HAITI National Contraceptive Prevalence Survey 1989 Final English Language Report

Publication date: 1991

HAITI NATIONAL CONTRACEPTIVE PREVALENCE SURVEY 1989 FINAL ENGLISH LANGUAGE REPORT CHILD HEALTH INSTITUTE JUNE 1991 U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES/Public Health Service/Centers for Disease Control 1989 HAITI NATIONAL CONTRACEPTIVE PREVALENCE SURVEY Final English Language Report June 1991 Child Health Institute Port-au-Prince, Haiti Dr. Michel Cayemittes Dr. Antoine Augustin Mr. Antonio Rival With the Technical Collaboration of: Division of Reproductive Health Centers For Disease Control Atlanta, Georgia, USA Jay S. Friedman, M.A. Paul W. Stupp, Ph.d. Howard I. Goldberg, Ph.d. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE Centers for Disease Control Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health Atlanta, Georgia 30333 TABLE OF CONTENTS CHAPTER 1: BACKGROUND .1 CHAPTER 2: METHODOLOGY AND ORGANIZATION OF THE SURVEY.3 2.1 Objectives of the survey.3 2.2 Administrative structure and staffing of the survey .4 2.3 Sampling Methodology.4 2.4 Questionnaire Design and Content.5 2.5 Training and Field Work .6 2.6 Data Management.7 2.7 Response Rates.7 CHAPTER 3: CHARACTERISTICS OF THE POPULATION .9 3.1 Socio-demographic Characteristics of Respondents .9 3.2 Fertility Characteristics . 11 3.3 Breast-Feeding . 12 3.4 Reported Abortions . 13 CHAPTER 4: MCH CARE, CURRENT PREGNANCY INTENTION AND PLANNING STATUS OF LAST LIVE BIRTH . 15 CHAPTER 5: CONTRACEPTION . 19 5.1 Knowledge of methods. 19 5.2 Contraceptive use now or in the past (ever use) . 19 5.3 Current use of contraception . 20 5.4 Reasons for non-use. 23 CHAPTER 6: RISK OF UNPLANNED PREGNANCY . 25 CHAPTER 7: AVAILABILITY OF SERVICES . 29 7.1. Source of Contraception . 29 7.2. Condom use. 30 CHAPTER 8: ATTITUDES TOWARD FAMILY PLANNING. 33 CHAPTER 9: SEXUAL BEHAVIOR AND CONTRACEPTIVE USE AMONG YOUNG ADULTS.35 9.1 Socio-Demographic Characteristics.35 9.2 Sexual Experience .36 9.3 Use of Contraception.38 9.4 Current Sexual Activity .39 CHAPTER 10: KNOWLEDGE OF AIDS. 41 CHAPTER 11: CONCLUSIONS AND RECOMMENDATIONS . 43 REFERENCES . 45 TABLES PREFACE In 1989, the Child Health Institute (CHI), Port-au-Prince, Haiti, with technical assistance from the Division of Reproductive Health, Centers for Disease Control (CDC), conducted a Contracep- tive Prevalence Survey among both men and women of reproductive age to examine fertility, contraceptive behavior (particularly use of condoms), use of maternal and child health services and childhood immunization levels. Preliminary reports in both English and French were issued in May and October, 1990, respec- tively. The final French language report was prepared by the Child Health Institute, Port-au-Prince, Haiti. This final Eng- lish language report was prepared by CDC in collaboration with CHI for those interested readers who do not read French. The English language report was prepared by Jay S. Friedman and Paul W. Stupp, and reviewed by Howard Goldberg and Leo Morris of the Division of Reproductive Health, CDC, and Dr. Michel Cayemittes of the CHI. We would like to acknowledge the valuable contributions made to the various phases of the survey by the following people: CHILD HEALTH INSTITUTE Dr. Michel Cayemittes, Director Dr. Antoine Augustin, Director, CAPS Mr. Antonio Rival, Survey Director Ms. Carol Jacob, Field Coordinator Mr. Paul Brea, Computer Programmer Dr. Deborah Barnes, Technical Advisor Ms. Gina Schott, Administrator CENTERS FOR DISEASE CONTROL, DIVISION OF REPRODUCTIVE HEALTH Dr. Leo Morris, Chief, Behavioral Epidemiology and Demographic Research Branch Dr. Howard I. Goldberg, Demographer Christian Barrett, M.P.H., Public Health Advisor John Patrick Whitaker, M.P.H., Computer Specialist K. Lisa Whittle, M.P.H, Public Health Advisor USAID PORT AU PRINCE Dr. Michael K. White Ms. Janet Smith Ms. Giselle Balmir Mr. John Burdick Ms. Shelagh O'Rourke INTERNATIONAL PLANNED PARENTHOOD FEDERATION, FIELD OFFICE Dr. R. Magloire, Director 1. BACKGROUND Haiti occupies the western third of the Caribbean island of Hispaniola, about 800 miles (1300 kilometers) southeast of the southern tip of the state of Florida, USA. Its area is 10,714 square miles (27,856 square kilometers) and its estimated popula- tion as of 1990 is 6.5 million. The crude birth rate is approxi- mately 35 per 1000 and the crude death rate is estimated at 14 per 1000, resulting in a rate of natural increase of 2.2 percent per year. If these rates were to remain unchanged, the popula- tion would double every 32 years. The infant mortality rate in Haiti was estimated to be about 101 per thousand live births for the period from 1982 to 1987 according to the Morbidity, Mortali- ty, and Utilization of Health Services Survey performed by the Child Health Institute in 1987. The country is quite mountainous and only one-third consists of arable land. The per capita income, at less than $400 per annum, is one of the lowest in the western hemisphere, but is comparable with most countries in West Africa. The 1989 Haiti National Contraceptive Prevalence Survey is the most recent of a continuing series of surveys in Haiti on fertil- ity and contraceptive use. Although there was a Fertility Survey conducted in Haiti in 1977, followed by a Contraceptive Preva- lence Survey in 1983, and a Morbidity, Mortality, and Utilization of Health Services Survey in 1987, there were still enough unan- swered questions in 1989 concerning certain aspects of family planning and health in Haiti, particularly condom use, to warrant another nationwide survey, especially since these previous sur- veys had female respondents only. The 1977 survey, part of the World Fertility Survey project, found contraceptive prevalence to be about 14 percent for all methods and 5 percent for modern methods among women of reproduc- tive age who were in union. At that time it appeared that contraceptive use would increase, as in other developing countries, and eventually have an impact on Haiti's relatively high fertility rates when compared to levels existing in most other Caribbean nations. However, the 1983 survey revealed a decline in contraceptive use to 7 percent overall and 4 percent for modern methods. By 1987 the situation had not changed; the survey in that year found contraceptive prevalence to be similar to the level recorded in 1983. 1 2. METHODOLOGY AND ORGANIZATION OF THE SURVEY 2.1. Objectives of The Survey In addition to the general objectives of evaluating family plan- ning and maternal/child health care program performance, examin- ing the family planning needs of the male and female population, and describing fertility levels, the 1989 Haiti National Contra- ceptive Prevalence Survey had several more specific objectives, as follows: a. To explain the large discrepancy between the number of con- traceptives, particularly condoms, reportedly distributed, and the estimated number used according to past surveys and service statistics. Previous surveys (of females only) had indicated that about 1 percent or 14,000 Haitian couples used condoms as a method of preventing pregnancy. This finding persisted in spite of the seemingly incompatible data showing that as many as 15 million or more condoms have been issued from warehouses in Haiti in some years, which would be sufficient to supply 10 percent or 150,000 couples. The 1989 Haiti National Contraceptive Preva- lence Survey sought to resolve this discrepancy by including an independent sample of males and using a newly designed condom module questioning both males and females about condom use, the number of condoms distributed to individuals, the number used, and the number remaining unused. Equally important were ques- tions to ascertain the extent to which Haitians are using condoms outside of marital unions and/or as a means of preventing trans- mission of HIV and other STD infections rather than pregnancy prevention. Condoms are currently the most effective means of preventing sexual transmission of HIV short of abstinence, but as in most developing countries, the amount of condom use for this purpose in Haiti is unknown. b. To obtain current data on contraceptive prevalence, method mix, sources of contraception, fertility, and levels of unplanned pregnancy. The 1989 Haiti National Contraceptive Prevalence Survey also ascertained whether there have been any changes in these areas and defined target groups for family planning activi- ties in both the public and private sectors. c. To investigate barriers to increased family planning use and identify programmatic factors that are important in improving acceptance and continuation of contraception. To achieve this objective, the survey collected information on perceived and actual problems with obtaining supplies, access to services, and the methods themselves. d. To examine male roles in family planning decision making and male attitudes about family planning. It is often argued that male attitudes constitute a major impediment to both the adoption of family planning methods and to a reduction of family size in much of the developing world. In Haiti, contraceptive use re- 3 mains low while fertility remains high, and male attitudes are sometimes cited as a reason for this lack of change. The 1989 Haiti National Contraceptive Prevalence Survey, the first to include males, collected data on the male's role in the couple's decision on whether to use a method and what kind of method to use, as well as how male and female attitudes compare regarding desired family size and the use of family planning. These data will show whether program activities might be modified to take male roles and attitudes into account. e. To examine the proximate determinants of fertility including both modern and traditional contraception, breastfeeding, amenor- rhea and patterns of union and cohabitation. Analysis of the 1989 Haiti National Contraceptive Prevalence Survey should cast further light on the difference between the 1983 estimates of total fertility of 5.5 births per women and the 1987 survey which found total fertility to be substantially higher at 6.4 births per woman. f. To examine certain sexuality issues, particularly as these issues relate to family planning, condom use, and HIV transmis- sion. The 1989 Haiti National Contraceptive Prevalence Survey included questions on such topics as coital frequency and numbers of sexual partners for currently sexually active persons and, for 15-24 year-olds, a module on the age at which sexual activity began and early use of contraception. 2.2 Administrative Structure And Staffing of the Survey The 1989 Haiti Contraceptive Prevalence Survey was implemented by the Child Health Institute (CHI), which was responsible for the day-to-day management of all survey activities, including the supervision of collection of data in the field and data entry. Technical assistance was provided for all phases of the survey by the Division of Reproductive Health (DRH) of the Centers for Disease Control (CDC). Data analysis and report writing were accomplished in collaboration with DRH/CDC. Funding was provided by the International Planned Parenthood Federation/Haiti, through a cooperative agreement with the United States Agency for Inter- national Development (USAID/Haiti). A survey director was recruited and was made a temporary employee of the CHI. Working under the survey director was a fieldwork coordinator, who was also recruited from outside of CHI. CHI also provided an administrator to oversee and supervise financial management activities and a data manager who was in charge of data entry and editing. The survey questionnaires were adminis- tered by 6 interview teams, each consisting of a team leader and four interviewers. 4 2.3 Sampling Methodology The 1989 Haiti National Contraceptive Prevalence Survey was a nationwide population-based household survey. The population to be surveyed was divided into 3 domains: Metropolitan Port-au- Prince, other urban areas and rural areas. Urban areas contain only about one-fourth of Haiti's population. Port-au-Prince and other urban areas were over-sampled so that they include approxi- mately one-half of the sample households so estimates in urban areas would have greater precision. Rural areas were correspond- ingly undersampled. Thus, all total estimates for Haiti require weights to reflect the true population distribution in each domain (stratum) while unweighted numbers of cases are shown in tables. The sampling strategy consisted of a two-stage cluster design to select respondents for the survey. The first stage consisted of the selection of independent samples of census enumeration dis- tricts (SDEs in French) within each domain. These SDEs were sub- sampled from SDEs selected for a larger 1987 survey of household expenditures (selection of SDEs for that survey was done with probability proportional to size). There were 28 SDEs selected in Port-au-Prince, 22 in other urban areas and 44 in rural areas--a total of 94 SDEs. The second stage consisted of the random selection of households in each cluster: 46 households in clusters in Port-au-Prince and other urban areas and 54 households in clusters in rural areas. Half the households in each cluster were designated as "male" households and half as "female" households. Male interviewers interviewed all males between the ages of 15 and 59 who resided within selected male households, while female interviewers inter- viewed all females between the ages of 15 and 49 years in female households. A total of 4,650 households were included in the sample. (One SDE on the island of Gonave was not visited because of inaccessi- bility.) It was estimated that this sample size would yield about 4,000 completed individual interviews--1,800 male and 2,200 females. The sample size was based on the minimum number of interviews needed per stratum to obtain adequately precise esti- mates for most of the survey topics, based on census estimates of potential respondents per household and projected response rates. As discussed in section 2.7, complete interviews were conducted with 1,842 males and 1,996 females. 2.4 Questionnaire Design and Contents The survey instrument consisted of two parts--a short household questionnaire and a much longer respondent questionnaire. The household questionnaire was filled out for every residence visit- ed. It included information on the household's location and type of construction, water and latrine facilities, a listing of all residents and a small amount of information on each person 5 listed. The respondent questionnaire was to be administered in "male" households to all males 15-59 years of age and in "female" households to all females 15-49 years of age listed on the house- hold questionnaire. The male questionnaire covered the following topics: a. Socioeconomic and demographic characteristics, including age, religion, and socioeconomic status indicators; b. A complete marriage and cohabitation history; c. Contraceptive knowledge and use, including knowledge and past and current use of all family planning methods; d. Condom utilization, including information on numbers of condoms obtained, the number used and on hand, and attitudes toward condoms and their use; e. Male roles in the couple's decision regarding use of family planning methods and male attitudes concerning contraception and fertility; f. Numbers of current sexual partners, coital frequency and, for 15-24 year old young adults, information on the initiation of sexual activity. The female questionnaire covered all of the above topics except male roles and attitudes. In addition, it included: a. Pregnancy and childbearing information and information on breastfeeding, postpartum amenorrhea, desired fertility, and the planning status of the last pregnancy; b. Barriers to family planning use, including information on reasons for not using or for having stopped using contraception, accessibility of family planning services, satisfaction with services used or available, and other factors which may be hin- dering acceptance or continuation of methods; c. Pregnancy termination, including information on reported induced abortions. 2.5 Training and Fieldwork Training of interviewers and interview team supervisors took place during the 3-week period immediately preceding the start of fieldwork on September 1, 1989. Training was conducted by the survey director, CDC consultants, and CHI staff. Training consisted of teaching prospective interviewers the principles of successful interviewing and field procedures, as well as ensuring that they were completely conversant with the questionnaire 6 content and procedures for asking questions and filling out questionnaires. As part of the training process, each interview- er conducted practice interviews in non-sample households before the start of actual fieldwork. In addition, those selected as interview team supervisors received training in team logistics, selection of households according to the sample design, editing questionnaires, and forms management. Six teams of interviewers were employed, each consisting of a team supervisor, two interviewers of each sex, and a driver. Several more interviewers were trained than were needed in order to provide substitutes in case any interviewers left the survey, which, in fact, happened. Fieldwork began September 1, 1989 and required about 9 weeks to complete. 