Key words

Fertility, Family planning, working women, Decisions making, Behaviors, Bangladesh

Introduction

Fertility and family planning behavior are central importance in demographic analysis as births are a vital component of population growth. The study of fertility and family planning also provides important information about women’s reproductive behavior and attitudes (Islam MM et.al, 2010). Fertility is the natural capability to produce offspring. Fertility rate is the number of offspring born per mating pair, individual, or population (Wikipedia, 2014). Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and management, and infertility management((Wikipedia,2014). Bangladesh has been considered as a success case in the developing world for popularizing its family-planning services during the last 20 years (Greenspan, 2000). The rate of contraceptive use among married couples of reproductive age increased from a mere 58.1 percent in 2004 to 61.2 percent in 2011 (BDHS,2011). This was paralleled with a decline in the total fertility rates from 3 percent in 2004 to 2.3 percent in 2011 (BDHS, 2011). Fertility decline is the crucial aspect of women’s empowerment and its impact on reproductive decisions. Most research on the empowerment explanation of fertility behavior assumes that a greater degree of autonomy in important decisions in the family may lead to a higher degree of influence in fertility and family planning decisions. Recent studies have suggested that the status of women may be the single most important element in explaining the fertility and family planning behavior (Mitra, 1978; Dyson and Moore, 1983). The proportion of unwanted births and use of familyplanning methods among couples with less than four and four or more living children in rural and urban Bangladesh using data from the Bangladesh .Demographic and Health Surveys and Matlab Demographic Surveillance System of ICDDR,B results of the study showed that 90% of 2,750 couples with more than three living children did not want an additional child. The contraceptive use rate among them was only around 50%. Thus, by catering to the needs of this motivated group of high-parity couples who contribute to 30% of total births in the country, the total fertility rate can be reduced to around 2.5. The possible strategies for targeting high-parity couples through the existing serviced delivery system were discussed (Bhuiya and Rahman 2007). Women’s employment and their childrearing are competing activities, which bring to bear much pressure on their time and energy. Many studies have found, accordingly, that women who partake in paid employment, and especially those who chase a demanding career, limit their fertility and either have relatively few children or none at all (Brewster and Rinfduss,2000; Budig, 2003; Hakim, 2003; Spain and Bianchi, 1996). The links between mobility and decision making has been found to be positive. Women who had higher decision making ability and higher mobility were more likely to use modern contraception (Cleland et.al, .1996). Female education creates awareness that their reproductive and health seeking behaviour show a noticeable difference than illiterate women. Research has been carried out to find out the linkages between female education and fertility (Jejeebhoy, 1992).Female education largely affects fertility through the proximate determinants. Age at marriage of educated females is higher than their illiterate counterparts and the use of family planning methods is also greater among educated women. However, the duration and intensity of breast-feeding is lower among educated women than the illiterate women (Jain and Nag, 1986). Social norm is the significant forecaster of desired fertility; and the positive effect to higher order desires suggesting in Bangladesh still now on average society approves more than two children as ideal family size; however, access to mass media and social interactions increase individual’s probability of choosing small family as ideal(Islam and Hasan 2000). Despite insidious poverty and underdevelopment, Bangladesh has achieved a considerable decline in fertility. Indeed, Bangladesh represents an visible anomaly for its decline in fertility, in spite of the absence of conditions believed to be necessary for such reproductive changes. Bangladesh is the only country among the world’s twenty poorest countries where such a change has occurred. Under such circumstances, in this endeavor, an attempt has been made to address the fertility and family planning behavior of working women.

Methods and Materials

The nature of this study was exploratory and survey research design was used to conduct the research. Data were collected from 15-49 age group married working women, from 17,23,24,25,26,27,28,29 and 30 no ward in Khulna city. A sample of 440 working women of wards was interviewed purposively. Data were collected through personal interview based on an interview schedule that contained both open ended and close ended items. 11 female students collected data individually from 40 respondents, and then collected data organize in same data sheet. Data were processed by editing. Coding and tabulation. Processed data were analyzed and interpreted regarding the objectives of the study. After data processing, data analysis and interpretation were done through using statistical techniques, including frequency and percentile distribution, measures of central tendency, and Pearson’s Chi–square test.

Variables (Dependent and independent) of the Study

Results

Socio-Demographic Information

Age Structure

Respondents belonged to the age structure of (15- 26) to 42 percent, 40 percent were (27-38) age and only 17 percent from (39-49) age. Most of the respondent’s husband’s ages were (33-47) and its percent were 46.1 percent and 33.4 percent respondents husbands ages were (18-32).

