CHAPTER 5.

FAMILY PLANNING

This chapter presents results from the 2007 RMIDHS regarding aspects of contraceptive use, knowledge, attitudes, and behavior. Although the focus is on women, some results from the male survey are discussed, since men play an important role in the realization of reproduction goals. Data on inter-spousal communication and husbands’ knowledge about their wives’ contraceptive use are also presented. The results presented in this chapter include contraceptive prevalence and unmet need for contraception, which have important implications for program managers to assess to what extent family planning services are reaching users and how effectively the methods are being adopted. One of the important indicators resulting from the survey is the percentage of married women aged 15–49 who are currently using any method of contraception. It is important to note that the study of contraception prevalence in the country is vital because contraception plays an important role in determining fertility levels and trends.

5.1.

KNOWLEDGE OF CONTRACEPTIVE METHODS

One major objective of the 2007 RMIDHS was to assess the level of knowledge of contraceptive methods among Marshallese women and men. Individuals who have adequate information about available methods of contraception are better able to develop a rational approach to planning their family. Information on knowledge of contraception was collected in the survey by asking female and male respondents to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked whether the respondent had heard of it. Contraceptive methods are grouped into two types in the table: modern methods, which include female sterilization, male sterilization, the Pill, IUDs, injectables, implants, and the male condom2 ; and traditional methods, which include the rhythm method (periodic abstinence), withdrawal, and folk methods. Provision was made in the questionnaire to record any other methods, including folk methods named spontaneously by respondents. Knowledge of contraceptive methods is presented in Table 5.1 for all Marshallese women and men within the age group of 15–49 who are currently married or sexually active and unmarried. Sexually active is defined as respondents who have been sexually active within the last months at the time of the survey. According to the 2007 RMIDHS, over 9 in 10 women and men (97 percent and 99 percent respectively) have knowledge of any contraceptive methods, whether modern or traditional. The results show that there is almost universal knowledge of any method of contraception by women and men. About 98 percent of currently married women say that they are aware of any methods of contraception, which is only 2 percent lower than for all men’s report of universal knowledge of the methods listed in the men’s questionnaire. In addition, there is universal knowledge among unmarried and sexually active women and men of any method of contraception (99 percent compared to 100 percent). Table 5.1 also shows the results of respondents’ knowledge of modern contraception. The levels of knowledge and distribution are the same as reported above for all methods: about the same for all women and men, currently married or unmarried. About 8 in 10 women and men know about any traditional method (79 percent compared to 81 percent). The least-known modern methods are IUD and male sterilization, which less than 65 percent of women and men know about. The least-known traditional method is folk method, which is known by only 7 percent of women and 2 percent of men. In comparing the level of knowledge of modern and traditional contraceptive methods, it can be noted that both women and men are likely to know more about modern methods than traditional methods. However, the level of knowledge varies by different marital status of women and men.

2

Female condom information was not collected in the survey.

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The mean number of known contraceptive methods varies by marital status of women and men, with the lowest of four methods estimated for unmarried men and the highest of seven methods observed for married women.
Table 5.1. Knowledge of contraceptive methods Percentage of all respondents, currently married respondents and sexually active unmarried respondents aged 15–49 who know any contraceptive method, by specific method, Marshall Islands 2007
Women Currently married women 98.4 98.2 86.3 63.3 85.7 57.1 90.8 86.3 93.9 84.5 78.4 77.7 8.0 7.3 1,145 Sexually active unmarried women1 99.4 99.4 78.5 57.8 77.4 44.8 83.3 79.5 95.4 75.8 62.5 71.4 4.6 6.6 114 na na Men Currently married men 100.0 100.0 85.4 65.8 73.9 44.9 78.1 64.1 99.6 91.4 54.7 88.4 1.9 6.6 534 6.7 654 Sexually active unmarried men1 99.6 99.6 65.9 43.6 42.6 19.2 42.3 28.3 99.6 76.4 20.9 75.2 2.2 4.4 183 4.5 189

