Choosing A Contraceptive

Method Choice In Asia And The United States

Rodolfo A. Bulatao

• Publisher: Taylor & Francis
• Year: 2019
• eBook ISBN: 9780429713743
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

This book presents evidence from investigations of contraceptive method choice in a variety of countries, focusing on Asia and the United States. Included are discussions of psychosocial and economic approaches to understanding method choice and descriptive and statistical analyses of choices.

Part I
Perspectives on Method Choice

2
Psychosocial Aspects of Contraceptive Method Choice

by Andrew R. Davidson

Students of family planning frequently observe substantial differences among countries in the relative popularity of various contraceptive methods. For example, the condom is the most widely used method of contraception in Japan, but in the Republic of Korea it is the least used of the modern methods of fertility regulation. In Puerto Rico, female sterilization is much more prevalent than oral contraceptive use, whereas in nearby Jamaica the relative popularity of the two methods is markedly reversed. Such variability in the acceptance and use of specific contraceptive methods is influenced by decisions made at various levels.

At the national and regional level, policies are set concerning the methods to be included and excluded from public and private family planning programs. By national law, sterilization is not permitted, for example, in Burma and Iran. Abortion is illegal in many nations for religious reasons. Injectable contraceptives (e.g., Depo-provera) have been approved by some governments, but their use is not permitted in the United States because of safety concerns.

At the community and clinic level, resources and administrative decisions influence the relative accessibility of particular contraceptive methods. Until recently, the pill was not offered through social marketing arrangements in India and was dispensed only in some rural and urban outlets. In many developing countries a wide range of methods is theoretically available, but a shortage of qualified medical providers (e.g., for menstrual regulation, IUD insertion, and sterilization), in conjunction with supply constraints, limits method availability. The result of these policies and resource limitations is that when a client appears at a family planning clinic, certain methods may be out of stock, others may not be mentioned or may be downplayed by clinic staff, and yet other methods may be available only at more distant supply points (Ainsworth 1984).

Finally, at the individual level, people desiring to avoid or delay an additional birth make decisions about which method of fertility regulation to use. Their decisions obviously are constrained by the policies and decisions made at the national, community, and clinic levels. Yet, it is the sum of the decisions made by individuals and couples that accounts for the national contraceptive prevalence rates presented in the subsequent chapters of this volume. The study of how people choose a method of contraception is a recent topic of research which is being investigated primarily by social psychologists and behavioral decision theorists. The theoretical frameworks that guide these investigators and the results of their studies are the focus of the present chapter.

The effort to investigate people’s contraceptive decision making has the potential for being a complicated endeavor, not readily yielding to systematic investigation. The potential for complication is due to the diversity among methods of fertility regulation and to differences among potential users in their knowledge, values, and motivations. Fertility-regulating methods vary in such important aspects as efficacy, cost, reversibility, frequency and convenience of use, and potential for side effects. Individuals choosing among methods in many cases make decisions based on limited and incorrect information about important method characteristics, such as the likelihood and type of side effects and correct method use. Moreover, considerable differences exist among the decision makers’ motives for using fertility regulation. Many younger couples may be interested in using a contraceptive only to delay a birth. Some couples are unsure about whether they want any children or more children and seek effective protection until such time as they make a decision. Still other couples are strongly motivated to avoid any additional pregnancies. In the face of this diversity among both potential users and contraceptive methods, decision theorists have attempted to develop models of individual decision making that are both general enough to serve as useful summary statements of the decision process and idiosyncratic enough to capture the individual differences in the content and values associated with this process.

The Decision-Making Process

The task faced by contraceptive decision researchers is to elucidate the process by which an individual who wishes to delay or avoid a pregnancy chooses a contraceptive method from a set of available methods. Although many different frameworks have been proposed to explain the decision process, most theories tend to divide the process into the following stages: identification of consequences, belief judgments, evaluation of consequences, information integration, and choice.

In the first stage, the person making the decision identifies the possible consequences of using the contraceptive method. A woman may believe that the possible consequences of using the pill include protection against pregnancy, convenience of use, and the danger of cancer.

In the belief judgment stage, the decision maker assigns to each of the consequences a likelihood rating according to her or his perception of the probability that the consequence will result from using the contraceptive method. Thus, a woman may believe that the pill will very probably protect her against pregnancy and be convenient to use but that it is extremely unlikely to cause cancer. The identified consequences and belief judgments may or may not be correct. The accuracy of a person’s beliefs tends to be of minor importance to researchers interested only in predicting contraceptive choice because they assume that the person’s decisions are determined by what he or she perceives to be true, as opposed to what is actually true. But erroneous beliefs about contraceptive methods are of substantial interest to those providing contraceptive information, education, and services.

In the evaluation stage, the individual assigns to each perceived consequence of using the contraceptive method a value according to its desirability. The woman in the example just given may value the consequence of protection against pregnancy and convenience as very desirable and cancer as extremely undesirable. Although the identified consequences and belief judgments may be correct or incorrect in an objective sense, the evaluation judgments are entirely subjective.

In the information integration stage, the likelihood and evaluation judgments of the consequences associated with the behavior are combined in some manner to form an overall evaluation of the contraceptive method. The hypothetical woman in our example would be likely to evaluate pill use positively because she has assigned highly positive ratings to the two most likely consequences (pregnancy prevention and convenience) and an extremely low probability to the only very negative consequence (cancer).

In the choice stage, the decision maker compares her or his overall evaluation of the available contraceptive alternatives and on that basis selects a method for use.

Expectancy-Value Models

In the most widely used class of models for predicting contraceptive choice-expectancy-value models-it is assumed that individuals attempt to perform the information integration and choice stages to maximize their potential benefits in relation to costs. A brief overview of the three most popular expectancy-value models is presented here.

The Subjective Expected Utility Model

The subjective expected utility (SEU) model (Edwards 1954; Lee 1971) has its origins in behavioral decision theory. Formal applications of the model have been conducted generally in the context of contrived laboratory settings. Nevertheless, the model has served as the framework for field studies of fertility decision making (see, e.g., Arnold et al. 1975; Beach et al. 1979; Luker 1975).

For the present purposes, each decision maker can be viewed as deciding which contraceptive method to use from a set of alternative methods. The assumption is that decision makers choose the alternative they perceive to have the maximum subjectively expected net value. The SEU model prescribes a way of calculating the net value of each contraceptive alternative, based on the value of each consequence associated with the particular contraceptive and the subjectively perceived probability that each consequence will occur should that method be used. The model is:

$$SE{U}_i={\displaystyle \sum }_{j=1}^n{p}_{ij}{u}_j$$

(1)

where SEU_i is the subjective expected utility of choosing contraceptive alternative i, P_ij is the subjective probability that use of contracep...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures and Exhibits
• List of Tables
• List of Contributors
• Foreword
• Acknowledgments
• INTRODUCTION
• PART I. PERSPECTIVES ON METHOD CHOICE
• PART II. METHOD CHOICE IN ASIA
• PART III. METHOD CHOICE IN THE UNITED STATES
• CONCLUSION
• APPENDIX
• References
• Index