PIP: Analysis of family planning clinic services offered by the FFPA and its state Family Planning Associations in Malaysia in 1978 has shown that oral contraceptives continued to be the most popular contraceptive method among family planning acceptors, but there had been notable increases in acceptance of the condom and the IUD. There was a marginal decrease from 1977 figures in the acceptance rate among the new and continuing acceptors of OCs in Peninsular Family Planning Associations. 77.1% of new acceptors chose OCs in 1978, compared with 85.3% in 1977. 15% of the new acceptors chose condoms in Peninsular Family Planning Associations last year, compared with 10.2% in 1977. The injectable contraceptive has been well received in Sawawak; 14,681 vials were dispensed in 1978.
This study explores contraceptive practice and decision making of women who have experienced abortion in Malaysia. In-depth interviews were carried out with 31 women who had abortions. Women in this study did adopt some method of modern contraception prior their abortion episodes. However, challenges to use a method consistently were experiences and fear of side effects, contraceptive failure, partner's influence, lack of confidence, and cost. The decision to adopt contraception was theirs but the types of contraceptive methods to adopt were influenced by their spouses/partners. The women wanted to use modern contraception but were faced with challenges that hampered its use. More proactive contraceptive promotion is needed to educate people on the array of contraceptive methods available and made accessible to them, to correct misconceptions on safety of modern contraception, to increase men's involvement in contraceptive choices, and to encourage consistent contraceptive use to prevent unintended pregnancies.
OBJECTIVE: Many forms of contraception are available on prescription only for example, the oral contraceptive pill (OCP) and long-acting reversible contraceptives (LARCs). In this analysis we aim to identify key determinants of prescription contraceptive use.
DESIGN: Cross-sectional population survey. Data on sociodemographic indices, concerns about the OCP and perceived barriers to access were collected.
SETTING: Data set constructed from a representative population-based telephone survey of community dwelling adults in the Republic of Ireland (RoI) PARTICIPANTS: 1515 women aged between 18 and 45 years
MAIN OUTCOME MEASURE: Self-reported user of the OCP or LARCs (intrauterine contraception, contraceptive injections or subdermal contraceptive implants) in the previous 12 months.
RESULTS: For at least some of the previous year, 35% had used the OCP and 14% had used LARCs, while 3% had used two or more of these methods. OCP users were significantly younger, more likely to be unmarried and had higher income than non-users. Overall, 68% agreed with the statement 'that taking a break from long-term use of the contraceptive pill is a good idea' and 37% agreed with the statement that 'the OCP has dangerous side effects' and this was the strongest predictor variable of non-use of the OCP. Intrauterine contraception users were significantly older, more likely to be married and had lower income than non-users. Injections or subdermal contraceptive implant users were significantly younger, less likely to be married, had lower income and were less likely to agree that taking a break from long-term use of the pill is a good idea than non-users.
CONCLUSIONS: Prescription contraceptive use is sociodemographically patterned, with LARCs in particular being associated with lower incomes in the RoI. Concerns about the safety of the OCP remain prevalent and are important and modifiable determinants of contraceptive-related behaviour.
Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.
The continuing decline in fertility despite a contraction in contraceptive use in Peninsular Malaysia since the mid-1980s has triggered considerable interest in the reasons behind this phenomenon, such as increase in abortion, sterility, and out-of-wedlock pregnancy. Fertility decline has been attributed to rapid socioeconomic development, which can only influence fertility through the intermediate variables. Application of vital statistics, population census, and survey data of Peninsular Malaysia on Bongaarts's model vindicates that marriage postponement and contraceptive use are the 2 most important proximate determinants of fertility, but the effects are not uniform across the ethnic groups. For instance, the predicted total fertility rate for Chinese and Malays are 2.9 and 1.6, respectively, compared with the observed level of 3.0 and 1.9. Postpartum infecundability and abortion also play a part in explaining ethnic fertility differentials. The fertility inhibiting effects of these proximate determinants have significant implications on reproductive health and future population growth.
