UNFPA COUNTRY SUPPORT TEAM
Office for the South Pacific
DISCUSSION PAPER NO. 17
Prospects for Demographic Behavioural Change
in Vanuatu:
The Results of a KAP Survey
by
William J House
Adviser on Population Policies & Development Strategies
UNFPA/CST, Suva
The views and opinions contained in this Report
have not been officially cleared and thus do not
necessarily represent the position of the
United Nations Population Fund
December 1998
EXECUTIVE SUMMARY
Information on the nature and determinants of demographic behaviour in Vanuatu is
extremely limited. A Knowledge, Attitude and Practice (KAP) Survey was conducted in
urban and rural areas of Vanuatu in June 1995 with support from the South Pacific Alliance
for Family Health (SPAFH), the South Pacific Commission (SPC) and the Statistics Office of
the Government of Vanuatu.
Our analysis of the survey reveals that 71% of women and 65% of men know of at least one
contraceptive method. Male knowledge exceeds female knowledge for those methods which
are strictly male i.e. condom, male sterilization and withdrawal, as well as for the Billings
method. The pill, condoms and female sterilization were the most widely known methods;
“inefficient” methods - withdrawal, abstinence and traditional methods - were among the
least known.
As expected, knowledge of family planning rises with age and education. The relatively low
level of knowledge for younger age groups should be disturbing to the authorities given their
concern with the increasing incidence of teenage pregnancy and the threat from HIV/AIDS.
Of those aged 15-24 69% of currently married women and only 53% of single women are
aware of family planning. The corresponding data for currently married and single men were
60% and 55%. Evidently, large numbers of young persons are ignorant of the benefits to be
derived from contraception and family planning, which must impede progress in promoting
delayed pregnancy and child spacing as methods of improving the health of mothers and
children.
The current contraceptive prevalence rate is estimated to be 31% for all methods but only
21% for modern methods. Almost one half of female users of modern methods are dependent
on the contraceptive pill. While better educated women are more likely to know of the
concept of family planning, they are no more likely than less educated women to have
adopted the practice. In contrast to female respondents, the rate of male current use at 35%
(half of which are using condoms) rises consistently across education levels.
There are still wide gaps across the country in the knowledge and use of contraceptive
methods. While awareness of family planning is far from universal, it is very much higher
than the actual practice of family planning. Past engagement of health workers and radio
programmes to spread the message has been very effective. More extensive use of these
mechanisms seems justified, particularly in light of the relatively low rate of use of modern
methods of contraception. Major emphasis must be given to closing the gap between
awareness of family planning and recognition of the benefits to be derived by individual
families from actually practising family planning, particularly modern, effective methods of
contraception. Such an approach would assist in closing the extremely large unmet need for
limiting future childbearing at 30% of currently married women. While this analysis was
unable to estimate the level of unmet need for child spacing, evidence from other countries
would suggest this far exceeds the size of the unmet need for limiting future births, which is
already quite extensive in Vanuatu.
The perceived dispersion in access to service facilities across the country is wide, as is the
kind of services offered in the clinics. More in-depth assessment of these perceptions is
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warranted, as would be an evaluation of the actual disparity in services offered across the
regions.
The generally pronatalist, high fertility and non-contracepting environment prevalent in
Vanuatu is characteristic of many other less developed countries at its stage of development.
Thus, it would be surprising if individual behavioural factors were to be important in
explaining demographic behaviour. For example, women’s education attainments do not
assist in explaining inter-personal differences in achieved fertility or the use of
contraceptives. That more education seems to induce a decline in desired family size (mean
of 3.85) offers some hope for an eventual change in demographic behaviour. The same is
true of our finding that women in non-agricultural wage employment achieve lower fertility
and are more likely to use contraception. As Vanuatu creates more opportunities for female
education and non-traditional economic opportunities, demographic behavioural changes will
be more likely.
Vanuatu has commenced an exercise in designing a comprehensive population and
development policy and some of the results of the KAP survey reported here may be of direct
interest to the drafters of the policy. Evidently, enlargement of the extent of knowledge of
family planning and its benefits to the individual family and its members throughout all
corners of Vanuatu is a pre-requisite for future demographic behavioural change. Measures
to raise the overall status of women to a level where they can identify the incompatibility
between their own fertility and both the share of economic responsibility they bear for raising
children and the ever greater costs of feeding and educating them should receive priority in
such a policy statement. Only then will those with the requisite knowledge and awareness be
induced to adopt methods to plan and control their fertility.
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TABLE OF CONTENTS
PROSPECTS FOR DEMOGRAPHIC BEHAVIOURAL CHANGE ................................. 1
EXECUTIVE SUMMARY ................................................................................ I
I. INTRODUCTION .................................................................................. 1
Overview .................................................................................................................... 1
Family Planning Policy .............................................................................................. 3
II. AN EXPANDED KNOWLEDGE BASE ON DEMOGRAPHIC BEHAVIOUR ............... 4
The 1995 Vanuatu Family Planning or KAP Survey ................................................. 5
III. THE VANUATU KAP SURVEY ANALYSIS ................................................... 6
Demographic Behaviour: Some Theoretic Underpinnings ........................................ 6
The Survey Results ..................................................................................................... 7
Current Use of Family Planning ............................................................................... 10
Ever Use of Family Planning.................................................................................... 14
Perceptions of Service Facilities............................................................................... 15
IV. ESTIMATING THE UNMET NEED FOR FAMILY PLANNING ........................... 19
Conceptualising the Level of Unmet Need for Family Planning ............................. 21
Socio-Economic Characteristics of Women with Unmet Need ............................... 25
V. THE DETERMINANTS OF DEMOGRAPHIC BEHAVIOUR ............................... 27
Other Factors ............................................................................................................ 28
Multivariate Analysis of Demographic Behaviour ................................................... 29
Fertility Behaviour .................................................................................................... 29
Desired Family Size.................................................................................................. 32
Knowledge and Use of Contraception ...................................................................... 33
Unmet Need for Family Planning ............................................................................. 37
VI. CONCLUSIONS .................................................................................. 38
REFERENCES ......................................................................................... 41
Appendices……………………………………………………………………….43
I.
INTRODUCTION*
Overview
The Republic of Vanuatu, formerly known as the New Hebrides, has a population of over
170,000, which is concentrated on the three major islands. The capital of Port Vila has a
population of about 24,000 and Luganville, the only other major town has a population of
about 8,000. Villages tend to be scattered around the coastal zones of the archipelago and
have poor infrastructure and limited communication links to the urban centres. The
Melanesian people speak around 100 dialects with Bislama, English, and French used as
official languages, the latter reflecting the influence of the pre-Independence Anglo-French
Condominium government.
The rural population has avoided the severe poverty experienced in many low income
countries but access to education beyond basic schooling is extremely restricted, workforce
skills are very underdeveloped and primary health care receives too little attention in rural
areas. The dualistic structure of the economy is reflected in a highly skewed income
distribution; ni-Vanuatu people constitute 97 per cent of the population but receive only 70
percent of measured GDP, meaning that their incomes are only 7 percent of the expatriates’
average.
In keeping with its status as a least developed country Vanuatu ranks 124th of 175 countries
in the UNDP 1997 Human Development Index (UNDP, 1997). The HDI combines a
weighted mean of life expectancy at birth, adult literacy and purchasing power per capita.
According to the 1997 UNDP report, Vanuatu has a life expectancy of 65.9 years, a 64% rate
of adult literacy and US$2,276 in purchasing power per capita. This compares for example,
with nearby Australia which ranks 14th on the HDI, with life expectancy of 78.1 years, 99%
adult literacy and purchasing power per capita of US$19,285. Neighbouring Papua New
Guinea lies below Vanuatu in 128th place with life expectancy of 56.4 years, adult literacy of
71% and purchasing power of US$2,821.
Vanuatu’s demographic dynamics reflect its underdeveloped status in that fertility is
relatively high, mortality and life expectancy have improved but do not warrant complacency,
population growth has declined but still, at the current rate, population size will double in 23
years, and the rate of urbanisation exceeds overall population growth by a factor of almost
three.
From the 1989 Census it is estimated that the total fertility rate fell during the 1979-89
intercensal years, from 6.5 to 5.3, with that of rural women being higher than urban women,
while rural childbearing continues into the 40 plus years (Republic of Vanuatu, 1991). Over
the same period the infant mortality rate declined from 94 to 45 per thousand live births while
the crude death rate fell from 12 to 9 per thousand population and the annual rate of
population growth fell from 3.4% to 2.8%. Women’s educational attainment is negatively
related to fertility, which is line with the findings of global research. The use of modern
contraceptives is becoming more common, but they are thought to be more widely used by
urban rather than rural women. It is believed that the latter rely more on traditional methods
* The author wishes to thank Barney Cohen, Director, Committee on Population, National Research Council, Washington
D.C. and CST colleague Susan Aradeon for constructive comments made on an earlier version of this paper.
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to reduce fertility, such as the use of the lif (leaf) and extended periods of abstinence after a
birth. However, reporting and record keeping are poor and past estimates of the national rate
of contraceptive prevalence must be viewed with some skepticism.
Family Planning services have been provided through the Department of Health since before
Independence. During the early 1980s it was an active service providing family planning
(FP) to around 4,000 users. Then, in 1983, due to concerns regarding the use of the long
acting contraceptive Depo-Provera, the practice of FP fell into disrepute and the number of
users fell dramatically. Consequently the programme was inactive during the mid-1980s.
However, late in the decade, community interest in family planning increased in recognition
of the strong health-related arguments for using family planning. In order to reach the
objectives of the FP programme, an estimate of the contraceptive prevalence rate is essential,
but it has been very difficult to establish because of gross inaccuracies in the data collected,
since they reflect the number of FP visits and not the number of users. Therefore, the
contraceptive prevalence rate for women of childbearing age (CBA) has been inaccurate and
unreliable.
Conventional wisdom has it that many women consider four children an ideal number, and
since the current fertility rate is higher, this suggests that there may be an unmet demand for
family planning. However, in most communities traditional methods of birth control have
fallen into disuse, and modern methods of family planning are not yet widely used. Although
modern methods are available through health care channels, service statistics from the
Department of Health suggest that few women are using them. Since close to 15% of the
population are Catholic, the Church’s official attitude to family planning may have a negative
impact on the uptake of modern methods, both for Catholics and, via rumor-mongering, for
non-Catholics. One rural survey indicated that modern family planning methods (most
commonly sterilization) were used primarily by women who already had over four children.
This suggests that these methods are used to limit family size, perhaps after the “ideal” size is
reached, rather than to space births. The reasons given for the limited use of modern family
planning methods include a lack of knowledge of these methods and a fear of side effects,
inadequate counselling, and reluctance by women to approach male nurses on these sensitive
matters. Cultural views of the role of women in bearing children, and misconceptions about
family planning, may also be important factors. The Department of Health has
acknowledged that unambiguous messages on family planning methods are not yet widely
available, that sometimes they are restricted to certain age groups of married women, that the
choice of methods offered may be inadequate and that men are not sufficiently involved in
family planning. Currently, activities are underway to broaden the scope of family planning
services to encompass more reproductive health concerns following the International
Conference on Population and Development (ICPD) and its Programme of Action of 1994.
The suggested improvements include better training of service providers in the use of family
planning methods and the development of counselling skills, and increased community
education on family planning. Education initiatives need to involve men, women and
adolescents.
As is the case in much of Melanesia, men play the prominent role in traditional society in
Vanuatu. As a result women still suffer from limited opportunities to participate in the
economy and decision-making generally. They are largely excluded from government
extension programmes in the productive sectors and are hardly represented in the higher
levels of government. Women account for only about a third of paid employment and 30% of
the public service, mostly in low status occupations. In education, the overall female
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enrolment rate is 36% compared with 42% for males, with the disadvantage concentrated in
secondary and post-secondary education. For ages 6-14, in 1989 the male and female
enrolment rates were close to 70% but, for those aged 15-19, the male rate was close to 26%
while the female rate was around 18% (Republic of Vanuatu, 1991). In addition, women
have poor access to family planning, with only about 25 % of the relevant age group believed
to be using some modern form of family planning method, according to service statistics.
However, this paper throws much more reliable evidence on the nature and level of
contraceptive prevalence in the country, as reported later. Maternal and child care facilities
are also rudimentary.
This paper concentrates on an in-depth analysis of the data collected in a recent 1995
Vanuatu Family Planning or KAP (Knowledge, Attitudes and Practice) survey undertaken in
the country. The analysis identifies some of the socio-economic determinants of
demographic behaviour, including knowledge and use of family planning, the unmet need for
family planning, desired family size and children ever born. The paper also explores male
and female perceptions of the family planning programme and its facilities in Vanuatu. It is
expected that the results of this analysis will prove useful to population policy-makers and
planners who are attempting to respond to the demographic challenge by improving access to
quality reproductive health and family planning services in a cost-efficient manner.
Family Planning Policy
While Maternal and Child Health/Family Planning (MCH/FP) is one of the eight elements
under the umbrella of the Primary Health Care (PHC) approach, the Ministry of Health has
also published a National Family Planning Policy Statement and Guidelines (Vanuatu, NFPP,
1993) to provide official support to the family planning programme. The basic premise of the
Vanuatu NFPP is:
"For the good health and prosperity of the people of Vanuatu, it is a
basic right of all individuals and couples within community norms, to be
able to freely and responsibly decide on when to have children and how
many to have. To allow individuals and couples to exercise their choice
in the timing, spacing and number of their children, then they must be
provided with family planning services, the information on how to plan
their families and the means to do so" (National Family Planning Policy
Statement, 1993)
The overall goal of the FP programme is proclaimed as:
"Family planning services, including family planning education, shall be provided in
Vanuatu to benefit the health and welfare of individuals, families and communities and
to promote the socio-economic development of the country".
The statement identifies the need to raise awareness and involve political and community
leaders in family planning issues. It notes that women and men of reproductive age,
including teenagers, need to be provided with adequate information, education and
counselling to make informed choices and that they will have access to the family planning
method of their choice. How do these noble intentions fare in practice?
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As noted earlier, estimates of the rate of contraceptive prevalence remain imprecise and
scepticism is warranted. However, current national estimates of the Ministry of Health on
family planning acceptance suggest that about 25% of women of childbearing age (15-49
years) use modern contraception ("pills, condoms, the intrauterine device or sterilisation”).