Year of Schooling

The success of the family planning and fertility behaviour depends mainly on the literacy level of the people. If more people are literate, more people will adopt family planning and thereby reduce the growth of population. Data, in the Table 1, showed that 59.3 percent of the respondents have ≤5 years of schooling, only 1.8 percent have 11≥ year of schooling. Most of the respondents in the sample area are not well educated.In Bangladeshi society, husbands are major decision makers in households regarding family planning. Educational level of husband as an important variable on contraceptive use . . Data, in the Table 1, showed that 52.5 percent of the respondents have ≤5 years of schooling, only 7.3 percent have 11≥ year of schooling.

Age of the Respondents (in Years) Number of the Respondents Percentage (%) Age of the husband (in Years) Number of the Respondents Percentage (%)
15-26 185 42 18-32 147 33.4
27-38 180 40.9 33-47 203 46.1
39-49 75 17 48-61 90 20.5
Total 440 100 Total 440 100
Mean=29.54 Std. Deviation =7.77 Mean=38.05 Std. Deviation =8.86
Year of schooling of the respondents Year of schooling of the husband
≤5 261 59.3 ≤5 231 52.5
10-Jun 171 38.9 10-Jun 177 40.2
11≥ 8 1.8 11≥ 32 7.3
Total 440 100 Total 440 100
Mean=4.93 Std. Deviation =3.36 Mean=5.62 Std.Deviation=3.83
Monthly income Respondents Monthly income husband(in BDT)
(in BDT)
500-4500 313 71.1 2000-6500 250 56.8
4600-8600 109 24.8 7000-11500 137 31.1
≤12000 18 4.1 ≤15000 53 12
Total 440 100 Total 440 100
Mean=3662.13 Std. Deviation =2178.32 Mean=6946.62 Std. Deviation.=3199.51
Occupation respondent Occupation husband Number of the Respondents Percentage (%)
Day labor 134 30.4 Farmer 28 6.4
Day labor 100 22.7
Domestic maid 137 31.1 Van or richshaw puller 65 14.8
Small business 142 27.7 Business 126 28.6
Other 47 10.7 Easy bike driver 86 19.5
Total 440 100 Other 35 8
Total 440 100

Types of Religion
Islam 343 78.0
Hinduism 92 20.9
Christianity 5 1.1
Total 440 100.0

Type of Family Number of the Respondents Percentage (%) Total family members Number of the Respondents Percentage (%)
Nuclear family 282 64.1 2-4 232 52.7
Extended family 158 35.9 5-7 158 35.9
Total 440 100.0 8≥ 50 11.4
Total 440 100.0
Mean=4.9 Std=1.82

Head of the Family Types
self lf 17 3.9 Pucca 40 9.1
Husband 365 83 Semi pucca 115 26.1
Father-in-law 58 13.2 Thatched 36 8.2
Total 440 100 Mud 94 21.4
Teen shed 155 35.2
Total 440 100

Total family income BMI
27.7
1000-7000 122 54.1 Underweight (less than 18.5) 8 1.8
8000-14000 238 18.2 Normal (18-24.9) 315 71.6
15000-21000 80 100 Overweight (25-29.5) 105 23.9
Total 440 Std=4180.15 Obese (30-34.9) 12 2.7
Mean=10285.57 Total 440 100
Mean= 23.6621 Std. Deviation=2.59965

Monthly income

Majority of the respondents monthly income were (500-4500) and 24.8 percent respondents monthly income were (4600-8600) and 56.8 percent respondents husbands monthly income were (2000-6500) and it was very difficult to run a family with this little income and most of them were belonged to poor class, 31.1 percent respondents husbands monthly income were (7000-11500).

Head of family

Almost all the respondents 83.0 percent reported that their husbands were the head of family because of patriarchal structure and 3.9 percent respondents were the head of family.

Household Assets

Majority of the respondents 83.9 percent respondents house hold assets were (1000-50000) taka and it indicate their lower status, 15.2 percent had (51000-100000) assets and it was also low for a family or to support them.

Household Income

Majority of the respondent’s total monthly income were (8000-14000) taka and it were 54.1 percent and 27.7 percent respondent’s income were (1000-7000) as they were rickshaw puller or working class so their income was very poor to sustain their family.