This report examines Malaysian women's perceptions of the contraceptive effect of breastfeeding, the determinants of their perceptions, and any effect these perceptions might have on nursing duration and contraceptive use. The report also considers whether women are consciously replacing breastfeeding with modern contraceptive methods. Data from the 1976 Malaysian Family Life Survey are analyzed, and the author concludes that Malaysian women do perceive that breastfeeding has a contraceptive effect, but that this perception is not universal. Ethnicity and desire for a particular family size are the most significant determinants of this perception. Finally, Malaysian women's recognition of the contraceptive effect of nursing does not influence either the duration of their breastfeeding or their adoption of contraception. Malaysian women may not be abandoning breastfeeding to adopt contraception. More probably, breastfeeding declines and contraceptive prevalence increases with modernization.
Recent research has shown that children born before and after short birth intervals run a considerably greater risk of dying in infancy or childhood than do others. This report investigates which women have short interbirth intervals, under what circumstances, and for what reasons. The analysis uses data from the Malaysian Family Life Survey to examine influences on the two main behaviors--breastfeeding and contraceptive use--that affect birth interval length, and assesses the the impact of these same variables on the probability of having a birth interval of less than 15 months. The analysis shows that many of the independent variables affect breastfeeding and contraceptive use in opposite directions, with no significant net effect on the likelihood of a short interval. For example, a woman's education is negatively related to the probability that she breastfeeds, positively related to the probability that she uses contraceptives, and has no significant effect on the likelihood that the interpregnancy interval is less than 15 months. Having a family planning clinic nearby is associated with less breastfeeding, offsetting whatever positive effects family planning clinics have on contraceptive use in terms of the percentage of birth intervals that are so short as to be detrimental to infant and child health. Hence, factors that increase contraceptive use do not necessarily reduce the incidence of short interbirth intervals, because they are also associated with reduced breastfeeding. We simulate the proportion of intervals that would be short for alternative combinations of breastfeeding and contraceptive use in the population and show that over the period covered by the data (1961-75), breastfeeding had a considerably greater effect on preventing short interbirth intervals than did contraceptive use.
Analysis of World Fertility Survey data from five countries--Colombia, Costa Rica, Korea, Malaysia and Nepal--shows that the availability of contraceptive services and supplies is a major determinant of use. In Nepal, where few women know where to obtain supplies, only two percent are contracepting. In Costa Rica, where almost all married women know an outlet nearby, 53 percent use effective methods.
The intervals between pregnancies have important effects on fertility and maternal and infant health outcomes. This study uses linear regression with censored observation to assess the determinants of the waiting time to third pregnancy. The analysis is applied to data from the Second Malaysian Family Life Survey consisting of 1172 women who had their second delivery ending in a live birth. Contraceptive use, age of the woman, duration of breast-feeding, length of previous pregnancy interval and education of the woman all affect the waiting time to third pregnancy significantly.
Background and Objectives: Unmet need for contraception is the gap between women's reproductive intentions and their contraceptive behavior. This community based interventional study was carried out to determine the unmet needs for contraception, the reasons for this and to assess the impact of interventional measures on acceptance of contraception.
Subjects and Methods: This study was conducted in 52 villages in the state of Maharashtra, India, among 363 married women selected by cluster sampling. Data was collected using an interview guide. An intervention was done for the women who had an unmet need and an assessment of the change was done subsequently. Data was analyzed by using SPSS.
Results The prevalence of contraceptive usage was 59.2% and the prevalence of unmet need for contraception was 44% (160). The unmet need for spacing births was 53.8%, 38.7% for limiting births and 7.5% women were dissatisfied with the current contraceptive method. The reasons ranged from side effects to contraceptives to source of obtaining contraceptives. Age of the respondents, education and number of living children showed statistically significant association with unmet needs. Post intervention, the contraceptive prevalence rate increased significantly 85.7% and there was a significant reduction in the unmet needs for spacing and limiting births, equally there was a significant reduction of dissatisfaction with using contraception.
Conclusion: Improvement in the use of contraception and addressing the unmet need for contraception requires community involvement and ongoing, sustained efforts by health workers to ensure quality care to the beneficiaries.