Moreover, the contraceptive prevalence rate in rural areas is thought to be significantly lower
than in urban areas; and births occurring within 2-3 years of the previous birth are greater in
rural areas. This is due, at least partially, to the lack of family health education, the generally
pro-natalist environment, and the consequent lack of effective demand for contraceptive
services. However, major problems in service provision also contribute to low contraceptive
use. More and better community education on family planning is believed to be fostering a
growing interest in contraceptive use and generating a demand for services which needs to be
fulfilled.
In addition to difficulties common to most programme activities in Vanuatu (e.g. logistical
problems in a widespread archipelago), two specific challenges confront the Family
Health/Planning programme: reaching two important target groups, men and young people,
and bridging the gap between ideal cultural and religious moral values and the reality of a
changing society where teenage pregnancy and sexually transmitted diseases are no longer
uncommon. Strategies to overcome these are being addressed by rural health workers
familiar with the problems and able to identify appropriate and practical solutions.
Evidently, inducing change in fertility behaviour will require a multi-sectoral approach.
Success in fulfilling some of the key elements of the ICPD Programme of Action, including
meeting the reproductive health needs of the population and reducing fertility in the near
future, will help to determine whether long-term sustainable development is achievable in
Vanuatu. For this to happen, policy-making requires better information and an improved
demographic database.
II.
AN EXPANDED KNOWLEDGE BASE ON DEMOGRAPHIC BEHAVIOUR
Information on the nature and determinants of demographic behaviour in Vanuatu is
extremely limited. The decennial Census of Population provides a snapshot of the situation
relatively infrequently and is limited to standard demographic analysis including a count of
the total population, its age and sex structure, geographic distribution, educational
attainments, internal migration, economic activities and birth and death rates. Fertility is
estimated using indirect methods. Civil registration of births and deaths in Vanuatu suffers
from a lack of reporting of these vital events and the system has fallen into such disrepair that
less than 20% of all births are registered in the calendar year of birth. The proportion of
deaths registered is even lower.
The decennial Census is clearly not the best source of information for exploring fertility
behaviour since the number of questions posed to respondents is necessarily limited. Indepth information about respondents’ knowledge and practice of family planning, desire for
more children, perceptions about family planning providers and facilities etc. can only be
realistically collected in sample surveys.
One of the few attempts to undertake such an exercise in Vanuatu took place under the
auspices of the Asian Development Bank in 1994 (Jayaraman, 1995). The small sample
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survey of 300 married women was conducted only in Port Vila and analysis of the data was
restricted to an examination of the determinants of current contraceptive use.
Results of multiple regression logit model estimation found six principal significant
determinants of contraceptive use, including the respondent’s and her husband’s educational
attainments, husband’s occupation, number of living children, whether the woman had
suffered the loss of a child and whether she had been visited by a family planning counsellor.
The policy implications of this small, unrepresentative sample survey and its analysis are
evidently quite restricted.
The 1995 Vanuatu Family Planning or KAP Survey
A Knowledge, Attitude and Practice (KAP) Survey was conducted in urban and rural areas of
Vanuatu in June 1995 with support from the South Pacific Alliance for Family Health
(SPAFH), the South Pacific Commission (SPC), the Department of Health and the Statistics
Office of the Government of Vanuatu. In the survey design1 eligible respondents were
drawn from both sexes from ages 15 to 49 years for females and 15 to 59 years for males.
The eligible populations in these age ranges were estimated to be 42,086 males and 40,217
females. Using a stratified cluster sampling technique, assuming a rate of 25% of women
interviewed will have used family planning services at least once, and in order to achieve a
confidence interval of 95% (p=0.05), it was estimated that the minimum sample size should
be 900 eligible females and 900 eligible males. In order to be able to compare data from
urban and rural areas, it was decided to carry out two separate surveys, one for Vanuatu
Urban, which comprises Port Vila, and Luganville, and one for Vanuatu Rural, which
comprises the remainder of the country. The total sample size was set at 3,600; 1800 females
and 1800 males, with half selected from the urban clusters and half from the rural clusters i.e.
900 females and 900 males each selected from rural and urban areas. In order to achieve this,
the 1995 projected population was stratified by Health Districts and then by urban and rural
components.
A list of villages, based on the 1993 Agriculture Census was divided further into households.
The list of villages was divided into clusters ensuring that each cluster would provide
adequate numbers of eligible respondents to be included in the survey. The enumeration areas
(EAs) and their total number of households were listed geographically by urban and rural
areas. Where EAs did not include the minimum number of households, then geographically
adjacent EAs were amalgamated to yield sufficient households. This provided the frame for
selecting the clusters to be included in the survey according to a stratified systematic
sampling technique in which the probability for the selection of any cluster was proportional
to its size. A sampling interval was calculated by dividing the total number households by
the number of clusters. A random number between 1 and the sampling interval was computer
generated. The EA in which the random number fell was identified as the first selected
cluster. The sampling interval was applied to that number and then progressively until the 15
(urban) and 20 (rural) clusters were identified. These clusters made up the sample for the
survey. Households were randomly selected from these clusters for interview.
While the questions asked are fairly standard for this kind of KAP survey a number of major
oversights on the part of the questionnaire designers impedes the full exploitation of the data.
1This description of the survey design is taken from SPAFH/SPC (1995).
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For example, it is impossible to determine the relationship between the male and female
persons interviewed in the selected households. The inability to know whether a male and
female interviewed in the same household are husband and wife is a major constraint, given
that the husband’s socio-economic characteristics can help to determine his wife’s fertility
behaviour, particularly her use or non-use of contraception.
The size of women’s unmet need for family planning is an important policy and planning
indicator reflecting the non-use of contraception by fecund, non-pregnant women who say
that they wish to stop childbearing or postpone the date of the next birth. However, the
Vanuatu survey does not allow a clear estimate of unmet need to be made according to this
definition because women were neither asked if they believed whether they were capable of
giving birth to another child, whether they are currently pregnant nor whether they wished to
postpone the birth of their next child. Furthermore, while women were asked “How many
children have you given birth to?” they were not asked for the number who have died and the
number still alive, which might be important factors determining whether they currently use
family planning, as Jayaraman (1995) found in his Port Vila survey. Nor did the survey
collect complete birth histories from female respondents.
Deficiencies aside, the Vanuatu Family Planning survey was a bold initiative, the in-depth
analysis of which forms the basis of the subsequent sections of this paper. Indeed, while the
survey over-sampled men and women in urban Vanuatu, as explained earlier, this was
corrected in this analysis by weighting the sample observations in order that they reflect the
underlying geographic distribution of the population according to its location by health
district. Furthermore, the age distribution of the sample of men and women is remarkably
similar to the underlying age distribution of women age 15-49 and men age 15-59 in the
population, according to the 1989 Census.
III.
THE VANUATU KAP SURVEY ANALYSIS
Demographic Behaviour: Some Theoretic Underpinnings
Before beginning the analysis of the KAP survey in Vanuatu, it is worthwhile to consider the
underlying theory of fertility behaviour according to the new household economics and its
disciples. The theory of household decision-making considers households to be rational in
attempting to maximize their welfare or well being subject to a number of constraints.
Children are viewed in a similar manner as other “commodities” and the demand for children
is dependent on the relative preferences for children and their relative costs compared with
other goods. Cross-section variation in fertility is attributed primarily to differences in the
relative value of human time, particularly to the opportunity costs of women’s time that is
thought to constitute a substantial share of the total costs of child rearing (Schultz, 1981).
In relatively poor, less-developed countries such as Vanuatu, however, this demand-oriented
approach is viewed as being too simplistic for a number of reasons (Anker and Knowles,
1982). The economic contribution of children in farm work and child-minding activities is
largely ignored in the theory, yet it can be considerable and, together with an obligation to
care for parents in old-age, provides an important incentive for high fertility. The approach
also ignores factors such as poor health, high rates of infant mortality and cultural constraints
which affect the supply of children and which may result in desired fertility being greater
than that which is capable of being attained (Cohen and House, 1994).
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In the following analysis of inter-personal demographic behavioural differentials in Vanuatu,
a large number of the determinants that the theory of household decision-making suggests are
important, are considered. In an extensive literature, more education for the mother is usually
believed to proxy for the increased value of her time in wider labour market opportunities and
to influence her tastes and preferences by enhancing her desire for material goods and leisure,
time uses which compete with the care of children. Education may also improve the quality
of infant and childcare, reducing the need for high fertility to ensure a minimum surviving
family size. Labour market activities performed outside the home are introduced into the
analysis as an additional proxy for the cost of child bearing. Socio-cultural differences in the
demand for children are represented by variables denoting district of residence; and
knowledge of family planning methods to reduce fertility are included as a factor to be
explained and as a determinant of fertility behaviour. Finally, it is essential to control for
life-cycle variation in fecundity by accounting for the age of the respondents. While
respondent households face different budgetary constraints which help to determine their
demand for children and other goods and services, the survey instrument made no attempt to
collect household income nor proxies for economic differentiation between households.
Departures from a natural fertility regime will occur through behavioural changes,
particularly through the adoption of efficient family planning methods. Family planning
indices were developed from questions about whether the female respondent had ever heard
of any method of family planning to prevent childbirth and whether any method had actually
ever been used.
The Survey Results
The original KAP sample survey in Vanuatu contained an almost equal number of male and
female respondents from urban and rural areas, a clear over representation of urban areas
when the population there amounts to only about 20% of the total. Such over sampling is an
efficient strategy since it would help to minimize sampling errors in the urban areas. In order
that the sample would be representative of the national picture as a whole, observations were
weighted according to the distribution of residents - males aged 15-59 and females aged 1549 - by health districts in the 1989 Census of Population.2
2The weights were, for males: Northern district (1.724), Eastern (1.833), Central 2 (1.338), Central 1 (1.014), Southern
(1.298), Port Vila (0.563) and Luganville (0.417). For females the weights were: Northern (1.630), Eastern (2.191), Central 2
(0.913), Central 1 (1.718), Southern (1.471), Port Vila (0.511) and Luganville (0.387).
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Knowledge of Family Planning
Table 1
Percentage of Respondents Who Have Heard of Family Planning, by Method
Method
Any Method
Condom
Pill
Calendar
Billings
Loop
Injection
Female Sterilization
Male Sterilization
Withdrawal
Abstinence
Traditional
No. of Observations
Females
71
58
64
33
14
47
38
55
40
25
32
33
1763
Males
65
61
47
28
17
31
30
51
42
32
29
29
1732
Source: Vanuatu KAP Survey, 1995
Our analysis reveals that 71% of women and 65% of men know of at least one contraceptive
method3. The pill, condoms and female sterilization were the most widely known methods;
“inefficient” methods - withdrawal, abstinence and traditional methods - were among the
least known. Male knowledge exceeds female knowledge for those methods which are
strictly male i.e. condom, male sterilization and withdrawal, as well as the Billings method.
Respondents were asked how they had heard of family planning. Analysis showed that, of
those women who had heard, the most cited source of information was health sector workers
(80% of those who had heard of family planning), followed by the radio (66%), friends
(49%), books (46%) and the Vanuatu Family Health Association (43%). Only 19% of those
women familiar with family planning had heard of it from newspapers. For the 65% of men
who had heard of family planning the most widely cited source of information was the radio
(by 81%), followed by health workers (67%), books (58%), friends (52%) and newspapers
(31%). Not surprisingly, because it caters largely for women’s needs, only a minority of men
(23%) mentioned the Vanuatu Family Health Association as their source of information. On
this evidence health workers and the radio have made the deepest penetration in Vanuatu in
generating information on family planning and may be the best positioned and most
appropriate to be further utilised to extend knowledge to the remaining one-third of adults
still unfamiliar with the concept of family planning. There appears to be a relatively high
level of contact between health workers and men which may indicate that the former are
performing their counselling tasks with some conviction.
Of those respondents who had not heard of family planning, the overwhelming majority of
women (93%) and men (94%) claimed to want to learn more, reflecting the wide scope of
opportunities for awareness-raising in Vanuatu.
3Respondents were first asked if they knew of each method without any prompt and were only prompted when they
appeared initially not to know of the method. The data in Table 1 refer to respondents who claimed to know of the method,
regardless of whether they needed a prompt.
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Table 2
Percentage of Respondents Who Have Heard of Family Planning by Age Group and Sex
Age Group
15-19
20-24
25-29
30-34
35-39
40+
Total
F Statistic
Females
50 (365)
68 (415)
81 (293)
78 (235)
80 (193)
78 (254)
71(1754)
24.4*
Males
49 (364)
63 (357)
67 (274)
72 (189)
75 (155)
72 (390)
65(1729)
12.8*
Numbers in parentheses denotes number of observations; * Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Table 3
Percentage of Respondents Who Have Heard of Family Planning by Level of
Education and Sex
Education
No Schooling
Primary
Junior High
Senior High
College/University
Total
F Statistic
Females
58 (199)
67(1108)
80 (276)
92 (100)
88 (80)
71(1763)
17.2*
Males
46 (140)
61(1032)
68 (293)
79 (108)
90 (156)
65(1729)
21.3*
Numbers in parentheses denotes number of observations; * Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Table 4
Percentage of Respondents Who Have Heard of Family Planning by District of
Residence and Sex
District
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
Females
68 (287)
70 (263)
69 (315)
62 (258)
76 (265)
78 (282)
69 (93)
71(1763)
3.6*
Males
44 (291)
76 (247)
74 (302)
65 (259)
74 (234)
65 (301)
45 (95)
65 (1729)
18.8*
Numbers in parentheses denotes number of observations; * Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Tables 2, 3 and 4 report on the proportion of respondents who had heard of family planning
by age, highest level of education attained, health district and sex. As expected, knowledge
of family planning rises with age and education in tables 2 and 3. The relatively low level of
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knowledge for the younger age groups (15-19 and 20-24) should be disturbing to the
authorities given their concern with the increasing incidence of teenage pregnancy and the
threat from HIV/AIDS. Of those aged 15-24 69% of currently married women and only 53%
of single women claimed to have heard of family planning. The corresponding data for
currently married and single men were 60% and 55%. Evidently, large numbers of young
persons are ignorant of the benefits to be derived from family planning which must impede
progress in promoting delayed pregnancy and child spacing as methods of improving the
health of mothers and children.
The low level of knowledge by those in the two lowest levels of education (no schooling and
primary) suggests the need to strengthen out-of-school sources of information and to
introduce population education into the primary school curriculum.
Table 4 indicates significant differences across the districts of Vanuatu in knowledge of
family planning, particularly for men. Northern district appears to lag behind the national
average, as does Central 1 and Luganville for both men and women. While the level of
awareness needs to be raised in all districts, Northern, Central 1 and Luganville should be the
prime focus of efforts in information, education and communications (IEC).
