Coitus-dependent family planning methods: observations from Bangladesh

Abstract

Some coitus-dependent methods of family planning, such as withdrawal, periodic abstinence, and the condom, require male involvement for their use, and using these methods in combination has proved to be sensible. An investigation of why male and female respondents in a survey conducted in Bangladesh often gave conflicting answers about which methods they were currently using, particularly about "traditional" methods and condoms, showed that inconsistency in their reports arose because these methods are used in combination to such an extent that they are difficult to distinguish. In order to obtain reliable responses about these methods, a survey approach different from the long-established one is required.

PIP: In-depth interviews conducted with 150 women and 141 men (128 matched couples) from rural Bangladesh as part of a survey of contraceptive use patterns revealed many inconsistencies between partners, especially in terms of use of condoms, the safe period, and withdrawal. In general, respondents who used coitus-dependent methods had difficulties answering survey questions on method use. Although many couples are known to use a combination of coitus-dependent methods (e.g., condoms during the fertile period of the cycle and coitus interruptus on days considered to be associated with a lower probability of conception), the interviews did not reflect this pattern. If one coitus-dependent method was mentioned by the woman and another by the man, investigation showed that, in most cases, the couple was using a combination of all the coitus-dependent methods they had mentioned. In some cases, the method mix employed by a couple changed from month to month. As a result, different aspects of a couple's regular sexual practice might be reported by each partner. Occasional unavailability of condoms was another reason for multiple method use. Overall, these findings indicate that inconsistencies in reported use of coitus-dependent methods of family planning are not due to careless or misleading responses to survey questions. These methods are so often used in combination, in order to enhance contraceptive effectiveness, that the combination itself is really the method being used. More accurate assessment methods are needed to capture use of coitus-dependent methods