Women's Voices, Women's Lives:The Impact Of Family Planning

Conceptual Framework

To understand better the impact of family planning on women's lives, the WSP staff developed a broad conceptual framework, which served as a tool for designing studies and analyzing research findings.46 The framework proposes relationships between family planning use and multiple domains of women's lives, in a context where external factors can affect both. (See Figure 1) This framework became a road map for planning projects as well as a compass for monitoring the direction of the work and conceptualizing the overall goals of the WSP.

In developing this WSP framework, staff built upon their own experiences and the work of other researchers in reproductive health, population, and women's studies, including:

• Oppong's framework on the seven roles of women, which describes women's roles as individual, parental, conjugal, domestic, kinship, community and occupational.47

• The Hong-Seltzer framework, which is designed to examine the impact of family planning on six domains of women's lives: autonomy and self-esteem, health status, family relations, public standing, educational attainment, and economic resources.48 This framework was USAID's original theoretical basis for the design of the Women's Studies Project.

• Schuler and Hashemi's framework on women's empowerment, which presents women's sense of self and vision of the future, their status and decision-making in the household, the ability to interact in the public sphere, participation in non-family groups, mobility and visibility, and economic security.49

• Studies on quality of life, which examine psychological status and well-being, physical health, social interactions, and economic status.50

• J. Mayone Stycos' model of the psychosocial consequences of contraceptive use, which postulated short-term positive and negative consequences of contraceptive use (diminished anxiety about pregnancy, increased sexual freedom versus anxiety about side effects, guilt and shame) on women's roles and their quality of life.51

• Women's perceptions of their reproductive rights, developed by the International Reproductive Rights Research Action Group (IRRRAG) as the basis for an international study on women's perceptions of their reproductive rights and entitlement.52

The work of these researchers not only informed the WSP conceptual framework but also reinforced the need to develop a framework that: 1) incorporates multidimensional and multidirectional variables; 2) recognizes that powerful external factors influence women's family planning use and its impact on the various domains of their lives; 3) considers family planning in the context of women's larger reproductive health needs; and 4) takes into account women's diverse roles in documenting their experiences with family planning.

The starting point of the framework is women's experiences with family planning. This includes contraceptive use and non-use, childbearing and pregnancy, family planning programs and other reproductive health services. Under this rubric, researchers asked women about their perceptions of method availability and variety, method efficacy, quality of services, and decisions to start or stop contraceptive use.

It is important to note that the mandate of the WSP was to study the impact of family planning, not the broader topic of reproductive health. In the WSP, family planning was viewed as one component of reproductive health services. However, case studies did document women's experiences with integrated reproductive health services.

The WSP investigated interactions of family planning with various domains of women's lives, including their roles as individuals, as family members, and as members of the work force and of the larger community. Researchers sought to understand how family planning affects women's psychological well-being, whether it gives them more autonomy and increases their self-esteem, how partners feel about family planning and how they affect women's contraceptive experiences, how family planning affects women's time for home and work tasks, and whether family planning improves women's participation and standing in the community.

In examining the relationship between family planning experience and aspects of women's lives and analyzing study results, WSP investigators generally concluded that the impact of family planning is greatest on women's roles in the family and in the work place. Family planning has given women the opportunity to spend less time in reproductive (childbearing) roles and more time in productive (income-earning roles) -- a change that some women have accepted (China) and others have resisted (Philippines). Family planning also affects women as individuals, in some cases increasing their autonomy and self-esteem (Bolivia). Yet, family planning has minimal impact on women's participation in community activities), and many women said community activities are not a priority for them, since home and work take up most of their time (Zimbabwe, Egypt).

In the conceptual framework, relationships between family planning and women's lives were explored in the context of three sets of external factors: (1) gender norms; (2) societal, political and economic factors; and (3) life cycle stage. Of the three external factors, gender norms emerged as a dominant influence during data analysis. The WSP would now redraw the framework to emphasize the tremendous impact gender norms have on both family planning experience and various domains of women's lives.

On the left side of the framework, researchers found that gender norms affect women's family planning experiences in multiple ways. For example, gender norms determine who makes decisions about family size, who makes contraceptive decisions within the family, if and when women contracept, and what opportunities are available to women when they are not restricted by childbearing and childrearing.

On the right side of the framework, gender norms determine, within a particular country, whether it is acceptable for women to define their own roles and goals and to participate fully in the educational, economic, and political system; whether women can move freely beyond their household; and whether they influence how money is spent or whether their children go to school. If gender norms are strong and traditional, as in South Korea, women may not see political or economic activities as attractive options. If gender norms are less traditional, as in the Philippines, the demarcations between the public and private spheres begin to blur and women gain more autonomy.

The conceptual framework was designed to help researchers explore the impact of gender norms on family planning and women's lives, but it also offers an opportunity to reverse the equation and examine the ways in which family planning practice affects gender roles. In terms of creating greater gender equity between women and men, change is slow, WSP researchers found. Women -- both contraceptive users and non-users -- are held accountable for the maintenance of their homes and upbringing of their children (and women hold themselves accountable). This is true even when women take on additional responsibilities in the work force or in the community. Data from Egypt, China, Indonesia, the Philippines and Korea provide examples. Women also remain the primary contraceptive users; the limited availability of reproductive health services for men and the few contraceptive method choices available to them have further minimized the impact of family planning on this gender norm.

While gender was the most powerful external factor, the other external factors also affect women's family planning use and the domains of their lives, analysis showed. Political climates influence the acceptability of contraceptive use and the availability of methods (Bangladesh). Economic situations determined whether women can work or need to work to support their families (Indonesia, China, South Korea). Life cycle stage affects women's perceptions of whether they need contraception and their access to contraceptive services (adolescents in Brazil).

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