Current Use of Family Planning
Using monthly service statistics provided by institutions and health workers, Gaminiratne
(1995) estimated the contraceptive prevalence rate in 1994 for all women of reproductive age
to be 13.4%, and 23% for only married women. He also reported that these sources showed
an increase of new acceptors between 1993 and 1994 from 1,038 to 4,116, a remarkable yet,
perhaps, suspect growth of almost 300% in a single year which could be easily attributed to
improved reporting.
In the 1995 Vanuatu KAP survey, both male and female respondents were asked whether
they were currently practicing family planning and, if so, which methods they were using.
Where women claimed not to be using any method but indicated that their husbands or
partners were using a method, at the analysis stage they have been defined as being current
practitioners of contraception. From table 5, it is estimated that 31% of all adult women of
childbearing age in Vanuatu, and 39% of married women or those in a de facto relationship,
are currently using contraception of one form or another. Meanwhile, 21.3% of all women
and 28.3% of women who are married or in a de facto relationship are using a modern or
“effective” method while another 6.6% of all women, and 6.9% of married women or those in
a de facto union, are using “ineffective” or unreliable methods. Fewer still, 3-4%, rely solely
on husband’s or partner’s methods. Evidently, this is not a very satisfactory situation with
only 1 adult woman in 5 using a modern “female” method of contraception in Vanuatu4.
Yet, compared with past estimates, the contraceptive prevalence rate has grown significantly,
and the family planning programme has made progress in recent years.
4From the female respondents it was not possible to distinguish between "effective" and "ineffective" methods used by
husbands and partners.
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Table 5
Percentage Distribution of All Women Using Family Planning by Method Mix
All
Women
(%)
“Effective” Methods
Pill
IUD-Loop
Injection
Female Sterilization
Total “Effective”
“Ineffective Methods”
Calendar
Billings
Abstinence
Custom
Other
Total “Ineffective”
Husband’s/Partner’s Methods
Total
Users
Only
(%)
Currently
Married/
De Facto
Union(%)
Users
Only
(%)
10.5
3.0
0.1
7.7
21.3
35.2
10.0
0.3
25.8
71.3
13.8
4.1
0.1
10.3
28.3
36.4
10.7
0.2
27.3
74.6
2.7
1.1
0.8
0.2
1.8
6.6
3.1
31.0
9.1
3.8
2.7
0.6
2.1
18.3
10.4
100.0
2.8
1.4
0.6
0.3
1.8
6.9
3.8
39.0
7.3
3.8
1.5
0.7
2.0
15.3
10.1
100.0
Source: Vanuatu KAP Survey, 1995
Of those women using female “modern” methods almost one-half are dependent on the
contraceptive pill, indicating the narrow focus of the programme on a single method. A
further one-third has undergone sterilization. Not unexpectedly, only 17 of the 136 sterilized
women, or 12.8%, are aged under 25, and 75% have had at least 4 children. Very few
women were using injectables in 1995, reflecting the ban imposed by the Government of
Vanuatu on Depo Provera from 1983. In 1995, however, the ban was lifted and Depo was
reintroduced, largely in urban areas. However, the resulting subsequent uptake of this
method is not reflected in the KAP survey results, presumably because Depo had been
reintroduced just prior to the survey.
Tables 6, 7 and 8 estimate the contraceptive prevalence rate for all methods and modern only,
of women by age group, education level and district of residence.
Table 6
Contraceptive Prevalence Rate (CPR) of Women by Age Group
Age Group
15-19
20-24
25-29
30-34
35-39
40-49
Total
F Statistic
All Methods
13.3
31.2
40.7
37.0
36.8
34.0
30.8
15.5*
Modern Methods
5.1
24.6
29.2
25.9
25.9
22.3
21.3
15.9*
No. of Obs.
365
415
293
231
193
254
1751
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
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Table 7
Contraceptive Prevalence Rate (CPR) of Women by Education Level
Education
All
Methods
37.0
29.1
32.6
31.6
33.9
30.8
1.5
No Schooling
Primary
Junior High
Senior High
College/University
Total
F Statistic
Modern
Methods
21.4
21.9
19.9
21.2
18.3
21.3
0.2
No. of
Obs.
193
1108
276
100
80
1763
Table 8
Contraceptive Prevalence Rate (CPR) of Women by District of Residence
District
All Methods
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
* Significant at 1% level.
46.0
24.2
27.3
20.7
34.1
30.8
34.9
30.8
Modern
Methods
28.4
11.7
17.7
18.7
20.6
26.8
31.5
21.3
8.9*
6.4*
No. of Obs.
287
263
315
258
265
282
93
1763
Source: Vanuatu KAP Survey, 1995
In tables 6 and 7, the distinguishing features are that the share of effective methods in all
method use is relatively smaller for younger and older women, and for those with no
schooling and surprisingly, for the small number of women with college/university education.
It is disconcerting to find little variation in the CPR across education levels. While better
educated women are more likely to know of the concept of family planning, they have yet to
take up the practice of contraception in significantly larger numbers. There are significant
regional differences in current use of contraception in table 8 with Northern district
exhibiting the highest CPR and Central 1 the lowest. Yet, women’s knowledge of family
planning was highest in Port Vila and the Southern district (see table 4) but they do not
maintain this ranking in the current use of modern methods. The use of modern methods is
lowest in Eastern, Central 2 and Central 1 districts. The relative use of ineffective methods
appears quite large in Northern, Central 2, Southern and Eastern districts, a result which
warrants further investigation.
One in three male respondents (34.8%) claimed to be currently using a male contraceptive
method. Of these 54% were using condoms and a negligible number (4 individuals) had
undergone vasectomy. The remainder (46%) were using such inefficient methods as
withdrawal, abstinence and custom. Two-thirds of current users were first-time users. The
pattern of current use is portrayed in tables 9, 10 and 11, and is what might be expected. The
percentage of users rises from 21% of 15-19 year olds to peak at 48% for 25-29 year olds and
falls consistency with age to only 23% for men 40 years and older. In stark contrast to
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female respondents, male current use rises consistently across education levels, from 25% for
those with no schooling to 56% for those with college/university education.
Once again, there are major differences in the male use of contraceptives between health
districts, with the highest rates found in Port Vila and Luganville and the lowest in Eastern
and Northern districts.
The share of modern methods in total usage is smallest in the older age groups of men, for
those with the least education, and, following the female pattern reported in table 8, in
Northern, Eastern and Southern districts.
Table 9
Contraceptive Usage by Males Across Age Groups (%)
Age Group
15-19
20-24
25-29
30-34
35-39
40+
Total
F Statistic
Usage (%)
All
Modern
Methods
Methods
21.1
16.1
45.9
35.0
48.2
27.2
43.3
18.5
36.6
10.6
23.4
5.2
34.8
19.1
21.0*
27.5*
No. of
Obs.
365
357
274
189
155
390
1729
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Table 10
Contraceptive Usage by Males by Educational Attainment
Education
No Schooling
Primary
Junior Secondary
Senior Secondary
College/University
Total
Usage (%)
All
Modern
Methods
Methods
25.0
9.5
28.6
14.6
43.0
24.1
54.1
41.3
56.4
32.3
34.8
19.1
F Statistic
21.5*
No. of
Obs.
140
1032
293
108
156
1729
20.6*
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
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Table 11
Contraceptive Usage by Males by District of Residence
District
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
Usage (%)
No. of
Obs.
All
Modern
Methods
Methods
24.3
10.1
291
20.1
12.6
247
46.0
20.8
302
36.1
25.5
259
31.1
7.8
234
46.1
31.5
303
38.8
27.6
95
34.8
19.0
1732
12.4*
14.7*
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Of current male non-users only 17% had used contraception before, with the rate of past use
rising from 3% for 15-19 year olds to 24% for 30-34 year olds, after which the rate peaks at
27% for those over 40. Among current users 44% had used a method in earlier times,
indicating 56% were first-time users. In contrast to the female respondents, the rate of firsttime usage is fairly constant across age groups, except for the 30-34 year olds, where the rate
peaks at 65%. Among the first-time users 53% were using modern methods, with condom
use being paramount and a negligible uptake of vasectomy.
The disparity between males and females in their reporting of contraceptive use, with men or
husbands generally reporting greater use of contraceptives than women or wives, has been
widely documented (Ezeh and Mboup, 1997). The treatment of apparent inconsistencies in
the reporting of contraceptive use between married partners in the literature as mis-reporting
by one partner assumes that spouses use contraceptives exclusively with the marital partners.
An extension of this assumption is that sexual activity among married men and women
occurs exclusively within marriage. To infer underreporting on the part of women assumes
that spouses or partners have equal knowledge of the use of a method and that both partners
have the same idea of what constitutes contraceptive practice. It is conceivable that three
particular methods, condoms, periodic abstinence and vasectomy, could account for a large
part of the male-female disparity. Except for prolonged abstinence the male could use these
methods without his wife or partner knowing. He may use condoms for extramarital relations
while he might practice abstinence within a union without his partner’s associating the
practice with contraception. He could, conceivably, undergo vasectomy without his partner’s
knowledge (Ezeh and Mboup, 1997). Thus, the male-female gap in reported contraceptive
use in Vanuatu could be due to one or more of these factors as well as, of course, small
sample error.
Ever Use of Family Planning
All female respondents were asked whether they had ever used a method of family planning
some time in the past. Their answers revealed that 23% of current non-users had earlier used
contraception and, for their own various reasons, had terminated its use. The rate of former
usage amongst current non-users rises from 2% of 15-19 year olds to 43% of the 35 and over
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14
group. In contrast, amongst current users, 45% had used a family planning method before,
indicating 55% were currently first-time users. As expected, the rate of first-time usage
decreases with age, from 71% for 15-19 year olds to 36% for the 35 and over group. Among
current users of modern methods, 46% are first-time users, a rate which falls from 67% for
15-19 year olds to 15% for those women 35 years and over.
Of first-time current users the largest number are currently using the pill (44%) followed by
husband/partner methods (14%), IUD-Loop (12%), the Calendar method (12%) and
Ovulation-Billings method (6%). Among past and current users, there are very few cases in
the sample of women formerly using one method but currently using a totally different
method. Switching methods seems to be a rare occurrence in Vanuatu.
Amongst the 275 current female non-users in the sample who had earlier used a method, the
most frequently mentioned methods used were Pills (54%), Injection (16%), IUD Loop
(13%) and traditional methods (2%). These women were asked why they had stopped using a
method. From their responses, 12% claimed that they wished to become pregnant while 13%
responded that they had become pregnant. The latter may denote method failure or that they
had stopped using contraception to become successfully pregnant. Significantly, 23% claimed
that they gave up using contraception because of experiencing side effects or from the fear of
side effects. An additional 19% claimed to have entered menopause.
It is of interest to examine the reasons these women gave for ending their use of
contraception according to the principal methods used. The pill was formerly the most widely
used method and 26% of these former users complained of side effects, which induced them
to curtail its use. Of the 44 women formerly using injections, one-quarter discontinued
because of side effects. The perception of side effects as a major reason for curtailing the use
of family planning methods, particularly the Pill and Depo Provera by women currently not
using any method, warrants further in-depth study on a case-by-case basis.
Perceptions of Service Facilities
Both male and female respondents were asked whether they perceived access to family
planning to be easy in their area of residence. For both sexes three-quarters of respondents
felt that access was quite easy while only 11% said that it was difficult. The lowest degree of
satisfaction for women was found in Northern district (69%) and the highest in the urban
areas in Port Vila and Luganville (86% in both). For men, Northern district was perceived as
least accessible (66%) and Luganville as the most accessible (91%). Still, only 24% of
women who said access was easy were using a modern method of family planning compared
with 14% of those who claimed it was not easy. The corresponding numbers for males were
21% and 19%.
Respondents who claimed that access was not easy were then asked about the nature of the
difficulties, whether the nearest clinic was far away, whether transport costs were high,
whether the clinic lacked contraceptive supplies and whether hours of opening were
unsuitable. Their answers according to district of residence and sex are reported in table 12.
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Table 12
Percentage of Respondents Claiming Access to FP Services Is Difficult
According to Distance, Transport Costs, Availability of Contraceptives and
Opening Hours of Facilities by Sex
Characteristic of Nearest Service Facility
District
Females
Far
Dista
nce
High
Trans
port
cost
Unavaila
bility
of
Contrace
ptives
Males
Unsuit
able
Openi
ng
Hours
No.
of
Obs
Far
Distan
ce
28
22
47
26
56
13
2
194
57
9
75
82
46
30
62
7.6*
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
65
20
58
73
61
50
60
57
12
20
51
0
23
15
0
24
0
50
8
7
3
8
0
10
0
10
2
7
0
0
0
2
F Statistic
2.9**
5.9*
10.1*
1.6
High
Trans
port
Cost
Unavaila
bility of
Contrac
eptives
Unsuit
able
Openi
ng
Hours
31
100
0
47
68
6
50
39
0
18
2
7
15
25
5
0
0
0
4
0
13
1
7.4*
3.2*
1.8
No. of
Obs.
6
2
15
54
36
21
4
192
* Significant at 1% level; ** Significant at 5% level.
Source: Vanuatu KAP Survey, 1995
The absolute number of respondents perceiving that access to service facilities is not easy is
small and, therefore, the number of cases in table 12 is necessarily few. However, a
relatively large number of both men and women complain that access is constrained by the
distance they have to travel to obtain family planning services, particularly in Northern,
Central 1 and Southern Districts. This seems to be the major complaint, which might need to
be rectified by building and staffing more service outlets in these districts. Very few are
unsatisfied with the availability of supplies or the hours of opening of the existing facilities.
Female respondents were asked whether they were “happy” with the family planning services
available; only in Luganville, with 68%, did less than 85% fail to say that they were happy
with the service. Their main complaints seemed to be with the amount and quality of
information provided. For male respondents, only in Eastern district were less than 90% not
“happy”, at 77%, and the main complaints there were again with the information provided. A
very small minority of both men and women (less than 10%), claimed that contraceptives are
not always available when needed, and these were mainly women in Northern district (13%)
and Luganville, and men in Southern district (16%).