2.6 Data Management Data processing activities were carried out at the CHI using micro-computer operators hired for the survey. A CHI programmer supervised data entry and editing. Data entry and editing were done concurrently using software developed at the Centers for Disease Control (CDC) and modified for this survey. This soft- ware performs checks on the ranges of all variables, the consist- ency between variables and the "skip patterns" of the question- naires. The data entry staff, thus, had the added responsibility of passing questionnaire problems on to the data manager. These staff members were trained with the interviewers to insure famil- iarity with the data collection instruments. A CDC programmer traveled to Haiti shortly after field work and data collection began for the purpose of installing the software and training the CHI staff in the use of the software, as well as testing and debugging the program that had been modified for the Haiti ques- tionnaire. 2.7 Response Rates Table 2-1 presents the interview status of selected households and individuals--both males and females. In the 2,324 "male" households, interviews were completed in 91.1 percent of the selected dwellings. Interviewers identified males eligible respondents in 76.6 percent of the selected dwellings, while 14.5 percent of the selected dwellings did not contain eligible males. In occupied "male" households where household interviews were not obtained, the reasons were because selected individuals could not be located in 3.4 percent of selected dwellings and because of refusals in 1.6 percent of the selected dwellings. Of the rest, 3.1 percent were found to be unoccupied and 0.8 percent were classified as "other" (demolished, no longer existing, etc.). In the 2,326 "female" households, the results were almost identi- cal. Female household interviews were completed in 90.8 percent 7 of the sample dwellings. As a result, interviewers found females eligible to be respondents in 78.1 percent of the selected dwell- ings and no one eligible in 12.7 percent of the selected dwell- ings. Among occupied "female" households where household inter- views were not conducted obtained, the reasons were that resi- dents could not be found in 3.3 percent of selected dwellings and because of refusals in 1.3 percent. Of the rest, 3.7 percent were found to be unoccupied and 0.9 percent were classified as "other" (demolished, no longer existing, etc.). The completed household questionnaires identified 2,287 men as eligible for an interview. Of these, interviews were completed with 1,842, or 81 percent. The major reason that individual interviews were not completed was the absence of the respondent despite several visits to the households (17.5 percent). Only 0.7 percent refused to be interviewed. The completed household questionnaires identified 2,301 women as eligible for interview. Of these, completed interviews were obtained for 1,996, or 87 percent. Contact was not made with 11.2 percent and 0.7 percent refused to be interviewed. Table 2-2 shows the percent distribution of the total survey population by age group compared with those respondents for whom interviews were completed. The column to the left for both males and females shows the percent distribution of all household residents, not just respondents, based on listings of residents from the household questionnaire. These data were gathered on the separate household questionnaire which listed all household residents. The data in the right hand column for both males and females show the proportion each age group represents in the sampled population, and in general, decreases as age increases, reflecting recent high fertility. However, respondents 20-24 years of age of both sexes represent a smaller proportion of the population than expected, reflecting lower response rates for this hard-to-reach mobile population. Except for this one age group, completed interviews follow the same pattern seen for all household residents. 8 TABLE 2-1 Household and Individual Interview Status, By Sex (Number and Percent Distribution) The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 2-1 Etat des Interviews des Foyers et des Individuels, Par Sexe (Nombre et Répartition en Pourcentages) Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 2-2 Percent Distribution of Females, 15-49, and Males, 15-59, With Complete Interviews by Age, Compared to Household Population by Age Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 2-2 Répartition en Pourcentage des femmes, 15-49 et hommes, 15-59 Qui Ont Achevés des Interviews Complétements, par Age Comparés à Tous les Résidents des Foyers, par Age Enquête Nationale Haitienne sur la Contraception, 1989 All Household Residen Respondents With ts Including Respondents Complete Interviews Tous les Résidents des Enquêtés Qui Ont Achevés Foyers Y Compris Les Enquêtés des Interviews Complétements 3. CHARACTERISTICS OF THE POPULATION 3.1 Socio-Demographic Characteristics of Respondents Table 3-1 presents the percent distribution of respondents by age group, according to their residence. In general, for both males and females, the populations are younger in urban areas, probably reflecting internal migration of younger people from rural to urban areas in search of employment, and possibly, better educa- tional opportunities. Table 3-2 presents the distribution of men and women in each domain by selected socio-demographic characteristics: education, religion and employment status. Women have lower education levels than men. Almost half of all women have no formal educa- tion at all (never attended primary school), compared to about one-third of men. As might be expected, the education levels of both men and women are much higher in urban areas compared to rural areas. While in rural areas, 60 percent of women report no education, this is true of only 2 0 percent of women in Port-au-Prince and 35 percent of women in other urban areas. Looking at men from the opposite point of view, while more than half of men in Port-au-Prince and more than 40 percent of men in other urban areas have some sec- ondary education or more, this is true of only six percent of men in rural areas. The proportion of men in each residence category with any education is greater than the corresponding category for women. About two-thirds of Haitians of both sexes report that they are Catholic; a higher proportion of women (27 percent) than men (20 percent) reported that they are Protestants. Also, the propor- tion of Protestants among the non-Catholics is slightly higher in Port-au-Prince than in other areas for both sexes. Slightly less than one-third of women report that they were employed in the past four weeks, with fewer women in urban areas reporting employment compared to rural women. While almost 60 percent of men report employment in the past four weeks, the disparity between the three strata is more striking than that of women; less than one-fourth of men in Port-au-Prince report employment, compared to 42 percent of men in other urban areas and 70 percent of rural men. For the purposes of this survey a person "in union" is defined as being in one of three types of Haitian unions: "maryé" or reli- gious marriage; "plasé" or socially acceptable consensual union; and "vivavek", a visiting relationship. Table 3-3 shows the percentages of men and women, by age, who have ever been and are currently in union. One in eight women under 20 is currently in union compared with only one in twenty men. The proportions of both sexes under the age of 30 who have 9 ever been and who are currently in union are comparable to other countries in the Caribbean and Latin America, but are lower than most sub-Saharan African countries. Table 3-4 presents the proportions ever in union and currently in union, according to residence. In general, higher proportions of both men and women in each age group outside Port-au-Prince--in other urban areas and even more so in rural areas--reported they were currently in union. Table 3-5 shows the proportion of each age group in each union category. Fewer women than men have never been in union in all age categories, indicating that, in general, women enter into a union at a younger age than men. The percentages of all women and all men in each union category are similar for each sex. However, there is a tendency for younger men and women to report consensual unions rather than legal marriage. Many of the con- sensual unions may lead to formal marriages at a later age. Table 3-6 shows union status by education level. Among both women and men the proportion of persons who have never been in union increases with education. Only 13 and 17 percent of women and men, respectively, with no education have never been in union, compared to 56 percent of both men and women with some secondary education. This difference reflects, in part, the better educational status of younger people and a later age at first union. After entry into a union, the type of union varies according to education level. Less educated persons in union tend to be plasé (in consensual union), while a greater propor- tion of respondents at higher education levels who are in union report legal marriages. While 45-47 percent of women and men with no education are plasé compared to only 26-27 percent who are married, 20-21 percent of men and women with some second- ary education are married compared to only 10-12 percent who report a consensual union (plasé). Although "vivavek" means "living together", in fact, the term in Haiti describes a less intensive relationship. While more than 85 percent of women who are maryé or plasé spent the previous night with their partner, this was true of only 20 percent of women in the vivavek-type union (Table 3-7). Also, while 90 percent of women who are maryé or plasé see their partner every day this is true of only one-third of women who are in a vivavek union. In fact, almost half (48.5 percent) of women who are in a vivavek union do not see their partner as frequently as once per week. Table 3-8 shows that the mean age at union for women in Haiti is fairly high at 22.5 years. It increases somewhat from rural to urban residence, and increases sharply with education from 21 years for women with no education to 26 years for women with some secondary education. 10 3.2 Fertility Characteristics ■ * Table 3-9, shows that the mean number of children ever born is highest in rural areas and among the least educated. (However, this data is not controlled for differences between the groups in age composition). The mean number of live births to all rural women (2.9) is almost twice that of all women in Port- au-Prince (1.5), while the mean number of live births to women with no education (3.6) is four times greater than the mean number of live births to all women in the highest education category. Women in the 45-49 year old category (who have reached the end of their childbearing years) who are in rural areas or have no education bear, on average about six children per woman: this is at least two more children than women who live in urban areas or who have some secondary education. Table 3-10 shows the distribution of women by number of live births for each residence group. Considering the proportion of women in each residence grouping (domain) with no live births it is clear that the more urbanized the area the higher the propor- tion of women who have had no live births. This reflects, for the most part, a later age at the beginning of child-bearing among urban women. Women with 7 or more live births constitute a fivefold greater proportion of women in rural areas compared to women in Port-au-Prince. In the fertility module of the survey women were asked to report the date of birth of all their live births since January 1984. By combining this information with the information on the date of birth of the woman herself, it is possible to estimate age- specific fertility rates (ASFR) for any period of time since January 1984, and to compute a Total Fertility Rate (TFR) for that period. The TFR can be interpreted as the average number of lifetime births per woman if during their lifetime women were to experience the age-specific fertility rates estimated for a given period. Table 3-11 presents direct estimates of age-specific fertility rates (ASFR's) and the corresponding TFR, for three different periods of time (1984-89, 1987-89, and 1988-89). As can be seen in Table 3-11, the longer the period of time before the date of the survey (July-September, 1989), the lower are the estimated ASFR's and TFR (e.g., the TFR is 4.59 for the 60 months before the survey, 1984-89, 5.05 for the 24 months before the survey, 1987-89, and 5.82 for the 12 months before the survey, 1988-89). This probably indicates that there was a tendency for women not to report or to underreport births that occurred at successively earlier dates before the date of the survey. We are therefore inclined to accept the most recent period, 1988-89, as giving the most accurate estimate of recent fertility, with a TFR of 5.82. Table 3-11 also contains indirect, or adjusted estimates for the 1988-89 period and estimates for the period 1982-87 from the EMMUS survey. The indirect estimate of a TFR of 6.0, which is calculated as an adjustment to the direct estimate using informa- 11 tion on the total children ever born, is somewhat higher than the direct estimate for the 1988-89 period. The estimate of 6.3 from the EMMUS with a larger sample size (4,976 woman) is also higher than the direct estimate of 5.8 from the Haiti CPS, indicating that the indirect estimate of 6.0 for 1988-89 may be a better indicator of the level of recent fertility than the direct esti- mate. This higher TFR of 6.0 is also consistent with the strik- ingly low level of contraceptive prevalence found in the survey, and discussed in Chapter 5. Table 3-12 presents estimates of TFR for the same periods of time as in Table 3-11, by area of residence of the woman at the time of the survey. Again, the recommended estimates from the Haiti 1989 CPS are the indirect estimates for the period 12 months prior to the survey, 1988-89. These show a considerable contrast between Port-au-Prince, with a TFR of 3.1, and the other urban areas and rural areas, with TFR's of 5.9 and 7.0, respectively. The differences in results for urban areas are in opposite direc- tions from results in the EMMUS, where the TFR's were 4.6 for Port-au-Prince and 4.8 for other urban areas respectively. The small difference between Port-au-Prince and other areas urban in the EMMUS study, compared to the 1989 Haiti CPS, indicates that the definition of "other" urban in the EMMUS study likely in- cludes peripheral areas of Port-au-Prince, which were classified as being part of Port-au-Prince in the 1989 CPS. For this reason a final row has been included in Table 3-12, labeled "all urban", which shows essentially equal results for the two surveys. This joining together of urban areas in the 1979 CPS also doubles the sample size available, reducing the higher variance associated with the Port-au-Prince and other urban domains. Comparing the results of the two surveys, we are left with the conclusion that there have been only very modest declines, if any, in fertility in both rural and urban areas. 3.3 Breastfeeding Breastfeeding is another of the proximate determinants of fertil- ity since its duration and intensity affect the length of the postpartum anovulatory period (Bongaarts and Potter, 1983).2 Depending on factors such as intensity, breastfeeding inhibits the resumption of ovulation and menstruation, thus delaying susceptibility to pregnancy after a birth. Overall, results of the survey show the mean duration of breast- feeding in Haiti to be 18.2 months (Table 3-13). Not shown in the table is that breastfeeding is nearly universal in Haiti: 96.1 percent of women who reported a live birth within the past 5 years breastfed their last live born child. Women in Port-au- Prince, on average, breastfed their children for a shorter period (14.5 months) than their counterparts in other urban and rural areas, who breastfed their children an average of 18-19 months. This is the usual pattern seen in developing countries. In addition, duration of breastfeeding was negatively associated with education; women with some secondary education or more only 12 breastfed their children an average of 15 months, compared to women in lower education categories who breastfed their children an average of 18-19 months. This is similar to patterns found in Latin America (Anderson et al., 1983)3. 3.4 Reported Abortions Abortion is another proximate determinant of fertility. Unfortu- nately, it is very difficult to obtain reliable data in a cross- sectional survey, especially where abortion is illegal. Due to under-reporting, the estimates presented here, therefore, proba- bly underestimate true incidence of induced abortion in Haiti and represent a core of women at risk of unintended pregnancies. The true figure is probably higher, as it is expected that induced abortions are underreported by a factor of three to four. Table 3-14 shows that 5.6 percent of women who have been pregnant at least once report having had one or more induced abortions. The percentage of women who report abortions decreases from urban to rural areas, with almost 10 percent of women in Port-au-Prince reporting an induced abortion, compared to only 4.5 percent of rural women. There is little difference in reported abortion according to whether a women is in union or not. As might be expected, in general, the proportion of women who report an abortion increases with age. While there is no clear pattern of having had an abortion according to education, in general, a much higher per- centage of women with no living children report having had an abortion than women with children. This may indicate women not in union wanting to continue their education and/or women not being ready for marriage or resposibilities associated with childbearing. Among women with children, the proportion report- ing an abortion generally increases as the number of living children increases, but this may be highly correlated with great- er age and a longer period of exposure to the risk of abortion. Table 3-15 shows that of women who report having had an induced abortion, almost two-thirds (64.3%) report having had only one abortion, but 23 percent report having had 2 abortions, and over 12 percent report 3 or more induced abortions. Table 3-16 shows that, for the most recent abortion, while the largest percentage of the abortions was performed by a medical doctor, a large percentage of women, 35.4 percent, report that they induced their last abortion themselves. This percentage was even higher in rural areas, where 42 percent reported that they performed their own abortion. 