By: 
Dr. Najeebah Ba-Hubaish,
National Program Officer, UNFPA

Information on contraceptive use is of particular interest to policy makers, program managers, and researchers in the areas of population and family planning. Providing easy access to reliable and safe methods of family planning increases women's control over there own fertility. This article describes women's knowledge of family planning methods and sources where they can be obtained, use of contraception, sources of information about family planning, and exposure to media messages about family planning. Differentials in knowledge and use are also discussed. In addition, problems with current use, and reasons for not intending to use a method in future are included in this chapter.

Knowledge of Family Planning Methods and Sources
Family with contraceptive methods and sources for methods are among the prerequisites for the adoption of fertility regulation. Knowledge of methods is a necessary but not sufficient condition for use. The Yemen Demographic and Maternal and Child Health Survey (YDMCHS) provides information on the level on knowledge of family planning methods and providers of family planning services.

Estimates indicate that 84% of current married women have heard of at least one family planning method and slightly less than four-fifth reported knowing a modern method. This indicates a substantial increase in contraceptive knowledge in Yemen since the 1991-92 survey. The most widely known method is the pill, which is known to more than 75% of currently married women. About two-thirds of the women have heard of the IUD, 56% know about injectables, and 48% have heard of female sterilization. Knowledge of other modern methods is much lower: condoms and male sterilization (24%, each), vaginal methods (19%), and implants (6%).

About 7 in 10 women know of a traditional method, mainly prolonged breastfeeding (61%), while periodic abstinence and withdrawal are known by smaller proportion reported in the 1991-92 survey.
Knowledge of sources for specific methods shows that 44% of currently married women know injectables and female sterilization. Sources for other methods are even less well-known.

Only small differences by age exist in knowledge of modern methods among women 15-49; 78 to 81% of women 20-49, and 73% of the women 15-19 have heard of a modern method of family planning.
There is a great variation in the level of contraceptive knowledge by residence and region. More than 9 in 10 urban women know of at least one modern method compared with less than 75% of rural women. Knowledge of modern methods is much higher in the Plateau and Desert (85%) and the Coastal regions (82%) than in the Mountainous region (68%).
There are substantial differences in knowledge of contraceptive methods by education. Among illiterate women, 76% know a modern method compared with 93% of women who have completed primary education, and 98% of women with secondary or higher education. The differences in knowledge of family planning by education may account, in large part, for the great knowledge of family planning in urban areas and in the Plateau and Desert region, since a great proportion of educated women live in those areas.

Differentials in knowledge of service providers show relatively more variability than differentials in knowledge of modern methods. By age groups, between 53 and 55% of currently married women age 20-44 know a source for a modern contraceptive method. Older and younger women are less likely to know about serve providers. The differences are much greater by residence. Eighty-one % of urban women know a source, compared with only 43 % of rural women. Regionally, a woman in the Plateau and Desert region (62%) is more likely to know a source for a contraceptive method than a woman who lives in the Mountainous region (36%). The most striking differences in knowledge of service providers are by level of education. Only 47 % of illiterate women know a source. Among women who have completed primary school, knowledge of service providers is more than 70% higher (82%), while knowledge of a source is twice as high among women who have completed at least secondary school (93%).

Ever Use of Contraception
About 38% of ever-married women have used a method to regulate their fertility at some point in their lives. Twenty-three percent have used a modern method. A quarter ever-married women have used traditional methods (including breastfeeding); thus, the majority of ever-users have heard experience with modern methods, and some have used more than one method. Currently married women and ever-married women have about the same level of experience with ever use of contraceptive.

The age differentials for ever use among currently married women indicate that the rate for women age 15-19 is only 13%; it increase to 34% for women age 20-24, and to 24% among women age 25-29. Ever-use peaks at 45 to 47% among women in their thirties before declining to 39% among women age 45-49. The modern methods most used by married women are the pill (16%) and the IUD (7%). Overall, however, the most widely used method is prolonged breastfeeding (20%).

Number of Children at First Use of Contraceptive
Fourteen percent of women, or 38% of ever-users start using contraception before having their second child. This tendency to being using contraception early- probably for the purpose of spacing births- is most noticeable among younger women, i.e. women under 35 years of age.

Reason for First Use of Contraception
Overall, 82% of ever-users began using contraceptive to delay the next birth, while 18% started using because they wanted no more children. .
The proportion of women who began using family planning to avoid the next birth increases rapidly with the number of children the woman has at the time of first use. Among women with four or more children at the time of first use, 40% reported that they wanted no more children.
The proportion of ever-users who adopted a family planning method for the first time for the purpose of spacing births rather than for limiting family size was higher among urban women than rural women, higher among more educated women than among those who are illiterate, and higher among those living in Coastal region than in the Mountainous region.

Current Use of Contraception
The contraceptive prevalence rate (including prolonged breastfeeding) for currently married women (pregnant and non-pregnant) is 21%. Almost half are using a modern method.
The modern methods most commonly used are the pill (4 %) and the IUD (3 %). One% of women use injectables and the same proportion use female sterilization; 8 % depend on prolonged breastfeeding, 2 % use withdrawal, and 1% use periodic abstinence.

