DETERMINANTS OF MODERN CONTRACEPTIVE USE IN CAMEROON FROM 1991 TO 2004 By CONSOLER TENUG TEBOH Presented to the Faculty of the Graduate School of The University of Texas at Arlington in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY THE UNIVERSITY OF TEXAS AT ARLINGTON December 2011 Copyright © by Consoler Teboh 2011 All Rights Reserved DEDICATION This dissertation is dedicated to a few very special people in my life, my mother: Esther Acha Teboh; my beloved wife: Christina Teboh; and the kids: Sheila, Batuo, and Esther. ACKNOWLEDGEMENTS The pursuit of studies at the doctoral level requires persistence, dedication and perseverance. In spite of these tenets, the student’s social capital in the form of guidance, mentorship and support cannot be overemphasized. Although it is humanely impossible to mention every individual who has financially, physically and emotionally supported me during the course of the program, I would like to acknowledge those who symbolically shaped my life and helped me in the completion of my academic work. I would like to start by thanking my wife and children without whom I may not have been motivated to finish the program. They have endured the long absences that I took away from quality family time. I would also like to thank my mothers: Mrs. Sophie Teboh and Mrs. Esther Teboh; brothers: Ni Dan, Ni Gabby Ni Alex, John and Emmanuel; my sisters: Ma Eli, Ma Anna, Ma Mado and Ma Bri; my in-laws, Mrs. L. Baiye, Mrs. A. Baiye, Mr. J. Baiye the children, Ni Mike, Manyi Yellow; and my aunt, Ma Grace Ndam, and all my nieces and nephews for their constant support and encouragement throughout the years. Adequate completion of a dissertation requires direction and support from one’s guiding committee. I was especially lucky to have had an uncommonly supportive and understanding committee, who constantly nurtured me throughout the program. I thank my dissertation chair Dr. Vijayan Pillai, who has earned the right to be called my academic father. His dedication, flexibility and support are unquantifiable and far exceeded extraordinary expectations. It is an understatement to say he is the best mentor I could ever ask for. Special thanks also go to rest of my committee members who together worked diligently to help me throughout the program: Dr. Maria iv Scannapieco, Dr. Doreen Elliott, Dr. Randy Basham, and Dr. Rashmi Gupta. I would also extend a hand of gratitude to Dr. Emily Spence-Almaguer, Dr. Diane Mitschke, Dr. Danis, Dr. Alex Osborne, Dr. Hegar, Dr. Black, Dr. Jordan, Dr. Moon, Dr. Woody, Dr. Lehmann, Dr. Watson, Dr. Schoech, and Dr. Hernandez, Dr. G. Teboh. Dr. B. Teboh. Dr. E. Mbah, who in one way or another taught me something. I sincerely thank Ms. Nancy Ashenhart, John Dillard, and Rita Hay and other non-academic staff for their constant support throughout the program. I especially thank Maya Porter, for a fantastic editing job. I am also thankful to friends and colleagues of the PhD Program especially Dr. Diana Opollo and Fangshun Wei have earned their place as my academic sisters; I deeply value their friendship. Ruby Bouie, Sadia Saeed, Dr. Dheeshana Sugandhi, Dr. Sachi Ando, Yasoda Sharma, Bonita Sharma, Dr. Nairtuti Jani, and Mashooq Salehin, Benjamin Grant, Kingsley Chigbu all made my student years worthwhile and helped me without reservations. Beyond academics, are always friends, mentors and groups that provide an enabling support system; I sincerely thank everyone who, helped, advised and encouraged me to keep on but whose name I cannot be remembered at this time. Last and definitely not least, I would like to give special thanks to my roommate and wife Mrs. Christie Teboh, without whose immeasurable support this work would not have been a success story. Put differently, this dissertation is an apology for my extramarital romance with books and the computer, at the expense of quality family life. Above all else, to God be the Glory! November 18, 2011 v ABSTRACT DETERMINANTS OF MODERN CONTRACEPTIVE USE IN CAMEROON FROM 1991 TO 2004 Consoler Tenug Teboh, PhD The University of Texas at Arlington, 2010 Supervising Professor: Dr. Vijayan K. Pillai The purpose of this research is to examine the determinants of contraceptive use among women ages 15–49 of childbearing age (WCA) and to describe the compositional and processual changes that have taken place in Cameroon between 1991 and 2004. The study constituted a sample size of 3,871 and 10,656 15 to 49 year old women of childbearing from 1991 and 2004 Cameroon Demographic and Health Survey datasets respectively. Regression results confirmed that there was considerable support for the hypotheses in 1991 and 2004 except for age at first marriage which was significant but contradictory to the direction proposed in the