VOICES FROM THE COMMUNITY ON BIRTH SPACING

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VOICES FROM THE COMMUNITY ON BIRTH SPACING

• A Five Country Perspective
• Reynaldo Pareja, PhD
• Senior Advisor, BCC
• CATALYST Consortium

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The Clients view point
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How did we find out peoples opinions?

• By doing Focus Groups in five countries
• Bolivia 24
• Peru 24
• India 34
• Pakistan 40
• Egypt 51
• _______
• Total 173 Focus Groups

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Who did we talk with?

• Women who have practiced birth spacing
  Women who have not practiced birth spacing
  ages 15-19 and ages 20-35

• Male partners ages 15-19 and ages 20-35

• Health care providers as found in facilities

• Mothers-in-law from India, Pakistan and Egypt

Number of participants over 1100
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Concept of birth spacing

• Most of participants had a clear concept of birth
  spacing.

• In Peru waiting period,
• India the gap between children
• Bolivia the rest after birth.

• The majority said that it should be
• more than 2 years. Many mentioned
• 3-5 years.

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Attitudes towards birth spacing

• The majority of participants expressed a very
  positive attitude towards a longer birth spacing
  interval.

• Three to five year waiting period
• did not make them feel defensive,
• and there was no open opposition.

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Perceived Benefits for the Child

• More attention for the new born.

• Increased care and love for new born
• enhances childs psychological
• development.

• Better nourishment for the new-born.

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Perceived Benefits for Mothers

• More time to recuperate fully after giving birth.

• Free time to engage in income
• generating activities

• More time to sleep better, gain
• strength and relax (Pakistani women).

• Overcoming anemia (Indian
• women).

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Perceived Benefits for male partner

• She has time and energy to give her partner more
  attention.

• Birth spacing gives the couple more
• time together.

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Perceived Benefits for Family Economy

• A new pregnancy has its own expenses.

• All participants said they were able to
• save money for daily expenses if they
• practiced spacing.

• Women perceived financial resources
• available if babies spaced further apart.

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Birth Spacing Practices

• In all five countries women, men and providers
  agreed that it is easier
• to calculate when to get pregnant again

• rather than calculate when the next
• child should be born and
• then when to get pregnant

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Birth Spacing Practices

• There is a discrepancy between womens knowledge
  and the practice of optimal birth spacing.

• This disconnection is attributable
• to many determining factors.

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Common Barriers

• Cost contraceptives are too expensive, facility
  has fees, transportation is high.

• Access facility too far away, not always
• open, health provider not well informed.

• Availability contraceptives are not
• always available when requested.

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Common Barriers

• Myths about contraceptives pill makes them
  sterile and produces cancer.

• IUD travels inside the body, causes
• bleeding.

• Women are fearful of side effects
• some providers do not counsel well.

• Discontinuation when side effects
• appear.

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Cultural Beliefs

• The Macho Myth
• Men have to prove virility by getting women
  pregnant.

•  If no pregnancy occurs, the man may be viewed
• as impotent.

• Men and women in all five countries said
• sexual relations are a mans right.

• Couples do not talk when next pregnancy
• should occur it mostly just happens.

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Cultural Beliefs

• The fertility Myth
• A woman is truly a woman, only if she conceives.

• Husband, mother, and mother-in-law pressure
  woman to become pregnant frequently.

• A woman not becoming pregnant as soon as
• married, is considered infertile not a true
• woman.

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Cultural Beliefs

• The son-belief
• The first born son is a blessingname and
  heritage are assured.

• If the first born is a daughter, there is
• immediate pressure to have a son as
• soon as possible.

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Conclusions

• Most women understand the concept of birth
  spacing.

• Women prefer to calculate when to get pregnant
• rather than the birth date of next child.

• Spouses seldom plan pregnancies. It just
  happens.

• The perceived benefits of optimal birth spacing
  are very
• strong motivating factors.

• Obstacles to practicing OBSI are cost, access,
  misinformation, availability of contraceptives,..

• and strong cultural pressures, such as the macho
• and fertility myths, and the son preference.

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Thank you for opening your ears and hearts to
what our clients had to say