13 TABLE 3-1 Percent Distribution of Age Group, By Residence Women Aged 15-49 and Men Aged 15-59, Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-1 Répartition En Pourcentage Des Tranches d'Age, Par Résidence Des Femmes Agées de 15 à 49 Ans et Des Hommes Agés de 15 à 59 Ans, Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-2 Percent Distribution of Education Level, Religion and Employment Status By Residence, Women Aged 15-49 and Men Aged 15-59, Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-2 Répartition En Pourcentage Du Niveau d'Education, Religion et Statut d'Emploi Des Femmes Agées de 15 à 49 Ans et Des Hommes Agés de 15 à 59 Ans, Par Résidence Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-3 Percent of Females, 15-49, and Males, 15-59, Who Were Ever in rently in a Union,* a Union and Curby Age Group Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-3 Pourcentage des Femmes, 15-4 9 et Hommes 15-59 Qui Ont Eté en Unio ement en Union,* n et Qui Sont Actuellpar Tranche d'Age Enquête Nationale Haitienne sur la Contraception, 1989 * union is defined as being either "maryé" (legal marriage), "plasé" (consensual union) or "vivavek" (visiting relationship). * en union est defini comme maryé, plasé ou vivavek. TABLE 3-4 Percent of Females, 15-49, and Males, 15-59, Who Were Ever in a Union and Currently in a Union, by Age Group and Residence Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-4 Pourcentage des Femmes, 15-4 9 et Hommes 15-59 Qui Ont Eté en Union et Qui Sont Actuellement en Union,* par Groupe d'Age et Résidence Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-5 Percentage of Women 15-49 and ach Union Category, Men 15-59 in Eby Age Group Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-5 Pourcentage de Femmes 15-49 Chaque Catégorie d'Union et d'Hommes 15-59 de Par Tranche d'Age Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-6 Percentage of Women 15- ach Union Category, 49 and Men 15-59 in Eby Education Level Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-6 Pourcentage de Femmes 15-4 que Catégorie d'Union 9 et d'Hommes 15-59 de ChaPar Niveau d'Education Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-7 Percent of Women In Union Who Spent The Previous Night With Their Partner And Percent Distribution of Frequency Of Contact With Partner By Union Status, Women Aged 15-49, The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 3-7 Le pourcentage des femmes qui ont passé la nuit dernière avec leur partenaire Et répartition en pourcentage de la fréquence du contact avec le partenaire Les femmes en union âgées de 15 à 24 ans, par êtat d'union actuel Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-8 Singulate Mean Age at Union, By Residence and Education, Women, 15-49 Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-8 Age Moyen à l'Un ducation, ion, Par Résidence et Niveau d'EFemmes Agées de 15 à 49 Ans Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-9 Mean Number of Live Births per Woman by Age Group By Residence and Education Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-9 Nombre Moyen de Nai r Tranche d'Age, ssances Vivantes par Femme, papar Résidence et Education Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-10 Percent Distribution of Number of Live Births By Residence, Women 15-49 Years of Age Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-10 Répartition en Pourcentage du Nombre de Naissances Vivantes Par Résidence, Femmes Agées de 15 à 49 Ans Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 3-11 Age-Specific Fertility Rates per 1000 Women and Total Fertility Rate 1 For Selected Periods Prior To This Survey,Compared With Results of 1987 EMMUS* Survey Haiti National Contraceptive Prevalence Survey, 1989 TABLEAU 3-11 Taux de Fécondité par Age Pour 1000 Femmes et Descendance Totale Par Période Sélectionée Avant Cette Enquête 1En 7 Comparaison des Résultats de l'Enquête EMMUS* de 198Enquête Nationale Haitienne sur la Contraception, 1989 NOTES 1- Survey conducted September-November 1989, and included birth history of all births since Jan. 1984, excluding 59 women who do not know the month of their last live birth. 2- Direct estimates per 1000 women based on all births and woman-months of exposure within the age and time interval. 3- For the periods 1984-89, 1987-89 and 1988-89, the 60, 24 and 12 months prior to interview, respectively, were used to calculate ASFR and TFR. 4- Indirect estimates calculated by the Brass' P/F method of adjusting fertility rates for the year before the survey by using information on children ever born. 5- EMMUS survey estimates are direct estimates based on responses of 4976 women, using a complete history of all births. 1- L'enquête a été menée Septembre-Novembre 1989, avec une histoire génésique de toutes les naissances depuis Janvier 1984, en excluant 59 femmes qui ne savent pas le mois de leur dernière naissance vivante. 2- Les estimations directes pour 1000 femmes ont été basées sur toutes les naissances et les mois/femmes d'exposition dans l'intervalle de temps et d'âge. 3- Pour les périodes 1984-89, 1987-89 et 1988-89 les 60, 24 and 12 mois avant l'interview, respectivement, ont été utilisés pour faire ces calculs. 4- Les estimation indirectes ont été calculées par la méthodolgie P/F de Brass d'ajuster les taux de fécondité de l'année avant l'enquête en se servant des données sur tous les enfants qui sont nés. 5- Les estimations de l'enquête EMUUS sont des estimations basée sur les réponses de 4978 femmes, en utilisant une histoire génésique complète. TABLE 3-12 Total Fertility R To Survey1, ate, By Residence, For Selected Periods Prior Compared With Results of 1987 EMMUS* Survey Haiti National Contraceptive Prevalence Survey, 1989 TABLEAU 3-12 Descendance Totale, Par Résidence, Pour des Périodes Sélectionées Avant l'Enquête , 1 En Comparaison des Résultats de l'Enquête EMMUS de 1987 Enquête Nationale Haitienne sur la Contraception, 1989 NOTES: See TABLE 3-11 NOTES: Voir TABLEAU 3-11 * EMMUS = Morbidity, Mortality and Use of Services Survey , 1987 * EMMUS = L'Enquête Mortalité, Morbidité et Utilisation des Services, 1987 ** Average of Port-au-Prince and Other Urban Areas. ** Moyen de Port-au-Prince et les villes de province. TABLE 3-13 The Mean Duration Of Breastfeeding (In Months), By Residence and Education* Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-13 La durée moyenne en mois de l'allaitment* Par résidence et niveau d'éducation Enquête Nationale Haitienne sur la Contraception, 1989 *Mean duration of breast-feeding calculated by the prevalence-incidence method: Mean Duration= (No. Currently Breastfeeding/Number of Births Last 24 Months) x 24 *La durée moyenne d'allaitment calculée par la méthode prévalence-incidence: Durée Moyenne = (No. Allaitment Actuelle/Nombre de Naissances 24 Dernières Mois) x 24 TABLE 3-14 Of W ce, omen 15-49 Who Have Been Pregnant At Least OnTh n, e Percentage Reporting An Induced AbortioBy Selected Characteristics and Residence Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-14 Des ois, femmes âgées de 15 à 49 ans qui ont été enceinte au moins une fLe pourcentage qui déclarent d'avoir eu un avortment provoqué. Par caracteristiques sélectionées et résidence Enquête Nationale Haitienne sur la Contraception, 1989 * 10 women who refused to answer this question are not included in the total. * 10 femmes qui ont refusé de répondre à cette question ne sont pas comprises dans le total. ( ) = Nombre de cas non-ponderés **Less than 25 cases / Moins de 25 cas. ( ) = Number of unweighted cases TABLE 3-15 Percent Distribu y Women 15-49 tion of Number of Induced Abortions Reported BWho Reported Having Had An Induced Abortion, Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-15 Répartition en pourcentage du nombre d'avortments provoqués Qui ont eue les femmes âgées de 15 à 49 ans Qui signalent d'avoir eue un avortment provoqué. Enquête Nationale Haitienne sur la Contraception, 1989 *One women who refused to answer this question is not included in the total. *Une femme qui a refusé de répondre à cette question n'est pas comprise dans le total TABLE 3-16 Of Women 15-49 Who Reported An Induced Abortion, Type of Person Who Performed Abortions, By Residence (Percent Distribution) Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 3-16 Répartition en pourcentage de la personne qui a éffectué les avortments Parmi les femmes âgées de 15 à ue un avortment provoqué, 49 ans qui ont ePar résidence Enquête Nationale Haitienne sur la Contraception, 1989 4. MCH CARE, CURRENT PREGNANCY INTENTION AND PLANNING STATUS OF LAST LIVE BIRTH The upper panel of Table 4-1 presents the percentage of women who had prenatal care for their last live birth (of those women who had a live birth in the past five years). Overall, two-thirds of women had prenatal care, with much higher proportions in urban (> 80%) than rural (61%) areas. Also, the proportion of women who had prenatal care increases with education; almost all women (94%) with some secondary education had prenatal care, compared to only 57 percent of women with no formal education. As seen in the second panel of Table 4-1, which only includes women who had prenatal care, both urban and better educated women had a greater tendency to seek prenatal care in the first trimes- ter of pregnancy. Almost three-fourths of women in Port-au- Prince and almost two-thirds of women in other urban areas had their first prenatal visit during the first trimester of pregnan- cy. In rural areas this was true of only 40 percent of women. Similarly, while only 41 percent of women with no education had their first prenatal visit during the first trimester of pregnan- cy, almost three-fourths of women with some secondary education had their first prenatal visit during the first trimester of pregnancy. Among all women receiving prenatal care, slightly less than half had four or more prenatal visits. In Port-au-Prince almost half the women (46%) had 7 or more prenatal visits and more than three-fourths (78.3%) had four or more, while in other urban areas the percentages were less, with 60 percent of women having had 4 or more prenatal visits. In rural areas, however, only 38 percent of women had 4 or more prenatal visits. The contrast is even more striking by educational level: in general, with greater education a larger percentage of women had prenatal care, began the care earlier in the pregnancy and had more prenatal visits. Table 4-2 shows the place of delivery of the last live birth for the 904 female respondents with a birth in the last five years. More than half of all women (54.5%) had their last live birth at home with professional assistance. However, there are notable differences, according to the residence and education of the mother. In Port-au-Prince more than 70 percent gave birth in a health facility, while this was true of only 44 percent of births in other urban areas and only 11 percent of births in rural areas. Similarly, while 73 percent of births to women with some secondary education took place in a health facility, this was true of only 11 percent of women with no education. Table 4-3 shows current pregnancy intentions of women in union. Overall, four-fifths stated that they did not desire a pregnancy at the time of the survey, while 7 percent desired to become pregnant. Another 12 percent were currently pregnant. There were only minor differences according to place of residence. As may be expected, the proportion who were currently pregnant or 15 who desired a pregnancy decreased with age and the number of living children. While 30 percent of 15-24 year old women are currently pregnant or desire a pregnancy, this is true of less than 12 percent of women 40-44 years of age and less than 3 percent of women 45-49 years of age. Similarly, while 44 percent of women in union with no children are currently pregnant or desire to have a child, this is true of less than 15 percent of women with four or more children. However, it should be noted that 56 percent of women in union with no children did want to delay their first pregnancy. There is no clear pattern of a current desire to become pregnant according to employment status. The slightly higher prevalence of pregnancy among better educated women probably reflects their lower parity and younger age dis- tribution. A stated objective in family planning is that a couple should have the number of births they want when they want them; i.e., pregnancies should be planned. On the survey questionnaire all women who had ever had a live birth were asked whether the preg- nancy resulting in their last live birth was desired. If not, they were asked whether they had wanted no more children or whether they merely wanted to wait longer before having another child. (Some women could not answer and said it was up to God or fate, etc.) On the basis of these questions, each woman's last pregnancy was classified as either "planned", "mistimed", "un- wanted", or "unknown". Planned pregnancies were defined as those that were desired at the time the women became pregnant; mistimed pregnancies wer classified as those that were desired, but at some time in the future; and unwanted pregnancies were those not desired, even at a future time (without implying that the child itself is unwanted, however). Using this scheme, the mistimed and unwanted pregnancies can be combined as an estimate of un- planned pregnancies. Table 4-4 presents the planning status of the last live birth of those women who had a live birth in the last five years, by residence, number of live births, education level and employment status. Overall, 56 percent of pregnancies resulting in a live birth in the last five years in Haiti were reported to be planned, 11 percent were mistimed, 21 percent were unwanted and 10 percent said this was up to fate or the will of God, etc. In other words, almost 32 percent of last live births in Haiti were unplanned. The proportion of planned pregnancies is highest among women who are younger and/or have a lower number of live births. While approximately 70 percent of pregnancies to women with 1 or 2 live births were planned, only 40 percent of pregnancies to women with 6 or more live births were planned. As might be expected, the proportion of planned pregnancies is higher among women with at least some secondary education (70 percent as opposed to 50-56 percent for women with less education). This is due in part to the differences in parity and/or age between well educated and less well educated women. 16 Of the births that are unplanned among women who are younger and who have fewer live births, the proportion that are mistimed is higher than the proportion unwanted. The reverse is true of older women with more live births. The lowest proportion report- ing that the number of children they have is up to the will of God, fate, etc. is among women with some secondary education or more. In Table 4-5 the findings on the planning status of the last live birth shown in Table 4-4 are compared to the woman's view of whether her partner considered the birth to be planned. Mothers responded that they and their partners agreed on whether the pregnancy was desired (planned) or not desired for three-fourths of the births. (These are the data that are underlined in the table.) It is noteworthy that while both the mother and father desired the birth for 58.9 percent of the pregnancies, only 1.9 percent of father's disagreed when the mother planned to have the pregnancy, but 12.8 percent of mothers did not plan to have a pregnancy, although her partner wanted her to become pregnant. 17 TABLE 4-1 Of Women 15-49 Who Had a Live Birth in the Past Five Years The Percentage Who Ha e Birth, d Prenatal Care For the Last LivAnd Percent Distribution of The Month of Pregnancy o the Number of Visits f the First Prenatal Visit andby Residence and Education Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 4-1 Des femmes 15 à 49 ans qui ont eue une naissance depuis cinq ans Le pourcentage qui a eue des soins prénatals Pour la dernière naissance vivante, Et des répartitions en pourcentage Du mois de grossesse de e no. de visites la première visite prénatales et lpar Résidence et Education Enquête Nationale Haitienne sur la Contraception, 1989 *Two women for whom data on prenatal care is unknown are not included *Deux femmes dont les données sur les soins prénatals sont inconnus ne sont pas comprises dans le total. TABLE 4-2 Place of Delivery of Last Live Birth Within Past Five Years by Residence and Education, Women 15-49 Years of Age Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 4-2 Lieu d'accouchment de la dernière naissance vivante depuis 5 ans Par résidence et éducation, femmes agées de 15 à 49 ans Enquête Nationale Haitienne sur la Contraception, 1989 * Not including one women for whom information is missing. * Il y a une femme pour laquelle on n'a obtenu aucune donnée. TABLE 4-3 Percent Distribution of Current Pregnancy Intention, By Residence, Number of L and Employment Status ive Births, Education Level Women In Union Aged 15-49 The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 4-3 La Répartition en Pourcentage de l'Intention Actuelle d'Avoir Une Grossesse Par Résidence, Nombre de Naissances Vivantes, Education et Statut d'Emploi Femmes En Union Agées de 15 à 49 Ans Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 4-4 Of Those Women Who Had a Live Birth in the Past Five Years Percent Distribution of The Planning Status of The Last Pregnancy Which Resulted in A Live Birth by Residence, Number of Live Births, Education Level and Employment Status The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 4-4 Des Femmes Q es Années, ui Ont Eue Une Naissance Vivante Pendant Les 5 DernièrRépartition en Pourcentage du Statut de Planification De la Dernière Grossesse Qui a Abouti à Une Naissance Vivante, Par Résidence, Nombre de Naissances Vivantes, Education et Statut d'Emploi Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 4-5 Of Those Women Who Had a Live Birth in the Past Five Years The Planning Status of The Last Pregnancy Which Resulted in A Live Birth By The Planning Status According To The Father The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 4-5 Des Femmes Qui Ont Eue Une Les 5 Dernières Années, Naissance Vivante PendantLe Statut de Planification De la Dernière Grossesse Qui a Abouti à Une Naissance Vivante, Par Le Statut de Planification D'après Le Père Enquête Nationale Haitienne sur la Contraception, 1989 * Includes those who responded "up to the will of God, fate, etc". * Y compris ceux qui on repondu "d'après la volonté du Dieu, le sort, etc". 