As part of a larger study that documents changing reproductive and gender norms in six villages in two regions of Bangladesh, ethnographic research was conducted on women's perceptions of the benefits of contraception and their concerns about the use of family planning. Women reported both positive and negative experiences with family planning methods and programs.

Bangladesh

In Bangladesh, rural women live and work in the confines of the extended family home and compound. Many women have no independent sources of income, little or no education, and few marketable skills. Reproductive decision-making has been influenced by traditional female role expectations and women's dependence on men.

The massive family planning program in Bangladesh has taken into account women's isolation and dependence. It employs a vast force of female field workers to visit women in their homes and provides contraceptive methods free of charge.

Research Findings

As part of a larger study that documents changing reproductive and gender norms in six villages in two regions of Bangladesh, ethnographic research was conducted on women's perceptions of the benefits of contraception and their concerns about the use of family planning. Semi-structured, in-depth interviews were held with 104 women from the six villages. The women were selected from poor families with little or no land.

Women reported both positive and negative experiences with family planning methods and programs.

• The three areas of benefits that women perceived included economic, health and happiness.

• Economic benefits. Four-fifths of the women mentioned economic pressures as the primary reason, or one of the most important reasons, for limiting their family size. They perceived that family planning and smaller families enabled them to give their children better food, clothing and education.

• Health and physical well-being. Women mentioned relief from the physical stress of frequent childbearing as a benefit of family planning. One-third of the women said that limiting family size had positive effects on the mother's health and well-being.

• Happiness and harmony in the home. Twenty-seven percent of the women said that domestic peace and happiness were consequences of small families.

• Family planning is seen as a way to avert suffering, conflict and chaos. Yet for many women, the overwhelming feeling is that they missed an opportunity to achieve a better life through not starting family planning early enough or using it effectively.

Women also reported negative experiences with family planning.

• Side Effects. Among the 87 women who had ever used a contraceptive method, nearly half had experienced troublesome physical symptoms that they attributed to contraceptive use.

• Criticism for Using or Not Using Contraception. Many of the older women had been condemned for violating social norms when they started using contraception. In general, women adopting sterilization faced greater social stigma than pill users. However, as norms in the local community changed, criticism decreased. Now, some women feel social pressure against having too many children too rapidly.

• Regret. A few women expressed emotional distress about family planning decisions, such as sterilization and abortion.

Although women expressed some concerns about their experiences with contraceptives, most said they regretted that they had not used family planning earlier in life.

Recommendations

In contrast to other areas of their lives, family planning is a domain in which rural women are encouraged to take the initiative. In general, reproductive empowerment has not translated into better opportunities for women's control of other areas of their lives. The home contraceptive delivery system has reinforced the isolation of rural women using family planning. At this point in Bangladesh's family planning program, women may benefit from a shift in the venue of family planning services. By gradually encouraging women to leave their homes and seek information and services at fixed facilities, women will have access to a broader range of family planning services. At the same time, they may be able to translate reproductive empowerment into social and economic areas of their lives.

Study Details

This summary is based on: Schuler SR, Hashemi SM, Cullum A and Hassan M. The advent of family planning as a social norm in Bangladesh: Women's experiences. Reproductive Health Matters. 1996;7:66-78. This secondary analysis was supported by the Women's Studies Project, through a Cooperative Agreement to the U.S. Agency for International Development.