Couples Pregnancy Ambivalence in Indonesia

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Couples Pregnancy Ambivalence in Indonesia

• Janine Barden-OFallon, PhD
• Ilene Speizer, PhD
• University of North Carolina at Chapel Hill
• October 29, 2008
• Session 5183.0 Contextual Factors Influencing
  Fertility Decisions
• Annual Meetings of the American Public Health
  Association

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Presenter Disclosure

• Janine Barden-OFallon
• The following personal financial relationship
  with commercial interests relevant to this
  presentation existed during the past 12 months
  No relationships to disclose.

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Working definition of pregnancy ambivalence

• The expression of seemingly contrary fertility
  desires and/or the expression of fertility
  desires that are contrary to contraceptive
  behavior
• Conventional method of categorizing fertility
  intentions may not accurately reflect the complex
  nature of fertility decision-making
• In the US, 32 of women who experienced a
  contraceptive failure did not report the
  pregnancies as unintended (NSFG 1995)

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Public health implications

• Women with ambivalent pregnancy attitudes are
  less likely to be current users of contraception,
  and when using, tend to use less effective
  methods and to use them less effectively
• Pregnancy ambivalence can lead to contraceptive
  failure and contraceptive discontinuation for
  reasons other than to become pregnant
• Measurement researchers use of fertility desires
  may misrepresent womens actual fertility
  intentions

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Study objectives

• Explore the issue of ambivalence using a couples
  perspective with recent data from Indonesia
• How do husbands and wives respond to the same
  questions on fertility desires?
• Is there evidence of pregnancy ambivalence in
  both husbands and wives? What is the
  correspondence between husbands and wives
  ambivalent attitudes?
• Does pregnancy ambivalence influence womens
  contraceptive use?

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Data Indonesia Demographic and Health Survey
2002-2003

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Methods

• Sample includes 5,148 couples who responded to
  the problem question and were not missing any
  key variables used in the analysis
• Problem question categorized as No problem vs
  Any problem (Big/Small)
• Other variables include current contraceptive
  use, fertility desires, age, education,
  children ever born and HH wealth
• Descriptive comparisons and multivariate analysis
  with contraceptive use as the outcome
• All proportions are weighted for sample design

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Husbands and wives contraceptive use and
fertility desires, IDHS 2002/03 N5,148
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Most husbands and wives who want to delay or stop
childbearing are using contraception
Husbands and wives contraceptive use by
fertility desires N5,148
Contraceptive use
Husbands ()
Wives ()
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Pregnancy ambivalence is high in contraceptive
users, especially among men
Husbands and wives' fertility desires by whether
a pregnancy in the next few weeks would be no
problem, among contraceptive users
Husbands Sample N3,919
Wives Sample N3,985
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Similar levels of ambivalence are seen in
non-users
Husbands and wives' fertility desires by whether
a pregnancy in the next few weeks would be no
problem, among non-users
Husbands Sample N1,229
Wives Sample N1,163
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Couples agreement on ambivalence is relatively
low among users
Couples concordance on pregnancy ambivalence
report of no problem among contraceptive users
that want to delay or stop childbearing N3,085
Husbands report
Kappa value agreement 63 kappa statistic0.26
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Couples agreement on ambivalence is also
relatively low among non-users
Couples concordance on pregnancy ambivalence
report of no problem among non-users that want
to delay or stop childbearing N750
Husbands report
Kappa value agreement 61 kappa statistic0.24
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Multivariate logistic regression of wifes
reported contraceptive use among couples in which
at least 1 partner wants to delay or stop
childbearing N4,914

• Variables
• Age 15-24, 25-34, 35 (REF)
• Education none, primary, secondary (REF)
• Children ever born 0-1 (REF), 2-3, 4
• HH wealth poorest 40, middle 20 (REF),
  wealthiest 40
• Couples ambivalence one partner ambivalent,
  both ambivalent, neither ambivalent (REF)
• Couples fertility desires
• one partner wants to delay while other wants to
  stop
• one partner wants to delay or stop while other
  wants another child w/in 2 years or is undecided
• both want to delay
• both want to stop (REF)

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Couples discordance on pregnancy ambivalence and
fertility desires has an effect on contraceptive
use
MV Regression of wifes contraceptive use among
couples in which at least 1 partner wants to
delay or stop childbearing N4,914
Adjusted Odds Ratios

• One partner wants to delay other to stop (2) one
  partner wants another child soon or is undecided
  
• P

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Conclusions

• In Indonesia, more men than women express
  ambivalence, which may present barriers to
  contraceptive adoption, effective and/or
  continuous use
• There is not always agreement within the couple
  women in couples that were discordant on
  pregnancy ambivalence were significantly less
  likely to be using contraception
• If pregnancy ambivalence is to be addressed
  programmatically, both members of a couple should
  be targeted
• Pregnancy ambivalence in non-users indicates that
  estimates of true unmet need may be too high

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Thank you

• MEASURE Evaluation is funded by the U.S. Agency
  for International Development (USAID) through
  Cooperative Agreement GPO-A-00-03-00003-00 and is
  implemented by the Carolina Population Center at
  the University of North Carolina in partnership
  with Futures Group International, John Snow,
  Inc., Macro International Inc., and Tulane
  University. The authors views expressed in this
  presentation do not necessarily reflect the views
  of USAID or the U.S. Government. Visit us online
  at
• http//www.cpc.unc.edu/measure