5. CONTRACEPTION 5.1 Knowledge of Methods Table 5-1 presents information on the proportion of men and women reporting that they have heard of each contraceptive method, by residence. Approximately four out of five female and male re- spondents had heard of at least one method. There are no strik- ing differences overall between urban and rural areas. Women report higher levels of knowledge of the major "female" methods (pills, injectables, and female sterilization) than men, while men report somewhat higher knowledge of the major "male" methods; condoms and withdrawal, but not vasectomy. A little more than half of women reported knowledge of injectables and 60 percent of males know of oral contraceptives. No other method is known by more than one-third of either sex, a low level compared to other countries. Table 5-2 presents knowledge of methods by education level of the respondent. In general, respondents with more education have higher levels of knowledge of all methods. This is especially true of the respondents with the most education, who have second- ary schooling or more. Nevertheless, aside from pills and con- doms, knowledge of most methods is not very high, even among the best educated. Again, male knowledge, even controlling for education level, is lower than female knowledge, except for condoms, withdrawal and rhythm. Tables 5-3 and 5-4 show knowledge of methods by union status for males and females, respectively. There is no consistent rela- tionship between knowledge of contraceptive methods and union status among men for all methods shown. Legally married men do report somewhat higher knowledge of the pill, injectables and the IUD than do other men. Among women, those never-in-union or in a visiting relationship are less likiely than those in a consensual or legal union to know about most methods. 5.2 Contraceptive Use Now or in the Past (Ever Use) Only 17 percent of males and 11 percent of females report that they or their partner have ever used a contraceptive method (Table 5-5). For men this figure ranges from 31 percent in Port- au-Prince to 12 percent rural areas. The corresponding range for females is from 15 to 10 percent. Pill use now or in the past is reported by almost 6 percent of women with no significant differ- ences by residence. Overall, nine percent of males report ever using a condom, but in urban areas the figure was more than three times higher than in rural areas. Reported use of withdrawal is also notably higher in urban areas. There are also some important differences in reported ever use of contraceptive methods according to gender. Respondents reporting that they or their partners ever used a method is significantly 19 higher for condoms and withdrawal among men compared to women. This is especially true in urban areas. In fact, the differen- tial in ever use of "any method" (at least one method) is largely due to higher reported ever use of condoms and withdrawal by males. Table 5-6 presents data on the percentage of all men and women, (or their partners) who have ever used a contraceptive method, by union status and method. Among women, higher proportions of those who are currently or formerly in union have ever used a method compared to those who have never been in union. The differences are most significant for the three major female methods - pills, injectables and sterilization. Among men, ever use is roughly similar in all union categories, except for those in a visiting relationship for whom ever use of male methods-- condom and withdrawal--is higher. 5.3 Current Use of Contraception Table 5-7 presents the percentage of all men and women, whether in union or not, who report that they or their partner currently use a contraceptive method, by residence and method. Few Hai- tians, 6.6 percent of all women and 8.5 percent of all men report they are currently using a method. Among women, only 2.6 percent report using the pill, 1.7 percent are using female sterilization and 1 percent are using inject- ables. For men, the primary method used is the condom. While among women there is little difference according to residence, there is higher prevalence reported by men in urban areas, re- flecting the much higher use of condoms, and to a lesser extent the pill and withdrawal, in urban areas. As is the case for ever use shown in Table 5-5, about 10 times more men than women report current condom use and most of this condom use is in urban areas. Table 5-8 presents the percentage of all men and women, who are using a contraceptive method, by their union (marital) status. Most female contraceptive use is among women in union; almost 12 percent of women who are married and almost 10 percent of women in a consensual union (plasé) use a method, with fewer women in a visiting (vivavek) relationship, 6.4 percent, using a method. There is little difference in the methods used by women in the three types of union, except that female sterilization use is reported only by women in plasé and marriage relationships, the more stable unions. Very few women who have never been married, less than 1 percent, use a method, while the few formerly married women who use a method are sterilized, presumably while they were still in union. Among men also, as might be expected, the highest usage rates are among men who are in union. Female sterilization reported by men is also restricted to men who are married or plasé. However, what is most striking about men in union is the relatively high use (18.0%) of contraception (mostly condom use) by those who are 20 in a visiting union (vivavek). This is approximately three times the level reported by women in a visiting union. The fact that not one women in a visiting union reported condom use may be the result of a gender gap in reporting this male method. This suggests that men in this less stable type of union tend to use condoms more (15.6%) because a higher proportion have more than one partner, resulting in a greater concern about sexually trans- mitted diseases and/or preventing pregnancy. This is shown to be the case in Table 5-9 which presents data on the proportion of sexually active men who have had more than one sexual partner in the past 3 0 days, according to union status. One in five men (21.1 percent) who are in a visiting relationship (vivavek) report more than one sexual partner in the past 30 days, which shows behavior almost identical to the 21-23 percent of men who are not in union (never or formerly married). By comparison only about 3 percent of men who are plasé or married report having had more than one partner in the past 30 days. Less than one percent of women in union report more than one partner in the past 30 days. Figures 1 and 2 are summaries of current contraceptive use among women and men in union. As shown in Graph 5-A more than 10 percent of women in union are currently using a contraceptive method, mainly the pill, followed by female sterilization and injectables. Very few women in union report using the IUD and even fewer condoms. Graph 5-B shows that more than 11 percent of men in union are currently using a contraceptive method. Com- pared to female users similar proportions of male users in union report current use of female sterilization and injectables. On the other hand relatively few men report their partners are using the pill, while a relatively large proportion report they are using of condoms and withdrawal. Table 5-10 breaks down the information in Figures 1 and 2 by residence. Among women in union there is somewhat greater use in urban as compared to rural areas. For males, the residential differential is even greater with more than a three times greater proportion of men in union in Port-au- Prince using any method, compared to men in rural areas, and a distinct differential between Port-au-Prince and other urban areas. The fact that roughly 7 times more men in union than women report using condoms suggests that women may not be reporting use of the condom by their male partners (the differential in urban areas is even greater). This could be due to three reasons: the first isthat women may consider it a "male" method which is not actual- ly "used" by women, even though they are asked about contracep- tive methods used by them or their partner; the second might be consideration of condoms as secondary "female" method used as a backup when initiating other "female" methods of contraception and/or as a disease preventive measure only; or, lastly, in-union males who are reporting relatively high condom use maybe using condoms with women outside of their union for disease prevention and/or pregnancy prevention. However, only 5 percent of all in- 21 union males report more than one sexual partner in the past 30 days. Since there is a higher level of pill use reported by women com- pared to men, it could be that some men are not aware of their partner's use of this method or are less likely to report their use. It may also be a reflection of the independent samples for men and women. In both Tables 5-7 and 5-10, reported levels of use of female sterilization is similar for both men and women. These observations suggest that males are very likely to be aware of their partners having been sterilized. Table 5-11 presents the percentage of men and women currently in union, by age group, who report current use of a contraceptive method. Among women, those in the 15-24 age group have the lowest level of contraceptive use at 5.1 percent, while those in the 30-34 and 35-39 age groups have the highest levels of use, at 16 and 14 percent, respectively. Among females, there is in- creasing use with age of the two most used methods--the pill and sterilization--until age 40. Although males report roughly similar increases with age of these two methods, and of inject- ables, male use of condoms is highest in the youngest age group and then steadily decreases with age. Although condom use will be discussed in detail in a later section of this report (See section 7.2), it has been shown so far that condom use is mostly among younger, urban men, regardless of their union status. Table 5-12 presents the percentage of men and women, currently in union, who are using a contraceptive method, by educational level. Among both women and men there is a higher level of contraceptive use among persons with a higher level of education. The difference between the highest and lowest levels of education is greater for males than females. For males, there is greater than a six-fold difference compared with a two-fold difference reported by women. This is primarily due to the low condom use reported by males with a no education. Table 5-13 shows the level of current contraceptive use by women and men, by religious affiliation. Among women, the overall percentage using a contraceptive method is similar for the three religious groups: Catholic, Protestant and other. Also, use of individual methods differs very little between religious groups, although female sterilization is lower among Catholics compared to the two other groups, and is highest in the "other" religious grouping. Among men, results are similar. Overall use and use of individu- al methods differ only slightly according to religion, with the exception of female sterilization. As is the case for women, contraceptive sterilization is highest in the "other" religious grouping, but there is little difference between Catholics and Protestants. As mentioned previously, this survey is the fourth nation-wide, household-based survey to measure contraceptive prevalence in 22 Haiti. Table 5-14 compares the results of this survey with the three previous surveys: the Haitian Fertility Survey of 1977 (part of the World Fertility Survey project), the Haitian Contra- ceptive Prevalence Survey of 1983 and the Morbidity, Mortality and Use of Services Survey of 1987. Since 1977 contraceptive prevalence in Haiti has remained at low levels; only 5.4 percent of women in union were using a modern method of contraception in 1977, 3.9 percent in 1983, and 4.9 in 1987.1 The levels reported in the three earlier surveys were not significantly different. The present survey found that 9.6 percent of women in union were using a modern contraceptive method. This is approximately double the 1977 level, with increases in each domain studied. 5.4 Reasons for Non-Use of Contraception Table 5-15 presents the reasons reported for not using a contra- ceptive method by men and women in union. The overall results are similar for males and females since three-fourths of both men and women report non-use because of reasons related to pregnancy, sub-fecundity and sexual activity. Nevertheless, there are important differences between men and women. Only 9 percent of women report menopause as a reason for non-use, while 17 percent of men report non-use because their partners are menopausal. Also, while almost one- fourth of women report the fact that they are post-partum as a reason for non- use, only 14.5 percent of men report that their partners are post-partum and/or breastfeeding as a reason for non-use. Some of these differences are perhaps due to the sample including men to the age of 59 and women only to the age of 49, making it possible that the sampled women are, on average, younger and more fecund than the wives of the sampled men. A similar percentage of women and men report that they or the female partner are currently pregnant as a reason for non-use, but almost twice as many men compared to women report they desire that their female partner become pregnant as a reason for non-use. Table 5-16 shows the reasons reported by former users of contra- ceptives who discontinued using a method. The data are roughly similar for men and women, with slightly less than 40 percent of both groups reporting reasons related to pregnancy, sub-fecundity and sexual activity. In the "other reasons" category, the data are also similar for both men and women, with health concerns and method-related problems cited most often. Six percent of male discontinuers reported that the method being used was unavailable and a similar percentage said that the spouse was responsible for discontinuing use of the method. Table 5-17 shows that 40 percent of fecund women in union, not currently using a contraceptive method, would like to use a method. There is not a great deal of difference according to residence, though a slightly greater percentage of rural women would like to use a method. The demand for contraception in- creases with parity; 52 percent of women with four or more chil- 23 dren would like to use a contraceptive method. Table 5-17 also shows that a greater proportion of less well educated women would like to use a method, which may reflect that they are also more likely to be of higher parity. For those women who would like to use a contraceptive method, Table 5-18 presents data on the specific method they would prefer to use. More than half, 55.4 percent, would want to use a hor- monal method--the pill or an injectable. Except for women with 6 or more children, very few preferred contraceptive sterilization. It is notable that 30 percent would use any method and a further 5 percent feel they are not well enough informed to have a pref- erence, which reflects the relatively low level of knowledge of contraceptive methods. 