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BRIEF RESEARCH ARTICLE
Year : 2015  |  Volume : 59  |  Issue : 3  |  Page : 220-224  

Interpersonal communication and contraception: Insights and evidences from Bangladesh demographic and health survey, 2011


Regional Manager, Research and Evaluation, Micronutrient Initiative, Asia

Date of Web Publication7-Sep-2015

Correspondence Address:
Manoj Kumar Raut
F-63, 1st Floor, East of Kailash, New Delhi - 110 065
Asia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.164666

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   Abstract 

This paper examines the role of exposure to mass media and interpersonal communication in predicting the current use of contraception in Bangladesh. Bivariate and multivariate analyses were carried out using the Bangladesh Demographic and Health Survey (BDHS), 2011 data to explore the association between communication and the current use of contraception. After adjusting the related socioeconomic and demographic factors, the mass media did not seem to have any role in predicting contraceptive use behavior while the findings revealed that interpersonal communication [prevalence ratio (PR): 1.0984, 95% confidence interval (CI) 1.0801-1.1170] is a strong positive predictor of the current contraceptive use. It is a well-known fact that mass media performs only the knowledge function while interpersonal communication performs an additional function of persuasion. This analysis corroborates the statement that the role of interpersonal communication is quite important in predicting contraceptive use.

Keywords: Bangladesh, Bangladesh Demographic and Health Survey (BDHS), current use of contraception, family planning, interpersonal communication, mass media


How to cite this article:
Raut MK. Interpersonal communication and contraception: Insights and evidences from Bangladesh demographic and health survey, 2011 . Indian J Public Health 2015;59:220-4

How to cite this URL:
Raut MK. Interpersonal communication and contraception: Insights and evidences from Bangladesh demographic and health survey, 2011 . Indian J Public Health [serial online] 2015 [cited 2019 Nov 13];59:220-4. Available from: http://www.ijph.in/text.asp?2015/59/3/220/164666

One of the most important problems that many countries in the early stages of demographic transition are facing is the burgeoning population. To address this issue, national family planning programs that began in the mid-20 th century have evolved rapidly to meet the information and service needs of target groups. All these programs relied heavily on communication as a means of promoting behavioral change. Worldwide communication campaigns have been shown to increase contraceptive use but a lot needs to be known about the comparative effectiveness of the different types and channels of media such as whether mass media or interpersonal communication has a greater impact. So, a need was felt to study the comparative impact of both. Hence, this study tries to understand the differential impact of exposure to mass media and interpersonal communication on contraceptive use behavior in Bangladesh that is known to have a successful family planning program. [1] The mass media channels include radio, television, and newspapers and the interpersonal channels include counseling by health workers. It is a well-known fact that mass media performs only the knowledge function while interpersonal communication performs the additional function of persuasion. [2] This analysis corroborates the statement that the role of interpersonal communication is quite important in predicting contraceptive use. Family planning programs around the world employ different types of communication media after segmenting the population based on their specific and peculiar needs and choices. [3] Bangladesh, with 149.7 million people, ranks eighth in population among all countries in the world [4] (Bangladesh Population and Housing Census 2011 adjusted as on March 15, 2011). It is projected to be 160.4 million [5] as on July 1, 2015 [United Nations (UN) projections]. Bangladesh, with a total land area of 147,570 sq. km, [6] is administratively divided into seven divisions and 64 districts. The religious composition of the country is characterized by about 90% Muslims, 9% Hindus, and 1% of the population belonging to other religions. [7] The total fertility rate (TFR) is 2.3 [6] lifetime births per woman and the crude birth rate (CBR) is 22.6 [6] births per 1,000 mid-year populations. The family welfare program was launched in Bangladesh (then East Pakistan) in the early 1950s through the voluntary efforts of social and medical workers. The government, recognizing the urgency of moderating population growth, adopted family planning as a government sector program in 1965. The current contraceptive use has increased substantially from 8% [8] in 1975 to 61% [6] in 2011 (Bangladesh Demographic and Health Survey (BDHS), 2011). The TFR has registered a more than 60% decline in 36 years from 6.3 [8] births per woman (Bangladesh Fertility Survey, 1975) during 1971-1975 to 2.3 [6] births per woman during 2009-2011 (BDHS, 2011). With regard to the use of any modern method, it has increased by 15.9% from 36.2 [8] births per woman to 52.1% [6] during the same period.

