Academic journal article International Family Planning Perspectives

Effects of Sex Preference on Contraceptive Use, Abortion and Fertility in Matlab, Bangladesh

Academic journal article International Family Planning Perspectives

Effects of Sex Preference on Contraceptive Use, Abortion and Fertility in Matlab, Bangladesh

Article excerpt

Context: Contraceptive prevalence in Bangladesh has been increasing, but for the last 6-7 years the total fertility rate has remained at 3.3 lifetime births per woman. Son preference is thought to be a constraint on further fertility decline.

Methods: Data from the Matlab Demographic Surveillance System were used to investigate the effects of son preference on contraceptive use, abortion and fertility, and trends in these effects overtime, in the Matlab maternal and child health and family planning project area and in a comparison area. A modified Arnold Index was used to estimate the increase or decrease in contraceptive prevalence, abortion or fertility that would occur in the population in the absence of sex preference. The level of sex-selective abortion was measured by the deviation from the expected ratio of males to females at birth.

Results: Between the early 1980s and the middle 1990s, contraceptive use and recourse to abortion increased in Matlab, while fertility declined. Method use rose with parity in the project area. (Adequate data were not available for the comparison area.) At low parities, method use increased with the number of sons; among women with three or more children, however, it stabilized or decreased among those who had at least two sons. In the absence of sex preference, contraceptive use in the project area would have risen by 9% in 1983, by 8% in 1988 and by 6% in 1993. The abortion ratio increased with parity; within parities, it was generally lowest for women with no sons and was often highest for those with at least two sons and a daughter. In the absence of sex preference, the abortion ratio would have increased by 27% in 1982-1986, by 36% in 1987-1991 and by 55% in 1992-1995 in the project area, and by 36%, 37% and 38%, respectively, in the comparison area. The percentage of women giving birth declined as parit y rose and, within parities, was highest for women without sons. Among women with more than two children, fertility was lowest for those who had sons and a daughter. In the absence of sex preference, fertility would have decreased by 9% in 1984-1986, by 10% in 1989-1991 and by 12% in 1994-1995 in the project area, and by 7%, 8% and 9%, respectively, in the comparison area. There was no evidence of sex-selective abortion in Matlab.

Conclusions: Sex preference does not have a strong effect on contraceptive use in Matlab. Its absence, however, would probably increase recourse to abortion, which is used to limit fertility once couples have the number of sons they desire. The effect of sex preference on childbearing is becoming stronger as fertility declines, because couples must achieve their desired number of sons within a smaller overall number of children.

The decline in the total fertility rate (TFR) of Bangladesh from more than six lifetime births per woman in the mid-1970s to slightly more than three births per woman in the early 1990s is remarkable. Some observers, pointing to a sharp increase in contraceptive prevalence--from less than 10% in the mid-1970s to about 45% in 1993-1994--attribute this decline to a successful national family planning program. [1] Others, however, express doubt that the program could have reduced fertility by half without societal change. [2]

Fertility remained relatively static in Bangladesh between 1993 and 2000, despite a seven-point increase in contraceptive prevalence. [3] In Matlab, where fertility was also stable during that period, the effect of an eight-point increase in contraceptive use was offset by the effect of a decrease in abortion. [4] On the other hand, recourse to abortion is increasing in the country overall. [5]

Son preference, which has its roots in the patriarchal form of society, dependence on sons for financial support during old age and continuation of the family name, and the necessity of a dowry for female children, may be an obstacle to further decline in fertility. …

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