1 \ , : ~ ;•, ~..".,' • ,'>--, MF Gonda IV! F Aligarh IV! F Kanpur Nagar Banda "I UTTAR PRADESH MALE REPRODUCTIVE HEALTH SURVEY 1995-1996 • The EVALUATION Project Carolina Population Center University of North Carolina at Chapel Hill CB #8120 University Square Chapel Hill, North Carolina 25716-3997 USA 1997 USAID Contract Number: DPE-3060-00-1054-00 I The EVALUATION Project / PERFORM ii CONTRIBUTORS Joseph deGraft-Johnson • Amy Ong Tsui Bates Buckner Kaushalendra K. Singh Ingrid Bou-Saada Christina Fowler Claire Viadro Julia Beamish Maria Khan In collaboration with Centre for Population and Development Studies, Hyderabad Indian Institute for Health Management Research, Jaipur Marketing and Research Organization, New Delhi Operations Research Group, New Delhi CONTENTS Page Tables , vii Figures '.' xii Acknowledgments .................................................... xv Executive Summary 1 CHAPTER 1 INTRODUCTION 5 Background of survey 5 Survey design and implementation .. : 6 Selection of rural villages and households 7 Selection of urban blocks and households 8 CHAPTER 2 RESPONDENT BACKGROUND CHARACTERISTICS 14 CHAPTER 3 KNOWLEDGE OF AND ATTITUDES TOWARD FEMALE REPRODUCTIVE ISSUES 17 Knowledge of the menstrual cycle 17 Knowledge of pregnancy and childbirth complications 18 Perception of fertility problems 19 Locus of control for pregnancy 20 Wife's ability to practice contraception 21 Importance of pregnancy prevention f9r husbands wanting no more children 23 Importance of pregnancy prevention for husbands wanting more children 24 CHAPTER 4 KNOWLEDGE AND USE OF FAMILY PLANNING METHODS 35 Exposure to family planning messages 35 Type of family planning message 35 Source of family planning messages 38 Contact with health workers 39 Unwanted pregnancy 40 Current use of contraceptives ............................ 40 Method mix among current users of contraception 41 Intention to use contraception in future 42 Method mix for future users 43 iii The EVALUATION Project I PERFORM iv CHAPTER 5 PHYSICAL ACCESSIBILITY AND QUALITY OF FAMILY PLANNING SERVICES 60 Accessibility 60 Cognitive access .............................. 60 Physical access 61 Quality of care 63 Sterilization clients 63 Temporary method clients 64 CHAPTER 6 DOMESTIC VIOLENCE 72 Family history of domestic violence 72 Prevalence of domestic violence 72 Types of domestic violence 74 Forced sexual relations 75 Attitudes toward wives' proper behavior with elders 76 Attitudes toward wives' proper behavior with husbands 78 CHAPTER 7 MEDICAL AND HEALTH EXPENDITURES 90 Needed additional care 91 Type of medical or health expenditure 92 Medical care for wife's last pregnancy 92 Medical care for wife's gynecologic condition .............. 94 Annual medical expenditures .................. 94 CHAPTER 8 PREMARITAL AND EXTRAMARITAL SEXUAL PRACTICES 106 Premarital sexual experience .. ....................... 106 Prevalence and type of contraceptive use during first marital sex 108 Marital sexual behavior. ............................. 108 Extramarital sexual experience ........................ 109 CHAPTER 9 SYMPTOMS OF SEXUAL MORBIDITY 120 Premarital sexually transmitted diseases ................ 120 Prevalence of STDs after marriage 122 Current STD prevalence ............................. 123 Beliefs about STDs ................................. 124 CHAPTER 10 GENDER DIFFERENCES IN FERTILITY INTENTIONS AND CONTRACEPTIVE BEHAVIORS 134 Background characteristics 134 Future fertility perferences 134 The EVALUATION Project I PERFORM v Sources known for modern contraceptive methods 135 Exposure to family planning messages 0 136 Current and future intention to use contraception . 0.. 0 0. 137 Summary 0 138 CHAPTER 11 SUMMARY AND IMPLICATIONS 0 0. .. 145 KnOWledge and awareness of family planning/ reproductive health issues 0 0. 145 Perceptions of family planning service and quality and contraceptive practice 146 Attitudes about and physical behavior towards wives 147 Financial support for family medical and health needs . 0 148 Past and current sexual activity and reported sexual morbidity 0..0............. 149 Gender differences in fertility preferences and contraceptive practice ......................... 149 APPENDICES 0. 0 151 Table A708 Number of husbands reporting medical expenditure in past year by beneficiary and selected background characteristics 00 0 151 Table A7.9 Number of husbands reporting medical expenditure in past year by type of expense, beneficiary and district 152 Male survey questionnaire .. 0.. 00 0.. 0 0.. 