Method Any method Any modern method Female sterilization Male sterilization Pill IUD Injectables Implants Male condom Any traditional method Rhythm Withdrawal Folk method Mean number of methods known by respondents 15–49 Number of respondents

All women 96.7 96.5 81.4 58.4 80.3 52.1 85.4 80.7 92.3 78.5 71.9 71.8 7.0 6.8 1,625

All men 99.2 99.2 72.9 53.2 59.0 33.9 61.0 48.3 98.6 80.5 39.5 78.0 1.7 5.5 913 5.7 1,055

Mean number of methods known by respondents 15+ na na Number of respondents na na na = not applicable 1 Had last sexual intercourse within 30 days preceding the survey

5.2.

KNOWLEDGE OF CONTRACEPTIVE METHODS BY BACKGROUND CHARACTERISTICS

Table 5.2 explores the level of knowledge about contraceptive methods for currently married women and men aged 15–49 who have heard of at least one contraceptive method or who have heard of at least one modern method, by their background characteristics. Modern methods of family planning are the most important to examine because of their greater relevance to fertility planning and reproductive health advocacy. The analysis is restricted to currently married women and men to allow comparison between different age groups within the same category.

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Table 5.2. Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men aged 15–49 who have heard of at least one contraceptive method and who have heard of at least one modern method by background characteristics, Marshall Islands 2007
Women Heard of any modern method1 96.5 98.3 97.4 97.5 100.0 97.8 100.0 Men Heard of any modern method1 * 100.0 100.0 100.0 100.0 100.0 100.0

Background characteristic Age 15–19 20–24 25–29 30–34 35–39 40–44 45–49 Residence Urban Rural Education No education/ primary Secondary More than secondary Wealth quintile Lowest Second Middle Fourth Highest Total 15–49 50+ Total men 15+ na = not applicable

Heard of any method 96.5 98.3 97.4 98.2 100.0 97.8 100.0

Number 65 217 240 196 185 141 102

Heard of any method * 100.0 100.0 100.0 100.0 100.0 100.0

Number 11 97 96 97 95 76 62

97.7 99.6

97.6 99.6

762 383

100.0 100.0

100.0 100.0

348 186

99.0 98.5 96.1

99.0 98.3 96.1

293 721 131

100.0 100.0 100.0

100.0 100.0 100.0

122 309 103

99.6 99.4 97.6 97.8 98.2 98.4 na na

99.6 99.4 97.6 97.4 98.2 98.2 na na

148 181 220 313 284 1,145 na na

100.0 100.0 100.0 100.0 100.0 100.0 98.0 99.6

100.0 100.0 100.0 100.0 100.0 100.0 98.0 99.2

69 91 124 115 135 534 82 654

Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
1 Female sterilization, male sterilization, Pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception

The results in Table 5.2 show consistency in the level of knowledge by age and sex, but particularly for men there is universality in the knowledge by all backgrounds compared to women. That is not to say that women’s knowledge is low: on the contrary, their knowledge is almost universal as well.

5.3.

EVER USED CONTRACEPTION: WOMEN AND MEN

The 2007 RMIDHS asked questions about any methods women have used in the past to try avoiding or delaying getting pregnant, particularly for those women and men who have heard of any family planning methods. Table 5.3.1 show the proportion of all women, currently married women, and sexually active unmarried women aged 15–49 who report that they have ever tried any methods, while Table 5.3.2 presents the same information for men. A descriptive discussion of the results will help determine the level of use of contraceptive methods by women and men. The discussion also examines the differences between age groups in order to reflect some effects of lifetime changes in the use of contraception by Marshallese women and men. Contrary to the discussion in Table 5.2 related to the level of knowledge of contraceptives, which was universal among men and almost universal among women in the reproductive age groups, Table 5.3.1