The specific objectives of the study are to explore the relationship between different sociodemographic characteristics, mass media, interpersonal communication, and contraceptive behavior and to explore the comparative role of mass media in instances such as exposure to family planning messages in the newspaper, radio, and television and interpersonal communication on contraceptive behavior. It is hypothesized that those who are exposed to interpersonal communication on contraceptive use promotion are more likely to use contraception compared to those who are exposed to mass media channels such as the newspaper, radio, and television.

This study uses data on currently married women in the reproductive age of 15-49 years from the 2011 BDHS. The 2011 BDHS is the sixth demographic and health survey (DHS) undertaken in Bangladesh. Before the analysis, DHS sampling weights were applied to the data and the weighted sample of 16,635 currently married women has been used in this paper. [6] The data were analyzed using SAS 9.1 software (SAS Institute, Inc., Cary, NC, USA). The P value of 0.05 was considered significant. In addition to the bivariate analysis, multivariate analysis was carried out to control the effects of other correlated factors as results from bivariate analyses could be thoroughly misleading; for example, contraceptive use could be higher in urban areas not because the type of place of residence has something to do with it but because urbanites are more educated and have a higher standard of living. So in order to arrive at the true significance of each factor independently while keeping all others at their mean values, it is necessary to control or nullify the effects of the other factors. As the dependent variable is categorical and dichotomous in nature with two categories, namely, nonuse = 0 and use = 1, a log-binomial regression was carried out to explore the effect of interpersonal communication and mass communication on contraception. The log-binomial model is similar to logistic regression in assuming a binomial distribution of the outcome. [9]

Definitions of predictors and covariates used in the regression model: The variables used in the model are the place of residence, divisions of the country, religion, age group, total children ever born, number of sons dead, number of daughters dead, education of the respondent and her spouse (husband), current work status of the respondent and her husband, wealth quintile, exposure to mass media, and interpersonal communication. Based on the hypothesis that contraceptive usage is expected to be affected by interpersonal communication not mass media modes of communication like; exposure to newspaper, radio and television, these variables were considered as predictors or independent variables in the regression model after adjusting for the socio-economic and demographic background characteristics of the respondents expected to confound the results like; place of residence, divisions of the country, religion, education, work status, wealth index, the number of children ever born, number of sons and the number of daughters dead. The place of residence here refers to whether the respondent hailed from an urban or a rural area. The divisions of the country refer to the seven administrative divisions in the country. The exposure to family planning messages on the newspaper, radio, and television are considered to be mass media predictors. The respondent's interaction with the family planning worker on family planning has been considered as a predictive indicator of interpersonal communication.

The sample is 74.20% rural-based. A little more than one-fourth of the women were illiterate (26.32%) while a little less than one-third (30.08%) of their spouses were illiterate. More than half of the respondents had two or more than two children. A little more than one out of 10 of the respondents were working at the time of sample collection while 10 of their spouses were reported to be working at the time of sample collection. A negligible portion of the respondents had exposure to family planning messages in the newspaper and radio while about one-fourth had watched family planning messages on television.

