FHI - July 1998

Study Reports on First-time Contraceptive Users in Mali -- July 1998

RESEARCH TRIANGLE PARK, NC, USA -- A new study undertaken in Mali shows that women sometimes risk divorce or abandonment when they use modern methods of contraception, if their husbands oppose family planning. And women whose husbands approve of family planning are more likely to be satisfied with their contraceptive decisions than those with husbands who do not.

To learn more about women's experiences -- why they start using contraception, why they continue or discontinue use -- researchers from the Centre d'Etudes et de Recherche sur la Population pour le Développement (CERPOD) in Bamako, Mali conducted a study of first-time contraceptive users. The research was part of the Women's Studies Project (WSP) at Family Health International (FHI), a five-year international project to explore the impact of family planning on women's lives. Mali was one of 10 countries to participate in field studies, with funding provided by the U.S. Agency for International Development.

The study found that when husbands did not approve of family planning, some women used contraception without the men's knowledge. Approximately one-third of new contraceptive users were clandestine users. Women sometimes hid contraceptive methods in their homes, at their work places or at friends' houses. Others used injectable contraceptives, which did not require them to keep supplies where they might be discovered. One woman who used oral contraceptives said, "On holidays, I am nervous. Each time he goes into the room, I tell myself he must have found them [pills]. My heart beats faster until I take my pill in the morning." At the time of the first follow-up interview eight months after the study began, two women had revealed their contraceptive use to their husbands with no negative consequences.

Women cited several benefits of contraceptive use: more time to devote to their families, better health when pregnancies were not close together, and more time for work and leisure activities. One woman explained, "I am free to work now because I do not have a small baby, I am not pregnant, and I do not have a sick child at home." Another said she had more time to care for her family. "Your children will be well taken care of, they will eat as they should, you won't be tired or anything."

One in four women in Mali wants to space or limit pregnancies, but fewer than 5 percent of all women currently use a modern family planning method. In urban areas, the number of contraceptive users is higher: 16 percent of all women in Bamako, the capital. However, one recent study of new users in Bamako found that 60 percent had discontinued family planning in the first 15 months.

Women in the WSP study were interviewed to learn what they expected from family planning, if and how they discussed it with their husbands and other family members, and how family attitudes affected their use of contraceptives. The study also examined strategies that some women adopt when they want to use family planning in spite of opposition.

In-depth interviews were conducted with 55 married women on the first day they arrived at the Association Malienne pour la Promotion et Protection de la Famille (AMPPF) clinic to obtain family planning services. Additional interviews were held nine months and 18 months later with the 41 women who remained in the study. Thirty-two women from the same communities who did not use contraception also were interviewed. In addition, husbands, mothers-in-law and experienced contraceptive users were interviewed in focus group discussions.

Women seeking services at the AMPPF clinic said mothers-in-law, often a powerful force within the Malian family, had little influence on their contraceptive decisions. However, husbands' opinions were very important. Husbands were unanimous that they should have the final say on women's contraceptive use. "(The husband) is the decision-maker, he does not need anyone else's opinion," said one man. Another said, "Only the man has the right to make decisions." Among married men who were interviewed in focus groups discussions, less than one-third said they would want their wives ever to use family planning.

To convince their husbands of the benefits of family planning, many women sought help from their older sisters-in-law. "(My sister-in-law) asked me to speak about it first to my husband and if he refused, to have him talk to her, and she would make him understand," said one woman.

Other women tried to explain to their husbands that child spacing would benefit the entire family. One 32-year-old woman with five children said, "I showed him that the children are closely spaced and that life is difficult -- it (contraception) would give us a rest. That's how I told him, and he agreed." Another woman said that fewer children would mean greater economic security for the family. "Each time you get sick, he spends money on prescriptions. When he brings the medicines to you, you say, 'If I had adopted family planning, I would not be sick and you would not have this expense.' "

Eight months after the initial interviews, nine of the 41 women still in the study had discontinued their contraceptive methods. Six said they stopped because of side effects, two because their husbands disapproved, and one because she did not have money to travel to the clinic. Although some women said they had been counseled about possible side effects and knew what to expect, the reality was too unpleasant. "Even though they told me ... I would go all this time without seeing my [menstrual] period ... well, I wasn't really ready for that."

Among female study participants who had never used contraception, the majority approved of family planning but had little information on methods and services. More than half assumed their husbands would disapprove, and few had broached the subject. Others said they did not want to use family planning until after they had their desired number of children, and others feared side effects.

Because men play such a crucial role in their wives' use or non-use of contraception, researchers recommended that family planning programs expand education and counseling for men. Because women seek advice from sisters-in-law and other female relatives about contraception, and because successful users in the study told other women about family planning benefits and side effects, researchers also suggested that peer networks be formed to help educate and support women's use of contraception.

FHI is a US-based, not-for-profit organization that provides the highest quality research, education and services in family planning, STDs/HIV and family health to improve the health and well-being of populations worldwide.

For more information about these studies, contact Barbara Barnett, Senior Science Writer/Editor, Family Health International, at 1-919-544-7040, Ext. 482. Or fax 1-919-544-7261 or e-mail: bbarnett@fhi.org.

See Also:

Study Reports on First-time Contraceptive Users in Mali -- July 1998