24 TABLE 5-1 Percent of Females, 15-49 and Males, 15-59, Reporting That They traceptive Methods Have Heard of Specific Conby Residence and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-1 Pourcentage des Hommes Agés de 15 à 59 et Femmes Agées de 15 à 49 Qui Déclarent Avoir Enten aceptives Spécifiques du Parler des Méthodes ContrPar Résidence et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-2 Percent of Females, 15-49, and Males, 15-59, Reporting That They Have Heard of Specific Contraceptive Methods by Education Level and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-2 Pourcentage des Hommes Agés de 15 à 59 et Femmes Agées de 15 à 44 Qui Déclarent Avoir Enten raceptives Spécifiques du Parler des Méthodes Cont Par Education et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-3 Percent of Men, Aged 15-59 Reporting That Th aceptive Methods ey Have Heard of Specific Contrby Union Status and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-3 Pourcentage des Hommes Agés de 15 à 59 Qui Déclarent Avoir Ent raceptives Spécifiques endu Parler des Méthodes ContPar Etat Civil et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-4 Percent of Women, Aged 15-49 Reporting They Have Heard of Specific Contraceptive Methods by Union Status and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-4 Pourcentage des Femmes Agées de 15 à 49 Qui Déclarent Avoir Enten ceptives Spécifiques due Parler des Méthodes ContraPar Etat Civil et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-5 Percent of Women, 15-49, and Men, 15-59, Who Have Ever Used A Contraceptive Method by Residence and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-5 Pourcentage des Hommes Agés de 15 à 59 et des Femmes Agées de 15 à 44 Qui Ont Utilisés Une Méthode Contraceptives Au Moins Une Fois Par Résidence et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 * Includes vaginal tablets, cream and foam. * Y compris les tablettes vaginales, la crème, et la mousse TABLE 5-6 Percent of Women, 15-49, and Men, 15-59, Who Have Ever Used A Contraceptive Method, by Union Status and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-6 Pourcentage des Hommes Agés de 15 à 59 et des Femmes Agées de 15 à 44 Qui Ont Utilisés Une Méthode Contraceptive Au Moins Une Fois Par Etat Civil et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-7 Percent of All Women, 15-49, and All Men, 15-59, Who Are Currently Using A Contraceptive Method, by Residence and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-7 Pourcentage de Tous les Hommes Agés de 15 à 59 Ans et de Toutes les Femmes Agées de 15 à 49 Ans Qui Utilisent Actuellement Une Méthode Contraceptive Par Résidence et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 * Persons in a union were asked the method they are currently using; for persons not currently in a union, current use is defined as having either been contraceptively sterilized or else having used the method at last sexual intercourse and having had sexual intercourse in the past 30 days. *On a demande aux enquêté(e)s en union de citer la méthode qu'ils / qu'elles utilisent actuellement. Pour ceux qui ne sont pas en union, l'utilisation actuelle a été defini comme l'enquete(e) ayant eu(e) une ligature des trompes pour des raisons contraceptives, ou bien ayant utilisé(e) une méthode contraceptive pendant les derniers rapports sexuels et ayant eu des rapports sexuels pendant les 3 0 derniers jours. TABLE 5-8 Percent of All Women, 15-49, and All Men, 15-59, Who Are Currently Using A Contraceptive Method, by Union Status and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-8 Le Pourcentage des Tous les Hommes Agés de 15 à 59 Ans et Toutes les Femmes Agées de 15 à 49 Ans Qui Utilisent Actuellement Une Méthode Contraceptive, Par Etat Civil et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 * Including 9 cases whose marital status is unknown * Y compris 9 cas dont l'êtat civil est inconnu. TABLE 5-9 Percentage of Sexually Active Women 15-49 and Men 15-59 Who Report More Than One Sexual Partner In The Last 30 Days By Union Category Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 5-9 Des Femmes 15-49 et Des Hommes Qui Sont Actifs Sexuellement Le Pourcentage Qui A Eu Pl e Sexuel Depuis 30 Jours us D'Un PartenairPar Etat Civil Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-10 Percent of Females, 15-49, and Males, 15-59, Currently in Union* Who Are Currently Using Specific Contraceptive Methods by Residence and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-10 Pourcentage des Hommes Agé s Agées de 15 à 44 Ans s de 15 à 59 Ans et FemmeActuellement en Union* Qui Utilisent Actuellement Une Méthode Contraceptive Par Résidence et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 * union is defined as being either "maryé" or legal marriage, "plasé" or consensual union, or "vivavek" or visiting relationship. * en union est défini comme maryé, plasé ou vivavek. TABLE 5-11 Percent of Women, 15-49, and Men, 15-59, Currently in Union, Who Are Currenty Using a Contraceptive Method, by Method and Age Group The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-11 Pourcentage des Femmes, 15-49, et des Hommes, 15-59, Actuellement en Union, Qui Utilisent llement, Une Méthode Contraceptive ActuePar Méthode et Groupe d'Age Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-12 Percent of Women, 15-49, and Men, 15-59, Currently in Union, Who Are Currently Using Contraceptive Methods by Education Level and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-12 Pourcentage des Femmes, 15-49 et Hommes 15-59, Actuellement en Union, Qui Utilisent Une Méthode Contraceptive Actuellement, Par Education et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-13 Percent nion, of Women, 15-49, and Men, 15-59, Currently in U Who Are Currently Using Contraceptive Methods by Religion and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 5-13 Pourcentage des Femmes, 15-49 et Hommes 15-59, Actuellement en Union, Qui Utilisent Une Méthode Contraceptive Actuellement, Par Religion et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-14 Percent of Women, 15-49, Currently in Union Who Are Currently Using A Modern Contraceptive Method, by Residence The 1989 Haiti Natio Prevalence Survey nal Contraceptive Compared to: The Morbidity, Mortality and Use of Services Survey (EMMUS), 1987, The Haiti Contraceptive Prevalence Survey (EHPC), 1983 and The Haitian Fertility Survey (EHF), 1977, TABLEAU 5-14 Pourcentage des Femmes Agées de 15 à 49 Actuellement en Union Qui Utilisent Actuellement Une Méthode Contraceptive Moderne* Par Résidence Enquête Nationale Haiti ception (ENHAC), 1989 enne sur la Contra Comparé Avec: L'Enquête Mortalité, Morbidité et Utilisation des Services (EMMUS), 1987 L'Enquête Haitienne Sur La Prévalence de la Contraception (EHPC), 1983 et L'Enquête Haitienne Sur La Fecondité (EHF), 1977 * The methods considered to be modern are: the pill, the IUD, the condom, female or male sterilization, injectables, vaginal foam and vaginal tablets * Les méthodes considérées comme modernes sont: la pilule, le stérilet (DIU), le condom, les injectables, la mousse vaginale et les tablettes vaginales. ** Data broken down by residence not available. ** Des données par résidence ne sont pas disponible. Source: Survie et Santé de l'Enfant en Haiti. Cayemittes et Chahnazarian, (Child Survival and Health in Haiti) Institut Haitien de L'Enfance, 1989, page 48. TABLE 5-15 Percent Distribution of Reasons for Not Currently Using a Contraceptive Method Among Women 15-49 and Men 15-59 In Union Not Currently Using a Method Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 5-15 Répartition en Pourcentage Des Raison uellement s Pour Ne Pas Utiliser Une Méthode Contraceptive Act Parmi Les Femmes 15-49 et Les Hommes 15-59 En Union Qui N'Utilisent Pas Une Méthode Actuellement Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-16 Percent Distribution of Reasons for Discontinuing Use of a Contraceptive Method Am d ong Women 15-49 and Men 15-59 Who Formerly Used a Metho Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 5-16 Répartition en Pourcentage Des R tive aisons Pour Avoir Cessé l'Utilisation d'Une Méthode Contracep Parmi Les Femmes de 15 à 49 Ans et Les Hommes de 15 à 59 Ans Qui Ont Utilisés Une Méthode Dans le Passé. Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 5-17 Percent Of Women In of Contraception, Union 15-49, Who are Fecund, Non-Users Who Want To Use a Contraceptive Method, By Residence, Age, Education, Number of Live Births and Union Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 5-17 Le pourcentage des femmes âgées de 15 à 49 ans, Qui sont fertile ontraception, s, en union et qui ne se servent pas de la cQui veut utiliser une méthode contraceptive Par résidence, âge, éducation, no. de naissances vivantes et Etat Civil Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés **Fewer than 25 cases / Moins de 25 cas ( ) = Number of unweighted cases TABLE 5-18 Percent Distribution of Contraceptive Method Preferred By Fecund rs of Contraception, Women 15-49, Currently In Union, and Non-UseWho Want To Use A Contraceptive Method, By Residence, Age, Education, Number of Live Births and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 5-18 Répartition en pourcentage de la méthode contraceptives désirées Par les femmes fertiles, âgées de 15 à 49 ans, actuellements en union, Et non-utilisatrices de la contraception, Qui veulent utiliser une méthode contraceptive Par résidence, âge, éducation, no. de naissances vivantes et statut d'emploi Enquête Nationale Haitienne sur la Contraception, 1989 6. RISK OF UNPLANNED PREGNANCY A woman was characterized as "in need of services" (or "at risk of an unplanned pregnancy") if she was not currently pregnant, stated that she did not desire to become pregnant, and she was not using any method of contraception for reasons not related to pregnancy, sub-fecundity, or sexual inactivity. Men are consid- ered in need of family planning services who are: sexually ac- tive, whose partners are not currently pregnant, who do not currently want their wife or partner to have a pregnancy, and are not using a contraceptive method for reasons not related to pregnancy, sub-fecundity, or sexual inactivity. Table 6-1 shows that more than 27 percent of women in union 15-49 years of age are in need of family planning services. A similar proportion of women in urban and rural areas are in need of family planning services. Unlike most other countries, where the percent of women in need of family planning services is usually far greater in rural areas than in urban areas, in Haiti they are about equal. This is probably because of the low overall preva- lence of contraception in Haiti. There is also little difference in the need for family planning services according to age. However, as might be expected, women who have no children and who are at lower risk of an unplanned pregnancy because of family presure to have a child once in union, are less likely to be in need of family planning services. Not shown in the table is that of those women not in need of family planning services, 41 percent were not in need because they were not sexually active in the past thirty days for a variety of reasons. Of those women, 44.4 percent were not sex- ually active because they were postpartum and/or breastfeeding at the time of the survey and will obviously be in need in the near future. If these women were included in the definition of women in need of family planning services, the percentage in need would have been 40.3 percent, rather than 27.2 percent. Table 6-2 shows that, compared to women, a similar proportion of men in union or their partner, 21.4 percent, are in need of family planning services. The only exception is men in the group with no education whose need for family planning is much lower than women in the same category. As with women, there is little difference between men in urban and rural areas, except for the couples with husbands in the 50-59 year age group, who are much less likely to be in need of family planning services. A more detailed investigation of the older men, which is not shown in a table, revealed that the major difference between urban and rural men in the 50-59 year old age group is that while only 40 percent of the wives/partners of urban men in this age group are sub- fecund or menopausal, fully 64 percent of the wives/partners of rural older men are sub-fecund or menopausal, which excludes them from the 'in need' category. In general, the need for family planning services for men increases with the number of living 25 children and education. There is no difference according to the type of union. Also not shown in the table is that among men not in need of family planning services, 21 percent were not in need because they were not sexually active in the past thirty days for a variety of reasons. Of those men, 37 percent were not sexually active because their wives/partners were postpartum and/or breastfeeding at the time of the survey and will be in need in the near future. If these women were included in the definition of women in need of family planning services, the percentage in need would be 26.2 percent, rather than 21.4 percent. Table 6-3 shows the percent distributions of the of men and women in need of family planning services, by selected characteristics. This distribution represents the numerators of the percentages in Tables 6-1 and 6-2. Previous tables showed that similar propor- tions of men and women in urban and rural areas are in need of family planning services or at risk of unplanned pregnancies. However, in absolute terms, since the population distribution of Haiti is mostly rural, almost three-fourths of the men and women who are in need of family planning services, live in rural areas. Of rural women in need of family planning services, those with no education, who have at least 4 children, who are at least 25 years of age and who are married or in a consensual union predominate. Rural men in need of family planning services tend to be those who are aged 25-49, who have 4 or more children, who have lower levels of education and who are married or in a con- sensual union. Fecund women in union were asked if they wanted any more children at some point in the future. Table 6-4 shows that more than one- half of these women (55%) said they did not want any more chil- dren. As one would expect, the proportion of women who did not want any more children increased with age and family size. Here it is noteworthy that urban women, particularly those living in the metropolitan area, want to terminate childbearing earlier in life and at lower parities than rural women. The data are similar for men whose wives/partners are fecund (data not shown). Overall, forty-seven percent of men want no more children, with the percentage increasing from 45 percent among rural residents to 61 percent among metropolitan Port-au- Prince residents. Also, as is the case among women, the proportion of men who do not want any more children increases with age and family size and, as also is the case for women, urban men want their wives/partners to terminate childbearing earlier in life and at lower parities than rural men. Table 6-5 presents data on contraceptive use among those men and women in union (shown in Table 6-5) who do not want any more children. Overall, only 18 percent of women who desire to limit their births are using a method. Use is highest in Port-au- Prince and drops off slightly in other urban and rural areas. The primary method used is the pill, followed by female sterili- 26 zation and injectables. Most women who want to limit their births are using more effective methods of contraception, but it is striking that approximately four-fifths of women in union who do not want any more children are not using contraception. The data are similar for males who currently desire that their wives/partners limit their births. Almost 23 percent of men (or their wives/partners) in this group are using a method, with use being highest in Port-au-Prince, lower in other urban areas and lowest in rural areas. However, the primary method used by men or their partnes is female sterilization, followed closely by the condom and then the pill. Obviously, contraceptive sterilization would be appropriate for this group since they do not want any more children, while condoms are less suitable to their needs. 27 TABLE 6-1 Percent of Women In Union, 15-49, In Need* of Family Planning Services, By Residence, Age, Education, Number of Live Births and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 6-1 Le pourcentage des femmes en union, âgées de 15 à 49 ans, Qui ont besoin des services de planification familiale, Par résidence, âge, éducation, no. de naissances vivantes et statut d'emploi Enquête Nationale Haitienne sur la Contraception, 1989 *Women are defined as being in need of family planning services who are: fecund, sexually active, not currently pregnant, not currently desiring a pregnancy, and not using a contraceptive method for reasons not related to pregnancy, subfecundity, or sexual inactivity. *Une femme qui a besoin des services de planification familiale est fertile, est active sexuellemente, n'est pas enceinte actuellement, ne désire pas de tomber enceinte actuellement et n'utilise pas une méthode contraceptive actuellement pour des raisons n'ayant pas rapport avec une grossesse, la sous-fertilité ou l'inactivité sexuelle. ( ) = Nombre de cas non-ponderés **Fewer than 25 cases / Moins de 25 cas ( ) = Number of unweighted cases TABLE 6-2 Percent of Men In Union, 15-59, In Need* of Family Planning Services, By Residence, Age, Education, Number of Children and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 6-2 Le pourcentage des hommes en union, âgées de 15 à 59 ans, Qui ont besoin des services de planification familiale, Par résidence, âge, éducation, no. d'enfants et statut d'emploi Enquête Nationale Haitienne sur la Contraception, 1989 *Men are in need of family planning services who are: sexually active, whose partners are not currently pregnant, who do not currently want their partner's to be pregnant, and are not using a contraceptive method for reasons not related to pregnancy, subfecundity, or sexual inactivity. *Un homme gui a besoin des services de planification familiale est active sexuellemente, son partneaire n'est pas enceinte actuellement, il ne désire pas que son partenaire tombe enceinte actuellemente et il n'utilise pas une méthode contraceptive actuellemente pour des raisons n'ayant pas rapport avec une grossesse, la sous-fertilité ou l'inactivité sexuelle. ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 6-3 Percent Distribution Of Women 15-49 and Men 15-59, In Union, In Need of Family Planning Services, By Selected Characterisitics and Residence Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 6-3 Répartition en pourcentage des femmes 15-49 et des hommes 15-59, en union, Q , ui ont besoin des services de planification familialePar Des Caracteristiques Sélectionées et Résidence. Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Number of unweighted cases ( ) = Nombre de cas non-ponderés TABLE 6-4 Fecund* Women In Union, 15-49: The Percent Who Want No More Children By Residence, Age, Education, Number of Live Births and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 6-4 Des Fem 49 Ans, mes Fertiles et en Union, Agées de 15 à Le Pourcentage Qui Ne Veut Plus d'Enfant Par résiden t d'emploi ce, âge, éducation, no. de naissances vivantes et statuEnquête Nationale Haitienne sur la Contraception, 1989 *Refers to ability to conceive. Women who are surgically sterilized are considered fecund, but not desiring more children *Se référe à la capacité de devenir enceinte. On considere comme fertile les femmes qui ont été stérilisée chirugicalement, mais qu'elles ne désirent plus d'enfants. ** Fewer than 25 cases / Moins de 2 5 cas ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 6-5 Fecu nd, nd Women 15-49 and Men 15-59 Whose Wives/Partners Are Fecu Who Are Currently in Union and Who Want No More Children, Percent Who Are Currently Using A Contraceptive Method, by Residence and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 6-5 Parmi Les Femmes Fertiles Agées de 15 à 44 Et es Les Hommes Agés de 15 à 59 Dont les Femmes/Partenaires Sont Fertil Qui Sont Actuellement en Union et Qui Ne Désirent Plus d'Enfants, Le Pourcentage Qui Utilisent Actuellement Une Méthode Contraceptive Par Résidence et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 7. AVAILABILITY OF SERVICES 7.1 Source of Contraception Table 7-1 shows the source of contraceptive methods reported by male and female current users, by place of residence. There is little difference in source by residence except that there is a greater use of non-public sources by men in the urban compared to rural areas. This may be due to the greater use of condoms in urban areas by men, which are easily obtained in pharmacies and from friends. Table 7-2 supports this explanation, showing that almost 40 percent of males obtained their condoms from sources other than in the hospitals or other public sector facilities. Among women, apart from 10 percent who obtain their pills in pharmacies, almost all pills are obtained from hospitals and government dispensaries. All female sterilizations reported by women were done in hospitals, with the remainder performed in other public facilities. The pattern for men is the same except that all their wives 'or partners' surgical contraception procedures were performed in public facilities. For the women aged 15-49 who are not currently using a contracep- tive method, 62 percent of women who are in union and 55 percent of women who are not in union know of a source for obtaining contraception (Table 7-3). The proportion increases with educa- tion to more than 80 percent of women with any secondary educa- tion. Otherwise, there is no clear pattern according to resi- dence, age or number of children. For women not in union, knowl- edge is lower among women over 40 years of age or with 4 or more children. Since the use of contraception in Haiti is relatively low, the 38 to 45 percent not knowing a source represents a substantial number of women. The same data are shown for men in Table 7-4. Fifty-one percent of men in union and 46 percent of men not in union know of a source of contraception, slightly lower than for women. As is the case for women, knowledge of a source increases with educa- tion. However, unlike women, among men, knowledge is higher in urban areas than rural areas and is generally higher for men in union. The specific sources known by these men and women are almost all in the public sector, as shown in Table 7-5. Although there may be some understandable confusion as to whether a health facility is public or private, except for a few men and women in Port-au- Prince, it is clear that pharmacies are relatively unknown as a source of contraception. IEC activities should seek to make both men and women aware to a greater extent of the existence of facilities that provide family planning services, particularly among young, rural men. In spite of few people knowing of pharmacies as a potential 29 source of contraception, the commercial sector could play a greater role in providing contraceptive methods in Haiti. Table 7-6 shows that about 80 percent of both current users and non- users who would like to use report that they are able, if payment were necessary, to buy a contraceptive method. There is a slightly greater proportion of urban residents, as well as those with more education, who could buy a method. Younger non-users also stand out as a group who could purchase a method. There is no clear message that women who work have greater purchasing power. Table 7-7 shows similar results for men, of whom more than three- fourths stated that they could pay for a method, if necessary. There is an even more striking difference between urban and rural men than was the case for women; 81 percent of urban men could pay for a method compared to only two-thirds of rural men. The same is true of education; while only 65 to 73 percent of men with a primary education or less could pay for a contraceptive method, 85 percent of men with a secondary education or more could do so. As is the case for women, this is undoubtedly due to these men having greater purchasing power. This analysis also found that between 4 0 and 50 percent of men and women, respectively, did not know the approximate amount they could afford to pay each month for a contraceptive method (not shown in a table). Of those men and women who could state the amount they could afford, about two-thirds said they could afford one dollar or more. 7.2 Condom Use Slightly more than three percent of all Haitian men are currently using condoms (Table 7-8). This is 10 times the 0.3 percent of women who report their partner uses condoms (See Table 5-7). There are important differences in condom use according to the respondent's residence and union status. Higher proportions of men in urban areas, 6 to 7 percent, report using condoms compared to less than 2 percent in rural areas. Also, condoms are used to a much greater extent by men who are in a visiting type union, known as "vivavek" in the Creole language. As shown earlier, in Tables 5-8 and 5-9, this may be due to a greater proportion of men in this less stable type of union having more than one part- ner, perhaps resulting in a greater concern about sexually trans- mitted diseases or avoiding an unplanned pregnancy. Table 7-9 presents the estimated average number of condoms obtained per year based upon the number obtained in the past 30 days. About 8,872,000 condoms per year are estimated to have been obtained by male users, mostly in urban areas. As can be seen in the footnote, about 11,770,000 condoms were issued by storage facilities at various levels. Most of the difference between these two figures probably represents quantities stocked in storage facilities until they are distributed to ultimate users. 30 Reasons for using condoms by men who had obtained them during the previous 12 months are shown in Table 7-10, by union status. (Although similar data were obtained for women, there were too few among them who obtained condoms to do a detailed analysis, as was done for men.) Significantly, for men in union, while 62 percent use condoms exclusively to prevent pregnancy, 13 percent do so only to protect themselves from AIDS or other sexually transmitted diseases (STDs). Among men not in union, more than twice this proportion, 35 percent, use condoms exclusively to prevent AIDS and other STDs. Moreover, if one adds the percent of men who use condoms for both reasons, then a total of 60 percent of men not in union who use condoms are doing so at least partially for STD prevention reasons, compared to just one third of men in union. Table 7-11 shows the frequency of condom use reported by men who had obtained them during the previous 12 months, by union status. About three-fourths of this group of men, regardless of union status, report using condoms for all coital acts. 31 TABLE 7-1 Percent Distributio traceptive Method, n of Source of Currently Used Con Of Women, 15-49 and Men, 15-59, by Residence The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-1 Répartition en Pourcentage des Sources des Méthodes Actuellement Utilisé Des Femmes, 15-49 et Des Hommes, 15-59, Par Résidence Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 7-2 Percent Distribution ntraceptive Method, of Source of Currently Used CoOf Women, 15-49 and Men, 15-59, for Selected Contraceptive Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-2 Répartition en Pour ement Utilisé centage des Sources des Méthodes ActuellDes Femmes, 15-49 et des Hommes, 15-59, Pour Des Méthodes Contraceptives Selectionées Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 7-3 Women Aged 15-49 Not Currently Using A Contraceptive Method: Percentage Who Know A Source For Obtaining Contraceptive Methods, By Union Status and Selected Characteristics The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-3 Des Femmes Agées de 15 à 4 9 ans, Qui N'utilisent Pas Une Méthode Contraceptive Actuellement, Le Pourcentage ontraceptives Qui Connait Une Source D'Obtenir Des Méthodes CPar Etat Civil et Caracteristiques Sélectionées Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 7-4 Men Aged 15-59 Not Currently Using A Contraceptive Method: Percentage e Methods, Who Know A Source For Obtaining ContraceptivBy Union Status and Selected Characteristics The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-4 Des Hommes Agées de 15 à 59 ans, Qui N'utilisent Pas Une Méthode Contraceptive Actuellement, Le Pourcentage ontraceptives Qui Connait Une Source D'obtenir Des Méthodes CPar Etat Civil et Caracteristiques Sélectionées Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases ** Fewer than 25 cases / Moins de 2 5 cas TABLE 7-5 Percent Distrib tion Mentioned ution of The Specific Source of Contracep By Women Aged 15-49 and Men Aged 15-59, Not Currently Using, But Who Know of A Source of Contraceptive Methods, By Residence The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-5 Répartition en Pourcentage de la Source Spécifique Mentionnée Par Les Femmes Agées de 15 à 49 Ans et Les Hommes Agés de 15 à 59 Ans N'utilisant Pas La Contraception Actuellement, Mais Qui Connaissent Une Source de Contraception, Par Résidence Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 7-6 Percent Of Women 15-49 Who Could Pay For A Contraceptive Method: Current Users and Non-Users Who Want To Use A Method, By Residence, Age, Education, and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 7-6 Le pourcentage des femmes agées de 15 à 49 ans Qui pourrait acheter une méthode contraceptived: Utilistrices Actuelles et Non-Utilistrices Qui Veulent Utiliser Une Méthode Par résidence, âge, éducation et statut d'emploi Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés **Fewer than 25 cases / Moins de 2 5 cas ( ) = Number of unweighted cases TABLE 7-7 Men 15-59 Currently Using A Contraceptive Method: Percent Who Could Pay For The Method, By Residence, Age, Education, and Employment Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 7-7 Le pourcentage des hommes agés de 15 à 59 ans Qui e, utilisent actuellement une méthode contraceptivQui pourrait acheter une méthode contraceptive, Par résidence, âge, éducation et statut d'emploi Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés **Fewer than 25 cases / Moins de 25 cas ( ) = Number of unweighted cases TABLE 7-8 Percent of All Men, 15-59, Who Are Currently* Using Condoms, By Union Status and Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-8 Pourcentage des Tous les Hommes Agés de 15 à 59 Qui Utilisent Actuellement des Condoms, Par Etat Civil et Méthode Enquête Nationale Haitienne sur la Contraception, 1989 *Visiting Relationship **Consensual Union ***Including 9 cases whose marital status is unknown ***9 cas dont l'êtat civil est inconnu sont compris dans le total. TABLE 7-9 Estimated Average Number of Condoms Obtained Per Year* And Estimated Total Annual Quantities Obtained by Men, 15-59 By Residence, Education, Union Status and Age The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-9 Nombre Moyen Estimés de Condoms Obtenus Par An** Et Quantités An de 15 à 59 Ans nuelles Totales Obtenues Par les Hommes Agés Par Résidence, Education, Etat Civil et Age Enquête Nationale Haitienne sur la Contraception, 1989 * The annual total of condoms obtained is estimated by multiplying the average number of condoms obtained in the past year (6.2) by the weighted number of male respondents in the survey (1,414), then multiplying the result by 1012, an estimate of males 15-59 in the population per each male survey repondent. Above results slightly different due to rounding. **On a estimé la quantité annuelle totale de condoms obtenues en multipliant la quantité moyenne annuelle obtenues (6.2) par le nombre ponderé d'enquêtes masculin (1,414), puis en multipliant le résultat par 1012, une estimation des males 15-59 ans dans la population pour chaque enquêté masculin. Les résultats en dessus sont un peu différent car les moyens ont été arrondis. 1 989 Condoms Issued From Min. Of Health / Min. de la Santé 9,154,832 Storage Facilities, 1989: PSFPP / Projet de PF-Secteur Privé 1,892,527 Sorties des Condoms des Profamil 826,320 Entrepots, 1989: Total 11,773,679 TABLE 7-10 Percent Distribution of Reasons for Using Condoms By Males, 15-59, Who Obtained Condoms During the Last 12 Months, by Union Status The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-10 Répartition en Pourcen Utilisation des Condoms tage des Raisons Pour l'Parmi les Hommes, 15-59, Qui Ont O at Civil btenus des Condoms Pendant les 12 Derniers Mois, Par EtEnquête Nationale Haitienne sur la Contraception, 1989 * Of those not in union, only those having had sexual intercourse in the past 30 days were included. * Parmi Ceux Qui Ne Sont Pas en Union, On a Inclus Seulement Ceux Qui Ont Eu des Rapports Sexuels Pendant Les 3 0 Derniers Jours TABLE 7-11 Percent Distribution of Regularity of Condom Use Among Males, 15-59, Who Ev in the Last 12 Months, er Obtained Condomsby Union Status The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 7-11 Répartition en Pourcen lisation des Condoms tage de la Fréquence de L'UtiParmi les Hommes, 15-59, Qui Ont Obtenus de rniers Mois, s Condoms Pendant les 12 DePar Statut Matrimoniale Enquête Nationale Haitienne sur la Contraception, 1989 8. ATTITUDES TOWARDS FAMILY PLANNING This chapter presents results of questions on attitudes pertain- ing to family planning. Overall, more than three-fourths of all women approve of family planning (Table 8-1). Although there is little difference by residence or education, age appears to have some influence. Only two- thirds of 15-19 year old women, those who have never been in union and those who have no children approve of family planning. This is to a certain extent due to a greater proportion replying "not sure", probably because they have not yet faced the issue. The proportion of men who approve of family planning is shown in Table 8-2. The data are similar to those for women. Men who are 15-19 years of age, those who have never been in union and those who have no children approve of family planning to a lesser extent than other men, again no doubt because they have not yet faced the issue. Also, somewhat fewer men who have low levels of education approve of family planning. Women's perception of the purpose of family planning is shown in Table 8-3. Almost half of women, 47.2 percent, feel the purpose of family planning is to space rather than limit births. The largest proportions of women who feel the purpose of family planning is to limit births live outside of Port-au-Prince, are older and less educated. These characteristics are also associ- ated with higher parity. Table 8-4 presents male perceptions of the purpose of family planning. The data are similar to the data for women: overall 41 percent of males feel the purpose of family planning is to space births and 36 percent feel it is to limit births. As is the case for women, men who are living outside of Port-au-Prince, who are less educated and who have more children are more likely to feel that the purpose of family planning is to limit births. Table 8-5 shows that the proportion of men and women who feel it is important to space births is very high, roughly 90 percent. This seems inconsistent with the results in Table 8-3 that only 38 percent of women felt that the purpose of family planning was to limit births. Again, women who are younger, with no living children and who are not in union feel birth spacing is of less importance than do women in other groups. Among men, there is little difference in their perception of the importance of birth spacing according to socio-demographic characteristics. As shown in Table 8-6, according to 69 percent of women 15-49 years of age who approve of family planning, the main benefit of family planning is economic--to be able to have children when they are affordable. This varies little according to socio- demographic characteristics. Another 12 percent of women feel that the main benefit of family planning is better health for the mother, while the remaining 19 percent feel there are other miscellaneous benefits. 33 The data are similar for men in Table 8-7 which show that 78 percent of men 15-59 years of age who approve of family planning feel the main benefit of family planning is to be able to have children when they are affordable. Table 8-8 presents the percent distribution of the respondents' opinion as to who in a union/marriage should make the decision about using a contraceptive method; both partners, the respondent alone or the respondent's partner alone. The data are similar for men and women, with most respondents stating that the deci- sion should be a joint one. (men - 57.3%, women - 65.0%). A further 21-22 percent stated the respondent alone should make this decision and only 8-12 percent stating that the respondent's partner should make the decision. 