0 153 TABLES Table 1.1 Selected 1991 sociodemographic indicators for MRHS districts 12 Table 1.2 Sample coverage by interview outcome and district 13 Table 2.1 Percent of husbands with selected background characteristics by district 16 Table 3.1 Percent distribution of husbands' responses to questions about time in monthly menstrual cycle when a woman is most likely to become pregnant if she has intercourse 25 Table 3.2 Percent of husbands who know each type of warning symptom of pregnancy and delivery complications 26 Table 3.3 Percent distribution of husbands who believe that wife has fertility problems by selected background characteristics ..... 27 Table 3.4 Percent distribution of husbands who believe they have a fertility problem by selected background characteristics 28 Table 3.5 Percent of husbands who agree with statements about locus of control over pregnancy 29 Table 3.6 Percent of non-contracepting husbands who agree with statements about wife's ability to contracept 30 Table 3.7 Percent distribution of husbands wanting no more children by degree of importance and by selected background characteristics 31 Table 3.8 Percent distribution of husbands wanting no more children by degree of importance to ensure pregnancy protection by selected background characteristics ... 32 Table 3.9 Percent distribution of husbands wanting no more children by degree of importance to delay next birth and by selected background characteristics 33 Table 3.10 Percent distribution of husbands wanting more children by degree of importance to ensure pregnancy protection by selected background characteristics 34 Table 4.1 Percent of husbands hearing or seeing a family planning message in past month by di$trict 45 Table 4.2 Percent distribution of husbands hearing or seeing a family planning message in past month by type of message and selected background characteristics 46 Table 4.3 Percent of husbands who report hearing/seeing a message in past month about specific contraceptive methods by district 47 Table 4.4 Percent of husbands who report hearing/seeing a message in past months about specific contraceptive methods by selected background characteristics 48 vii The EVALUATION Project / PERFORM viii Table 4.5 Percent of husbands exposed to a family planning message in past month by message source and district 49 Table 4.6 Percent of husbands exposed to a family planning message in past month by message source and selected background characteristics 50 Table 4.7 Average number of contacts withCa female health worker in past six months by district and selected background characteristics 51 Table 4.8 Average number of contacts with a male health worker in past six months by district and selected background characteristics 52 Table 4.9 Average number of contacts with a health worker in past six months in which family planning was discussed by district and selected background characteristics 53 Table 4.10 Percent of husbands who report having discussed unwanted pregnancy with wives and percent experiencing pregnancy when not ready by selected background characteristics 54 Table 4.11 Percent distribution of number of times husbands experienced a pregnancy when not ready by selected background characteristics 55 Table 4.12 Percent of husbands currently using contraception by district and selected background characteristics 56 Table 4.13 Contraceptive method mix by district and selected background characteristics 57 Table 4.14 Percent of non-contracepting husbands intending to use family planning in future by district ., 58 Table 4.15 Contraceptive method mix for non-contracepting husbands intending to use family planning in future by district and selected background characteristics 59 Table 5.1 Percent distribution of husbands' reported awareness of a family planning sour-ee by method and place of residence for those unaware 66 Table 5.2 Percent of husbands who know a source for contraceptive methods or medical termination or pregnancy by type of method ................................... 67 Table 5.3 Percent distribution of husbands' reported travel distance to the nearest family planning source, by method, among men who are aware of a source, and by residence of nearest source within 5 kms 68 Table 5.4 Percent distribution of husbands' reported travel time to the nearest family planning source, by method, among men who are aware of a source, and by residence of nearest source within 30 minutes 69 The EVALUATION Project I PERFORM ix Table 5.5 Percent of husbands who report visiting a health facility or being visited by a health worker after sterilization procedure by district and selected background characteristics 70 Table 5.6 Percent of husbands who report a family planning worker visit after provision of a temporary method by district and selected background characteristics 71 Table 6.1 Percent of husbands ever witnessing or committing domestic violence by selected background characteristics 80 Table 6.2 Percent distribution of husbands' reporting number of years since first