64

shows a somewhat low level of about 54 percent of all women while Table 5.3.2 shows that three in four men (78 percent) have ever used any method of family planning. Similarly, the proportion of currently married women aged 15–49 who have ever used any method is almost two-thirds (63 percent) compared to over 8 in 10 men (86 percent). Meanwhile, those women who are categorized as sexually active and unmarried have a lower proportion of 45 percent who have ever used any method of family planning compared to 83 percent of men in the same category. Caution should be taken when interpreting this category of respondents because of the very small numbers of cases involved. In comparing modern methods and traditional methods, most respondents, male or female, married or unmarried, are more likely to have ever used modern methods. For instance, one in two (50 percent) of all women have ever used any modern method compared to only a little over 1 in 10 (13 percent) who have ever used any traditional method. Similarly, over three in four (76 percent) active unmarried men have ever used any modern method of family planning compared to over half (57 percent) who have ever used any traditional method. In terms of individual methods, the most commonly ever-used modern methods among all women, women who are currently married, and women who are sexually active and unmarried are female sterilization and injectables, while the most commonly ever-used modern method among men in all categories is the male condom. The most commonly ever-used traditional methods among women in all categories were withdrawal and rhythm (almost equal), compared to a high level of use of the withdrawal method among men in all categories.

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Table 5.3.1. Ever used contraception: Women

Percentage of all women, currently married women, and sexually active unmarried women aged 15–49 who have ever used any contraceptive method by method, according to age, Marshall Islands 2007
Modern method Male sterilization Pill ALL WOMEN 0.0 0.0 0.0 0.3 1.1 0.4 0.3 0.2 CURRENTLY MARRIED WOMEN 0.0 0.0 0.0 0.3 1.2 0.5 0.4 0.3 (0.0) (0.0) (0.0) 0.0 7.2 0.0 (0.0) (29.7) 17.3 (0.0) (0.0) (2.8) (24.7) (0.0) (5.0) (22.7) 8.7 11.3 0.5 23.1 8.6 10.2 0.0 8.6 7.7 2.5 8.7 (24.1) (10.5) (15.6) 17.7 1.0 7.8 13.9 14.1 13.9 10.8 0.0 0.0 0.4 0.2 1.5 0.9 13.7 24.1 29.6 29.2 25.1 14.4 4.8 7.8 9.8 8.4 8.4 10.6 10.0 9.1 9.7 10.2 9.6 6.9 5.8 13.9 12.4 19.9 14.5 15.8 11.8 14.3 (9.1) (14.1) (24.0) 15.3 3.9 6.1 5.3 13.9 9.6 9.7 7.7 8.3 (2.2) (4.7) (3.8) 3.4 2.7 10.6 9.2 11.1 8.6 8.8 4.7 8.9 (7.7) (6.2) (24.0) 12.6 0.0 2.0 3.2 1.7 4.4 3.3 1.9 2.6 (0.0) (3.9) (2.8) 1.9 65 217 240 196 185 141 102 1,145 47 30 37 114 9.6 0.4 19.6 7.0 8.8 12.8 7.0 8.3 2.0 6.2 15.3 15.0 13.7 9.8 8.7 0.0 0.3 0.3 0.2 1.4 0.8 0.0 5.0 21.7 28.3 29.5 26.3 13.8 7.4 1.0 6.1 9.2 9.3 8.7 10.3 7.8 9.2 8.4 11.7 9.8 8.7 7.1 2.4 5.3 12.7 13.8 20.0 15.1 14.9 10.6 1.9 5.8 5.6 14.1 9.3 9.4 7.1 3.8 8.5 11.1 11.7 9.4 8.1 4.5 0.5 2.5 2.6 1.5 4.5 3.0 1.6 2.2 306 334 293 213 205 155 119 1,625 IUD Injectables Implants Rhythm Male condom Any traditional method Withdrawal Folk method Traditional method Number of women

Age

Any method

Any modern method

Female sterilization

15–19 20–24 25–29 30–34 35–39 40–44 45–49

18.0 41.8 61.3 68.2 75.6 70.8 73.2

16.2 37.3 58.7 63.3 71.1 67.8 71.9

0.0 0.8 10.4 26.3 42.9 48.8 53.0

Total

53.6

50.3

19.5

15–19 20–24 25–29 30–34 35–39 40–44

32.0 46.2 61.3 67.7 75.9 73.0

27.8 41.9 58.5 62.6 72.3 70.3

0.0 0.5 10.9 27.6 45.1 49.2

45–49

72.3

70.8

50.6

Total

62.7

59.1

25.0

SEXUALLY ACTIVE UNMARRIED WOMEN1

15–19 20–24

(28.3) (42.1)

(26.9) (37.6)

(0.0) (3.2)

25–49

(69.6)

(64.4)

(17.3)

(1.7) (4.7) (16.2 )

Total

45.3

41.9

6.4

Note: Figures in parentheses are based on 25–49 unweighted cases.