Body mass index (BMI)

BMI, is a way to help figure out a healthy weight for height. BMI is a number based on weight and height. 71.6 percent respondents Body Mass Index were (18-24.9) that means it was normal, 23.9 percent had (25-29.5) and it was overweight for them and 1.8 percent respondents had Underweight and it was (< 18.5).

Knowledge of Married Women of Reproductive Age on Family Planning

Knowledge about Family Planning

Majority of the respondents 76.4 percent had knowledge about birth control system, 38.4 percent reported family planning as ways to avoid unwanted pregnancy and 8.2 percent seen family planning as way to avoid abortion.

Methods of Family Planning

82.5 percent respondents used pill as methods of family planning and it percent was highest among all methods. Injection were used by 65.5 percent respondents and it was the second highest, 9.7 percent used safe period as family planning methods as the rates of education were increased the practices of safe period will also be increased.

Sources of Information

38.6 percent respondents got information from their Mother/Mother in law as daughter have good relation with their mother so they got their basic information from them, 35.5 percent got information from their husband and it was the second largest sources of information, 18.6 percent were used advertisement on television/radio as their sources of information about family planning.

Fertility and Family planning Behaviour of the Respondents

Age at first marriage

Majority of the respondents that means 50.0 percent age at First Marriage was 11-16, 45.9 percent respondents were 17-21 age and it was the second largest category among the respondents and 4.1 percent respondents were 22-27 age and it was seen that the tendency of early marriage or child marriage were high in those time. 56.8 percent respondents husbands age at first marriage was (25-33) and it was highest than the women, 40.7 percent respondents husbands age at first marriage were (11-24) and 2.5 percent were (34-41) and it was the lowest percent among the category.

Age first and last conception

Majority of the respondents first conception age were (13-18) and it were 52.7 percent, 42.0 percent respondent’s conception age were (19-24) and the last category were (25-30) ages 5.2 percent respondent conceive in this age. 51.8 percent respondents last conception age were (23- 30), 42.5 percent respondents conception age were (15-22) and the last category that remains 5.7 percent respondents were possess above 31 for their last conception age.

Participation decision in first conception

Among them 41.6 percent respondents were agreed with their first conception, 22.5 percent were disagreed about conception, 15.9 percent respondents were undecided in conception and 3.9 percent respondents were strongly disagreed about their first conception.

Force for sexual intercourse

And they said that 38.6 percent respondents were disagreed in making sexual intercourse, 23.1 percent respondents agreed that their husbands make forced for sexual intercourse and 6.4 percent strongly agreed with this idea. After sexual intercourse 34.7 percent respondents feel annoyed, 20.2 percent respondents feel nothing and 15.0 percent respondents feel pain after sexual intercourse.

Use and Types of Contraceptive at Present

Contraceptive at present, 85.5 percent respondents agreed with using contraceptives and 2.7 percent strongly disagreed in using contraceptives at present. Among the Using Type of contraceptives 56.9 percent respondents used oral pill and it is the most common method among respondent, 30.2 percent used injection and 4.57 percent said safe period was safe for them and it’s percent was very low among the method.

Perception Regarding Family Planning Methods

Family planning methods that are useful for keeping population in control or to achieve a standard measurable population it was very useful but in our society different conception or perception were practiced where 71.4 percent respondents seen it was good for health and their perception level were high and rest 27.0 percent respondent also seen it as good but their perception level was medium.

Association between Year of schooling of respondent and Use contraceptive present

The findings clearly show that year of schooling is closely associated with Use contraceptive present and the differences were statistically significant (X 2 -28.513; p<.000).It is evident from the data, in the Table 5, higher level of education is associated with higher level of contraceptive use.

Association between Year of schooling of respondent and Perception Regarding Family Planning Method

The findings clearly show that year of schooling is closely associated with Perception Regarding Family Planning Method and the differences were statistically significant (X 2 -29.393; p<.000).It is evident from the data, in the Table 6, higher level of education is associated with higher perception regarding family planning method.

Association between Head of the family and Use contraceptive present

The findings clearly show that Head of the family influence the contraceptive use and the differences were statistically significant (X 2 -26.245; p<.000).

Association between Total family income and Menustration management system

The findings clearly show total family income influence the Menstruation management system and the differences were statistically significant (X 2 -14.318; p<.001). It is evident from the data, in the Table 8, higher family income is associated with modern means of Menstruation management system.

