Factors in contraceptive method choice in Bangladesh: goals, competence, evaluation and access

In this study, we have extended Bulatao's conceptual framework for selecting the determinants of method choice. Attempts have been made to capture Bulatao's dimensions directly rather than through proxies. The results of logistic regression analysis using the 1996-97 BDHS indicate that as the number of living children increases, women prefer non-terminal efficient methods such as the pill and injectable/IUD/implant and depend less on inefficient methods such as condom and permanent methods such as sterilization. With an increase in marital duration and age, women increasingly prefer sterilization as compared with other modern methods. The results may indicate a strong preference for male children among those in the sample, as women increasingly use permanent methods to prevent pregnancy as the number of living male children increases. Condom use increases with education of both women and their husbands, compared with other modern methods, indicating that more educated couples possibly have the greater understanding necessary to use the method. The better educated are significantly less likely to use sterilization. The two indicators of contraceptive evaluation, side effect and convenience of current modern method, are very important considerations in selecting the pill, injectable/IUD/implant, and condom over other modern methods. On the basis of convenience, women are most likely to use the pill over other modern methods, while they are least likely to use sterilization. Condom is the most preferred method on the basis of side effect. On the other hand, sterilization is the least preferred of other modern methods for the same reason. Sterilization is significantly less common among the Muslims, which is likely due to religious reasons, while condom use is significantly less common among non-Muslims. The two indicators of contraceptive access, accessibility/availability of current modern method and cost of current modern method, are very important considerations in pill use, while sterilization is less preferred over other modern methods on the basis of both accessibility/availability and cost. The programmatic factor visit of family planning workers/FWAs significantly increases the likelihood of using the pill compared to other modern methods.