1

Women who had sexual intercourse within 30 days preceding the survey

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Table 5.3.2. Ever used contraception: Men Percentage of all men, currently married men, and sexually active unmarried men aged 15–49 who have ever used any contraceptive method by method, according to age, Marshall Islands 2007
Any modern method 49.0 77.1 74.0 75.3 72.9 67.8 53.8 66.8 45.0 63.4 85.7 80.4 76.8 78.2 70.9 69.0 51.5 72.8 47.3 67.2 72.8 75.8 (82.8) 75.9 75.4 Modern method Male sterilizMale ation condom ALL MEN 15–19 20–24 25–29 30–34 35–39 40–44 45–49 Total 15–49 50+ Total men 15+ 15–19 20–24 25–29 30–34 35–39 40–44 45–49 Total 15–49 50+ Total men 15+ 15–19 20–24 25–49 Total 15–49 Total men 15+
1 Men

Traditional method Any traditional method 32.6 59.4 63.6 72.3 70.7 53.8 68.1 57.0 54.6 56.2 55.8 65.6 65.3 77.5 71.6 54.6 71.2 67.6 54.8 64.5 47.8 56.1 (76.1) 56.5 57.0 Withdrawal 32.3 58.9 61.9 66.1 68.2 49.9 51.3 53.8 48.9 52.4 52.8 64.6 64.5 70.1 68.8 50.3 52.7 62.7 48.5 59.0 47.5 56.1 (74.3) 55.9 56.5 Number of men

Age

Any method

Rhythm 1.9 11.9 19.4 26.0 28.6 23.9 31.4 17.1 23.3 18.0 12.9 16.4 18.3 29.2 31.1 26.1 34.3 25.1 26.2 25.2 2.1 9.2 (27.2) 9.7 10.3

57.0 84.7 84.4 85.9 82.2 78.6 84.9 77.6 68.4 75.8 88.6 91.7 86.6 90.0 81.2 80.7 85.0 86.2 69.5 82.0 82.1 80.4 (87.2) 82.6 82.2

0.0 0.0 0.1 0.0 1.4 4.3 4.1 0.9 4.0 1.3 0.0 0.0 0.1 0.0 1.5 4.7 4.8 1.5 4.5 1.9 0.0 0.0 (0.0) 0.0 0.0

49.0 77.1 74.0 75.3 72.2 65.9 52.4 66.4 45.0 63.0 85.7 80.4 76.8 78.2 70.0 66.9 49.9 72.1 47.3 66.6 72.8 75.8 (82.8) 75.9 75.4

209 190 137 115 106 83 73 913 93 1,055 11 97 96 97 95 76 62 534 82 654 84 62 38 183 189

CURRENTLY MARRIED MEN

SEXUALLY ACTIVE UNMARRIED MEN1

who had sexual intercourse within 30 days preceding the survey

Note: Figures in parentheses are based on 25–49 unweighted cases. The total for sexually active unmarried men 50+ is not shown due to the very small number of men in this category.

Figure 5.1 shows the proportion of currently married women and men who have ever used any method of family planning by age at the time of the 2007 DHS. The proportion of currently married men who have ever used contraception shows a stable pattern throughout all age groups. The low proportion of currently married women in the young age category is related to the smaller proportion of women in this age category. However, an increase pattern can be cited for women who have ever used contraception as their age increases to reach age 35–39, and then declines.