34 TABLE 8-1 Approval Of Family Planning By Women 15-49, By Residence, Age, Education, Number of Live Births and Union Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-1 L'approbation du planning familial par les femmes agées de 15 à 49 ans Par résidence, âge, éducation, no. de naissances vivantes et état d'union Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 8-2 Approval Of Family Planning By Men 15-59, By Residence, Age, Education, Number of Children and Union Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-2 L'approbation du planning familial par les hommes agées de 15 à 59 ans Par résidence, âge, éducation, nombre d'enfants et êtat civil Enquête Nationale Haitienne sur la Contraception, 1989 Approval of Family Planning (Percent Distribution) Approbation de la Planification Familiale (Répartition en Pourcentage) TABLE 8-3 Perception Of Purpose Of Family Planning By Women 15-49, By Residence, Age, Ed rths and Union Status ucation, Number of Live Bi(Percent Distribution) Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-3 La perception du but du planning familial par les femmes de 15 à 49 ans Par résidence, âge, éduc et statut d'union ation, no. de naissances vivantes(Répartition en pourcentage) Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 8-4 Perception Of Purpose Of Family Planning Of Men 15-59, By Residence, Age, Edu and Union Status cation, Number of Children (Percent Distribution) Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-4 La perception du but du planning familial par les hommes agés de 15 à 59 ans Par résidence, âge, éducation, nombre d'enfants et êtat civil (Répartition en pourcentage) Enquête Nationale Haitienne sur la Contraception, 1989 *Not including one case because of missing data. *Le total ne comprend pas un cas au cause des données qui manquent. **Not including three cases because of missing data. **Le total ne comprend pas trois cas au cause des données qui manquent. TABLE 8-5 Percent of Women 15-49 And Men 15-59 Who Think Birth Spacing Is Important By Residence, Age, Education, Number of Live Births and Union Status Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-5 Le pourcentage des femmes de 15 à 49 ans et les hommes de 15 à 59 ans Qui croient que l'espacement des naissances est important Par résidence, âge, éducation, no. de naissances vivantes et êtat d'union Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 8-6 Main Benefit Of Family Planning According To Women 15-49 By Residence, Age, Education, Number of Live Births and Union Status (Percent Distribution of Women Who Do Not Disapprove of Family Planning) Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 8-6 L'avantage principal du planning familial selon les femmes de 15 à 49 ans Par résidence, âge, éducation, no. de naissances vivantes et êtat d'union (Répartition en pourcentage des femmes qui ne désapprouvent pas du PF) Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 8-7 Main Benefit Of Family Planning According To Men 15-59 By Residence, Age, Education, No. of Live Births and Union Status Haitian National Contraceptive Prevalence Survey, 1989 (Percent Distribution Of Men Who Do Not Disapprove Of Family Planning) TABLEAU 8-7 L'avantage principal du planning familial selon les hommes de 15 à 49 ans Par résidence, âge, éducation, nombre d'enfants et êtat civil (Répartition en pourcentage des hommes gui ne désapprouvent pas du PF) Enquête Nationale Haitienne sur la Contraception, 1989 Main Benefit of Family Planning - Avantage Principal du Planning Familial TABLE 8-8 Women 15-49 And Men Aged 15-59 Percent Distribution of Who Should Make Decision To Use Contraceptive Method The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 8-8 Les Femmes Agées de 15 à 49 Ans et Les Hommes Agés de 15 à 59 Ans, La Répartition En Pou ndre La Décision rcentage De Quel Partenaire Devrait Pred'Utiliser Une Méthode Contraceptive Enquête Nationale Haitienne sur la Contraception, 1989 * One woman with missing information is not included. * Il y a une femme pour laquelle on n'a obtenu aucune donnée. 9. SEXUAL BEHAVIOR AND CONTRACEPTIVE USE AMONG YOUNG ADULTS 9.1 Socio-Demographic Characteristics Because of recent interest in adolescent fertility in the Carib- bean and Latin America, including early childbearing and high levels of unintended pregnancies, the Haitian National Contracep- tive Prevalence Survey included a special module for "Young Adults". This group is defined as males and females aged 15 to 24 years of age. This module focused on sexual experience, use of contraception at first sexual experience and attitudes about sex. Tables 9-1 and 9-2 present selected socio-demographic character- istics of men and women 15-19 years of age. Among 15-19 year old women, 85 percent have never been in union and 87 percent have never had a live birth. For 20-24 year old women, almost half have never been in union or had a live birth. Table 9-1 also indicates that levels of education among women are increasing, since 15-19 olds are better educated than 20-24 year olds. Whereas only 18.7 percent of women 15-19 years old have no education, this is true of 35.5 percent of women 2 0-24 years old, and as seen earlier in Table 3-2, 48.3 percent of women 15-49 years old never attended school. Similar socio-economic data for young men are presented in Table 9-2. The data show that 94 percent of men 15-19 years old and almost 72 percent of men 20-24 years old have never been in a union. More than 90 percent of young men have no living children and of those that do, almost all are 20-24 years old: roughly 10 percent of 20-24 year old men have one living child, 5 percent have 2 living children and less than two percent have three or more living children. Similar to young women, young men are better educated than older men in Haiti. Whereas only 13 percent of men 15-19 years have never attended school, this is true of 18 percent of men 20-24 years old, and as seen earlier in Table 3-2, one-third of men 15- 59 years old never attended school. Almost 60 percent of women in union who have had a birth con- ceived before the date of their first union (Table 9-3). Overall, about two-thirds of these premarital conceptions result- ed in a pre-union birth. The percentage of pre-marital concep- tions is especially high among women who enter into their first union after the age of 20 (80.9 percent), compared to women who are younger at the time of their first union (44.3 percent). In Haiti, there is a higher proportion of pre-union conceptions among young women living in "Other Urban" areas (67.9%), compared to both Port-au-Prince (53.6%) and rural areas (57.4%). There is an inverse relationship with education level. 35 As shown in Figure 3, this percentage is the second highest among areas in Latin America and the Caribbean for which these data are available. Table 9-4 presents data on the proportion of first births to the partners of young men that were conceived before their first union. Overall, 73 percent were conceived out of union and 70 percent of those were born outside of unions. This is somewhat higher than the percentage of pre-union births reported by young women themselves. The proportion of pre-union births to partners of young men is lower in Port-au- Prince and, as is the case for births reported by women, is higher for young men who enter into their first union at the age of 20 or older. The data suggest that Haitian men do not have problems entering into a union with women who have already had a child. All women who had ever been pregnant were asked whether the pregnancy resulting in their last live birth was intended. Intended pregnancies were defined as those that were wanted at the time the respondent became pregnant and unintended pregnan- cies were defined as those that were wanted at some future time ("mistimed") or not wanted, even at a future time. Overall, 32.3 percent of pregnancies resulting in the last live birth to women 15-24 in the last five years in Haiti were reported to be unin- tended (Table 9-5). However, the proportion of unintended preg- nancies among young women in union (27.6%) is about half the proportion reported by women not in union (54.4%). In fact, almost two- thirds (62.5%) of women not-in-union indicated that their first birth was unintended. Comparative data for women 15-24 who are not in union from recent surveys of young adults in various Latin American countries are shown in Figure 4. The data for Jamaica includes women in union, who are 15 % of the total. 9.2 Sexual Experience Less than four percent of young adults of either sex with sexual, experience reported that their first sexual partner was an "in union" partner (Table 9-6). As shown in Figure 5 this is the second lowest rate thus far found in Latin America and the Carib- bean--only the rate in Jamaica, a Caribbean neighbor, was lower. Outside the Caribbean, in Latin America, higher proportions of young women report that their first sexual experience was with a partner with whom they were in a consensual or legal union. The data in Figure 5 indicate that urban Mexico, Guatemala and Ecua- dor appear to be more conservative about preunion sexual rela- tions than the other urban areas in Brazil and Chile. In both Haiti and Jamaica, because of the low proportion of first sexual encounters reported to be within a union, reported sexual experience rates are essentially pre-union sexual experience rates, especially for those young adults who had their first sexual intercourse before the age of 20. Thus, in this report, 36 we will report sexual experience rates instead of pre-union sexual experience rates as was done in Jamaica. Whereas 86 percent of females reported their first partner to be their fiance or boyfriend, only 44 percent of males did so (Table 9-6). Forty-six percent of males reported their first partner to be a "friend". We can only speculate if this is a difference in perception between genders or whether females have a stronger emotional involvement at the initiation of their sexual experi- ence or both. Forty-one percent of young women and 44 percent of young men 15- 24 years of age report sexual experience. Sexual experience rates are shown by age group and residence in Table 9-7 and by age group and education in Table 9-8. For both sexes in Haiti, as may be expected, sexual experience rates increase with age. At 15-17 years age, the sexual experi- ence rate is almost twice as high for males as females. The rates begin to converge at age 18-19, and at ages 20-24 the sexual experience rate is essentially the same for men and women. Although, as stated before, first sexual experience in Haiti is essentially pre-union, young Haitians are not particularly preco- cious. By 15 years of age only four percent of young Haitian women report sexual experience. The same is true of young men; only twelve percent of 15 year old Haitian men are sexually experienced (data not shown). There are differences between men and women according to resi- dence. In Port-au-Prince, a higher proportion of men than women report sexual experience in all age groups. In other urban areas, the proportion of men and women with sexual experience is roughly similar at 15-17 years of age and less difference is seen at older age groups than in Port-au-Prince. In rural areas after age 17 a greater proportion of young women report sexual experi- ence than do young men. Since almost all first sexual experience is outside a union, this should not be due to a lower age at first union in rural areas. An alternative explanation may be that sexually experienced 15-19 year old males may be those more likely to migrate to urban areas after 19 years of age. Differ- entials by residence are less clear for females and the lower rate reported by 20-24 year olds in Port-au-Prince is puzzling, but, because of the small number of cases is not significantly different than other parts of the country. Sexual experience rates for men increase with greater urbanization, although rates are essentially the same for 20-24 year olds in Port-au-Prince and other urban areas. Among women, except for the 15-17 age group, the proportion reporting sexual experience decreases as the level of education increases (Table 9-8). For men the opposite is true with sexual experience increasing abruptly for those with some secondary education. Only for 15-17 year old males is there a consistent positive relationship between education level and sexual experi- ence. 37 Tables 9-9 (women) and 9-10 (men) present data on the respond- ents, self-reported age at first sexual experience. Ten percent of young women and almost one-fourth of young men with sexual experience report that they had their first sexual experience before the age of fifteen. In Port-au-Prince and other urban areas over half the women (57-61%), had their first sexual expe- rience by 17 years of age. In rural areas, this proportion is only 37 percent. 9.3 Use of Contraception Use of contraception at first intercourse is infrequent (Table 9- 11). However, men (22.7 percent) were more than twice as likely as women (9.9 percent) to have used contraception (p=<0.05). This is true at all ages except for those whose first intercourse was under the age of fifteen, where the proportion of men and women who used contraception was similar. Among men and women there is no clear pattern of contraceptive use according to age at first sexual experience. Among men, however, the use of contraception at the time of their first sexual experience is almost 4 0 percent for those who initiate sexual intercourse between 2 0 and 24 years of age. The method used by those young adults at the time of first inter- course shows that a large proportion of both sexes used less effective methods, such as withdrawal or the rhythm method (Table 9-12). While 44.6 percent of men (or their partner) who used a method at the time of their first sexual experience used a more effective method (condom, pill or tablets), this was true of only 28.5 percent of women. The greater use of condoms at first intercourse by males may reflect that, as seen previously, a greater proportion of first partners for males were "friends", while for females they were a fiance or steady boyfriend. These data, along with the data on age of first sexual intercourse support the need for sex education programs among young adults in Haiti, beginning at the primary level. Table 9-13 shows that among those young adults who did not use a contraceptive method at the time of first intercourse, the major reason for non-use was lack of knowledge of any method. More than half of women and 45 percent of men stated that lack of knowledge was the reason for non-use, while 13-14 percent of both sexes reported they did not plan on having sex when they did. More than 8 percent of women reported they desired a preg- nancy at the time of first intercourse. Another 10 percent of women and 26 percent of men had other undetermined reasons. The need for sex education is brought out in Table 9-14 which shows the percentage of men and women who know when during the menstrual cycle it is most probable for a woman to become preg- nant (two weeks after menstruation). Only 10.6 percent of women and 3.7 percent of men correctly answered this question. Among women, slightly higher proportions of urban, in-union and sexual- 38 ly experienced women have this knowledge. Among men these dif- ferences were greater. Overall, men who were more urban, older, educated and sexually experienced were more likely to know the correct answer to this question. However, the proportion with this knowledge was still very low. 9.4 Current Sexual Activity Forty-two percent of sexually experienced young women and 34 percent of sexually experienced young men reported having engaged in sexual activity within the past 3 0 days (Table 9-15). Howev- er, as one would expect, the proportion sexually active is high- est among those in union for both sexes. More than three times as many young women in union (53 percent) report they are sexual- ly active compared to those who are not in a union (17 percent). Similarly, 47 percent of young men in a union report that they are currently sexually active, compared to 27 percent who are not currently in a union. Not shown in the table is that of those women in union who are not sexually active, more than half, 51 percent, are either currently pregnant or post-partum/breastfeed- ing, while 40 percent of young men not sexually active report that their partner is pregnant or postpartum. Among those young women who are sexually active, only 6 percent report they are currently using contraception. Even fewer young women in union, 5 percent, report that they are currently using a contraceptive method. Compared to young women, a greater propor- tion of young men who are sexually active, 27 percent, report that they or their partner are using a contraceptive method. Among these young men who are not in union, more than one- third, 34 percent, use contraception, compared to 19 percent of young men in union. Table 9-16 shows the frequency of sexual relations during the past 30 days for women and men. Both women and men in union report sexual relations about four times, on average, during the past 30 days, while those not in union had sexual relations about three times, on average, during the past 30 days. Slightly more than half of women not in union had sexual relations twice or only once, while a similar proportion of men not in union had sexual relations three times or less. Except for men not in union, very few report more than one sexual partner in the past 30 days. A strong limitation to the interpretation of this table is the fact that 40 to 53 percent of those in union and 22 to 24 percent of those not in union did not respond. One hypothesis may be that those who did not report how many sexual acts they had are those who had many sexual relations and who could not recall and/or specify the number. Whatever the answer to this may be, the data for young adults who are not in a union, especially women, indicate that, in general, they are not promiscuous and have sporadic sexual encounters. This is important information for family planning program officials since it affects how to 39 reach these persons and how to determine the most appropriate methods. 