Respondents were asked whether various kinds of family planning services are available in
their nearby health centre. Over 90% of those women who had heard of family planning in
each district confirmed that pills are dispersed from their local clinic. The range was much
greater for the availability of female sterilisation, from 0% in Central 1 district and 50% in
Eastern to 98% in Luganville. Similarly, female perceptions of the availability of Depo
Provera ranged from only 13% in Northern district and 55% in Central 1 to 83% in Port Vila
and 96% in Luganville. Meanwhile 88% of women overall felt condoms were freely
distributed, ranging from 98% in Eastern to a low of 69% in Central 1. While 86% of these
women believed that counselling was available, this share ranged from 100% in Eastern
district to a low of only 52% in Southern district. The greatest disparities occur in
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16
perceptions about the availability of home visits by clinic staff, ranging from 93% in Eastern
districts to only 4% in Southern district, with 45% overall.
While it may be that some of these views do not reflect reality and that the geographic
availability of these services is much less dispersed than perceived by the respondents, the
fact that the perceived dispersion is so great warrants further investigation by the authorities.
If this is the reality, evidently much more needs to be done to provide the requisite services in
the under-served districts. If these views reflect misconceptions about the availability of
services, evidently much more intensive IEC activities are warranted.
Of those men who had heard of family planning, again there are wide disparities across the
districts in their perceptions of what services are available from their local clinic. While two
thirds said condoms were distributed and counselling was offered, only 1 in 10 could confirm
that vasectomy is available, and only 3% said home visits are made by clinic staff.
Interestingly, 22% said family planning was their wife’s or partner’s business and not theirs.
From those claiming to know whether these services are available, the proportion of men
identifying the availability of these services ranged, for condoms from 85% in Northern and
Southern districts to 100% in Eastern district; for vasectomy from 0% in Northern district to
100% in Eastern; for counselling from 74% in Central 1 to 100% in Eastern district; and for
those men who claimed family planning was their wife’s business, from 18% in Southern and
Northern districts to 100% in Eastern district.
Once again, further investigation is needed of whether these disparities reflect real
geographic differences in the provision of services or disparities in misconceptions across the
districts. The policy response will depend on the results of this investigation.
Respondents were also asked whether they wished for condoms to be sold in local stores,
indicating the potential for the social marketing of condoms. The results are reported in table
13 and reflect the conservative nature of some of the districts.
Table 13
Percentage of Respondents Who Want Condoms to be Sold in Local Stores, by District and
Sex
District
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
Females
48
29
45
61
46
56
53
48
11.0*
No. of
Obs.
285
263
314
258
263
282
93
1759
Males
86
30
53
66
69
87
90
67
62.0*
No. of
Obs.
291
247
302
259
234
301
95
1729
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
From unreported tabulations, younger men and women, in contrast to the older generations,
are much more favourably inclined to support the sale of condoms over the counter; women
generally are less supportive than men. For example, while 54% of women aged 15-24 likes
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17
the idea, only 39% of the 35-49 year olds feel similar. For men, the comparable positive
feelings are 82% for the 15-24 year olds and 51% for the 35-59 year olds. A large majority
of both men and women in Eastern and Central 2 districts are against the idea. Again, a good
deal more national awareness-raising of population issues, including safe sex, is warranted,
with a concerted effort made in these districts.
Additional questions were posed to respondents to assess the extent to which they have
gained access to family planning information through contacts with various IEC agents.
They were asked whether anyone had visited their homes to give information and counselling
about family planning and the characteristics of the persons making such visits, such as
health workers, youth workers, women’s groups, church workers and persons from the NGO,
the Vanuatu Family Health Association. Their responses are reported in table 14.
Table 14
Percentage of Respondents Who Had Been Visited and Given Information
about Family Planning, by District and Sex
District
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
Females
32
25
21
37
17
11
9
23
14.8*
No. of
Obs.
287
263
314
258
263
282
93
1760
Males
26
50
34
21
37
14
13
29
21.5*
No. of
Obs.
291
247
302
259
234
301
95
1729
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
It is revealing to note that only about 1 in 4 respondents appear to have ever received a visit
from a family planning counsellor of one kind or another. Surprisingly, urban areas seem to
be the most under-served, together with the Southern district for women and Central 1 district
for men. The most active seem to have been health sector workers, since 17% of all women
and 20% of all men claimed to have received visits from them. On the other hand, less than
5% said they had been spoken to by persons representing the sectors of youth, women, the
church or the Vanuatu Family Health Association. Even in Port Vila where the VFHA is
based, only 3 women out of 282 and 8 men out of 301 in our sample said they had been
visited by anyone from the Association.
These results, set beside the relatively low overall knowledge about family planning
displayed by our respondents, illustrates the need for these advocates and counsellors of
family planning to become very much more pro-active in Vanuatu.
Respondents were also asked whether they had ever attended any meeting/discussion about
family planning in their area. One-quarter of both women and men claimed to have attended
such a talk, with the largest number of those attending, 68% of women and 74% of men,
being addressed by a health worker. A smaller proportion of female and male respondents
had attended such talks in the provinces of Northern and Central 2, suggesting health workers
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18
here need to become more active. Those attending discussions called by workers
representing youth, women and the church were no more than a handful (1-3%) of the total.
On this evidence, there seems to be tremendous scope for greater IEC and awareness-raising
on population issues in general, and reproductive health and family planning in particular, in
Vanuatu.
It is of interest to note that the mean number of adult persons served per health facility is well
above the national average in Central 1, perhaps helping to explain its low uptake of family
planning. Furthermore, Central 2 district is the most difficult for communications and
transport while Eastern district has the largest area to be covered, both land and sea area, of
all the districts. These disparities in access may help to explain some of the differences in
knowledge and practice of family planning across the districts of Vanuatu.
IV. ESTIMATING THE UNMET NEED FOR FAMILY PLANNING
Many women who are sexually active would prefer to avoid pregnancy but, for various
reasons, may not be currently using any method of family planning. These women are said to
have an “unmet need” for services of which they are not availing themselves. This concept of
unmet need highlights the gap between some women’s reproductive intentions and their
contraceptive behaviour (Population Reports, 1996). The measurement of unmet need is of
critical importance to planners and policy makers, particularly those in the family planning
programme, since it gives an indication of the nature of the challenge required to reach and
service such women whose reproductive intentions resemble those of current contraceptive
users but who, for some reason or other, are not practising contraception.
Some of the common causes of unmet need include inconvenient or unsatisfactory services,
ignorance and lack of information about what services are available, fears of the side effects
of contraceptive methods, and opposition from husbands and other members of the extended
family.
Obviously, the identification of the nature and characteristics of unmet need can help the
family planning programme to better respond to the demands of these women. A programme
strategy focusing on such women as a distinct audience and clientele requires a
comprehension of the reasons underlying the unmet need; the determination of the size and
composition of sub-groups classified according to their socio-economic characteristics; the
prioritizing of certain sub-groups which the programme would be capable of reaching; and
the design of a strategy to deliver information and services to meet the essential and specific
needs of the various sub-groups.
Invariably, unmet need is defined on the basis of women’s responses to survey questions.
Those fecund and sexually active women who indicate that they would like to postpone or
avoid further childbearing, but also report that neither they nor their partners are using any
method of contraception, are said to have an unmet need. The standard formulation has been
developed by Charles Westoff (1988 a; 1988b) who defined the group with unmet need as all
fecund women who are married or living in union - thus presumed to be sexually active - who
are not using any method of contraception but they either do not wish to bear any more
children or wish to postpone their next birth for at least two more years. Those who wish to
bear no more children are said to have an unmet need for limiting births; those who do not
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want another child for at least two more years are considered to have an unmet need for
spacing births.
Also included in the group with an unmet need are all pregnant women whose pregnancies
are unwanted or mistimed and who became pregnant because they were not using
contraception. In addition, women who recently experienced an unintended pregnancy but
are in a state of postpartum amenorrhea are included in the group with an unmet need.
While the earlier standard formulation does not consider unmet need among unmarried
women, assessing this unmet need among young adults is especially important in order to
reflect the concerns of the International Conference on Population and Development (ICPD)
of 1994. More recently, Demographic and Health Surveys (DHS) have addressed the unmet
need of unmarried women.
Figure 1 conceptualises this approach to defining the level of unmet need for family planning.
From the 1995 KAP survey in Vanuatu, can we measure the extent of unmet need in the
country according to this conceptualisation? The short answer is ‘no’ since, as explained in
the introductory section, the survey questionnaire was inappropriately designed for this
exercise. For example, respondents were not asked whether they are currently pregnant or
amenorrheic; whether they perceive that they are capable of becoming pregnant i.e. whether
they are fecund; whether, if they are pregnant or amenorrheic, the related pregnancy was
intended, mistimed or totally unwanted; or whether, if they are fecund, whether they wish to
postpone their next birth for at least two years. Nor, indeed, were unmarried women asked
whether they are currently sexually active.
Given the importance of the concept of unmet need, however, it is still worthwhile to use the
available information from the KAP survey to derive some measure, albeit incomplete, of the
level of unmet need in Vanuatu.
The survey asked women, married or otherwise, whether they had ever given birth to a child
and, if so, how many. They were also asked the standard question: “How many children do
you want to have?” Those women who said that they did not wish for any additional births
are candidates for having an unmet need for limiting births if they or their partners are not
currently using a contraceptive. Unfortunately, as already mentioned, we do not know their
current pregnancy or amenorrheic status, nor do we know whether they believe they are able
to conceive.
However, as already explained, from additional questions in various parts of the survey
instrument, it was possible to subtract from this first approximation those women who
indicated that they had been sterilized earlier and therefore, have been classified as currently
using a contraceptive. Also subtracted are women who, when asked why they formerly used
contraception but did not currently do so, responded that they have entered menopause.
According to these definitions the derivation of our estimate of unmet need for limiting births
is portrayed in figure 2 (a) for all women and figure 2 (b) for women currently married or
living with a partner. For the reasons already explained, this estimate is likely to approximate
the upper limit. The analysis suggests that 24% of all adult women of childbearing age, and
30% of women with a husband or partner, have an unmet need for contraception for limiting
the size of their families. As expected, single women, who are generally younger women,
have only a negligible demand for terminating future childbearing and our estimate is that
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20
only 5% of them are in this state. Unfortunately, the Vanuatu KAP survey does not allow us
to measure it, but their more urgent unmet need is likely to be for delaying their first birth and
then for spacing births. Indeed, the level of unmet need among sexually active unmarried
women may be higher in this sense than among married women. Sexually active, unmarried
women, including not only the never-married but also the separated, divorced and widowed,
would typically have an even greater stake in avoiding pregnancy than do married women,
but, in Vanuatu, they may be less likely to use contraception.
Figure 1: Conceptualising the Level of Unmet Need for Family Planning
Not using contraception
Pregnant or amenorrheic
Not pregnant or amenorrheic
Sexually Active
Pregnancy
intended
Pregnancy
Pregnancy
mistimed
unwanted
Fecund
Want
later*
Need for
spacing
Not Sexually Active
Need for
limiting
Need for
spacing
Infecund
Want no
more
Want
soon+
Need for
limiting
Total Unmet Need
*After two years
+Within two years
Source: Population Reports (1996)
The implicit assumption in the above is that all women who are using contraception of any
form, whether effective or ineffective, are meeting their contraceptive needs. Yet, some of
the contraceptive users in our Vanuatu survey could be considered to have an unmet need if
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21
they are using an ineffective method5. It has been reported above (see table 5) that over 1 in
5 of female contraceptive users in Vanuatu is using such ineffective methods as calendar,
abstinence and custom, methods where the rate of failure is likely to be high. Furthermore, it
was not possible to determine the kind of method used by the woman’s husband or partner.
Treating the latter as all ineffective, and including women using ineffective methods as
having an unmet need, raises the proportion of all women with an unmet need from 24% to
33%. Alternatively, treating all male methods as effective raises the rate of unmet need to
30%.6
Of the currently married and those in union who are using an ineffective method and,
therefore, having an unmet need, raises the proportion of such women with an unmet need
from 30% to 42% if all male methods are treated as ineffective, and to 38% treating all male
methods as effective. Of these women, 53% want to terminate further childbearing.
These overall estimates suggest that a minimum of 24% of all women of reproductive age in
Vanuatu have an unmet need for family planning for limiting additional births. These would
have amounted to about 9,500 women in 1995. If women who are using ineffective methods
are also included, some of whom have an unmet need for spacing and not necessarily for
limiting, the number of women with an unmet need in 1995 rises to 12,000.
How does the rate of unmet need in Vanuatu compare with estimates from other parts of the
world? Based on data from Demographic and Health Surveys (DHS) and other comparable
national surveys, it has been estimated that about 20% of married women of reproductive age
in the developing world as a whole, excluding China, have an unmet need for spacing and
limiting births combined (Population Reports, 1996). There is wide variation between
regions and countries but the highest rates of unmet need are found in sub-Saharan Africa
where the range for married women of reproductive age varies from 37% in Rwanda to 15%
in Zimbabwe in the early 1990s. The corresponding contraceptive prevalence rates in these
countries were 21% in the former and 48% in the latter. The range of unmet need for limiting
additional births only varies between a maximum of 15% in Madagascar to 2% in Niger.
5With more in-depth, quality data, women using a method incorrectly or using a method that is unsafe or unsuitable for
them could be included in the group with an unmet need. For example, current users may need a more appropriate method
because their current method induces side effects, or is perceived to have side effects or because they are using a method
best suited to spacing births when their real need is to avoid any further births (Dixon-Mueller and Germain, 1992).
Unfortunately, the Vanuatu KAP survey data does not allow such fine distinctions.
6Some of these additional women (56%) using an ineffective method, but now included as having an unmet need, desire to
merely space births and not to terminate childbearing.
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Figure 2: Derivation of Unmet Need for Limiting Further Births in Sample of
Women
a) All Women
All Women
1757 (100%)
Using Contraception
542(30.8%)
Not Using Contraception
1215(69.2%)
Wanting More Children
751(42.7%)
Not Using Contraception and
Not Wanting More Children
464(26.4%)
In Menopause
50(2.8%)
Women With Unmet Need
414 (23.6%)
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b) Women Currently Married or in a Defacto
Relationship
All Women
1219 (100%)
Using Contraception
478(39.3%)
Not Using Contraception
740(60.7%)
Wanting More Children
321(26.3%)
Not Using Contraception and Not
Wanting More Children
419(34.4%)
In Menopause
50(4.1%)
Women With Unmet Need
369 (30.3%)
Source: Author's estimates
Our minimum estimate of 30% of currently married women of reproductive age in Vanuatu
having an unmet need for limiting additional births is very significant relative to these
estimates. Indeed, in most countries, the rate of unmet need for spacing is often 2-4 times
greater than the unmet need for limiting births. While the rate of unmet need for spacing
births cannot be estimated from the data for Vanuatu, the high estimated rate for limiting
additional births indeed suggests that a very significant proportion of women in Vanuatu have
an unmet need for family planning for spacing and limiting future births.