67

By far the most commonly used method among married women is female sterilization, which is used by one in four women (25 percent). The next most commonly used methods are injectables (9 percent) and the implant method (4 percent), while pills are used by 3 percent of women and male condoms and the rhythm method are each used by 1 percent of married women. The mix of methods is not very different among sexually active unmarried women, for whom the male condom is the most commonly used method (4 percent) compared to only 1 percent among married women. Use of any contraceptive method generally rises with age, from 25 percent among married women aged 15–19 to a peak of 58 percent at age 35–39, and then declining to 53 percent among women aged 45–49. The most popular methods among the youngest married women are injectables and male condoms, while married women in their twenties tend to use injectables, followed by implant, female sterilization and male condom. Older women aged 30 and over tend to apply injectables and are more likely to be sterilized. As stated earlier in this chapter, it is interesting to note that the level of knowledge of any contraceptive methods is almost universal among Marshallese women and men of reproductive age. However, the above discussion shows that the level of use of these known contraceptives is disappointing. The factors contributing to this low use should be assessed and improvements introduced to increase the level of contraceptive use.

69

Table 5.4. Current use of contraception by age

Percent distribution of all women, currently married women, and sexually active unmarried women aged 15–49 by contraceptive method currently used, according to age, Marshall Islands 2007
Modern method Any traditional method Rhythm 0.7 1.0 0.2 2.9 0.7 1.5 1.5 1.1 1.3 1.5 0.3 3.0 0.8 1.7 1.8 2.2 (1.4) (0.0) (4.5) 5.7 4.1 2.0 1.4 (1.4) (0.0) (0.5) 0.7 0.5 0.0 1.2 1.3 0.3 0.0 0.5 0.0 0.6 (0.0) (0.0) (2.2) 0.7 0.2 0.0 0.0 0.9 0.0 0.0 0.0 0.0 0.2 (0.0) (0.0) (1.8) 0.6 0.0 0.8 1.3 0.7 0.0 0.4 0.0 0.0 0.0 0.8 0.0 0.3 0.0 0.0 90.0 74.9 59.9 51.0 43.7 44.6 45.1 62.9 74.9 72.4 58.6 51.6 42.1 43.4 47.1 55.4 (85.9) (73.2) (55.5) 72.7 Withdrawal Folk method Not currently using Traditional method

Age ALL WOMEN 0.0 0.0 0.0 0.3 0.5 0.4 0.3 0.2 CURRENTLY MARRIED WOMEN 0.0 0.0 0.0 0.3 0.5 0.5 0.4 0.2 (0.0) (0.0) (0.0) 0.0 2.7 6.3 (0.0) (4.7) (4.5) (2.8) (13.9) (4.5) (0.0) (5.0) (13.6) (9.9) (0.0) (0.0) 2.7 9.2 3.8 1.4 1.0 3.3 5.1 4.5 1.3 0.1 0.0 10.9 12.2 16.3 8.4 7.1 2.4 0.2 4.8 6.8 5.6 3.5 2.7 0.5 0.0 7.0 2.1 1.1 0.5 0.4 1.6 0.0 1.3 2.6 2.5 3.3 0.8 2.1 1.8 2.6 8.4 3.2 1.4 1.8 1.1 2.7 6.2 4.7 1.1 0.1 0.0 4.0 12.3 15.1 8.8 7.9 2.2 0.2 1.0 5.5 5.2 4.8 2.4 0.5 0.0 3.2 2.0 0.9 0.5 0.4 1.5 0.0 0.7 1.7 2.2 3.5 1.1 1.9 1.5

Any method

Any modern method Pill Injectables Implants

Female sterilization Male condom

Male sterilization

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number of women 306 334 293 213 205 155 119 1,625 65 217 240 196 185 141 102 1,145 47 30 37 114

15–19 20–24 25–29 30–34 35–39 40–44 45–49

10.0 25.1 40.1 49.0 56.3 55.4 54.9

9.3 23.3 37.8 45.4 55.2 53.4 53.4

0.0 0.8 10.4 26.3 42.9 48.8 53.0

Total

37.1

35.3

19.5

15–19 20–24 25–29 30–34 35–39 40–44 45–49

25.1 27.6 41.4 48.4 57.9 56.6 52.9

23.7 24.9 38.9 45.0 57.1 54.4 51.1

0.0 0.5 10.9 27.6 45.1 49.2 50.6

Total

44.6

42.4

25.0

SEXUALLY ACTIVE UNMARRIED WOMEN1

15–19 20–24 25–49 6.4

(14.1) (26.8) (44.5)

(12.7) (26.8) (40.0)

(0.0) (3.2) (17.3)

Total

27.3

25.3

Note: If more than one method is used, only the most effective method is considered in this tabulation. Figures in parentheses are based on 25–49 unweighted cases.

