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Costs Can Influence Family Planning Decisions |
See Also:Issues in the Financing of Family Planning Services in Sub-Saharan Africa Brief 1: The Need for Additional Funds for Family Planning in Sub-Saharan Africa Brief 2: Charging Fees for Family Planning Services Brief 3: Expanding Commercial Sector Participation in Family Planning Brief 4: Reducing Costs and Enhancing Efficiency 
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Men and women who need family planning services often consider whether they can afford them, given other household expenses. They also weigh potential benefits of family planning against costs to obtain these services, which may include purchasing methods and supplies, traveling time to a clinic, child care during clinic visits and lost work time. And they should consider the future costs of having more children. Little research has been done on how couples make decisions about spending money on health care. However, a study in the Philippines, supported by FHI's Women's Studies Project, is exploring couples' decision-making, including decisions on family planning expenditures. Research in Cebu, located in the southern Philippines, found that women typically play the major role in decisions about household expenditures, while decisions about health and family planning are made jointly with other family members. For example, about two-thirds of women in a survey consulted no one else in their decisions to buy shoes or children's clothing, and 43 percent said they consulted no one when taking children to a doctor. However, women tend to consult others -- primarily spouses -- about decisions that involved larger expenditures. For example, 86 percent said they consulted spouses about major purchases for the household; 90 percent about buying land; 75 percent about hiring household help; and 84 percent about travel outside of Cebu. If conflicts arise, 82 percent of women said they and their spouse arrive at a mutual final decision, while only 12 percent said the husband's judgment prevails. In decisions about whether to use family planning, most women said they consult others. Only 12 percent of women said they made autonomous decisions about contraceptive use. Unlike other decisions where the spouse was the primary person consulted, some 20 percent of study participants said they talked with other adult females about family planning. Among women who consulted their husbands about family planning, 25 percent of women reported that, in case of conflict, the woman's decision prevailed. Only 7 percent reported that their husband's choice prevailed. The research was a recent follow-up to the 1983 Cebu Longitudinal Health and Nutrition Survey, a 10-year survey of approximately 3,000 households on contraceptive use and child spacing, as well as maternal diet and infant feeding patterns. The study was conducted by the Office of Population at the University of San Carlos in Cebu and the U.S.-based Carolina Population Center at the University of North Carolina, with support from FHI.1 To gather information for the follow-up study, interviewers named common household decisions and asked women whether they consulted anyone when making these decisions, whom they consulted, whose judgment prevailed in case of conflict, and what women do when they disagree with a decision made by someone else. Other studies have examined factors that influence couples' decision-making about household expenditures and have found that price is often only one consideration that affects family planning use. A study of rural women, also in Cebu, found that time spent in obtaining contraceptives was an important factor in women's use of contraception.2 Research in Thailand found similar concerns about the costs involved in obtaining methods.3 A small study, which surveyed 64 women in or near a fishing village in southern India, found that contraceptive prevalence was influenced by women's autonomy rather than income. In the village and surrounding rural area, contraceptive prevalence was 27 percent. Although women living in the village had higher family incomes and better access to health services, their use of family planning was the same as the rural women, who lived in a caste community. Researchers found that the main reason women gave for not using family planning was their lack of decision-making power. Women's age, family size, children's age and birth order affected women's decision-making power and access to money.4 A recent study in Pakistan found that a higher level of wives' unearned income -- possessions that the wife owns and the husband does not control, such as household goods, land or jewelry -- resulted in overall lower fertility for women in both urban and rural areas. Researchers found that if unearned income for rural women increased by 25 percent, compared to unearned income for men, the fertility rate would drop by one child per couple. Researchers recommended that since Pakistan's fertility rate is high -- 5.4 children per woman -- government policies that put more financial resources in the hands of women could ultimately help improve contraceptive use and lower fertility.5 -- Barbara Barnett References
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