-.013) Others (-.001) Region Barisal (.020) * Chittagong (.064) *** Dhaka (r) Khulna (-.033) ** Rajshahi (.005) Sylhet (.059) *** Number of children who died None (r) One or more (.338) *** Age at first marriage (-.243) *** n=9696, Notes: (r) indicates the reference group in each category. * P<0.05; ** P<0.01; *** P<0.001.

7 Ever-use of contraception and woman s status Table 3 presented the odds ratio (ORs) of logistic regression analysis, which was employed for ever-use of contraception. The odds ratio indicated that education was positively significantly associated with ever-use of contraception. Higher level of education showed stronger level of association. For example, women who had higher education were 5.2 times more likely to have ever-used contraception than those who had no education. The odds ratio was only 3.3 times more for women who had completed secondary education as compared to the reference category. Women from the skilled job category showed significantly higher likelihood (1.6 times) of ever-use of any contraception than those who were not working. However, the difference was insignificant between the women who did not work and who belonged to the unskilled job category. The women who discussed family planning with their partners showed 3.5 times higher likelihood of ever-use of contraception than those who did not discuss. The odds ratio of all control variables revealed significant association with respect to ever-use of contraception. Current use of contraception and woman s status Table 3 also showed the ORs of logistic regression analysis, which was employed for current use of contraception. The table indicated that only the ORs of complete secondary (OR=1.5) and higher education (OR=1.5) were significantly different from the OR of reference category (OR=1). Women with skilled jobs showed significantly higher current use (1.5 times) of contraception than the reference category. Similarly, women who discussed family planning with their partner was 2.8 times more likely to be a current user of contraception than reference category. Older age groups showed significantly higher ORs as compared to reference category. Rural women revealed significantly lower current use of contraception currently than urban women. Muslim women showed significantly lower use of contraception than Hindu and Christian women. As compared to Barisal region, Chittagong, Dhaka and Sylhet regions showed significantly lower use of contraception. Women who had lost one or more child were less likely to be a current contraceptive user than those who had not lost any child. TABLE 3 Odds ratios for ever-use and current use of contraception by women with selected background characteristics, Bangladesh Variable Odds ratios Ever-use Current-use Education No education (r) Incomplete Primary *** Complete Primary *** Incomplete Secondary *** Complete Secondary *** ** Higher *** *** Occupation Not working (r) Unskilled Skilled *** *** Discussed FP with partner No (r) Yes *** *** Age (r) *** *** *** *** *** *** *** *** *** *** *** *** *** *** Place of residence Urban (r) Rural *** ***

8 Religion Islam (r) Christian * *** Hinduism ** Others Region Barisal (r) Chittagong *** *** Dhaka ** * Khulna Rajshahi ** Sylhet *** *** Number of children who died None (r) One or more *** 0.98 ** Total n=9696 n=6493 Notes: (r) indicates the reference group in each category. * P<0.05; ** P<0.01; *** P< DISCUSSION AND CONCLUSIONS This study revealed that the three selected variables of woman s status namely education, occupation and discussion of family planning with partner were strongly associated with number of living children, ever-use of contraception and current use of contraception. This analysis supports all the three hypotheses mentioned earlier. According to the findings, higher education, skilled jobs, and discussion about family planning with partner were related with having significantly fewer number of children. However, our result relating to discussion of family planning with partner and number of living children was not similar (opposite) to the result of Alsaawi and Adamchak. 4 Martin and Juarez 26 explained the mechanisms of the inverse relationship between fertility and education. The educational experience has long-lasting implications for women s lives because education serves as a source of knowledge and cognitive skills, as a resource that enhances economic opportunities and social mobility; and as a socialization process that shapes attitudes, values and aspirations. According to their findings, the impact of education on reproductive behavior can be presented through the proximate determinants of fertility, particularly marriage timing, breastfeeding duration and contraceptive use. Women s expectations from family life, spouse selection, patterns of conjugal interaction, power relationships or women s sense of control over their body and destiny, may also work. Education increases women s knowledge and exposure to mass media. Mass media can influence fertility attitudes and behavior by publicizing nontraditional life styles, including smaller families, and by creating a climate conducive to behavioral change. Access to the various means of fertility control increases with education. Education considerably enhances women s knowledge about their bodies and reproductive physiology. Better educated women have higher household incomes, tend to reside in urban areas, and have a higher standard of living. Educated women have a less fatalistic approach to life and a higher command over their reproduction. When no additional child is desired, better educated women are more likely than less educated women to find the means to implement their desires. Women s schedules of family formation, which affect completed life time fertility, vary considerably with education. Compared with less educated women, those with more schooling enter into union later, and therefore they are older when they initiate childbearing. Women with better education find it easier to get a satisfying and financially rewarding job. Education enhances women s control over their own incomes through increasing labor force participation. 26 In summary, three indicators of women s status such as education, occupation, and