1

Women who have had sexual intercourse within 30 days preceding the survey

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5.5. CURRENT USE OF CONTRACEPTION BY BACKGROUND CHARACTERISTICS
Table 5.5 allows comparisons of the level of current use of family planning methods for currently married women aged 15–49 according to their different background characteristics, such as residence, education, number of living children, and wealth. The results can also be examined to determine any differences among each subgroup. As already noted in previous discussions, the contraceptive prevalence rate is 45 percent. As shown in Table 5.5, some married Marshallese women are more likely than others to use contraceptives. Married women in urban areas are less likely to use contraception (43 percent) than those in rural areas (48 percent). The level of current use is lower in urban areas for each of the specific methods except female sterilization, implants, the Pill, and male condoms, whose use is slightly lower among rural women. In general, women do not begin to use contraception until they have had at least one child, thus the level of use increases as parity increases. Interestingly, the current use of modern methods decreases with educational attainment whereas current use of traditional methods show an increase for women with more than secondary education. Almost half of the married women with no or primary-level education (47 percent) use a modern method compared to over one-third (38 percent) of the women with more than secondary-level education. In contrast, 3 percent of the married women with no or primary-level education use a traditional method compared to 4 percent of the women with more than secondary-level education. Meanwhile, little difference in the use of family planning methods is apparent by wealth category (Table 5.5). Contraceptive use ranges from 43 percent of married women in the lowest wealth quintile to 49 percent in the fourth wealth quintile. The gap is wider for modern contraceptive use, with 38 percent for the lowest quintile against 46 percent for the fourth quintile. It is also noticeable that women in the two bottom quintiles of wealth have a higher percentage of use of traditional methods than women in the higher wealth quintiles, which can be related to difficult access to modern contraceptives, cost, or sociocultural issues. However, lack of information does not appear to be a major factor as knowledge of contraception is very high for all women (Table 5.2).

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Table 5.5. Current use of contraception by background characteristics

Percent distribution of currently married women aged 15–49 by contraceptive method currently used, according to background characteristics, Marshall Islands 2007
Modern method Traditional method

Background characteristic Residence Urban Rural Pill 3.1 2.1 6.5 14.6 3.9 3.7 1.9 0.4 1.5 3.6 0.8 2.6 0.5 0.9 0.2 0.2 57.3 51.7 Injectables Implants Rhythm Withdrawal 0.0 0.7

Any method

Any modern method Male sterilization Male condom Folk method

Female sterilization

Any traditional method

Not currently using

Total 100.0 100.0

Number of women 762 383

42.7 48.3

41.2 44.7

25.8 23.2

Education No education/ primary Secondary More than secondary 0.3 0.2 0.0 5.8 6.5 1.8 1.4 3.8 2.2 1.6 0.6 3.1 10.6 9.2 3.4 4.4 1.7 1.3 2.9 1.6 1.6 1.2 0.6 0.4 0.8 0.0 0.0

50.1 43.2

47.2 41.6

30.5 23.5

49.9 56.8 60.1

100.0 100.0 100.0

293 721 131

39.9

36.1

20.5

Number of living children 0 1–2 3–4 5+ 0.0 0.0 0.0 0.9 0.7 0.9 0.0 0.0 0.0 0.2 2.7 9.2 3.8 1.4 2.4 1.2 0.5 3.4 4.9 14.7 11.9 11.0 6.6 6.3 4.0 2.4 4.0 4.7 3.5 0.9 0.2 1.1 1.4 2.7 5.4 2.8 1.7 0.7 2.2 2.2 2.7 2.5 1.0 0.4 1.5 1.4 1.3 3.6 4.2 0.6 0.0 10.8 13.0 6.7 1.5 5.0 4.5 2.5 2.6 2.4 0.6 0.5 0.6 2.7 2.3 2.2 0.6 1.5 1.3 1.7