Estimates indicate also the differentials in contraceptive prevalence among currently married women, by residence, region, level of education, the current family size. A large difference in prevalence is observed between urban and rural areas. Thirty-six% of urban women are using a contraceptive method, compared with only 16% of rural women. The prevalence rate in urban areas is more than twice that in rural areas. Prevalence in the Plateau and Desert region is also about twice as high as in the Mountainous region. Pronounces differences in current use exist by level of education. The proportion of married women using contraception increases dramatically for 18% among illiterate women to 32% among those with primary school completed, and then jumps to 49% among women with at least secondary education.
Contraceptive use increases with the number of living children. Current use is negligible among childless women and is 16% among women with one child. One in 4 women who has three or more children is currently using a method of contraception.

Since 1991-92, contraceptive use has doubled in the age group 20-24 (from 9 to 16%) and increased even more dramatically among women age 25-29 and 45-49. Except for childless women, contraceptive use has increased substantially in all groups regardless of the number of children.

Knowledge of the Fertile Period
The most common response, given by 36% of women and 47% of users was that the risk of pregnancy was greater after a woman's period ends. Only 8% of ever-married women and 29% of users correctly identified the middle of the cycle as the time a woman is most likely to get pregnant. Six% of periodic abstinence users compared with 3% of ever-married women believe that the most fertile time in the ovulatory cycle occurs just before the period begins. Almost one-third of ever-married women and 11% of users of periodic abstinence say that they do not know when woman is most likely to get pregnant during the ovulatory cycle.

Consolation before Using the Pill
Overall, 71% of women consulted doctors and 6% nurses/ midwives; pharmacists were consulted by 4% while 3% consulted friends or neighbors. Eleven % did not consult anyone.
For past users, about 73 % consulted doctors, 5% nurses/ midwives, and 4% pharmacists while 9 % did not consult anyone. For current users, the most likely persons to be consulted area again doctors (69%), nurses/ midwives (8%), and pharmacists (4%). About 13 % of current users did not consult anyone before use.

Knowledge of Contraceptive Effects of Breastfeeding
About 4 to 10 currently married women believe that breastfeeding does not affect the chances of becoming pregnant. About 20% of women either do not know about the contraceptive effects of breastfeeding or believe that breastfeeding increases the risk of pregnancy. Only 32 % correctly reported that breastfeeding can reduce the risk of pregnancy.
Differentials in knowledge of contraceptive effects of breastfeeding by age show that correct knowledge is lowest among women under 20 (40%), and ranges from 32 to 34 % among other age cohorts.

Correct knowledge of the contraceptive effect of breastfeeding is higher among women in urban areas, and in the Plateau and Desert region. Compared with illiterate and less educated women (32-37%), knowledge that breastfeeding can decrease pregnancy risk is slightly higher among those who have completed preparatory education and much higher among those with secondary or higher education (45%)
One in five women has at some time used breastfeeding to avoid pregnancy, 8% report they currently relay on breastfeeding as a contraceptive method.

Problems with Current Method of Contraception
Ten % of condom users and sizable proportion of women using injectables, the IUD, female sterilization, and the pill reported having problems with their methods. Around 40 % IUD and injectables users, and one third of pill users reported having problems with their method. Health concerns were the most frequently cited problem regarding the IUD (38%), injectables (38 %), female sterilization (33%) and the pill (31%). One to four percent of women using modern methods reported that the method was uncomfortable to use.

Reasons for Not Intending to Use Contraception
The reasons expressed by women for not intending to use family planning can be broadly grouped into the following categories: reasons related to contraceptive methods, attitude toward family planning, fatalistic attitude, and "other" reasons. The reasons related to contraceptive methods are lack of knowledge, side effects, inconvenience of use , and difficulty obtaining methods.

Twenty-three percent of women said they wanted more children and 10% reported that they were either menopausal or sub fecund. Only 8% of non users said they would not use a contraceptive method because they lacked knowledge of methods or their sources while 1% mentioned lack of access to methods. Twelve percent of women had no plan to use contraception because of fear of side effects, 1% considered contraceptive methods inconvenient to use, and 1% said the cost of methods was too high.
About 28% of women gave attitudinal reasons. Although 2% were personally opposed to family planning, the remaining women in this category were split between religious prohibition (17%) and disapproval of husbands (9%).

Younger women were more likely to mention wanting more children and other women were more likely to say they were menopausal. The major differences in other reasons by age was health concerns and husband's disapproval.
Among those who reported wanting more children, the major reason for not using contraception was desire to have more children (around 44%), followed by religious prohibition on contraceptive use (16%). Among those who had experience with contraceptive methods and wanted more children, the other important reasons for not intending to use were the side effects associated with contraceptive use (13%) and health concerns (9%).

Among those who reported wanting to limit family size but had never used a method, surprisingly, 23 percent said they would not use a method because they wanted more children. An even higher proportion (26%) does not intend to use because they believe that religious prohibits using family planning methods. On in seven women either does not know a method or does not know a source for a method.

Discussion of Family Planning with Husband
About 42% of women said they had not talked to their husbands about family planning in the year preceding the survey while 26% had discussed it once or twice and 32% had discussed it more often. Women in the oldest and youngest cohorts were least likely to have discussed family planning with their husbands.

In 40% of couples, both husband and wife approve of family planning; in 22% both disapprove. In 12% of couples, the wife approves but the husbands does not, while in 4 percent, the husband approves but the wife does not. There are marked differential by level of education: the higher the wife's level of education, the more likely it is the couple approves family planning. Partly for this reason, couples in urban areas are twice as likely to approve of family planning as those in rural areas. Couples' approval of family planning is highest in the Plateau and Desert region (48%) and lowest in the Mountainous region (29%).