Zambezin (2002), XXIX (ii)Family Planning Prevalence, Acceptanceand Use in ChitungwizaFREDDIE MUPAMBIREYI AND EMMANUEL ZIRAMBAUniversity ofZimbalnoeAbstract77iis study utilises data collected in the Chitungiuiza socio-demograpliic suiivy(1990) to determine the levels of knoivledge, ever-use and current use of familyplanning among Chitungwiza women. Also examined is the ideal number ofchildren and the channels used to distribute family planning information inChitungwiza. The study has shown that zuhilst the level ofknoiuledge is quite highamong Chitungzoiza women, levels of use particularly current use are notsubstantial. Discussion of the ideal family size is a common phenomenon amongChitungwiza spouses.IntroductionSurvey reports have shown that the level of contraceptive knowledge isalways higher than the levels of ever-use and current use (ZimbabweNational Family Planning Council [ZNFPC] 1985, CSO 1989, BotswanaCSO 1988, Ghana Statistical Service 1988, Uganda Statistical Office 1989,Liberia Bureau of Statistics 1986, Somalia Ministry of Health 1983). UsingChitungwiza as a case study, this study will explore the factors responsiblefor this trend. It will examine whether people are responding positively ornegatively to family planning. Receptivity to family planning programmesshould be reflected by an increased percentage of people effectively usingfamily planning facilities. Reservations should be indicated by a smallpercentage of people adopting family planning methods.ObjectivesŁ To determine the extent of contraceptive awareness, knowledge and useamong Chitungwiza women.Ł To determine the distribution channels for family planning information.Ł To determine the ideal number of children in a family and whethercouples normally discuss the number of children they desire.Ł To determine the relationships that exist between family planning usersand some socio-economic variables.235236 Family Planning Prevalence, Acceptance and Use in ChitungwizaMethodologySampling Design: The survey was conducted in all three residential areasof Chitungwiza. Households were used as the sampling units. The samplesize was set at 2 500 households which were arbitrarily chosen on aproportionate basis from each of the three residential areas.Household Selection: Prior to the survey households were systematicallychosen using lists which indicated the total number of households in eachresidential area. Absenteeism was encountered in the first week of thesurvey when interviewers were identifying the predetermined households.Knowledge of Family PlanningInformation concerning the level of knowledge of family planning methodswere collected through a series of questions on nine specific contraceptionmethods and a residual category group 'others'. The specific methods are:pill, loop, injection, diaphragm, condom or durex, foam or jelly or foamingtablets, female sterilization, male sterilization and withdrawal. In this study,contraceptive methods are analysed in terms of two broad categories: modernand traditional. Of the nine contraceptive methods, withdrawal is the onlytraditional method.The level of knowledge of family planning is high among Chitungwteawomen. Table 1 shows that 99.6% of all women and 99.7% of currentlymarried women indicated that they are aware of family planning methods.Knowledge of modern contraceptive methods is higher than that oftraditional methods. 95.5% of all women know at least one modern methodcompared with 84.7% who know of a traditional method. This disparity inlevels of knowledge can be explained by the fact that most of the awarenesscampaigns put more emphasis on modern methods than on traditionalmethods. Further, there are more distribution outlets where information onmodern methods can be obtained as compared to traditional methods.There is also more media publicity given to modern contraceptive methods.Table 1 shows that for both modern and traditional methods, levels ofknowledge are higher for currently married women than for all women.This is probably because currently married women are more exposed topregnancy risk.When comparing the Zimbabwe Reproductive Health Survey or ZRHS(ZNFPC 1985) and the Zimbabwe Demographic and Health Survey orZDHS (CSO 1989) with the Chitungwiza Socio-Demographic Survey orCSDS (University of Zimbabwe 1990), the CSDS reveals higher knowledgelevels than the two national surveys. This may be due to Chitungwiza'sproximity to Harare.Table 2 presents the percentage distribution of specific contraceptivemethods known by currently