Discussion

Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and wellbeing as well as on the outcome of each pregnancy. Contraceptive methods that enable person to take action according to these decisions. This ability to take action is also based upon the cost of contraceptives, ideas (sometimes correct and sometimes erroneous) people have about the different methods, and the support or lack thereof of the partners, extended family members, and wider community. People are deciding to have families at both younger and older ages, and contraceptive technology is enabling them to do so. It is important that these decisions be made not only freely but also with full information about the long-term consequences for both the parents and the children. The main focus of this paper is to know the fertility and family planning behavior of working women. In the Result section it is analyzed those socio-demographic characteristics of working women, their perception towards family planning, the relationship the contraceptive use between different variables. In the present study the mean age at marriage for the women was 16.73 years and that for the males was around 25 years. In a study conducted in 2005-10 it was found that mean age at marriage was over 17 years which nearly corresponds with the mean age at marriage for the girls found in the present study. Data from the 2011 BDHS, Twenty-eight percent of ever-married women and 26 percent of ever-married men age 15-49 have no education, while 12 percent of women and 18 percent of men have completed secondary or higher education. Compared with data from this study, show that there has been a decline in the proportion of women who have never attended school from 34 to 28 percent and for men from 30 to 26 percent. Overall, 61 percent of currently married women in Bangladesh are currently using a contraceptive method. The majority of women use a modern method (52 percent) and 9 percent use traditional methods. The pill is by far the most widely used method (56.9 percent), followed by injectables (30.2 percent), and condoms (8.4 percent). Participating in sexual intercourse decision-making is the second most important factor influencing the current use contraceptive methods. Studies have shown that the low age at marriage in Bangladesh is directly related to poor socioeconomic conditions and many cultural factors. Most married adolescent women in Bangladesh are economically poor and uneducated. Moreover their status in the family and society is so low that they have little say in the decision-making in a family. In a recent study, Kamal and Stogett observed that social conservatism is partly responsible for low performance with regard to contraceptive use among women in Chittagong division. The also pointed out that women’s mobility and their decision-making power in the family greatly determine their use of modern dependable contraceptive methods. In another study Red pointed out that it is cultural factors which inhibit women from adopting family planning, despite the fact that they high unmet need contraception. Although .contraceptive prevalence among currently married women in Bangladesh is increasing insidiously, the rates have not yet reached those of developed countries. The level of contraceptive use in most developing countries is highest among women in their thirties and, typically, lowest among teenage women and women in their forties (United Nations 1988).

Table 2: Knowledge of Married Women of Reproductive Age on Family Planning

Knowledge about Family Planning Number of Cases Responses (percent) Percent of Cases
birth control system 336 46.60% 76.40%
child spacing and choosing the number of children 102 14.10% 23.20%
ways to avoide unwanted pregnency 169 23.40% 38.40%
way to avoid abortion 36 5.00% 8.20%
sexual intercouirse without desire for children 78 10.80% 17.70%
Total 721 100.00% 163.90%
Knowledge about Family Planning Methods
Pill 359 38.90% 82.50%
Injection 285 30.90% 65.50%
Ligation 57 6.20% 13.10%
safe period 42 4.60% 9.70%
Condom 135 14.60% 31.00%
Vasectomy 45 4.90% 10.30%
Total 923 100.00% 212.20%
Sources of Information about Family Planning Methods
Friends 128 16.50% 29.10%
Mother/Mother in law 170 21.90% 38.60%
NGO workers 96 12.40% 21.80%
FWA/ HA/FWV/ Doctor 135 17.40% 30.70%
Husband 156 20.10% 35.50%
Advertisement on television / radio 82 10.60% 18.60%
others 9 1.20% 2.00%
Total 776 100.00% 176.40%
Contraceptive Service Centre Percentage (%)
Convenient 270 61.4
Inconvenient 122 27.7
Not sure 48 10.9
Total 440 100

Table 3: Fertility and Family planning Behaviour of the Respondents

Age at first marriage of the respondents Number of the Respondents Percentage (%)
16-Nov 220 5000.00%
17-21 202 4590.00%
22-27 18 410.00%
Total 440 10000.00%
Mean=16.73 Std. Deviation=2.72
Age at first marriage of husbands
24-Nov 179 40.7
25-33 250 5680.00%
34-41 11 250.00%
Total 440 10000.00%
Mean=25.21 Std. Deviation=3.74
Age first contraception
13-18 232 5270.00%
19-24 185 4200.00%
25-30 23 5.2
Total 440 10000.00%
Mean=18.81
Age at last contraception
15-22 187 4250.00%
23-30 228 5180.00%
Above 31 25 570.00%
Total 440 10000.00%
Mean=23.18 Std. Deviation=4.58