9 family planning discussion may have important implications in raising the current use of contraception, which ultimately reduce the fertility level and help to reach replacement level fertility. Since majority of women are still illiterate, unemployed, and not discussing family planning with their partners in Bangladesh, proper strategies should be implemented to improve the present condition. Women should be motivated to complete their education at least up to the secondary level. Information, education and communication (IEC) activities should continue to focus on the importance of dialogue between the husband and wife. REFERENCES 1. National Institute of Population Research and Training (NIPORT), Mitra and Associates (MA), and ORC Macro (ORCM). Bangladesh Demographic and Health Survey Dhaka, Bangladesh and Calverton, Maryland, USA, Govindasamy, P., and Malhotra, A. Women s position and family planning in Egypt. Studies in Family Planning, 27(3): , Dixon-Mueller, R. Female empowerment and demographic process: moving beyond Cairo. Policy and Research Paper N o 13, Paris: International Union for the Scientific Study of Population (IUSSP), Alsaawi, M. and Adamchak D.J. Women s Status, fertility and contraceptive use in Kazakhstan. GENUS, LVI (n.1-2): , Al-Riyami, A.A. and Afifi, M. Determinants of women s fertility in Oman. Saudi Medical Journal, 24(7): , Kawachi, I., Kennedy, B.P., Gupta, V. and Prothrow-Stith, D. Women s status and the health of women and men: a view from the States. Social Science & Medicine, 48(1): 21-32, Balk, D. Individual and community aspects of women s status and fertility in rural Bangladesh. Population Studies, 48(1): 21-45, Audinarayana, N. The effect of status of women on fertility in an urban setting in Tamil Nadu. Indian Journal of Social Work, 58(4): , Oppong, C. and Wéry, R. Women s Roles and Demographic Change in Sub-Saharan Africa, Policy and Research Paper No.5, Paris, International Union for the Scientific Study of Population (IUSSP), Lasee, A. and Becker, S. Husband-wife communication about family planning and contraceptive use in Kenya. International Family Planning Perspectives, 23(1): & 33, Chaudhury, R.H. The influence of female education, labor force participation and age at marriage on fertility behavior in Bangladesh. Social Biology, 31(1-2): 59-74, Mahmood, N. and Ringheim, K. Factors affecting contraceptive use in Pakistan. Pakistan Development Review, 35(1): 1-22, Salway, S. How attitudes toward family planning and discussion between wives and husbands affect contraceptive use in Ghana. International Family Planning Perspectives, 20(2): & 74, Tawiah, E.O. Factors affecting contraceptive use in Ghana. Journal of Biosocial Science, 29(2): , Oheneba-Sakyi, Y. Determinants of current contraceptive use among Ghanaian women at the highest risk of pregnancy. Journal of Biosocial Science, 24(4): , Ullah, M.S. and Chakraborty, N. The use of modern and traditional methods of fertility control in Bangladesh: a multivariate analysis. Contraception, 50(4): , Ullah, M.S. and Chakraborty, N. Factors affecting the use of contraception in Bangladesh: a multivariate analysis. Asia-Pacific Population Journal, 8(3): 19-30, Chaturvedi, H.K., Phukan, R.K. and Mahanta, J. Socio-economic factors and fertility or rural women: a study in upper Assam. Journal of Human Ecology, 9(2): , Larsen, U. and Hollos, M. Women s empowerment and fertility decline among the Pare of Kilimanjaro region, Northern Tanzania. Social Science & Medicine, 57(6): , 2003.

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