The Women's Studies Project (WSP) at Family Health International (FHI) is a five-year effort to study the impact of family planning on women's lives. To determine women's perspectives on this issue, researchers went directly to the women themselves, asking them which research issues were important to study, whether they felt they had or had not benefited from family planning methods and services, and, if so, how. Twenty-six studies were conducted in 10 countries, and both qualitative and quantitative data were collected and analyzed. Women expressed their views on family planning in surveys, in focus group discussions (FGDs) and in-depth interviews. Additional information was gleaned early in the WSP from secondary analyses of data collected in previous projects in four countries and through three case studies on women-centered health programs. The Project was supported by a Cooperative Agreement to FHI from the U.S. Agency for International Development, with the exception of a study in China, supported by the Rockefeller and Ford Foundations, and a pilot project in the Republic of Korea (South Korea), supported by FHI.
The Women's Studies Project sought to move beyond studying the impact of family planning on women's physical health. The studies 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 diversity of WSP research topics reflects the diversity of women's concerns:
- strategies developed by new users to cope with family and community opposition to contraceptive use (Mali);
- generational differences in family planning experiences (China);
- 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); and,
- family planning and women's participation in the development process (Zimbabwe).
These and other topics were selected by colleagues in countries participating in the WSP, including researchers, policy-makers and providers, and women's health advocates. This "triangle" became a critical component of the research process. Members of the triangle were represented on In-country Advisory Committees (IACs), which worked in each WSP emphasis country (countries that were the site of more than one WSP study) to establish the research agenda, monitor the research process and plan dissemination of research results.
To guide research and data analysis, the WSP 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 of and experience with family planning; and placed family planning in the larger context of women's reproductive health needs.
The WSP sought to understand the multiple factors that affect the impact of family planning. 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, commonalities emerged, which the WSP has formulated into 16 research themes:
General Themes
- Family planning affects numerous domains of women's lives -- domestic, economic and community spheres.
- Gender norms strongly influence women's family planning experiences.
Benefits to Women
- Most women and men are convinced that practicing family planning and having smaller families provide economic and health benefits.
- Family planning offers 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 more likely than non-users to take advantage of work opportunities.
- Family planning helps women meet their practical needs and is necessary, but not sufficient, to help them meet their strategic needs.
Costs to Women
- Contraceptive side effects -- real or perceived -- are a serious concern for many women, more than providers realize.
- 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, including the burden of multiple responsibilities at home and work.
Barriers to Contraceptive Benefits
- Social, political and economic barriers limit benefits of family planning for many women.
- The benefits of family planning 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 the quality of women's experiences with family planning.
- Women reap fewer benefits if family planning is 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 WSP is to encourage the use of research findings to improve the quality of women's reproductive health services, and indeed, the results have clear implications for health policies and programs. For example:
- Contraceptive counseling must take into account gender norms and the barriers they may pose to family planning.
- Peer networks should be established, in which experienced contraceptive users counsel new users about the everyday realities of method side effects.
- Men and other key family members need to be educated about family planning to help them make informed decisions about family planning use and to support women's contraceptive choices.
- Counseling should emphasize the benefits of contraceptive use beyond health and economics, including emphasis on improvement in family relationships.
- Family life education should begin early, and women should be encouraged to view family planning use as a component of life-long reproductive health.
The WSP 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. Women's dual perspectives should be taken into account as researchers, women's advocates, policy-makers and providers work collaboratively to improve family planning services. By understanding the intricate realities of women's lives and the factors that affect their reproductive health behaviors, family planning programs can offer services that match women's needs and ultimately can help improve the quality of women's lives.
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