married women. Among modern methods,F. MUPAMBIREYI and E. ZIRAMBA 237Table 1: Percentage Distribution of all and Currently Married Women whoKnow Contraceptive MethodsContraceptionMethodAny methodAny modern methodAny traditional methodOthers*Number of WomenCSDS (1990)Know MethodAW CMW99.6 99.799.5 99.784.7 84.9,6.7 7.51 391 1 235ZDHS (1989)Know MethodAW CMW96.3 98.795.4 97.875.3 86.834.2 40.64 201 2 643ZRHS (1985)Know MethodAW82.8N/AN/AN/A2 574AW = All Women CMW * Currently married womenN/A= Not available "Others' include herbs and other folk methodsCSDS = Chitungwiza Socio-Demographic Survey, University of ZimbabweDemographic Unit 1990ZDHS = Zimbabwe Demographic and Health Survey, Central Statistical Office (CSO),1989ZRHS = Zimbabwe Reproductive Health Survey, Zimbabwe National FamilyPlanning Council (ZNFPC) 1985.Table 2: Percentage Distribution of all and Currently Married Women whoKnow Specific Modern Contraceptive MethodsContraceptiveMethodPillLoopInjectionDiaphragmCondomFoam*Female sterilizationMale sterilizationNumber of WomenCSDS (1990)Know Method99.487.288.224.888.926.678.449.01235ZDHS (1989)Know Method97.059.172.414.580.314.954.617.62 643ZRHS (1985)Know Method80.540.267.6N/A48.317.440.010.82 574* Foam or jelly or foaming tablets N/ A Ł Not availableCSDS * Chitungwiza Socio-Demographic Survey (University of Zimbabwe 1999)ZDHS = Zimbabwe Demographic and Health Survey (CSO 1989)ZRHS « Zimbabwe Reproductive Health Survey (ZNFPC 1985)238 Family Planning Prevalence, Acceptance and Use in Chitungwizathe pill is the most widely known method (99.4%), followed by the condom(88.9%), the injection (88.2%), and the loop (87.2%). The diaphragm andfoam or jelly or foaming tables are the least known modern methods.Widely known methods may be the ones offered in most family planningprogrammes in Chitungwiza and about which information is readilyavailable. The high level of knowledge of the condom may be due tofrequent advertisements on radio and television and its use in preventingthe transmission of venereal diseases. Findings of the ZDHS (CSO 1989)and the ZRHS (ZNFPC 1985) have also shown higher levels of knowledgeof the pill, the condom, the injection and the loop than of the diaphragm,male sterilization and foam or jelly or foaming tablets.Knowledge Level/Background CharacteristicsDue to non-response to certain questions, the total number of respondentsto particular questions varies. All in all there were 1 391 respondents. Thereare minor variations in the level of knowledge of family planning methodsby age, marital status, and level of school completed. Chitungwiza womenare almost equally aware of family planning methods irrespective of theirbackground. As can be seen from Table 3, higher levels of knowledge arereported for modern methods than for traditional methods. This trend isconsistent across all the selected background characteristics. For example,of women aged 15-34 years, 98.4% indicated knowledge of moderncontraceptive methods while only 15.4% know of traditional methods. Theknowledge of 'other' methods is also low when compared with the othertwo categories.Table 3: Percentage Distribution of all and Currently Married Women whoKnow Contraceptive Methods by Selected Background CharacteristicsBackgroundCharacteristicsAge15-34 years35-49 yearsMarital statusNever marriedEver marriedLevel of educationNever attendedPrimarySecondary or higherModernMethods98.298.497.898.2100.098.197.7TraditionalMethods15.420.711.117.619.720.612.2OtherMethods*6.49.60.07.510.47.76.1Number ofWomen97932445134667777524Ł Includes herbs and other folk methodsSource: CSDS (University of Zimbabwe 1990)F. MUPAMBIREYI and E. ZIRAMBA 239Age: There is little difference between younger (15-34 years) and older (35-49 years) women in their knowledge of modern contraceptives. This isprobably because all people in Chitungwiza, an urban area, are equallyexposed to family planning programmes. Older women, however, knowmore about traditional and 'other' methods. This is expected as older womenprobably practised traditional and 'other' contraceptive methods beforemodern methods were introduced.Marital Status: Ever married women (separated, widowed, divorced andcurrently married) were slightly more knowledgeable than those who hadnever married, about both modern and traditional methods. None of thenever-married women knew of 'other' methods. However, the reversesituation, that is, that never-married women are more aware than ever-married women, is expected, since it is socially unacceptable