Researchers surveyed 630 couples of reproductive age (ages 20 to 49) who were married or in a consensual relationship to examine men's views or the roles men play in their partners' use of contraception or the perceived consequences of family planning.

Bolivia

In Bolivia, as in most countries, women are the primary users of family planning methods and services. Research has shown that contraceptive use is linked to culture, religion and education. However, gender norms also may influence women's contraceptive choices and patterns of use. Few studies in Bolivia have examined men's views or the roles men play in their partners' use of contraception or the perceived consequences of family planning.

Research Findings

Cooperazione Internationale, a non-governmental organization, surveyed 630 couples of reproductive age (ages 20 to 49) who were married or in a consensual relationship and living in urban Cochabamba,. The couples came from three neighborhoods, reflecting high, medium and low socioeconomic status (SES).

Prior to development of the survey questionnaire, researchers conducted eight focus groups to develop indicators of self-esteem, self-determination, overall relationship with partner, and sexual relationship with partner.

Ninety-three percent of the study population responded to the questionnaire with the following results:

• Although women are the primary users of contraception, men's awareness of family planning methods was slightly higher than women's. Both men and women expressed positive attitudes about family planning use, saying that men should support partners' contraceptive decisions and men themselves should assume responsibility for using a family planning method.

• In spite of widespread knowledge and positive attitudes about family planning, communication between couples was lacking and remains a barrier toward effective contraceptive use. Only half the men and women said they talked about the number of children they wanted, and concordance about current method use between couples ranged from 64 to 87 percent. Concordance was lowest for users of traditional methods.

• Women who used modern methods reported greater sexual satisfaction, possibly because the fear of pregnancy was reduced. To measure sexual satisfaction, women were questioned about whether they could tell their partners when they did not want to have sex, whether it was acceptable for women to initiate sex, and whether they felt free to tell their partners what they did and did not like sexually. Women who were most satisfied with their sexual relationship were those who used a modern method during the past 30 days, had been married less than five years, and had some college education.

• Women with higher self-esteem (determined by whether the woman viewed herself as a good mother and partner, good at work, responsible, happy, and smart) were also more likely to report higher levels of sexual satisfaction.

• Women currently using contraception (both modern and traditional methods) reported better overall relationships with their partners than did those who were not using a contraceptive method.

• Contraceptive use in urban Cochabamba was high. Two-thirds of study participants said they had used a modern contraceptive method during the past 30 days. Forty-one percent of couples said they used a modern method - the intrauterine device and the condom were the most commonly used - while 26 percent said they used a traditional method, mainly rhythm. However, of those using traditional methods, only 67 percent of women and 53 percent of men could accurately identify the fertile period of the woman's menstrual cycle.

• Forty-two percent of women (and men) who were not using family planning were at risk of pregnancy. Reasons for non-use were: breastfeeding or postpartum period (28 percent), medical problems (18 percent), lack of information (16 percent), or dislike for methods (14 percent). Only 1 percent feared health problems from contraceptive use.

• Ninety-five percent of study participants using contraception said they and their partner were satisfied with their current contraceptive method. Of those who were dissatisfied, men said the reason was because contraception diminished their sexual pleasure, while others said they believed their method was ineffective. Women said they were dissatisfied with their family planning method because they believed it was ineffective, while others said they wanted more children or were concerned about side effects (nervousness and weight gain). However, these numbers are small and the researchers advised caution in drawing conclusions.

• There were differences in contraceptive knowledge and use among the three different socioeconomic (SES) areas. Study participants from the medium socioeconomic income area reported the highest fertility levels, lowest knowledge and use of modern methods, highest traditional method use, largest households, and lowest self-esteem among women. Researchers concluded that residents of this "working poor" area may be missing public messages designed for residents of low-income areas and private-sector messages designed for those in the high SES area.

Recommendations

Contraceptive use in urban Cochabamba is high, with two-thirds of couples reporting that they used a modern or traditional method during the previous month. Men and women have positive attitudes about contraception, and men are slightly more knowledgeable about methods than women. Users of modern methods say they are more sexually satisfied than couples who do not use contraception. Yet, communication between partners is lacking, and this presents a barrier to family planning use. Family planning programs should encourage men and women to communicate with their partners regarding contraceptive use and other reproductive health decisions. Family planning programs should consider offering counseling for couples, to help them improve their communication skills regarding family formation. Programs should involve men with positive attitudes to work in peer networks designed to increase men's participation in the domain of reproductive health. Given the differences found among the three urban strata, messages should be targeted at the working poor who seem to have the least information and access to services.

Study Details

Mr. Emilio Zambrana of Cooperazione Internazionale and Ms. Donna McCarraher of Family Health International (FHI) were responsible for this study. The study was supported by the Women's Studies Project, with funding provided through a cooperative agreement to the U.S. Agency for International Development and field support from the Mission in Bolivia.