7.1 32.5 55.4 62.4

6.6 29.8 53.1 60.3

1.3 7.9 30.7 49.0

0.0 1.0 0.5 0.4 2.6 0.0 0.0 0.3 0.7 0.6

0.0 0.2 0.5 0.0 0.0 0.4 0.7 0.0 0.0 0.2

92.9 67.5 44.6 37.6 56.8 55.4 56.2 53.4 56.2 55.4

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

119 384 333 309 148 181 220 313 284 1,145

Wealth quintile Lowest Second Middle Fourth Highest

43.2 44.6 43.8 46.6 43.8

37.9 41.7 42.0 45.9 41.6

15.2 25.1 25.5 29.8 24.2

Total

44.6

42.4

25.0

Note: If more than one method is used, only the most effective method is considered in this tabulation.

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5.6.

TIMING OF FIRST USE OF CONTRACEPTION

The desire of women to have a certain number of children leads them to find ways to control their reproduction. The main purpose of Table 5.6 is to examine changes in the number of children (parity) for all women aged 15–49 at the time they first use any kind of contraception by their current age during the survey. It also allows an examination of the tendency of woman to adopt contraception at different ages, either younger or older. The 2007 RMIDHS asked questions on the number of children the woman had already had by the time she first used any method of contraception. Table 5.6 shows the distribution of women aged 15–49 by age group and number of living children at the time of first use of contraception. The results indicate that Marshallese women are currently adopting family planning at lower parities (that is, when they have fewer children) than in the past. Among younger women (age 20–24), 9 percent used contraception before having any children and 16 percent first adopted contraception when they had only one child. Among older women (age 45–49), only 7 percent used contraception before having any children and 1 percent first used contraception when they had one child.

Table 5.6. Number of children at first use of contraception Percent distribution of women aged 15–49 by number of living children at the time of first use of contraception, according to current age, Marshall Islands 2007
Current age 15–19 20–24 25–29 30–34 35–39 40–44 45–49 Total Never used 82.0 58.2 38.7 31.8 24.4 29.2 26.8 46.4 0 10.1 8.8 8.1 5.1 4.7 5.4 6.5 7.4 Number of living children at time of first use of contraception 1 2 3 4+ Missing 5.2 2.6 0.2 0.0 0.0 5.6 13.3 2.4 1.5 0.2 16.4 14.5 12.7 9.7 0.0 9.2 13.8 12.9 27.3 0.0 3.6 11.5 9.7 46.0 0.0 3.0 5.1 11.6 45.7 0.0 1.1 2.4 3.3 59.8 0.0 9.1 9.7 7.1 20.2 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 306 334 293 213 205 155 119 1,625

5.7.

TIMING OF STERILIZATION

The RMIDHS results from Table 5.5 show a prevalence rate of 25 percent for currently married Marshallese women who are sterilized. The timing of sterilization is important to understand, particularly the age of women, as it has implications for fertility level and family planning services in the country. The findings in Table 5.7 present the percentage distribution of sterilized women of childbearing age by age at the time of sterilization according to the number of years since the operation. The median age is presented only for those cohorts of women less than 40 years of age, to minimize the problem of censoring. The majority of women (62.6 percent) are sterilized between the ages of 25 and 34. About 18 percent are sterilized at age less than 20 years. Sterilization is less common among older women. The results indicate early timing of sterilization among Marshallese women. The median age of sterilization shows a fluctuation pattern. However, it is noticeable that the median age is higher for women who were sterilized less than three years ago than for women who undertook the method more than 10 years ago.

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Table 5.7. Timing of sterilization Percent distribution of sterilized women aged 15–49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Marshall Islands 2007
Age at time of sterilization Years since operation