Many studies have examined how aspects of women's lives influence their use of family planning. When FHI's Women's Studies Project (WSP) began in 1993, researchers reversed the equation, exploring how family planning use affects various aspects of women's lives.
Whether women felt they had or had not benefited from family planning methods and services, and if so, how, were central questions. In order to determine women's perspectives on this issue, in-country researchers as well as FHI staff went directly to the women themselves, asking them which research issues were important to study.
Twenty-six field studies were conducted in 10 very diverse developing countries, using both qualitative and quantitative research methods. Women expressed their views on family planning by completing surveys and by participating in focus group discussions and in-depth interviews. Additional information was obtained from secondary analyses of data from four countries as part of the project, which is supported by the U.S. Agency for International Development.
The project sought to look beyond the narrow focus of the impact of family planning on women's health. Studies also examined how women's family planning experiences -- their contraceptive use and non-use, their pregnancies and childbearing, and their experiences with family planning and reproductive health programs -- affected other aspects of their lives, including their roles as individuals, as family members and as participants in the larger community. Some studies interviewed women's relatives, including husbands or partners, parents and in-laws, to determine how family interactions and power dynamics influence contraceptive experience and use.
The variety of the project's research topics reflects the diversity of women's concerns:
the impact of men's views on women's contraceptive behavior (Bolivia)
the impact of family planning on women's domestic lives (Indonesia)
the impact of tubal ligation on quality of life (Brazil)
the social and behavioral consequences of unintended pregnancy (Egypt)
the effects of gender on adolescent views of sexuality (Jamaica)
the impact of family planning on women's self-esteem and self-image (the Republic of Korea)
the impact of family planning use on women's participation in the work force (the Philippines)
family planning and women's participation in the development process (Zimbabwe)
strategies developed by new users to cope with family and community opposition to contraceptive use (Mali)
generational differences in family planning use (China).
These topics and others were selected by colleagues who formed in-country advisory committees (IACs) in participating countries. Researchers, policy-makers and providers, and women's health advocates formed an IAC "triangle," which became a critical component of the research process, in each emphasis country (countries that were the site of more than one study). The IACs established the research agenda, monitored the research process and planned dissemination of research results.
To guide research and data analysis, the project staff developed a conceptual framework, based on previous models and research. This framework incorporated the complex and multidimensional aspects of women's lives; considered the possibility that strong external factors, such as gender norms and sociopolitical climates, influence women's use and experience with family planning; and placed family planning in the context of women's larger reproductive health needs.
Common issues emerge
The completed studies illustrate the differences in perceptions that exist between women and men, and among women, due to age, culture, place of residence, socioeconomic class, religion and gender norms. However, common issues emerged, which were formulated into 16 crosscutting themes.
There were two general themes: that gender norms (the roles prescribed by society for women and men) play a significant role in shaping women's family planning experiences and that family planning affects multiple domains of women's lives -- domestic, economic and community. The other 14 themes are more specific, and address benefits to women, costs to women, barriers to contraceptive benefits and service delivery issues.
Benefits to women
Most women are convinced that practicing family planning and having smaller families provide health and economic benefits.
Family planning can offer freedom from fear of unplanned pregnancy and can improve sexual life, partner relations and family well-being.
Where jobs are available, family planning users are often more likely than non-users to take advantage of work opportunities.
Family planning helps women in their roles as wives and mothers, but it is only part of what women need to attain equal opportunity with men in society.
Costs to women
Contraceptive side effects are a serious concern for many women.
When partners or others are opposed, practicing family planning can increase women's vulnerability.
When women have smaller families, they may lose the security of traditional roles and face new and sometimes difficult challenges.
Barriers to contraceptive benefits
Social, political and economic barriers prevent women from benefiting from family planning.
The benefits of family planning for women are reduced when contraceptive methods are ineffective, used incorrectly or inconsistently, or discontinued early (before pregnancy is desired).
For some adolescents, pregnancy is wanted.
Family members -- particularly husbands -- play a critical role in women's experiences with family planning.
Family planning is often initiated late in reproductive life.
Service delivery issues
Men often have a dominant role in family decisions but tend to be marginalized by family planning programs.
Women are generally satisfied with family planning services but want more female providers, more emotional support, help with side effects, and more information on contraceptive methods.
One of the main purposes of the project was to encourage the use of research findings to improve the quality of women's reproductive health services. Indeed, the results have clear implications for health policies and programs.
For example, contraceptive counseling must take into account gender norms, the barriers these norms may pose to family planning, and whether women benefit from family planning use. Peer networks, in which experienced contraceptive users counsel new users about the everyday realities of method side effects, should be established.
Men and other key family members need to be informed and educated about family planning. Providers need better training on how to assist clients experiencing contraceptive side effects. Counseling should emphasize the benefits of contraceptive use beyond health and economics, including emphasis on improvement in marital relationships. Family life education should begin early.
The project found that while women perceive numerous benefits of family planning use, they also see negative consequences, such as family disapproval and method side effects, which can discourage them from taking control of their fertility.
By understanding the intricate realities of women's lives and the factors that affect their reproductive health, family planning programs can offer services that match women's needs and ultimately can help improve the quality of women's lives.
By Nancy Williamson, PhD Former FHI Women's Studies Project Director
Note: Dr. Williamson led the Women's Studies Project from its inception until August, when she joined the Frontiers in Reproductive Health project, serving as global operations advisor. FHI and Tulane University School of Public Health are partners with the Population Council in the Washington-based Frontiers project.
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