Thesis (M.S.)--University of Wisconsin-Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 93-101).

Philosophiae Doctor - PhD / Postpartum family planning (PPFP) is the initiation of family planning methods among postpartum women, within 12 months after delivery. During this period, the women are a vulnerable group of people with high unmet need for family planning. They are exposed to the risks of unwanted pregnancy, which potentially, could increase maternal mortality, due to the consequences of too frequent pregnancies. Studies have revealed a consistent low use of family planning during the postpartum period. Additionally, it has been documented that the low use of postpartum family planning, most likely, was attributed to inadequate services that had been rendered at healthcare centres, as well as poor motivation by those providing family planning services.

Introduction: Unmet need for family planning is high in most African countries including South Africa and Malawi as witnessed by high levels of teenage pregnancies, unwanted births and unsafe abortion. As such unmet need for family planning was added to the fifth Millennium Development Goal (MDG) as an indicator for tracking progress on improving maternal health. Objective: The primary objective of the study is to determine the correlates of unmet need for family planning among women of reproductive age in South Africa and Malawi. Data and Methods: The study used the 1998 South African Demographic and Health Survey (SADHS) and the 2000 Malawi Demographic and Health Survey (MDHS). Univariate, bi-variate and multi-nominal regression was used to determine the correlates of unmet need for spacing and limiting. Results: The results showed that unmet need for spacing birth in South Africa is 4.7% whereas unmet need for limiting births is 10.3% and the total unmet need for family planning is 15.0% in 1998. In the case of Malawi, unmet need for spacing births was 19.7%, whereas unmet need for limiting births was 13.9% and total unmet need for family planning was 33.5% in 2000. Unmet need for family planning in both countries varies by socio-economic variables. The results for multinomial logistic regression for South Africa indicate that age of the respondents; population group, marital status and children ever born were found to be determinants of unmet need of family planning for spacing. Age, region, marital status, educational level, ideal number of children and children ever born were found to be unmet need of family planning for limiting in South Africa. In the case of Malawi multinomial logistic analyses indicate that age, type of place of residence, number of children ever born, ideal number of children, the husband's approval of family planning, discussion of family planning with the partner and reading news of family planning in the newspaper are significantly related to unmet need of family planning for spacing and age and approval of family planning by a partner are found to be significantly related to unmet need of family planning for limiting. Conclusion: The findings have important policy implications. It is therefore, recommended that raising the status of women through education and skills development, increasing participation of men in sexual and reproductive health, promoting communication between couples are of prime importance in eradicating barriers to the use of contraceptive methods. / Thesis (M) North-West University, Mafikeng Campus, 2013

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This thesis reports the results of a randomised controlled intervention study carried out between May and November 1993 in a major public hospital in the metropolitan area of Fortaleza City, Ceará, Brazil. The objective was to investigate the impact of post abortion counselling on uptake of contraception and on subsequent pregnancy and abortion. The study population was a sample of women hospitalised with complications of induced abortion which were identified during as larger hospital-based study on abortion. The intervention was half an hour of contraceptive counselling prior to discharge at the study site hospital. No contraceptive method was given. A total of 695 women were enrolled into the study, 345 in the intervention group and 350 in the control group. They were followed up at home at 2 weeks, 6 weeks, 4 months, 8 months and 1 year after discharge. Data were collected by trained interviewers using a structured questionnaire. Outcome measures of interest were; knowledge of contraceptive methods, seeking contraceptive services, uptake of contraception, having unprotected sexual intercourse, subsequent pregnancies and subsequent abortion. The study results show that this particular mode of counselling (single shot hospital-based post-abortion) increased the level of knowledge of some contraceptive methods, but did not have any effect in changing behaviour such as seeking contraceptive services, uptake of contraception or having unprotected sexual relationship. As a consequence, counselling did not show any impact on preventing another unwanted pregnancy and induced abortion. Among 695 women, 165 (23.7%) became pregnant again before the end of the 1 year follow-up; 81 (23.5%) in the intervention group and 84 (24.0%) in the control group. Of the 695 women, 42 (6.0%) had another abortion before the end of the 1 year follow-up; 27 (7.8%) in the intervention group and 15 (4.3%) in the control group. At 6 weeks visit, of the 662 women interviewed, 345 (52.1%) were using contraceptive methods; 178 (53.8%) in the intervention group and 167 (50.5%) in the control group. Women who were not using contraception after abortion tended to be young, single or without a partner. "Not having sexual intercourse" was the most frequently cited reason for not using a contraceptive method during the follow-up period. Suggestions were made on how a more effective intervention that might prove more successful in responding to these women' s needs for enhanced contraception can be developed.

In Bangladesh, use of modern contraceptive methods has increased dramatically in the last decade. However, the level of use has not been the same between rural clusters. This dissertation investigates the plausible reasons for areal variations in use of modern contraception in rural Bangladesh. This study randomly selects sixteen rural clusters as sub-samples from the 1991 Contraceptive Prevalence Survey of Bangladesh. Information from female respondents of eligible age, as well as family heads and family planning workers are collected along with cluster-level community data, and family level information. The data are analyzed using simple bivariate tables as well as more sophisticated multilevel analysis using the software 'MLn'. Analysis of respondents using modern reversible methods finds that apart from the woman's age and number of living children, education of the family planning worker is the most influential predictor of use. Other significant predictors of ever use of modern reversible methods are the woman's education, religion, socio-economic status and her position within the family. Bari-level random effects were significant, indicating that a woman with `typical' characteristics but residing in the most favourable bari would have a higher probability of use than a woman with very favourable characteristics residing in a `typical' bari. Simultaneous confidence intervals of probabilities of use, for all clusters, found that most clusters were not significantly different in their ever use, although pockets of low use were observed. Analysis of acceptors of sterilization finds that apart from age and number of living sons, religion is the most influential predictor of use. Non-Muslims are more likely to be acceptors. Other significant predictors are the woman's education, position within the family, the participation of bari members with non-government organisations, and sanction of bari girls' education by bari head. Bari-level random effects showed in the same directions as those in the modern reversible methods model. Heterogeneity in the bari-level effect could not be explained by the recorded explanatory variables. After controlling for these explanatory variables, between-cluster variance was very small for users of sterilization. However, educated women had more between-cluster variance compared to non-educated women. Religiosity, attitude and beliefs of the respondents are vitally important in shaping attitudes towards contraceptive use. Replacement of some family planning workers with those having appropriate education and training are recommended. Family Planning programmes are strongly recommended to target `bari heads' and encourage them to look favourably upon modern contraception. Attempts should be made at removing ill-conceived religious barriers. Further recommendations are to encourage non-government organisations in areas which have low contraceptive prevalence, and encourage female education and emancipation generally.