[Table 1] provides cross tabulations of association between the different sociodemographic variables, along with the communication variables with the dependent variable, namely, the current use of contraception. Chi-square tests were applied to test the significance of the association between the proportions. It was observed that the differentials of current use of contraception by most of the socio-demographic variables like; place of residence, seven divisions in the country, religion, education of the husband, age of the respondent, total children ever born, sons and daughters dead, respondent's current working status and respondent's exposure to interpersonal communication were significant. The variables that were not significant were education of the woman, wealth quintile, and exposure to mass media such as the newspaper, radio, and television.
Table 1: Currently married women of 15-49 years of age currently using contraception according to the sociodemographic-economic characteristics in BDHS, 2011

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[Table 2] shows the prevalence ratios (PRs) from the multivariate log-binomial model of logistic regression of the likelihood of current contraceptive use for mass media and interpersonal communication adjusting the probable sociodemographic and economic confounders. It was observed that exposure to interpersonal communication significantly predicts the likelihood of the current use of contraception after adjusting the sociodemographic and socioeconomic covariates of the place of residence (rural and urban), division, the respondent and her husband's education, wealth quintile, working status, total children ever born, and the number of sons or daughters dead.
Table 2: Prevalence ratio from the multivariate log-binomial regression model for the current use of contraception among currently married women of 15-49 years of age in BDHS, 2011

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This is an exploratory study. It shows that interpersonal communication is a significant predictor of the current use of contraception as hypothesized. The persuasion function of communication may have a greater role to play here than merely the knowledge function. Knowledge provided by mass media channels may make people aware and initiate behavioral change but only among those who are already motivated to accept the method. But the persuasion function may be more relevant in case of those who are not so motivated. From the policy and intervention point of view for the design of an effective communication strategy, both channels of media should be given adequate importance with greater emphasis on segmenting the target audience on the basis of their level of motivation. In case of those who are less motivated, interpersonal media should be employed while in the case of those who are relatively more motivated, mass media can suffice. On the one hand, interpersonal communication is more effective than mass media but on the other it has its own shortcomings of being too costly. In a developing country such as Bangladesh, it may not be feasible and advisable to opt for large-scale interpersonal communication through field workers, outreach workers, and counselors but it has to be considered as one of the significant components of any communication strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Schuler SR, Hashemi SM, Jenkins, AH. Bangladesh′s Family Planning Success Story: A Gender Perspective. International Family Planning Perspectives; 1995; 4:132-7, 166.  Back to cited text no. 1
    
2.
Rogers EM, Shoemaker FF. Communication of Innovations: A Cross-Cultural Approach. New York: The Free Press; 1971. p. 476.  Back to cited text no. 2
    
3.
Piotrow PT, Kincaid DL, Rimon JG 2 nd , Rinehart W. Health Communication: Lessons from Family Planning and Reproductive Health, Under the Auspices of the Centre of Communication Programs. Johns Hopkins School of Public Health. USA: Praeger Publishers; 1997. p. 307.  Back to cited text no. 3
    
4.
Bangladesh Bureau of Statistics (BBS). Available from: http://www.203.112.218.66/WebTestApplication/userfiles/Image/Census2011/Bangladesh_glance.pdf. [Last accessed on 2013 Apr 9].  Back to cited text no. 4
    
5.
United Nations Population Division. Department of Economic and Social Affairs. World Population Prospects: The 2012 Revision. Demographic Profiles. Vol. 2. New York: United Nations; 2013. p. 844.  Back to cited text no. 5
    
6.
National Institute of Population Research and Training (NIPORT). Mitra and Associates. ICF International. Bangladesh: Demographic and Health Survey 2011. Dhaka, Bangladesh, Calverton, Maryland, USA: NIPORT, Mitra and Associates, and ICF International; 2013. p. 431.  Back to cited text no. 6
    
7.
Bangladesh Bureau of Statistics (BBS). Statistical Year Book of Bangladesh. Dhaka, Bangladesh: Bangladesh Bureau of Statistics (BBS); 2012.  Back to cited text no. 7
    
8.
Ministry of Health and Population Control (MHPC) 1978. Bangladesh Fertility Survey 1975: First Country Report. Dhaka, Bangladesh: Population Control and Family Planning Division; p. XIV + 721.  Back to cited text no. 8
    
9.
Zhang J, Yu KF. What′s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998;280:1690-1.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]


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