40 TABLE 9-1 Percent Distribution of Selected Characteristics of Women Aged 15-24, By Current Age The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-1 Répartition en Pourcentage des Caracteristiques Sélectionées, Des femmes âgées de 15 à 24 ans, Par âge actuel Enquête Nationale Haitienne sur la Contraception, 1989 * Divorced, Separated, Widowed * Divorcée, Séparée, Veuve TABLE 9-2 Percent Distribution of Sel stics of Men Aged 15-24, ected CharacteriBy Current Age The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-2 Répartition en Pourcentage des Caracteristiques Sélectionées, Des hommes âgés de 15 à 24 ans, Par âge actuel Enquête Nationale Haitienne sur la Contraception, 1989 * Divorced, Separated, Widowed * Divorcé, Séparé, Veuf TABLE 9-3 Percentage of First Births That Were Conceived Before First Union, W omen Aged 15-24 Who Have Ever Been In Union, By Selected Characteristics and Current Age The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-3 Pourcentage des Première Naissances Qui Ont Eté Conçu Avant la Première Union Des Femmes Agées de 15 à 24 Ans Qui Ont Eté en Union Au Moins Une Fois Par Caracteristiques Sélectionées Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 9-4 Percentage of First Births That Were Conceived Before First Union, By Wives/Partners Of Men Aged 15-24 Who Have Ever Been In Union By Selected Characteristics and Current Age The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-4 Pourcentage des Première Naissances Qui Ont Eté Conçu Avant la Première Union Par Les Femmes/Partenaires des Hommes Agées de 15 à 24 Ans Qui Ont Eté en Union Au Moins Une Fois Par Caracteristiques Sélectionées Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 9-5 Percenta ntended ge of Last Pregnancies Resulting In A Live Birth That Were UniWomen Aged 15-24 Who Had A Live Birth In The Last Five Years, By Number of Live Births and Current Union Status The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-5 Pourcentage des Dernières Grossesses Qui Ont Aboutis à Une Naissance Vivante, Qui N'Etaient Pas Voulu Parmi les Femmes 15-24 Qui Ont Eues Une Naissance Vivante Depuis Cinq Ans Par Nombre de Naissnaces Vivantes et Etat Civil Actuel Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases ** Fewer than 25 cases / Moins de 25 cas TABLE 9-6 Percent Dist Intercourse, ribution of Relationship With Partner At First Sexual Women and Men Aged 15-24, By Age at First Intercourse The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-6 Répartition en Pourcentage du Rapport Avec Le Partenaire Aux Premiers Rapports Sexuels, Des Femmes et Des Hommes Agés de 15 à 49 Ans, Par Age aux Premiers Rapports Sexuels Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 9-7 Percentage of Women an exual Experience, d Men Aged 15-24 Reporting S By Age Group and Residence The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-7 Pourcentage des Femmes et des Hommes Agées de 15 à 24 Qui Déclarent Qu'ils Ont de l'Expérience Sexuelle Par Tranche D'Age et Résidence Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 9-8 Percentage o Sexual Experience, f Men and Women Aged 15-24 Reporting By Age Group and Education The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-8 Pourcentage des Femmes et des Hommes Agés de 15 à 24 Qui Déclarent Qu'ils Ont de l'Expérience Sexuelle Par Tranche D'Age et Niveau d'Education Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 9-9 Age At First Sexual Exp ced Women Aged 15-24, erience of Sexually Experien By Residence and Education (Percent Distribution) The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-9 Age à la Première Expérience Sexuelle Des Femmes Agées de 15 à 24 Ans Avec l'Expérience Sexuelle Par Résidence et Niveau d'Education (Répartition en Pourcentage) Enquête Nationale Haitienne sur la Contraception, 1989 * Not including 48 women who did not know their age at their first sexual experience, 22 women who refused to respond and 1 who was inadvertently not asked the survey question on age at first sexual experience. * Les 48 femmes qui ignorait leur âge au moment de leurs premiers rapports sexuels, les 22 qui ont refusée de répondre et 1 femme à qui en erreur on n'a pas posé la question sur l'age à la première expérience sexuelle, ne sont pas comprises dans le total. TABLE 9-10 Age At First Sexual Exp ced Men Aged 15-24, erience of Sexually Experien By Residence and Education (Percent Distribution) The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-10 Age à la Première Expérience Sexuelle des Hommes Agées de 15 à 24 Ans Des Hommes Agés de 15 à 24 Ans Avec l'Expérience Sexuelle Par Résidence et Niveau d'Education (Répartition en Pourcentage) Enquête Nationale Haitienne sur la Contraception, 1989 * Not including 8 men who did not know their age at their first sexual experience and 53 men who refused to respond to the survey question on age at first sexual experience. * Les 8 hommes qui ignorait leur âge au moment de leurs premiers rapports sexuels et 22 hommes qui ont refusée de répondre à la question sur l'age à la première expérience sexuelle ne sont pas compris dans le total. TABLE 9-11 Percent of Women And Men Aged 15-24 Who Used Contraception At First Intercourse, By Age at First Intercourse The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-11 Le Pourcentage Des Femmes et Des Hommes Agés de 15 à 24 Ans, Qui Ont Utilisé La C ports Sexuels, ontraception Au Moment de Leur Premiers RapPar Age aux Premiers Rapports Sexuels Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 9-12 Method Used By Women And Men Aged 15-24 Who Used Contraception At First Intercourse The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-12 La Méthode Utilisée Par Les Femmes et Les Hommes Agés de 15 à 24 Ans, Qui Ont Utilisé La Contraception Au Moment de Leur Premiers Rapports Sexuels Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 9-13 Percent Distribution of Reasons for Not Having Used A Contraceptive Method At The Time Of First Sexual Experience, Women and Men 15-24, Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 9-13 Les Raisons Pour Ne Pas Avoir Utilisée Une Méthode Contraceptive Au Moment Des Premiers Rapports Sexuels (Répartition en Pourcentage) Les Femmes et Les Hommes Agés de 15 à 24 Ans, Enquête Nationale Haitienne sur la Contraception, 1989 TABLE 9-14 Percent of Women and Men Aged 15-24 Who Know When During The Menstrual Cycle It Is Most P Pregnant, robable For A Women To Become By Selected Characteristics The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-14 Pourcentage des Femmes et des Hommes Agés de 15 à 24 Ans Qui Connait Le Moment Pendant Le Cycle Menstruel Lorsqu'il Est Le Plus Probable Qu'une Femme Puisse Tomber Enceinte, Par Caracteristiques Sélectionées Enquête Nationale Haitienne sur la Contraception, 1989 *One woman who refused to answer this question is not included in the total. *Une femme qui a refusé de répondre à cette question n'est pas comprise dans le total. TABLE 9-15 Percent of Sexually Experienced Women and Men Aged 15-24 Who Had Sexual Relations Within The Past 30 Days And Of Those Who Had Sexual Relations In The Past 30 Days, The Percent Currently Using Contraception, By Union Status The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-15 Parmi Les Femmes et Les Hommes Agés de 15 à 2 4 Ans Qui Ont de L'Experience Sexuelle, Le Pourcentage Qui A Eu des Rapports Sexuels Pendant Les 3 0 Derniers Jours, Et Parmi Ceux Qui A Eu des Rapports Sexuels Pendant Les 30 Derniers Jours, Le Pourcentage Qui Utilisent Actuellment La Contraception, Par Etat Civil Enquête Nationale Haitienne sur la Contraception, 1989 ** Fewer than 25 cases / Moins de 2 5 cas ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 9-16 Percent Distribution of Frequency of Sexual Relations In Past 30 Days Sexually Active Women Aged 15-49 and Men Aged 15-59, By Current Union Status And Percentage Who Had More Than One Sexual Partner The 1989 Haiti National Contraceptive Prevalence Survey TABLEAU 9-16 Répartition en Pourcentage de la Frequénce des Rapports Sexuels Pendant Les 3 0 Derniers Jours, Des Femmes Agées de 15 à 49 et Des Hommes Agés de 15 à 59 Ans Qui Sont Actifs Sexuelments, Par Etat Civil Actuel Et Pourcentage Qui A Eu Plus D'Un Partenaire Sexuel Enquête Nationale Haitienne sur la Contraception, 1989 *Excludes those whose frequency of sexual relations was unknown *On a exclu tout ceux dont la fréquence des rapports sexuels est inconnue 10. KNOWLEDGE OF AIDS Tables 10-1 shows that knowledge of AIDS in Haiti is almost universal, with 98 percent having heard of the disease, with no differences according to the socio-demographic characteristics shown. In addition, Table 10-2 shows that almost no one in Haiti believes there is a cure for AIDS, again with no difference according to socio-demographic characteristics. 41 TABLE 10-1 Percentage of Women 15-49 Who Have Heard of AIDS, By Residence By Union Status, Age and Education Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 10-1 Le pourcentage de parler du SIDA s femmes âgées de 15 à 49 ans qui ont entendu Par résidence, état civil, âge et éducation Enquête Nationale Haitienne sur la Contraception, 1989 * Does not include 5 women who were not asked this question. * 5 femmes auxquelles cette question n'a pas été posée ne sont pas comprises dans le total. **Fewer than 25 cases / Moins de 25 cas. ( ) = Nombre de cas non-ponderés ( ) = Number of unweighted cases TABLE 10-2 Of Those Women 15-4 9 Who Have Heard of AIDS, The Percentage Who Believe There Is A Cure For AIDS, By Residence By Union Status, Age and Education Haitian National Contraceptive Prevalence Survey, 1989 TABLEAU 10-2 Parmi les femmes âgées de 15 à 49 ans gui ont entendu parler du SIDA Le pourcentage qui A, par résidence croit qu'il y a un cure pour le SID Par état civil, âge et éducation Enquête Nationale Haitienne sur la Contraception, 1989 ( ) = Nombre de cas non-ponderés **Fewer than 25 cases / Moins de 25 cas. ( ) = Number of unweighted cases 11. CONCLUSIONS AND RECOMMENDATIONS The most striking conclusion from this survey is not the low level of contraceptive prevalence (11 percent), but rather the lack of knowledge of contraceptive methods and sources for ob- taining them. This lack of knowledge exists despite many years of family planning service delivery programs in Haiti and seems to be especially true among young adults. The result is that only slightly more than half of all births in Haiti are planned and almost 30 percent of women and more than 20 percent of men are in need of family planning services. The most pressing recommendation, therefore, is that information, education and communication (IEC) activities be stepped up in all family planning service delivery programs. The proposed new USAID-supported public sector family planning project must in- clude a strong IEC component. Current family planning service delivery programs in both the public and private sectors should also emphasize IEC activities to the maximum extent possible. These IEC activities must provide information about the contra- ceptive methods available in Haiti and where to obtain them. This must be carried out not only through the mass media, but also through community health workers (agents de santé communau- taire) and others who have regular contact with males and females of reproductive age. An additional recommendation in this area is that the survey results be used to promote certain contraceptive methods and to specific sub-groups in the population who were identified as needing particular education efforts. Specifically this should include promoting all methods to young adults and others who are not in a consensual or marital union, promoting methods other than the condom to men and promoting permanent and semi-permanent methods (IUD and sterilization) to all groups. A major reason for non-use of contraception by women is that they are post-partum and/or breastfeeding. However, as mentioned above, almost half of most recent pregnancies were unplanned. This group should be targeted for appropriate contraceptive methods, particularly since the duration of breastfeeding is long and is accompanied by supplemental feeding to an important ex- tent, reducing the length of post-partum amenorrhea. These women may be reached relatively easily since two-thirds of women re- ceive pre-natal care. Since more than half of all births outside Port-au-Prince take place at home with assistance from a health care worker, a pro- gram to train additional personnel in IUD insertion is indicated. This must be combined with efforts to overcome the reluctance of Haitians to use a product such as an IUD (whose use is extremely low), which is considered to be "foreign" to the body. Very few young adults of either sex know when during the menstru- al cycle a women is most likely to get pregnant. A further need 43 was thus identified in the related area of family life or sex education. This should be carried out in schools and elsewhere among those not in school and must begin at the youngest age possible in the Haitian cultural context. It is noteworthy that three-fourths of men and women say they are willing to pay for a method. Although is is recognized that respondents may have overstated their willingness to pay for a method, even if only half could truly do so, the potential may exist for a successful social marketing program, in spite of the fact that few non-users identified pharmacies as a potential source of obtaining methods. Again, educational efforts are indicated as innovative service delivery techniques are initiat- ed. Tighter control procedures must be used to track condom distribu- tion, as perhaps one million condoms per year are not accounted for by client use or waste. This could be accomplished through condom sales in a social marketing program, and/or an improved logistics management system. Prenatal care in rural areas is utilized to a lesser extent than in urban areas. Also, more women in rural areas than in urban areas give birth at home with no professional assistance. The policy implications of these findings are that efforts must be made to find the exact reasons why, and to establish accessible service delivery points to encourage rural women to obtain prena- tal care more frequently and earlier. Moreover, it is clear that further IEC activities must be carried out to convince women in rural areas and those with little or no education of the benefits of early prenatal care and delivering their children either at a health facility or at home with professional care. 44 REFERENCES 1. The methods considered to be "modern" by these surveys are: the pill, the iud, the condom, female or male sterilization, injectables, vaginal foam and vaginal tablets. Cayemittes and Chahnazarian, Survie et Santé de l'Enfant en Haiti. Editions de l'Enfance, Port-au-Prince, 1989. 2. Bongaarts, J. and Potter, RG, Fertility, Biology and Behavior. Academic Press, New York, 1983. 3. Anderson, J., Rodrigues, W. and Thome A. Analysis of Breast- feeding in Northeastern Brazil: Methodological and Policy Consid- erations. Studies in Family Planning. Volume 14, Number 8/9, August/September 1983, Pages 210-218. 45 COVER TABLE OF CONTENTS PREFACE 1. BACKGROUND 2. METHODOLOGY AND ORGANIZATION OF THE SURVEY 2.1. Objectives of The Survey 2.2 Administrative Structure And Staffing of the Survey 2.3 Sampling Methodology 2.4 Questionnaire Design and Contents 2.5 Training and Fieldwork 2.6 Data Management 2.7 Response Rates TABLES TABLE 2-1 TABLE 2-2 3. CHARACTERISTICS OF THE POPULATION 3.1 Socio-Demographic Characteristics of Respondents 3.2 Fertility Characteristics 3.3 Breastfeeding 3.4 Reported Abortions TABLES TABLE 3-1 TABLE 3-2 TABLE 3-3 TABLE 3-4 TABLE 3-5 TABLE 3-6 TABLE 3-7 TABLE 3-8 TABLE 3-9 TABLE 3-10 TABLE 3-11 TABLE 3-12 TABLE 3-13 TABLE 3-14 TABLE 3-15 TABLE 3-16 4. MCH CARE, CURRENT PREGNANCY INTENTION AND PLANNING STATUS OF LAST LIVE BIRTH TABLES TABLE 4-1 TABLE 4-2 TABLE 4-3 TABLE 4-4 TABLE 4-5 5. CONTRACEPTION 5.1 Knowledge of Methods 5.2 Contraceptive Use Now or in the Past (Ever Use) 5.3 Current Use of Contraception 5.4 Reasons for Non-Use of Contraception Tables TABLE 5-1 TABLE 5-2 TABLE 5-3 TABLE 5-4 TABLE 5-5 TABLE 5-6 TABLE 5-7 TABLE 5-8 TABLE 5-9 TABLE 5-10 TABLE 5-11 TABLE 5-12 TABLE 5-13 TABLE 5-14 TABLE 5-15 TABLE 5-16 TABLE 5-17 TABLE 5-18 Figures Figure 1 Figure 2 6. RISK OF UNPLANNED PREGNANCY TABLES TABLE 6-1 TABLE 6-2 TABLE 6-3 TABLE 6-4 TABLE 6-5 7. AVAILABILITY OF SERVICES 7.1 Source of Contraception 7.2 Condom Use TABLES TABLE 7-1 TABLE 7-2 TABLE 7-3 TABLE 7-4 TABLE 7-5 TABLE 7-6 TABLE 7-7 TABLE 7-8 TABLE 7-9 TABLE 7-10 TABLE 7-11 8. ATTITUDES TOWARDS FAMILY PLANNING TABLES TABLE 8-1 TABLE 8-2 TABLE 8-3 TABLE 8-4 TABLE 8-5 TABLE 8-6 TABLE 8-7 TABLE 8-8 9. SEXUAL BEHAVIOR AND CONTRACEPTIVE USE AMONG YOUNG ADULTS 9.1 Socio-Demographic Characteristics 9.2 Sexual Experience 9.3 Use of Contraception 9.4 Current Sexual Activity TABLES TABLE 9-1 TABLE 9-2 TABLE 9-3 TABLE 9-4 TABLE 9-5 TABLE 9-6 TABLE 9-7 TABLE 9-8 TABLE 9-9 TABLE 9-10 TABLE 9-11 TABLE 9-12 TABLE 9-13 TABLE 9-14 TABLE 9-15 TABLE 9-16 Figures Figure 3 Figure 4 Figure 5 10. KNOWLEDGE OF AIDS TABLES TABLE 10-1 TABLE 10-2 11. CONCLUSIONS AND RECOMMENDATIONS REFERENCES

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