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Socio-Economic Characteristics of Women with Unmet Need
Table 15
Percentage of Women with Unmet Need for Contraception by Age and Marital
Status
Age
Group
All Women
Not Using
Any Method
15-19
20-24
25-29
30-34
35-39
40-49
Total
F Statistic
2.8
12.9
19.6
34.6
45.3
48.2
23.5
63.3*
(365)
(415)
(293)
(235)
(193)
(254)
(1755)
Married Women or In Union
Not Using
Effective
Method (a)
2.8
(365)
13.4
(415)
22.5
(293)
38.4
(230)
51.1
(193)
54.5
(254)
26.1 (1754)
79.9*
Not Using
Any Method
6.1
17.4
19.5
33.8
44.6
47.5
30.2
21.9*
(49)
(278)
(256)
(219)
(185)
(231)
(1218)
Not Using
Effective
Method (a)
6.1
(49)
18.0 (278)
22.8 (256)
37.9 (219)
50.6 (185)
54.4 (231)
34.0 (1216
)
29.0*
Note: (a) This treats the use of male methods as being effective. Numbers in parentheses denote number of observations;
* Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
As might be predicted the proportion of all women and married women or in union with an
unmet need for limiting births rises consistently with age. Well over 40% of all women and
married women aged 35 and over appear to have an unmet need for contraception; this rises
to over 50% for women not using an effective method.
There are some clear differences within some age groups in unmet need between women who
have heard of family planning and who have not heard of family planning. These are
particularly marked for women age 25-29 (17% for women who have heard; 33% for those
who have not heard); age 30-34 (33% v. 43% respectively); and age 35-39 (44% v. 51%
respectively). The message is clear and predictable: women who are more familiar with the
concept of family planning are more likely to be fulfilling their need for contraceptive
services.
Differences in the percentage of women with an unmet need for contraception for limiting
additional childbearing between the major religious groups in Vanuatu are negligible except
that Anglicans (17%) have a lower rate than Catholics (24%), Presbyterians (24%), Seventh
Day Adventists (24%) and followers of other religious and sects (23%).
It might be expected that more educated women would have less unmet need than women
with little or no education. Table 16 reports on this pattern and illustrates that, indeed, the
rate of unmet need declines consistently with education up to Senior High level for all
women not using any method of contraception. The relatively high rate of unmet need by
women with college or university education is unexpected and may reflect the dominance of
age as an explanation of unmet need, given their above average age, and the small sample
size may lead to large sampling error.
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It might be expected that unmet need for contraception would rise as the number of births, or
parity, of the women increases. Indeed, a very strong positive relationship is apparent, with
unmet need rising consistently from only 8% for women with only one child to over 45% for
those with at least six children.
Table 16
Percentage of Women with Unmet Need for Contraception by Level of
Education and Marital Status
Education Level
All Women
Not Using
Not Using
Any Method
Effective
Method
Married Women or In Union
Not Using
Not Using
Any Method
Effective
Method
No Schooling
Primary
Junior High
Senior High
College/University
Total
F Statistic
30.3
24.0
19.8
12.8
26.4
23.5
3.5*
34.6
30.9
24.5
24.6
30.8
30.2
1.3
(199)
(1108)
(276)
(100)
(80)
(1763)
38.7
26.2
20.8
12.8
32.2
26.3
7.9*
(199)
(1108)
(276)
(100)
(80)
(1763)
(160)
(776)
(177)
(53)
(56)
(1222)
49.7
47.4
44.1
43.5
49.1
47.4
3.5*
(160)
(776)
(177)
(53)
(56)
(1222)
Numbers in parentheses denote number of observations; * Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
While there is little difference in the rate of unmet need between women in paid work and not
in paid work, it is worth noting that the rate for paid agricultural female workers is 29%
compared with 18% for those in professional and semi-professional jobs, perhaps reflecting
geographic and educational differences in knowledge and practice of family planning.
Effective IEC strategies need to stratify and target audiences, and such farm workers would
appear to be a prime target.
Table 17
Percentage of Women with Unmet Need for Contraception by District of
Residence and Marital Status
District
Northern
Eastern
Central 2
Central 1
Southern
Port Vila
Luganville
Total
F Statistic
All Women
Not Using
Not Using
Any Method
Effective
Method
18.2
(287)
23.9
(287)
28.3
(263)
30.0
(263)
23.8
(315)
27.8
(315)
24.0
(258)
24.0
(258)
27.2
(265)
31.1
(265)
20.7
(282)
21.9
(282)
22.0
(93)
23.7
(93)
23.5 (1763)
26.3 (1763)
1.9
1.7
Married Women or In Union
Not Using
Not Using
Any Method
Effective
Method
19.9
(222) 27.2
(222)
42.3
(156) 45.1
(156)
31.9
(226) 37.1
(226)
31.7
(179) 31.7
(179)
31.7
(181) 36.6
(181)
29.3
(185) 30.9
(185)
25.8
(74) 27.9
(74)
30.2 (1222) 34.0
(1222)
4.0*
2.9*
Numbers in parentheses denote number of observations; * Significant at 1% level.
Source: Vanuatu KAP Survey, 1995
Table 17 examines differences in the incidence of unmet need across the districts of Vanuatu.
All women have the lowest rate of unmet need in Northern district and Port Vila and the
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highest rate in Eastern and Southern districts. This pattern does not change when all women
who are using ineffective methods are defined to have an unmet need. One surprising result
in the final column of table 17 is the relatively high rate of unmet need for effective methods
for married women or women in union in Port Vila. While this result is intriguing, since it
suggests a high rate of use of ineffective methods by married women in the capital city,
because the sample size in this case is quite small, any firm conclusion awaits further
confirmation.
V. THE DETERMINANTS OF DEMOGRAPHIC BEHAVIOUR
The Demographic and Migration Analysis of the 1989 Vanuatu National Population Census
estimated the total fertility rate (TFR) for 1988-89 to be 5.32 (Vanuatu, 1993). This was very
close to the TFR estimated by the Vanuatu Vital Statistics Survey relating to 1987-907. This
implies a decline of fertility from a TFR of 6.5 during the 1974-78 period. From simple cross
tabulations, it was reported that rural women were estimated to have a TFR of 5.9 in contrast
to 4.5 for urban women; rural women with schooling experience had lower fertility but such
differentials were not found for urban women; and women of Catholic, Anglican and Custom
religious denominations achieve higher fertility in rural areas while Anglican and
Presbyterian women from urban areas achieve lower fertility. Yet, ‘as in the case of
maternal schooling, from the available data, the differential among urban women by religion
is very small, if at all’, (Vanuatu, 1993, p. 31).
The Vanuatu KAP survey allows additional, yet limited, in-depth analysis of the socioeconomic determinants of achieved fertility using, as a measure of fertility, the number of
live children born to women aged 15 to 49. It is also possible to examine the determinants of
desired family size of such women, their current and ever use of contraception, and their
unmet need for family planning.
According to the neo-classical theory of household decision-making, women’s schooling is
hypothesized to be inversely related to achieved fertility through a number of channels.
Firstly, child-rearing activities are believed to be intensive in woman’s time, the opportunity
cost of which is her foregone earnings in the labour market. Since her market wage will be
positively related to the level of her educational attainment, the latter proxies for the
opportunity cost of her time in childcare. The wage benefits of education may also induce
women to stay on longer in school, thereby delaying the onset of childbearing. Fertility, as
measured by children ever born (CEB), is expected to be negatively related to education
because of this “price” or substitution effect of children. In contrast, the income effect of the
higher wage associated with more education should lead to a positive relationship with
fertility, if children are “normal” goods.
Yet, education may also be associated with the “tastes” for children. Education generally
leads to opportunities for professional or career advancement and wider interests outside of
non-traditional female activities, all of which could be expected to induce a reduction in
family size. At the same time the woman’s education might be expected to further her desire
for a substitution of quality for quantity of children, the latter entailing increased monetary
7The TFR represents the number of live births that would occur to the average woman if she were to experience the current
age-specific fertility rates of women aged 15 to 49 years during her own reproductive period.
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costs for market purchases such as education, and the production of home-goods which are
intensive in her time.
Furthermore, education might be expected to be positively associated with the knowledge and
use of contraception, including modern or efficient contraception, which would tend to lower
completed family size.
Therefore, the relationship between fertility and the woman’s education is multi-dimensional,
with contradictory forces at work. However, the net effect is predicted to demonstrate a
negative relationship between fertility and education.
The simple bivariate relationship between CEB and woman’s education from the Vanuatu
KAP survey is portrayed in table 18.
Table 18
Mean Number of Live Births (CEB) by Woman’s Age and Education
Age Group
in Years
None
(EDO)
15-19
20-24
25-29
30-34
35-39
40-49
Mean Total
F Statistic
No. of Cases
Mean Rural
No. of Cases
Mean Urban
No. of Case
0.18(a)
1.46
2.27
3.94
5.57
6.38
3.90
39.2*
199
3.96
184
3.12
15
Primary
(ED1)
Education
Junior
Senior
High
High
(ED2)
(ED3)
0.13
1.31
2.46
3.66
4.74
5.25
2.55
359.4*
1108
2.57
886
2.50
222
0.20
1.08
2.32
3.87
4.39
5.27
1.99
88.1*
276
1.91
211
2.23
66
0.09
1.05
2.51(a)
3.96 (a)
3.82 (a)
(a)
1.57
34.3*
100
1.64
54
1.48
47
College/
University
(ED4)
Total
F Statistic
0.10 (a)
1.54
2.29
3.30 (a)
4.25 (a)
5.02 (a)
2.30
26.1*
80
2.53
54
1.82
26
0.14
1.26
2.41
3.71
4.76
5.52
2.55
551.8*
1763
2.62
1387
2.30
375
0.5
1.2
0.2
0.5
1.9
3.2**
24.7
21.1*
3.1**
* Significant at 1% level; ** Significant at 5% level.
Note: (a) Fewer than 20 cases
Source: Vanuatu KAP Survey, 1995
Overall, table 18 confirms the inverse relationship between educational attainments and
children ever born. Controlling for age, however, while this negative relationship is apparent,
the small number of cases for the education levels of Senior High and above leads to some
unexpected results.
In general, rural fertility is greater than urban fertility holding education constant, except for
the Junior High level. Within both rural and urban areas, fertility declines with education
except for the paradoxical result where CEB increases for college/university level, again
explained, perhaps, by the small number of cases.
Other Factors
According to the theory of household decision-making, other factors which might be
expected to influence a women’s level of parity, or the number of children she has borne to
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28
date, include, after accounting for her current age, her labour market experience, whether she
has heard of and ever used family planning (modern or otherwise), her age when she first
gave birth, her socio-economic status as reflected in her and her household’s job insertion in
the labour market, her perceptions about the ideal family size and the geographic location of
her residence.
Indeed, the influence of many of these factors is best examined in the context of multivariate
techniques. In the following analysis of interpersonal demographic behaviour differentials in
Vanuatu a large number of these and other determinants are considered. As noted earlier,
more education for the woman is usually considered to proxy for the increased value of her
time in wider labour market opportunities and to influence her tastes and preferences. Labour
market activity performed outside the home is an additional proxy for the cost of
childbearing. Cultural differences in the demand for children are represented by current place
of residence. Knowledge and practice of family planning, including modern methods, may
influence fertility outcomes while the household’s socio-economic status may also be an
important determinant of demographic behaviour.
Multivariate Analysis of Demographic Behaviour
Apart from attempting to explain inter-personal fertility differences, efforts are made to also
examine the determinants of family planning knowledge and use, the level of unmet need for
family planning and perceptions of desired family size.
Fertility Behaviour
Before presenting the empirical results, it is important to note that a number of econometric
problems plague the modeling of a fertility function (Cohen and House, 1994). First, using
the number of children a woman has ever borne violates two basic underlying assumptions of
ordinary least squares models: (1) the number of children a woman bears is a discrete rather
than a continuous variable; and (2) the number of children ever born can never be less than
zero. Left-censoring at zero implies that ordinary least squares estimates will be inefficient
and biased downward relative to the proportion of zero observations (Maddala, 1983, pp. 1516). Consequently, three estimation strategies are used to model fertility in this paper. The
first strategy, ordinary least squares, is included because the resulting coefficients are
conceptually the simplest to interpret. However, additional estimation procedures are also
considered. The second strategy takes account of the left-censoring at zero, by estimating a
maximum likelihood Tobit model. The assumption is that there is a latent demand for
children (y) which can be either positive or negative while the observed number of children
ever born (y*) can only take non-negative values. Hence:
yi*=Χi ΄β+εi if Χi΄β+εi>0
(1)
yi*=0 otherwise
(2)
where Χi΄, is a (1 x k) vector of explanatory variables, β is a vector of (k x 1) parameters to be
estimated, and εi are independent and identically distributed normal residuals with a mean of
zero and a constant variance. An important characteristic of this model is that we actually
know the values of the explanatory variables, (Χi΄), for the women who do not have any
children.
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The third estimation strategy assumes that the underlying distribution of the response variable
(y) under consideration is Poisson. The Poisson probability distribution with parameter μ is
given by the formula:
P(y=a;μ) = (μaexp-μ)/a!
(3)
where the random variable μ is believed to vary with a set of observable characteristics, (Xi).
Theoretically, a Poisson random variable can only take non-negative integer values. The
parameter of the Poisson distribution (μi) is assumed to be log-linearly dependent on the
explanatory variables in order to ensure that all the μi are positive. Thus the relation is
specified as:
1n (μi) = Χi΄β
(4)
The disadvantages of the Poisson model are: (i) it imposes the restriction that the mean equals
the variance, and violation of this assumption can lead to spuriously small standard errors
(Ainsworth, 1989); and (ii) it assumes that the rate of birth arrivals is a fixed constant over
time, while, in reality, there must be at least a nine-month interval between independent
births.
