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

Research Methodology

No single research method can adequately address the complex interrelationships between family planning and women's lives. Therefore, the WSP used multiple methods. Through a participatory process and in collaboration with FHI staff and consultants, investigators in each country identified critical questions about women's experiences with family planning and designed their studies to answer these questions. The nature of the research questions determined methodologies used and often required combinations of techniques to explore issues from different perspectives.

Of the 26 WSP field studies, 20 used both qualitative and quantitative methods. Two used quantitative methods only, while four were entirely qualitative. (The remaining subproject focused on guideline development.) WSP investigators typically collected both qualitative and quantitative data, using the two approaches to complement each other and bring different strengths and challenges to the research process. Quantitative data describe, while qualitative data interpret. Quantitative studies measure occurrences, trends and relationships; generalize findings to larger populations; administer structured questionnaires; and essentially ask, "How many? How often? and How is one thing related to another?" Qualitative approaches seek depth, insight and understanding. They explore the perceptions of individuals and groups; stress intuitive judgment; invite study participants into a dialogue; and ask "Why? How? Under what circumstances?"

Quantitative methods used in the WSP included longitudinal and cross-sectional surveys, follow-up surveys of participants in prior studies, situation analyses, inventories and secondary analyses of existing data. For example, in Cebu, the Philippines, investigators used a discrete time-life event history analysis to link women's contraceptive and birth histories with retrospective accounts of economic events in their lives. A modified version of this technique was used in Zimbabwe to study women's participation in development activities.

Qualitative methods included focus group discussions, in-depth interviews, case studies, and secondary analysis of ethnographic data. In Mali, for example, a longitudinal qualitative study explored the experiences of new contraceptive users through a series of in-depth interviews.

In some studies, the WSP combined qualitative and quantitative methods to provide greater understanding of women's experiences, women and men's decision-making behaviors, and women's multiple roles. In other studies, qualitative methods helped to develop and refine quantitative techniques -- for example, to identify cultural norms and vocabulary, to determine key variables including psychosocial measures, and to clarify research questions. And in other studies, qualitative methods contributed to a better understanding of findings produced by quantitative methods. An illustration of the integration of qualitative and quantitative methods as parallel tools is found in Egypt, where researchers collected quantitative data to describe female participation in the family planning labor force, and qualitative data (through focus group discussions) to explore employees' perceptions of their jobs. In Jamaica, adolescents participating in the Grade 7 Project, designed to delay first pregnancy, completed a questionnaire, administered by an interviewer once before students began the program and twice after they entered the program. Between surveys, students also participated in focus group discussions, where moderators encouraged them to express their views on family planning, parenthood and norms for sexual behavior. In China, selected study participants who took part in both a sample survey and focus group discussions provided rich insights into how lower fertility affects women in different domains of their lives. In Bolivia, a study of women's access to and use of reproductive health services used situation analysis, with the addition of focus group discussions and interviews, to understand clients' perceptions of reproductive health needs and barriers to services.

In several countries, data from qualitative studies informed or shaped quantitative research instruments. Researchers in the Philippines drew on focus group transcripts to develop survey questions. Filipino researchers also enriched the analysis of a household survey from a longitudinal study in Cebu with data from in-depth interviews. WSP investigators in Bolivia developed psychosocial indicators from focus group discussions and included the items in a structured interview on male attitudes toward family planning. Similarly in Brazil, a comparative study on the impact of female sterilization on women's lives benefited from focus groups discussions, which led to development of psychosocial measures for a survey. Focus group discussions with youth in Alexandria and Assiut, Egypt, helped researchers develop questionnaires on adolescent reproductive health.

In other subprojects, qualitative methods complemented quantitative findings. A study in Indonesia included secondary analyses of data from the 1993 Indonesia Family Life Survey (IFLS) to examine the impact of family planning on women's labor force participation. Researchers also conducted in-depth interviews to answer questions not covered in the IFLS, such as the effect of women's family planning use and labor force participation on their household autonomy. In another Indonesian study on family planning and women's empowerment, in-depth interviews with a sub-sample of 800 survey respondents provided insight into why method switching and discontinuation rates are high. In South Korea, a secondary analysis of national statistical data on women's fertility and work, combined with focus group discussions among women in different age groups, enabled researchers to explore generational perspectives. Cross-generational comparisons were also used in China to examine the impact of rapid fertility decline following a sweeping change in national family planning policy.

In many cases, quantitative findings validated qualitative findings, and vice versa. In Cebu, the Philippines, comparison of a sub-sample of women responding to a survey on family decision-making found that the women gave similar responses during in-depth interviews. In Zimbabwe, both quantitative and qualitative research findings showed that women typically use contraceptives only after they have proven their fertility.

In other studies, qualitative and quantitative findings were, at times, contradictory. In the study, Family Planning, Family Welfare and Women's Activities in Indonesia, quantitative findings (based on bivariate and multivariate analyses) showed that family planning and fertility had only a modest effect on women's social and economic activities and on family welfare. However, in in-depth interviews, most women cited family planning as an important factor that improved the overall quality of their lives. In China, the majority of women who responded to a survey said they were satisfied with their current contraceptive method. Yet in focus group discussions with a sub-sample of survey respondents, women said they worried about contraceptive failure.

In some studies, a qualitative component shed new light on research findings. In Bolivia, for example, female survey respondents spoke of husbands' "jealousy." When researchers probed the meaning of this term in focus group discussions, they learned that jealousy is a euphemism for domestic violence. In Korea, annual surveys found that younger women, who had more experience with family planning and smaller families than older women, also had more work opportunities. However, focus group discussions revealed that younger women felt stress and tension as they sought to balance their work inside and outside the home -- something older women, who typically quit their jobs when they married, had never encountered. In Jamaica, adolescents responding to a questionnaire said that contraceptives were used primarily by teens with multiple sexual partners. However, in focus group discussions, they expressed positive attitudes toward contraception and agreed that the use of family planning indicates responsible behavior.

One characteristic of qualitative data is that it leads to new questions for analysis. Qualitative analysis is an inductive process; themes emerge as the analysis unfolds. Thus, researchers return to their data with new questions and revised perspectives as analysis progresses. Quantitative studies also may have implications for further research, but investigators are more restricted by the original questions.

Most WSP-supported investigators initially had stronger skills in quantitative methods, which increased the need for technical assistance by FHI staff in qualitative techniques, including the integration of qualitative results in final reports. The interest of in-country colleagues in qualitative methodology suggests an important area for future technical assistance. Although the use of multiple methods can be costly in terms of efficiency and time, the advantages far outweigh the disadvantages for capturing the complexity of women's lives while simultaneously describing more general patterns of behavior and experience.

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