Participation dicision in first conception
Strongly agreed 71 1610.00%
Agreed 183 4160.00%
Undecided 70 1590.00%
Disagreed 99 2250.00%
Strongly disagreed 17 390.00%
Total 440 10000.00%
Dicision maker in first conception
Husband 20 1720.00%
Both 65 5600.00%
In-Laws 13 1120.00%
Mother 13 1120.00%
others 5 430.00%
Total 116 10000.00%
Facing irregular menstruation problem
Strongly agreed 73 16.6
Agreed 135 3070.00%
Undecided 19 430.00%
Disagreed 163 3700.00%
Strongly disagreed 50 1140.00%
Total 440 10000.00%
Menstruation Management System( Type) Number of the Respondents Percentage (%)
Traditional 393 8930.00%
Sanitary Napkin 47 1070.00%
Total 440 100
Force for sexual intercourse
Strongly agreed 28 6.4
Agreed 121 27.5
Undecided 63 14.3
Disagreed 170 38.6
Strongly disagreed 58 13.2
Total 440 100
Decision in sexual intercourse
Husband 205 46.6
Self 11 2.5
Both 224 50.9
Total 440 100
Postpartum complication
Yes 178 40.5
No 262 59.5
Total 440 100
Avail to contraceptive
Strongly agreed 86 19.5
Agreed 232 52.8
Undecided 28 6.4
Disagreed 82 18.6
Strongly disagreed 12 2.7
Total 440 100
Contraceptive at present
Strongly agreed 121 27.5
Agreed 255 58
Disagreed 43 9.8
Strongly disagreed 21 4.8
Total 440 100
Type of contraceptive
Oral Pill 211 56.9
Injection 112 30.2
Condom 31 8.4
Safe period 16 4.3
Don’t know 1 0.3
Total 371 100

Table 4: Perception Regarding Family Planning Methods

Perception Number of the Respondents Percentage (%)
Low 12 2.7
Medium 114 25.9
High 314 71.4
Total 440 100.0

Table 5: Relation between Year of schooling of respondent and Use contraceptive present

Year of schooling of respondent Use contraceptive present Total
Strongly agreed Agreed Disagreed Strongly disagreed
≤5 79 149 21 12 261
6-10 34 106 22 9 171
11≥ 8 0 0 0 8
Total 121 255 43 21 440
Pearson’s X2- 28.513(6); p less than.000 (.01)

Table 6: Relation between Year of schooling of respondent and Perception Regarding Family Planning Method

Year of schooling of respondent Perception Regarding Family Planning Method Total
Low Medium High
≤5 1 53 207 261
6-10 10 60 101 171
11≥ 1 1 6 8
Total 12 114 314 440
Pearson’s X2- 29.393(4); p less than.000 (.01)

Table 7: Relation between Head of the family and Use contraceptive present

Use contraceptive present Total
Head of the family Strongly agreed Agreed Disagreed Strongly disagreed
Self 8 9 0 0 17
Husband 105 214 28 18 365
Father-in-lw 8 32 15 3 58
Total 121 255 43 21 440
Pearson’s X2- 26.245(6); p less than.000 (.01)

Table 8:Relation between Total family income and Menustration management system

Total family income Menustration management system Total
Traditional Sanitary Napkin
1000-7000 112 10 122
8000-14000 219 19 238
15000-21000 62 18 80
Total 393 47 440
Pearson’s X2- 14.318(2); p less than.001 (.01)

Conclusion

The findings of our study as compared with other similar studies indicate that different socio-demographic variables affect working women contraceptive behavior. Although contraceptive prevalence rate is gradually increasing in Bangladesh, it is still very low compared to any developing country and many developing countries. Since the average age at marriage (around 15 years) in Bangladesh remains one of the lowest in the world, a large proportion of potential acceptors of contraception are working women. Policy-makers and programme managers should, therefore, provide due importance to this fact while formulating policy and designing programme strategy so that these potential acceptors could be turned into contraceptive users. If this could be done effectively not only CPR would be increased, but a substantial proportion of maternal and neonatal mortality would be decreased as a sizable proportion maternal and neonatal mortality result from teen-aged pregnancy. The supply of female health and family planning facilities may increase contraception by women. The awareness about the women rights and equal social status may also help a lot.