The outcome of the fertility analysis is presented in table 19 where only the results from
ordinary least square estimation are reported. The outcome is highly successful with 26-66%
of the variation in the dependent variable explained by our equations. Results of the
alternative estimation strategies are deferred to an Appendix. The dependent variable is the
number of children ever born (CEB). Table 19 contains various specifications for all
women, women less than age 30 and women age 30 and over. Equation (1) includes the
variable denoting the woman’s age at first birth (AGEFBIRTH), which thus reduces the
sample to women who had at least one birth, and equation (2) excludes AGEFBIRTH in
order to enlarge the sample size. The most consistent variables are the controls for age
(AGE15 etc) which reflect the cumulative nature of children ever born with differences in
fecundity over age. For all women in equations (1) and (2), the only dummy variable
representing educational attainments to be significant is that representing no schooling
(EDNONE) which suggests that these women have an average of one-third of a child more
than women with primary education, the excluded class. Thus, school attendance tends to
reduce fertility over those who never attend school; but fertility seems to have a limited
response to increasing amounts of education at this stage of Vanuatu’s development and
demographic transition.
Cultural, communications and other socio-economic differences significantly affect achieved
fertility in some localities since women in Northern district (NORTH) have 0.4-0.7 more
births than women in Port Vila (VILA), the excluded class. Women in Luganville, the other
major urban area, record about one-third of a birth more than women in Port Vila. Single and
divorced/separated women may be less likely to be sexually active and exposed to pregnancy
and, as expected, achieve about one less birth than currently married women (MARRIED),
the excluded class.
The relationship between women’s work, particularly formal sector wage employment, and
their fertility has been hypothesized earlier. The negative effects on fertility of mother’s work
might only be expected where wage work involves regular absence from the family home
which would be incompatible with childbearing and child-minding activities. The variable
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30
constructed to reflect female labour force participation in Vanuatu, including work in the
informal sector and unpaid family work, proved not to be significant (in unreported
equations). However, the variable reflecting paid work in formal, non-agricultural activities
(LFNONAG) is highly significant in both equations in table 19, indicating that such
economically active women achieve almost one-quarter of a birth less than other women.
Finally, the variables constructed to reflect knowledge of (HEARDFP) and previous use
(EVERUSE) of family planning are mostly significant in equations (1) and (2) yet their sign
is positive, indicating that such women attain one-third to one-half of a child more than
women who have not heard of, and never previously used, contraception.8 When dummy
variables are introduced in unreported equations to represent the religious denomination of
the respondent, only that indicating membership of the Presbyterian church is significantly
different (at the 10% level) from zero, suggesting such women bear one-fifth of a birth less
than Catholic women, the excluded class.9
It should be noted that an attempt was made to reflect the individual female respondent’s
household’s socio-economic status as a determinant of her fertility behaviour. The only two
indicators which could be constructed from the survey data were the highest educational and
occupational skill attainments of any male household member who featured in the survey. In
none of these alternative equations was either of these indicators significantly different from
zero.
In order to attempt to capture cohort effects in these relationships the sample was stratified
into women under 30 years of age and women age 30 and over. A time trend, or cohort
effect, may be present in fertility (e.g. either downward as the result of decreasing family size
norms and the acceptance of more efficient family planning methods, or upward as health
improves and traditional practices limiting fertility weaken). Additionally, the factors
determining fertility differentials in younger age groups may differ from those for older age
groups (i.e. a life cycle effect may be present). Among younger women, for example, fertility
differentials should be more closely related to female age at marriage and age at first birth, as
well as to the factors (e.g. wife’s education, place of residence) which help determine these
variables. Older women, on the other hand, have had time to “make up” for a late start in
child-bearing, and, thus, desired family size and the factors which determine it (e.g. the
demand-related variables) should be relatively more important (Anker and Knowles, 1982).
The results are reported in equations (3) - (6) and conform largely to those reported for all
women. Geographic differences are less important for younger women perhaps reflecting
evidence of a diffusion process taking place, a recent breakdown in communication and
service barriers across the country and reduced dispersion in desired and achieved fertility.
Interestingly, in equation (4), the dummy variable measuring Junior High School education is
significant and negative, suggesting improved education will have a fertility reducing effect
for younger women. And formal, non-agricultural employment (LFNONAG) is significant
and has the predicted negative sign only for younger women, perhaps reflecting more
“modern” aspirations and behaviour by these women.
8When knowledge and use of only modern methods are substituted for these indicators, the results are largely similar, suggesting that
this enigma cannot be attributed to the inefficiency of use of traditional contraceptive methods.
9 Some might argue that EVERUSE, and to a lesser extent AGEFBIRTH and LFNONAG, should be treated as endogenous variables.
CREF - g:\cstsuva\discusspa\bh_98
31
Table 19
Fertility Analysis, Vanuatu 1995 (Dependent variable: children ever born)
Ordinary Least Squares
All Women
(1)
Constant
Women <30
(2)
Women >30
(3)
(4)
(5)
(6)
6.7
3.2
6.6
(AGE 30-34)
(AGE 30-34)
(AGE 25-29)
(AGE 15-19)
(AGE 30-34)
(AGE 30-34)
AGE 15-19
-3.1 (12.5)*
-2.3 (15.5)*
-2.1 (10.4)*
-
-
-
AGE 20-24
-2.1 (16.2)*
-1.9 (15.8)*
-1.0 (10.0)*
0.5 (5.2)*
-
-
AGE 25-29
-1.2 (9.3)*
-1.1 (9.0)*
-
1.3 (12.2)*
-
-
AGE 35-29
0.9 (6.8)*
1.1 (7.8)*
-
-
0.9 (5.5)*
0.9 (5.0)*
AGE 40-49
1.7 (12.7)*
1.8 (14.2)*
-
-
1.6 (10.6)*
1.7 (9.9)*
EDNONE
0.3 (2.1)*
0.3 (2.4)*
-0.0 (0.1)
-0.0 (0.2)
0.4 (2.0)*
0.6 (2.7)*
EDJUN
-0.1 (0.6)
-0.1 (0.7)
-0.1 (1.1)
-0.2(1.8)**
0.2 (0.8)
0.3 (1.3)
EDSEN
-0.1 (0.4)
-0.1 (0.1)
-0.1 (0.2)
-0.1 (0.6)
0.2 (0.5)
0.0 (0.3)
EDCOLL
-0.2 (0.9)
-0.1 (0.3)
-0.1 (0.4)
0.1 (0.5)
-0.2 (0.6)
-0.2 (0.6)
NORTH
0.7 (5.1)*
0.4 (3.6)*
0.2 (1.0)
-0.1 (0.4)
1.3 (5.7)*
1.2 (4.8)*
EAST
-0.1 (0.9)
-0.1 (0.9)
0.0 (0.1)
-0.1 (1.1)
-0.1 (0.5)
-0.0 (0.1)
CENT1
0.2 (1.1)
0.2 (1.5)
-0.0 (0.2)
0.1 (0.6)
0.4 (1.6)
0.4 (1.7)**
CENT2
0.1 (1.0)
0.2 (1.4)
0.1 (0.5)
0.2 (1.5)
0.2 (0.9)
0.2 (1.0)
SOUTH
0.1 (0.7)
0.4(2.8)*
0.0 (0.2)
0.3 (2.7)*
0.2(0.8)
0.5(1.9)**
LUGAN
0.3(1.8)**
0.3(1.8)**
0.1(0.3)
0.1(0.9)
0.6(1.9)**
0.6(1.7)**
SINGLE
-0.7(4.0)*
-1.2(11.0)*
-0.5(3.2)*
-1.1(13.1)*
-1.7(4.1)*
-2.4(5.7)*
DIVSEP
-0.7(2.6)*
-1.4(5.1)*
-0.5(0.6)
-0.2(0.3)
-0.9(2.7)*
-1.6(4.5)*
HEARDFP
0.1 (1.2)
0.2(2.0)*
0.0(0.2)
0.1(1.2)
0.2(0.9)
0.2(1.0)
EVERUSE
0.3(2.9)*
0.5(5.9)*
0.2(1.9)*
0.5(5.8)*
0.3(2.0)*
0.5(3.5)*
AGEFBIRTH
-0.2(11.0)*
-
-0.2(9.7)*
-
-0.1(6.6)*
-
LFNONAG
-0.2(2.1)*
-0.2(2.2)*
-0.2(1.6)
-0.2(2.2)*
-0.2(1.6)
-0.2(1.3)
Adjusted R2
0.56
0.66
0.29
0.50
0.31
0.26
F-Statistic
75.6*
173.5*
14.3*
64.7*
17.0*
15.0*
Sample Size
1226
1763
573
1073
649
681
(EDPRIM)
(VILA)
(MARRIED)
Note: Students’ t statistics are in parenthesis; * significant at least at the 5% level; ** significant at the 10% level. Variables
excluded from the equation to avoid matrix singularity are in parentheses.
Desired Family Size
Respondents were asked, in addition to the number of births they had already borne, how
many more children they wished to have. The sum of these responses was interpreted to be
their “desired family size” and the results of the multivariate analysis are reported in table
20.10 The mean desired family size for the whole sample of women is 3.85, ranging from
2.8 for 15-19 year olds, 3.0 for those 20-24 to 5.1 for 35-39 year olds to 5.7 for those 40 and
over. Evidently, younger women aspire to have fewer children than their mothers and
grandmothers and, if they are to realise their fertility desires, it is important that they receive
10 It must be appreciated that older women with high parities will necessarily rationalize past behaviour by claiming to desire many
children.
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32
the necessary information and the means necessary to attain them. Fertility goals are
inversely related to educational attainments and, as might be expected, significantly higher
outside Port Vila. For example, women in Northern province appear to want an average of
0.8-1.0 child more than similar women in the capital.
The younger a woman begins childbearing the more children she has (see table 19) and the
more children she desires to bear. For example, postponing the onset of childbirth by 5 years
reduces achieved fertility by almost one child (table 19) and desired family size by one-half
of a birth.
College/university educated younger women desire one-half of a child less than primary
educated women and older women who never went to school aspire to one-half a child more
than primary educated women. More education may help to shape fertility goals directly, and
indirectly, as girls stay in school longer and postpone the onset of their first pregnancy.
Participation in formal non-agricultural employment does not appear to independently shape
fertility desires.
Knowledge and Use of Contraception
As reported earlier, only 71% of men and 65% of women admitted to knowing of any
contraceptive method. Furthermore, it was estimated that about 31% of all women, and 39%
of currently married women or those in a de facto relationship, are currently using a
contraceptive method. In addition, the corresponding users of “modern” methods were
21.3% and 28.3% respectively. Meanwhile, 48% of all women and 60% of currently married
or in-union women claimed either to be currently using a method or to have used a method in
the past.
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33
Table 20
Analysis of the Determinants of Desired Family Size, Vanuatu 1995 (Ordinary
Least Squares)
All Women
(1)
Constant
Women <30
Women >30
(3)
(4)
(2)
6.1
3.7
5.6
(AGE 30-34)
(AGE 30-34)
(AGE 25-29)
(AGE 30-34)
Age 15-19
-1.5(6.3)*
-1.1(7.7)*
-0.9(4.0)*
-
Age 20-24
-1.3(9.9)*
-1.1(8.9)*
B0.6(5.4)*
-
Age 25-29
-0.8(5.8)*
-0.6(5.1)*
-
-
Age 35-39
-0.7(4.9)*
0.8(5.6)*
-
0.6(4.1)*
Age 40-49
1.3(10.0)*
1.5(11.4)*
-
1.3(8.4)*
EDNONE
0.4(2.6)*
0.4(2.9)*
0.1(0.3)
0.5(2.6)*
EDJUN
-0.1(0.5)
-0.0(0.1)
-0.0(0.1)
0.0(0.0)
EDSEN
0.1(0.4)
0.1(0.3)
-0.1(0.4)
0.3(0.8)
EDCOLL
-0.5(2.7)*
-0.4(2.4)*
-0.5(2.3)*
-0.4(1.3)
NORTH
1.0(6.7)*
0.8(6.5)*
0.5(2.7)*
1.4(6.2)*
EAST
-0.0(0.1)
0.0(0.0)
0.1(0.2)
0.0(0.2)
CENT1
0.4(2.6)*
0.4(3.3)*
0.3(1.5)
0.5(2.3)*
CENT2
0.4(3.1)*
0.4(3.4)*
0.4(2.6)*
0.4(1.8)**
SOUTH
0.2(1.4)
0.5(4.1)*
0.2(0.9)
0.2(1.0)
LUGAN
0.4(2.1)*
0.3(2.1)*
0.2(0.8)
0.7(2.0)*
SINGLE
-0.4(2.2)*
-0.2(2.2)*
-0.2(1.1)
-1.3(3.3)*
DIVSEP
-0.8(2.8)*
-1.4(5.5)*
-0.8(1.0)
-0.8(2.6)*
HEARDFP
0.0(0.1)
0.1(0.4)
-0.1(0.8)
0.0(0.3)
EVERUSE
0.3(3.3)*
0.4(4.9)*
0.2(1.8)**
0.3(2.7)*
AGEFBIRTH
-0.1(7.4)*
-
-0.1(4.8)*
-0.1(4.9)*
LFNONAG
-0.1(0.5)
-0.0(0.4)
0.1(0.4)
-0.2(1.1)
Mean
3.85
3.85
3.36
5.1
(EDPRIM)
(VILA)
(MARRIED)
Adjusted
R2
0.39
0.39
0.10
0.26
F-Statistic
37.75*
58.40*
4.35*
13.39*
Sample Size
1225
1759
572
649
Note: Students t statistics are in parentheses; * significant at least at the 5% level; ** significant at the 10% level.
Variables excluded from the equation to avoid matrix singularity are in parentheses.
Few earlier studies have examined the interrelationships between socio-economic and
demographic variables and the use of family planning methods in the Pacific Island countries.
In sub-Saharan Africa Cochane and Farid (1989) found that use of contraception is generally
positively related to the level of education, with a general tendency for the proportion using
efficient methods to be higher among the more educated. From their econometric analysis of
data from Southern Sudan, Cohen and House (1994) concluded that, in a generally
pronatalist, non-contracepting regime, it would be hardly surprising if behavioural factors
proved to be very important in explaining fertility and the use of contraception.
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34
Rodgers et al, (1986) suggests that the lack of knowledge about and use of family planning,
in order to control fertility and family size, may be considered as an important component of
poverty. On the other hand, the lack of access to family planning may be considered as one
of the determinants of poverty if it results in unwanted births, high dependency and stress on
family resources.
In table 21 the dependent variables are dummy variables set equal to one if the respondent
admits to knowing of any method to control fertility and zero otherwise (column 1);
knowledge of modern only (column 2); equal to one if the respondent has ever used any
method and zero otherwise (column 3); equal to one if she is currently using any method and
zero otherwise (column 4); and equal to one and if they are currently using a modern method
zero otherwise. These are then regressed on a set of exogenous socioeconomic and
demographic indicators which include the respondent's age and its quadratic (AGE, AGESQ),
education (EDNONE, EDJUN, EDSEN, EDCOLL), health district of residence (NORTH,
EAST, CENT1, CENT2, SOUTH, LUGAN), marital status (SINGLE, DIVSEP), and
participation in non-agricultural wage employment (LFNONAG).