Which factors have the greater influence on family planning performance: fixed background variables such as racial composition, urbanization, and mortality, which are affected by level of development, or program inputs such as assignment of personnel and location of clinics, which are subject to manipulation by administrators? An analysis of differences in family planning acceptance among 70 districts of Malaysia shows that two main program-manipulable variables--level of personnel deployment and accessibility of clinics--have the largest direct effect upon acceptance levels. Variations in background factors explain a smaller proportion.
The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. Nevertheless, estimates of fecundability from World Fertility Survey data for women married in recent years appear to be plausible for most of the surveys analyzed here and are quite consistent with estimates reported in earlier studies. The estimates presented in this article are all derived from the first interval, the interval between marriage or consensual union and the first live birth conception.
INTRODUCTION: Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use.
METHODS: This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants.
RESULTS: A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77).
CONCLUSION: About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.
Study site: Outpatient clinic, three hospitals; 8 health clinics, Malaysia
BACKGROUND: The increasing trend of premarital sexual experience and unintended pregnancies in Malaysia warrants sustained and serious attention. The sensitivities of sex-related issues in a Muslim-majority country create various types of barriers to sexual and reproductive health information, support and practices. This study aims to gain understanding of knowledge, attitudes and behaviours of young women in Malaysia concerning reproductive, contraception and premarital sexual practices.
METHODS: A cross-sectional study was performed, using an anonymous self-administered questionnaire carried out among 1695 female university students in a public university in Malaysia.
RESULTS: Respondents had low scores for knowledge of reproduction and pregnancy (median=4, of maximum score 10), contraceptive uses (median=6, of maximum score 16) and contraceptive availability (median=3, of maximum score 13). The majority of women surveyed do not have liberal values in relation to premarital sexual behaviour (median=37, of maximum 40); higher scores on this scale corresponded to opposing premarital sex. The multivariate analyses showed that ethnic group was the strongest correlate of knowledge and attitude scores; being of Malay Muslim ethnicity was associated significantly with lower knowledge scores and premarital sex permissiveness. Other significant correlates were year of study, maternal occupational groups, level of religious faith, dating status and urban-rural localities. Level of premarital sex permissiveness was inversely correlated with reproduction and pregnancy knowledge score, and contraceptive knowledge scores.
CONCLUSION: Reproductive health knowledge and attitudes were intricately linked to religious values and cultural norms differences surrounding sexual issues.
Findings on the demographic and sexual health characteristics associated with the experience of a crisis pregnancy are important to inform the public health policy of a country, including Ireland. Studies from other jurisdictions have suggested that certain demographic groups are at risk for unintended pregnancies and the disparity between the groups has been growing in recent years. Ireland is a country which experienced much economic and societal change in the first decade of the 21(st) century; changes which are likely to have affected demographic variables pertaining to sexual health. The current study had two aims: to investigate changes in the socioeconomic characteristics associated with crisis pregnancies over a seven year period [2003 to 2010], and to investigate the recent  socioeconomic risk factors associated with crisis pregnancies in Ireland.
An increase in the use of health services and contraception is usually associated with a decrease in breastfeeding. This study seeks to establish the relationship between maternal use of health services and breastfeeding practice. Data was obtained from the Sarawak Population and Family Survey of 1989. The breastfeeding pattern of 1583 children born to 1047 women aged between 15-49 years in the five years preceding the study were analyzed and compared among the various groups using maternal health services and contraception. Results showed that Sarawak has a very short mean duration of about 6 months for breastfeeding. Women attending antenatal and postnatal clinics had shorter breastfeeding durations but higher initiation rates compared to those who did not. Those whose delivered by doctors and those delivering in private hospitals were least likely to breastfeed. Contraceptive use was also negatively associated with breastfeeding duration. Whilst it is commendable that the use of maternal health facilities is high in Sarawak, the inverse relationship to breastfeeding can offset its health benefits. Health policies can play a part to arrest this decline which is also related to socioeconoic development.