hypothesis. Compositional changes were found to have occurred between 1991 and 2004 with the following variables: audio or visual media, income, married, number of children, older, other forms, primary, Regions 1 to 4, residence, and secondary education, while Christian, income, married, other forms of relationships, old, primary, and residence showed processual changes during the same period. Only levels of education showed compositional as well as effect changes when the variables were decomposed. The study confirmed that social, cultural, political, and legal determinants affect modern contraceptive use. The study also confirmed that modernization & human capital have influenced modern contraceptive use in Cameroon from 1991 to 2004. Unlike age at first marriage, income, place of vi residence, and education, supported the hypotheses of the study. Lastly, the study confirmed that there have been compositional and processual changes in Cameroon from 1991 to 2004. vii TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS………………………………………………………..………………...iv ABSTRACT……………………………………………………………………….………………...vi LIST OF ILLUSTRATIONS…………………………..………………………………………….....ix LIST OF TABLES…………………………………………………………………..………………xii CHAPTER PAGE 1. INTRODUCTION……………………………...……………...…………………………..1 2. LITERATURE REVIEW…………..………….……………...…………………………...9 3. THEORETICAL FRAMEWORK…………...………………...…………………………44 4. METHODOLOGY……………………………………………...………………………..62 5. DATA ANALYSES AND RESULTS…………...……………...……………………….86 6. DISCUSSION AND SOCIAL WORK IMPLICATIONS…………...…………...….....189 APPENDIX A: ACRONYMS………….……………………….……………………..………………..207 B: SUMMARY OF LITERATURE REVIEW……………..……….......………………...210 REFERENCES…………………………………………………………………...………………..277 BIOGRAPHICAL INFORMATION………..…………………………………………..................267 viii LIST OF ILLUSTRATIONS FIGURE PAGE 3.1. Diagram of Theoretical Framework………………………….…………………………………61 5.1. 1991 Audio or Visual Bar Chart………………………………………………………………..88 5.2. 1991 Audio or Visual Histogram……………………………………………………………….88 5.3. 2004 Audio or Visual Bar Chart………………..........................................................................89 5.4. 2004 Audio or Visual Histogram……………….........................................................................89 5.5. 1991 Christian Bar Chart……………………….........................................................................91 5.6. 1991 Christian Histogram………………………........................................................................91 5.7. 2004 Christian Bar Chart ………………………........................................................................92 5.8 2004 Christian Histogram……………………….........................................................................92 5.9. 1991 Contraceptive Use Bar Chart …………………………………………………………….93 5.10. 1991 Contraceptive Use Histogram…………………………………………………………...93 5.11. 2004 Contraceptive Use bar Chart…………….........................................................................94 5.12. 2004 Contraceptive Use Histogram…………….......................................................................94 5.13. 1991 Income Bar Chart ……………………………………………………….…....................95 5.14. 1991 Income Histogram……………………………………………………….…....................95 5.15. 2004 Income Bar Chart ……………………............................................................................96 5.16. 2004 Income Histogram …………………………………........................................................96 5.17. 1991 Married Bar Chart………………………………….………………………....................97 5.18. 1991 Married Histogram………………………………….…………………………………...97 ix 5.19. 2004 Married Bar Chart………………………………….………………………....................98 5.20. 2004 Married Histogram………………………………….…………………………………...98 5.21. 1991 Number of Children Bar Chart …………………….……………………….................100 5.22. 1991 Number of Children Histogram…………………….……………………….................100 5.23. 2004 Number of Children Bar Chart ……………………………………….…….................102 5.24. 2004 Number of Children Histogram……………………………………….…….................102 5.25. 1991 Old Bar Chart ………………..……………………………………………...................103 5.26. 1991 Old Histogram………………..……………………………………………...................103 5.27. 2004 Old Bar Chart………..…………………………………………………………………104 5.28. 2004 Old Histogram………..………………………………………………………………...104 5.29. 1991 Older Bar Chart…………………………………….…………………………………105 5.30. 1991 Older Histogram…………………………………….…………………….....................105 5.31. 2004 Older Bar Chart …………………………………….…………………….....................106 5.32. 2004 Older Histogram…………………………………….…………………….....................106 5.33. 1991 Other Forms Bar Chart.……………………………..…………………….....................107 5.34. 1991 Other Forms Histogram.…………………………….…………………………………107 5.35. 2004 Other Forms Bar Chart.…………………..………………………………....................108