Logistic regression is employed in all specifications, hence for each outcome the coefficient
represents the change in log-odds of that outcome from a one unit change in each
independent variable.
Younger women in Vanuatu are expected to be more likely to have knowledge about and to
use contraceptive methods than older women, since the former are perhaps able to conceive
of wider, non-traditional lifetime roles for themselves. The separate effect of age on family
planning knowledge and current use in the hypothesized direction is confirmed in the
equations on knowledge (1) and (2) and on current use (5). In each case, older women have a
lower probability of knowing about any method and modern methods or ever using or
currently using any method or a modern method than younger women, even after controlling
for education, place of residence and work status. Table 21 also points to significant
differences between residents of the health districts, with Central1 and Central2 consistently
falling short of attainments in Port Vila, the excluded class, in terms of knowledge and past
and current use of family planning. Eastern district also fares badly in terms of current use of
modern methods while Northern district performs well in terms of current use of any method;
Luganvillle fails to outperform Port Vila in terms of any of the indicators. As expected,
knowledge of all methods and modern methods rises with education attainments but fails to
promote greater use of contraception.
The finding that, independently of the level of education, ever use and current use of
contraception rise for women working in non-farm wage employment is especially important
and suggests that such women have access to more open communications networks, higher
status, along with having more opportunities and income to seek family planning services.
These same equations were estimated separately for women under 30 years of age and for
women 30 years of age and over. For younger women, knowledge of contraception, both any
methods as well as modern methods, is unrelated to age and, similar to all women, increases
significantly with education. Knowledge is significantly lower than in Port Vila for younger
women in the Northern, Central1 and Central2 districts, indicating the need to disseminate
more information to adolescents and young adults in these districts. For women aged over 30
knowledge declines with age and is unrelated to education attainment.
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35
Ever use of contraception by younger women under 30 years of age is shaped by similar
factors as for all women except the log-odds on the variable measuring non-agricultural
employment (LFNONAGR) is much higher for younger women (0.41 compared with 0.29
for all women and insignificant for older women). Similarly, in terms of current use of
contraception, the response of younger women to having a non-farm wage is much greater
than for older women11. Clearly, targeting younger women for non-farm wage jobs and
family planning messages will have the greatest impact on the level of current contraceptive
use.
Table 21
Analysis of the Determinants of Knowledge, Ever use and Current Use of
Contraception, Vanuatu, 1995: Logistic Regressions
Heard of
Any
Method
(1)
Constant
AGE
AGESQx100
Heard of
Modern
Methods
(2)
Ever Use:
Family
Planning (3)
Currently
Using Family
Planing
(4)
Currently
Using Modern
Method
(5)
-3.11
-2.60
-2.44
-1.42
-1.90
0.27(0.5)*
0.22(0.1)*
0.17(0.5)*
0.06(0.5)
0.09(0.1)
-0.36(0.0)*
-0.30(0.0)*
-0.19(0.0)*
-0.09(0.1)
-0.15(0.0)**
(EDPRIM)
EDNONE
-0.89(0.2)*
-0.81(0.2)*
-0.28(0.2)
-0.01(0.2)
0.25(0.2)
EDJUN
0.83(0.2)*
0.68(0.2)*
0.39(0.2)*
0.23(0.2)
-0.09(0.2)
EDSEN
1.96(0.4)*
1.98(0.4)*
0.25(0.3)
0.23(0.3)
-0.01(0.3)
EDCOLL
1.18(0.4)*
1.23(0.4)*
0.19(0.5)
0.11(0.3)
-0.41(0.3)
NORTH
-0.22(0.21)
-0.23(0.2)
-0.06(0.8)
0.67(0.2)*
-0.01(0.2)
EAST
-0.12(0.22)
-0.10(0.2)
-0.17(0.4)
-0.16(0.2)
-0.91(0.2)*
CENT1
-0.66(0.21)*
-0.66(0.2)*
-0.76(0.0)*
-0.51(0.2)*
-0.51(0.2)*
CENT2
-0.28(0.20)
-0.59(0.2)*
-0.63(0.0)*
-0.18(0.2)
-0.67(0.2)*
SOUTH
0.37(0.23)
0.20(0.2)
0.25(0.2)
0.25(0.2)
-0.31(0.2)
LUGAN
-0.38(0.29)
-0.35(0.3)
-0.72(0.0)*
0.12(0.3)
0.08(0.3)
SINGLE
-0.61(0.17)*
-0.58(0.2)*
-1.80(0.0)*
-1.64(0.2)*
-1.99(0.3)*
DIVSEP
0.39(0.55)
0.09(0.5)
-0.32(0.4)
-0.77(0.5)**
-0.44(0.5)
LFNONAG
0.05(0.13)
0.19(0.1)
0.29(0.0)*
0.34(0.1)*
0.22(0.2)
0.71
0.69
0.47
0.31
0.21
1862.3*
1933.5*
2009.4*
1958.8*
1632.1*
1757
1757
1757
1757
1757
(VILA)
(MARRIED)
Mean
-2xLog
Likelihood
Sample Size
Note: Standard errors are in parentheses; * significant at least at the 5% level, ** significant at the 10% level.
Variables excluded from the equation to avoid matrix singularity are in parentheses.
11In the logit equation explaining current use of contraception, the coefficient on LFNONAGR is 0.46 for women under 30 years,
compared with 0.17 (not significant) for older women.
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36
Unmet Need for Family Planning
It needs to be recalled that the KAP survey from Vanuatu only allowed the unmet need for
family planning to be defined according to whether the respondent claimed that she wished to
bear no more children and that she was not using any method of contraception (UNMET) or
not using a modern method of contraception (UNMETMOD). Thus, it was only possible to
generate an indicator of the unmet need for limiting further childbearing.
Table 22 reports on the socio-economic and demographic determinants of these measures of
unmet need from logistic regression methods. As expected, from the manner in which the
dependent variables are defined, the likelihood of having an unmet need rises with the age of
the respondent, although at a declining rate. There are some significant differences among
the districts of Vanuatu which help to determine unmet need, with Northern district having a
consistently lower rate than Port Vila, the excluded class. Authorities in the district should
not feel complacent since this result likely reflects the above average desired family size
amongst the women in the North (see table 20), the higher fertility of older women (table 19),
and their lower knowledge yet above average use of contraceptives, particularly sterilization
(table 21)12. In other words, the demand for children is high in the district, particularly by
older women 30 years of age and over, and the use of terminal methods of contraception
relatively high, resulting in the below average level of unmet need. Interestingly, while all
women and older women in Eastern district have an above average unmet need, younger
women have a lower level of unmet need.
While divorced/separated women seemingly have a significant unmet need, this may simply
reflect their desire not to bear any more children and, perhaps, because they are not sexually
active, their non-use of contraceptives. Not surprisingly, the higher the parity of the women
(CEB) the greater the chance of her having an unmet need for family planning. And, the
longer she postponed the onset of her first pregnancy, the lower the chance of having a
current unmet need. This effect is particularly strong for younger women. Women who have
ever used a method of contraception in the past (USEBEF) have a highly significant lower
chance of having a current unmet need, presumably because they are more likely to currently
use a modern method.
12Nationally, 44% of women 30 years of age and over using a contraceptive have been sterilized.
In the Northern district this proportion is
60%.
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37
Table 22
Analysis of the Determinants of Unmet Need for Family Planning,
Vanuatu, 1995: Logistic Regressions
Constant
AGE
AGESQX100
(EDPRIM)
EDNONE
EDJUN
EDSEN
EDCOLL
(VILA)
NORTH
EAST
CENT1
CENT2
SOUTH
LUGAN
(MARRIED)
SINGLE
DIVSEP
CEB
HEARDFP
USEBEF
AGEFBIRTH
LFNONAG
Mean
-2xLog
Likelihood
Sample Size
All Women
Unmet Need
Unmet Need
All Methods
Modern Method
(1)
(2)
-4.85
-5.86
0.31(0.1)*
0.35(0.1)*
-0.37(0.0)*
-0.42(0.0)*
Women <30
Unmet
Need All
Methods (3)
-9.58
0.92(0.5)**
-1.78(0.1)
Women >30
Unmet
Need All
Methods (4)
-7.01
0.39(0.2)**
-0.47(0.0)**
-0.21(0.2)
0.04(0.2)
-0.23(0.4)
0.37(0.3)
-0.08(0.2)
0.01(0.2)
-0.38(0.4)
0.60(0.3)*
0.01(0.5)
-0.10(0.3)
-0.22(0.5)
0.32(0.5)
-0.22(0.3)
0.22(0.3)
-0.22(0.6)
0.71(0.4)
-0.85(0.3)*
0.58(0.2)*
-0.08(0.3)
-0.14(0.2)
0.19(0.2)
-0.27(0.3)
-0.65(0.3)*
0.58(0.3)*
-0.24(0.3)
-0.05(0.2)
0.29(0.2)
-0.35(0.3)
-0.70(0.5)
-0.67(0.5)
0.66(0.4)
-0.67(0.4)
0.34(0.4)
-0.44(0.5)
-0.78(0.3)*
0.89(0.3)*
-0.55(0.3)**
0.12(0.3)
0.05(0.3)
-0.16(0.5)
0.29(0.3)
1.09(0.4)*
0.19(0.0)*
-0.3(0.2)**
-1.05(0.2)*
-0.08(0.0)*
0.07(0.2)
0.24
1344.7*
0.22(0.3)
0.89(0.4)*
0.23(0.0)*
-0.20(0.2)
-1.39(0.2)*
-0.07(0.0)*
0.11(0.2)
0.26
1346.3*
0.50(0.4)
2.53(1.4)**
0.53(0.10)*
-0.65(0.3)*
-0.81(0.3)*
-0.21(0.6)*
0.03(0.3)
0.20
474.7
0.28(0.6)
0.78(0.5)
0.10(0.0)**
-0.07(0.2)
-1.12(0.2)*
-0.05(0.0)**
0.03(0.2)
0.44
796.6*
1764
1764
1098
659
Note: Standard errors are in parentheses; * significant at least at the 5% level; ** significant at the 10% level. Variables
excluded from the equation to avoid matrix singularity are in parentheses.
VI.
CONCLUSIONS
Analysis of the Vanuatu KAP survey has demonstrated that there are still wide gaps across
the country in the knowledge and use of contraceptive methods. While awareness of family
planning is far from universal, it is very much higher than the actual practice of family
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38
planning. Past engagement of health workers and radio programmes to spread the message
has been very effective. More extensive use of these mechanisms seems justified,
particularly in light of the relatively low rate of use of modern methods of contraception.
Major emphasis must be given to closing the gap between awareness of family planning and
recognition of the benefits to be derived by individual families from actually practising
family planning, particularly modern, effective methods of contraception. Such an approach
would assist in closing the extremely large unmet need for limiting future childbearing. While
this analysis was unable to estimate the level of unmet need for child spacing, evidence from
other countries would suggest this far exceeds the size of the unmet need for limiting future
births, which is already quite extensive in Vanuatu.
Policies and programmes to address this extensive unmet need in Vanuatu would conform to
the ICPD POA’s call that:
“All countries should, over the next several years, assess the extent
of national unmet need for good-quality family planning services
and its integration in the reproductive health context, paying
particular attention to the most vulnerable and underserved groups
in the popuation” (UN, 1994, para 7.16).
The low level of awareness of family planning by the younger citizens of Vanuatu, especially
the use of condoms for 'safe sex', is particularly disturbing, given the need to avoid an
epidemic of STDs, particularly the HIV virus which leads to AIDS. Since the great majority
of young adolescents in Vanuatu never progress beyond primary school, much more effective
IEC strategies are required for the out-of-school population. That only one male adult in five
is currently using condoms, whether it be as a contraceptive or to avoid contracting an STD,
is also disturbing and conducive to a future epidemic of HIV.
This paper has identified large differences in knowledge and practice of contraception across
the health districts of Vanuatu. Knowledge and use of modern methods are relatively low in
certain districts, especially Eastern, Central1 and Central2, which should be the recipients of
more intensive IEC campaigns. The relative use of ineffective methods appears quite large in
Northern, Central2, Southern and Eastern districts. Not surprisingly, most of these districts
register above average rates of unmet need for effective methods of family planning. While
hard data on socio-economic differences between the districts are hard to come by, which
might help to explain varying patterns of demographic behaviour, there is some indication
that access to health facilities is relatively more difficult in Central1, Northern and Southern
districts. The mean number of adult persons served per health facility is well above the
national average in Central1, perhaps helping to explain its low uptake of contraception. In
addition, Central2 district is the most difficult for communications and transport while
Eastern district has the largest area to be covered, both land and sea area, of all the districts.
The perceived dispersion in access to service facilities across the country is wide, as is the
kind of services offered in the clinics. More in-depth assessment of these perceptions is
warranted, as would be an evaluation of the actual disparity in services offered across the
regions.
The generally pronatalist, high fertility and non-contracepting environment prevalent in
Vanuatu is characteristic of many other less developed countries at its stage of development.
Thus, it would be surprising if individual behavioural factors were to be important in
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39
explaining demographic behaviour. For example, women’s education attainments do not
assist in explaining inter-personal differences in achieved fertility or the use of
contraceptives. That more education seems to induce a decline in desired family size offers
some hope for an eventual change in demographic behaviour. The same is true of our finding
that women in non-agricultural wage employment achieve lower fertility and are more likely
to use contraception. As Vanuatu creates more opportunities for female education and nontraditional economic opportunities, demographic behavioural changes will be more likely.
Vanuatu has commenced an exercise in designing a comprehensive population and
development policy and some of the results of the KAP survey reported here may be of direct
interest to the drafters of the policy. Evidently, enlargement of the extent of knowledge of
family planning and its benefits to the individual family and its members throughout all
corners of Vanuatu is a pre-requisite for future demographic behavioural change. Measures
to raise the overall status of women to a level where they can identify the incompatibility
between their own fertility and both the share of economic responsibility they bear for raising
children and the ever greater costs of feeding and educating them should receive priority in
such a policy statement. Only then will those with the requisite knowledge and awareness be
induced to adopt methods to plan and control their fertility.
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40
REFERENCES
Asian Development Bank (1995), Human Resources Development: Smaller Pacific Island
Countries, Office of Pacific Operations, Manila.
