Researchers followed 56 new contraceptive users over an 18-month period to see how family pressures encourage or discourage contraceptive use.

Mali

In Mali, 4.5 percent of couples of reproductive age use modern contraception. But the rate in Bamako, the capital, has increased to more than 16 percent. However, even in Bamako, some women attend family planning clinics secretly, and discontinuation rates tend to be high. Little is known about Malian women's experience with contraception, what they expect from it, why many are reluctant to try it, and why some start but do not continue.

Research Findings

In this project, researchers followed 56 new contraceptive users over an 18-month period to see how family pressures encourage or discourage contraceptive use. This qualitative study was designed to explore experiences of new users of contraception, focusing on communication, support, and strategies women use to control their fertility. Women were recruited during their initial visit to the Association Malienne pour la Protection et Promotion de la Famille (AMPPF) Clinic and interviewed three times at eight- to nine-month intervals. Eleven focus group discussions were held with approximately 100 experienced users, married men, and older women with daughters-in-law. Thirty-two women who had never used contraception were interviewed at two points nine months apart.

• Women seeking family planning for the first time hoped that contraception would give them some relief from pregnancies spaced too closely together and from the burden of caring for large families.

• Most new users had discussed family planning with other women; never-users had rarely discussed family planning with anyone. Mothers-in-law were usually excluded from discussions, but sisters-in-law and aunts frequently offered support and advice. Study participants said women are expected to initiate family planning and persuade their husbands to allow them to attend the family planning clinic. Experienced users were generally optimistic that men would eventually agree if women explained the health and economic benefits of smaller families and pointed out successful experiences of others. Most never-users believed husbands would be opposed to family planning and feared that raising the issue would anger them.

• Married men were unanimous that women had no right to engage in family planning without their husbands' approval, and some advocated divorce for those who do.

• Married men expressed ambivalence about the concept of family planning; less than half said they did not expect their wives ever to use it. Some recognized economic and health benefits but believed protection from pregnancy might encourage women's sexual freedom.

• Women who were not able to gain husbands' approval sought support from husbands' older sisters and aunts who sometimes intervened on the wife's behalf.

• One-third of new users came to the clinic in secret, having failed to convince their husbands to let them use contraception. Most women feared punishment if discovered, -from harsh words, to isolation, to divorce.

• At the time of the second interview, 9 of 24 new users had discontinued family planning -- six because of side effects, two due to fear of the husband's retaliation, and one because of costs.

• Successful family planning users with supportive husbands were sharing their experience with other women and advocating use of contraception.

Recommendations

• Men tend to be on the fringe of family planning discussions. However, in a patriarchal society such as Mali, men's views affect women's actions. Findings of this study point to a need to reach men with accurate information on contraception and opportunities for informal discussion of family planning with male role models.

• Community agencies could develop support networks that employ successful contraceptive users, both women and men, trained to do peer outreach through informal education.

• Because women are concerned about contraceptive side effects, providers should be trained to improve their counseling skills as well as their management of side effects.

• Some women are eager to control their fertility but feel exceptionally vulnerable to punitive backlash from husbands and other family members opposed to contraception. These women should be identified in health clinics, helped to protect their confidentiality, and provided special counseling as needed to enable them to proceed safely toward their family planning objectives. Community outreach programs should be developed to help women who may be reluctant to attend family planning clinics.

Study Details

This study was conducted by Mr. Mamadou Konaté of the Centre d'Etudes et de Recherche sur la Population pour le Développement (CERPOD). Ms. Aminatou Djibo and Mr. Mamadou Djiré of CERPOD and Ms. Alison Roxby of Family Health International (FHI) assisted. Dr. Priscilla Ulin of FHI provided technical assistance. The study will be completed by September 1998 with analysis and incorporation of data from the third interview period (18 months after the women's initial visit to the family planning clinic). A final synthesis will be posted on FHI's web site when available. This study was supported by the Women's Studies Project at FHI, through a cooperative agreement funded by the U.S. Agency for International Development (USAID) and as part of a USAID program to support the Promoting Population Policy Development (PPPD) Project of CERPOD.