Ainsworth, M., (1989), “Socioeconomic Determinants of Fertility in Cote d’Ivoire”, Living
Standards Measurement Survey, Working Paper No. 53 (Washington, DC: The World Bank)
Ainsworth, M., K. Beegle and A. Nyamete, (1996), The Impact of Women’s Schooling on
Fertility and Contraceptive Use: A Study of Fourteen Sub-Saharan African Countries, The
World Bank Economic Review, Vol 10, No. 1, January
Anker, R and J. Knowles (1982) Fertility Determinants in Developing Countries: A Case
Study of Kenya (Liege, Belgium: Ordina).
Cochrane, S.H. and S. Farid (1989), Fertility in Sub-Saharan Africa: Analysis and
Explanation, World Bank Discussion Paper No. 43 (Washington, DC: The World Bank).
Cohen, B. and W.J. House (1994), “Demographic Behaviour and Poverty: Micro-level
Evidence from Southern Sudan”, World Development, Vol.22, No. 7, July.
Dixon-Muller, R. and A. Germain (1992), “Stalking the Elusive ‘Unmet Need for Family
Planning’ ”, Studies in Family Planning, 23(5), Sept-Oct.
Ezeh, A.C. and G. Mboup (1997), “Gender Differentials in Contraceptive Prevalence Rates”,
Studies in Family Planning, Vol. 28, No. 2, June.
Fallon, J. (1994), The Vanuatu Economy: Creating Conditions for Sustained and Broad
Based Development, AIDAB, Canberra.
Gaminiratne, K. (1995), Preparation of Population Action Programme: Final Report,
Submitted to the Department of Health, Republic of Vanuatu and Asian Development Bank,
Port Vila, mimeographed.
Jayaraman, T.K. (1995), Demographic and Socio-economic Determinants of Contraceptive
Use Among Urban Women in the Melanesian Countries in the South Pacific: A Case Study of
Port Vila Town In Vanuatu, Occasional Papers No. 11, (Asian Development Bank,
Economics and Development Resource Center).
Maddala, G. S. (1983), Limited Dependent and Qualitative Variables in Econometrics,
(Cambridge: Cambridge University Press).
Population Reports (1996), Meeting Unmet Need: New Strategies, Volume XXIV, No. 1,
September
Republic of Vanuatu (1991), National Population Census, 1992-1996, (National Planning
and Statistics Office, Port Vila).
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Republic of Vanuatu (1992), Third National Development Plan, 1992-1996, (National
Planning and Statistics Office, Port Vila).
Republic of Vanuatu (1993), National Population Census 1989: Demographic and Migration
Analysis, (Statistics Office, Port Vila).
Republic of Vanuatu (1993), National Conservation Strategy, Prepared by the Environment
Unit with assistance from SPREP, AIDAB and IUCN, Ministry of Natural Resources, Port
Vila.
Republic of Vanuatu, (1994), National Country Report for the ICPD Conference, UNFPA
Fiji Office.
Republic of Vanuatu (1994), Family Planning Handbook for Nurses and Health Workers in
Vanuatu, South Pacific Alliance for Family Health (SPAFH) and Department of Health.
Republic of Vanuatu, (1997), Comprehensive Reform Programme, Comprehensive Reform
Programme Coordination Office, Office of the Prime Minister, Port Vila
Schultz, T.P., (1981), Economics of Population, (Reading, MA: Addison Wesley).
South Pacific Alliance for Family Health (SPAFH)/South Pacific Commission (1995),
National Family Planning Survey, Vanuatu, 1995, Noumea
UNDP (1997), Human Development Report, 1997, (New York, Oxford: Oxford University
Press).
UNICEF (1991), A Situation Analysis of Children and Women in Vanuatu, Port Vila
United Nations (1994), Programme of Action Adopted at the International Conference on
Population and Development, New York
Westoff, C.F. (1988a), “Is the KAP-Gap Real?” Population and Development Review, Vol.
14, No. 2, June.
Westoff, C. F. (1988b), “The Potential Demand for Family Planning: A New Measure of
Unmet Need and Estimates for Five Latin American Countries”, International Family
Planning Perspectives, Vol. 14, No. 2, June.
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APPENDICES
Table A1 Variable Definitions in Regression Analysis
Variable
CPR
CEB
UNMET
UNMETHOD
HEARDFP
HRDMOD
DESFAMSZ
EVERUSE
USEBEF
AGE 15-19
AGE 20-24
AGE 25-29
AGE 30-34
AGE 35-39
AGE 40-49
EDNONE
EDPRIM
EDJUN
EDSEN
EDCOLL
NORTH
EAST
CENT1
CENT2
SOUTH
VILA
LUGAN
SINGLE
MARRIED
DIVSEP
AGEFBIRTH
LFNONAG
AGE
AGSQ
Definition
Contraceptive Prevalence Rate (females)
Children Ever Born
D.V: One if Unmet Need for All Contraceptive Methods
D.V: One if Unmet Need for Modern Contraceptive Methods
Div. One if Heard of Family Planning
D.V: One if Heard of Modern Contraceptive Methods
Desired Family Size
D.V: One if Ever Used Family Planning Methods
D.V: One if Respondent Used Contraceptives in Earlier
Times D.V: One if Respondent Aged 15-19
D.V: One if Respondent Aged 20-24
D.V: One if Respondent Aged 25-29
D.V: One if Respondent Aged 30-34
D.V: One if Respondent Aged 35-39
D.V: One if Respondent Aged 40-49
D.V: One if Respondent Never Attended School
D.V: One if Respondent Attended Primary School
D.V: One if Respondent Attended Junior Secondary School
D.V: One if Respondent Attended Senior Secondary School
D.V: One if Respondent Attended College or University
D.V: One if Respondent lives in Northern District
D.V: One if Respondent lives in Eastern District
D.V: One if Respondent lives in Central 1 District
D.V: One if Respondent lives in Central 2 District
D.V: One if Respondent lives in Southern District
D.V: One if Respondent lives in Port Villa District
D.V: One if Respondent lives in Luganville District
D.V: One if Respondent Never Married
D.V: One if Respondent is Currently Married/Living in Union
D.V: One if Respondent is Divorced or Separated
Age at Which Respondent First Gave Birth
D.V: One if Respondent has a Non-Agricultural Wage Job
Age of Respondent in years
Age x Age of Respondent in Years
Mean
Standard
Deviation
0.31
2.55
0.24
0.26
0.70
0.69
3.85
0.47
0.30
0.21
0.24
0.17
0.13
0.11
0.14
0.11
0.63
0.16
0.06
0.05
0.16
0.15
0.15
0.18
0.15
0.16
0.05
0.29
0.69
0.02
20.02
0.29
27.85
859.97
0.46
2.42
0.42
0.44
0.46
0.46
1.79
0.50
0.46
0.41
0.42
0.37
0.34
0.31
0.35
0.32
0.48
0.36
0.23
0.21
0.21
0.37
0.35
0.38
0.36
0.37
0.22
0.45
0.46
0.13
3.05
0.45
9.19
569.52
DV = (1,0) Dummy Variable
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43
Table A2
Fertility analysis, Vanuatu (Dependent Variable: Children Ever Born)
METHOD OF ESTIMATION: TOBIT
(1)
Constant
(AGE 30-34)
AGE 15-19
AGE 20-24
AGE 25-29
AGE 35-39
AGE 40-49
(EDPRIM)
EDNONE
EDJUN
EDSEN
EDCOLL
(VILA)
NORTH
EAST
CENT1
CENT2
SOUTH
LUGAN
(MARRIED)
SINGLE
DIVSEP
HARDFP
EVERUSE
AGEFBIRTH
LFNONAG
-2 x Log.
Likelihood
Sample Size
(6)
3.13
4.67
(AGE 15-19)
(4)
-0.30
AGE 15-19)
(5)
6.78
(2)
(3)
5.93
(AGE 30-34)
-3.12(0.2)*
-2.14(0.1)*
-1.20(0.1)*
0.95(0.1)*
1.69(0.1)*
-3.85(0.2)*
-2.13(0.1)*
-1.23(0.2)*
1.05(0.2)*
1.78(0.2)*
1.10(0.2)*
2.12(0.2)*
-
1.61(0.2)*
2.50(0.2)*
-
0.90(0.2)*
1.64(0.2)*
2.84
(AGE 3034)
0.97(0.2)*
1.73(0.2)*
0.27(0.1)*
-0.08(0.1)
0.08(0.2)
-0.18(0.2)
0.30(0.2)**
-0.09(0.1)
-0.08(0.2)
-0.03(0.2)
0.00(0.2)
-0.13(0.1)
-0.03(0.2)
-0.08(0.2)
-0.12(0.2)
-0.26(0.1)**
-0.20(0.2)
0.13(0.2)
0.39(0.2)*
0.14(0.2)
0.18(0.4)
-0.19(0.3)
0.57(0.2)*
0.28(0.2)
-0.02(0.4)
-0.18(0.4)
0.72(0.1)*
-0.13(0.2)
0.16(0.1)
0.13(0.1)
0.10(0.1)
0.34(0.2)**
0.45(0.2)*
-0.31(0.2)**
0.21(0.2)
0.25(0.2)
0.56(0.2)*
0.40(0.2)**
0.15(0.2)
0.02(0.2)
-0.04(0.2)
0.06(0.1)
0.02(0.2)
0.04(0.2)
-0.12(0.2)
-0.51(0.2)*
-0.01(0.2)
0.29(0.2)
0.64(0.2)*
0.17(0.3)
1.26(0.2)*
-0.13(0.2)
0.37(0.2)
0.19(0.2)
0.18(0.2)
0.67(0.3)*
1.12(0.3)*
-0.02(0.3)
0.48(0.3)**
0.22(0.3)
0.49(0.3)**
0.69(0.4)**
-0.63(0.2)*
-0.70(0.3)*
0.10(0.1)
0.20(0.1)*
-0.16(0.0)*
-0.20(0.1)*
2153.2
-2.24(0.2)*
-1.38(0.3)*
0.17(0.1)
0.63(0.1)*
-0.30(0.1)*
2622.2
-0.48(0.1)*
-0.37(0.7)
0.08(0.1)
-0.03(0.1)
-0.20(0.0)*
-0.17(0.1)
908.0
-2.14(0.1)*
-0.14(1.0)
0.21(0.1)
0.44(0.1)*
-0.33(0.1)*
1253.1
-1.64(0.4)*
-0.86(0.3)*
0.12(0.2)
0.37(0.1)*
-0.13(0.0)*
-0.25(0.2)
1164.3
-2.45(0.4)*
-1.63(0.4)*
0.15(0.2)
0.72(0.2)*
-0.23(0.2)
1315.2
1241
1757
613
1098
628
659
Note: Standard errors in parentheses
*P < 0.05; **P < 0.1
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44
Table A3
Fertility analysis, Vanuatu (Dependent Variable: Children Ever Born)
METHOD OF ESTIMATION: Poisson
(1)
Constant
(AGE 30-34)
AGE 15-19
AGE 20-24
AGE 25-29
AGE 35-39
AGE 40-49
(EDPRIM)
EDNONE
EDJUN
EDSEN
EDCOLL
(VILA)
NORTH
EAST
CENT1
CENT2
SOUTH
LUGAN
(MARRIED)
SINGLE
DIVSEP
HEARDFP
EVERUSE
AGEFBIRTH
LFNONAG
-2 x Log.
Likelihood
Sample Size
(2)
(3)
(6)
-2.26(0.2)*
-0.82(0.1)*
-0.38(0.1)*
0.24(0.1)*
0.37(0.0)*
(4)
-0.94
(AGE 15-19)
1.38(0.2)*
1.80(0.2)*
-
(5)
1.63
(AGE 15-19)
0.63(0.2)*
1.05(0.2)*
-
1.79
(AGE 30-34)
0.20(0.1)*
0.34(0.1)*
1.14
(AGE 30-34)
0.22(0.0)*
0.37(0.1)*
0.04(0.1)
-0.02(0.1)
0.02(0.1)
-0.05(0.1)
0.07(0.1)
-0.03(0.1)
-0.02(0.1)
-0.03(0.1)
-0.00(0.1)
-0.07(0.1)
-0.02(0.1)
-0.05(0.1)
-0.07(0.1)
-0.16(0.1)*
-0.10(0.1)
0.02(0.1)
0.06(0.1)
0.03(0.1)
0.04(0.1)
-0.04(0.1)
0.10(0.0)*
0.05(0.1)
-0.00(0.1)
-0.04(0.1)
0.18(0.1)*
-0.02(0.1)
0.05(0.1)
0.04(0.1)
0.04(0.1)
0.10(0.1)
0.15(0.1)*
-0.04(0.1)
0.08(0.1)
0.06(0.1)
0.15(0.1)*
0.13(0.1)
0.06(0.1)
0.00(0.1)
-0.02(0.1)
0.02(0.1)
0.02(0.1)
0.01(0.1)
-0.03(0.1)
-0.18(0.1)
0.01(0.1)
0.10(0.1)
0.29(0.1)*
0.07(0.1)
0.24(0.1)*
-0.02(0.1)
0.08(0.1)
0.04(0.1)
0.05(0.1)
0.14(0.1)
0.23(0.1)*
-0.00(0.1)
0.10(0.1)
0.05(0.1)
0.11(0.1)
0.15(0.1)
-0.34(0.1)*
-0.14(0.1)
0.03(0.0)
0.05(0.1)
-0.04(0.0)*
-0.05(0.0)
2139.2
-1.27(0.1)*
-0.32(0.1)*
0.04(0.1)
0.15(0.0)*
-0.08(0.0)*
2568.2
-0.27(0.1)*
-0.13(0.5)
0.04(0.1)
-0.02(0.1)
-0.08(0.0)*
-0.08(0.1)
887.6
-1.42(0.1)*
-0.07(0.5)
0.07(0.1)
0.14(0.1)*
-0.15(0.1)*
1196.9
-0.55(0.2)*
-0.17(0.1)**
0.03(0.1)
0.08(0.0)**
-0.03(0.0)*
-0.05(0.1)
1212.6
-0.83(0.2)*
-0.34(0.1)*
0.03(0.1)
0.15(0.0)*
-0.05(0.1)
1331.4
1241
1757
613
1098
628
659
2.06
1.16
-1.26(0.1)*
-0.74(0.1)*
-0.36(0.1)*
0.21(0.1)*
0.35(0.1)*
Note: Standard errors in parentheses
*P < 0.05; **P < 0.1
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45