to fall pregnantbefore or outside marriage.Level of Education: There is no clear pattern, with the exception of 'other'methods, between the level of knowledge of family planning methods andthe level of education completed. As with the age background characteristic,this is probably because in Chitungwiza all people, whether educated oruneducated, are equally exposed to family planning awareness campaigns.Women who have been to school reported higher levels of knowledge of'other' methods than those who have some formal education. This couldsuggest that women with no formal education believe these 'other' methodsto be better than modern or traditional methods, or that older women havepassed information to them.'Ever-use' of Family Planning MethodsSummary data on ever-use of family planning methods by currently marriedwomen is presented in Table 4. The level of ever-use for modern methods ishigher (79.0%) than for traditional (29.0%) and 'other' (0.5%) methods.Modern methods may be preferred because they are more effective andmore readily available than traditional and 'other' methods. The urbanenvironment of Chitungwiza may not be conducive to the use of traditionalmethods given the availability of modern methods and the many relatedreferral services. Traditional methods such as withdrawal require a highdegree of self-control, particularly on the part of the male, which, togetherwith the high failure rate, may cause people to opt to use modern methods.The low level of ever-use of traditional methods can also be explained bythe lack of mass media coverage given to these methods. Findings of theZDHS (CSO 1989) also indicate higher levels of ever-use by currently marriedwomen of modern methods (63.0%) than of traditional (48.1%) and 'other'(9.4%) methods.240 Family Planning Prevalence, Acceptance and Use in ChitungwizaTable 4: Percentage Distribution of currently Married Women who HaveEver Used Contraceptive MethodsContraceptiveMethodAny methodsModern methodsTraditional methodsOther methods*Number of WomenCSDS (1990)85.079.029.00.51235Ever-useZDHS (1989)79.063.048.19.42 643CSDS * Chitungwiza Socio-Demographic Survey (University of Zimbabwe 1990)ZDHS = Zimbabwe Demographic and Health Survey (CSO 1989)* Includes herbs and other folk methods.Considering ever-use of specific modern contraception methods, the pillis the most frequently used. As can be seen from Table 4 the proportion ofwomen having ever used the pill (75.2%) is almost five times the proportionthat have ever used the injection (16.0%). Ever-use of other modern methodsis very limited in Chitungwiza. Only 0.2% and 0.6% of currently marriedwomen indicated ever-use of male sterilization and the diaphragmrespectively. Low ever-use of male and female sterilization can be attributedto the fact that they require specialized physicians, cost much more thanother methods and are permanent (irreversible) methods.The condom is expected to be one of the most widely ever used methodsince it is the cheapest (free in some situations) and most readily availablemethod. Condom use has risen dramatically in many sub-Saharan countriesin response to Acquired Immune Deficiency Syndrome or AIDS (Goliber1989). For example, the demand for condoms in Kenya rose from 10 000 permonth in 1987 to 300 000 per month in 1988. In Africa, condoms haveordinarily been used by prostitutes and extra-marital partners (Goliber1989).Table 5: Percentage Distribution of Currently Married Women who HaveEver Used Specific Modern MethodsContraceptive Method Ever-useFifi : 752Loop 22Injection 16.0Diaphragm 0.6Condom 3.2Foam or jelly or foaming tablets 1.0Female sterilization 1.6Male sterilization 0.2Number of Women 1235Source: CSDS (University of Zimbabwe 1990)F. MUPAMBIREYI and E. ZIRAMBA 241'Ever-use' of Family Planning/Selected Background CharacteristicsThere are discernible differences in the levels of ever-use of family planningmethods by selected background characteristics, as can be observed fromTable 6.Table 6: Percentage Distribution of Ever-use of Contraceptive Methods byCurrently Married Women by Selected Background CharacteristicsBackgroundCharacteristicAge15-34 years35-49 yearsMarital StatusNever marriedEver marriedLevel of EducationNever attendedPrimarySecondary or higherReligionMuslimCatholicProtestantApostolicTraditional/othersModernMethods80.873.746.778.356.776.779.460.076.978.972.880.6TraditionalMethods19.210.540.074.3 Ł77.678.184.413.317.919.515.017.1OtherMethods0.40.60.00.40.00.40.50.00.00.21.21.8Numberof Women9793244513466777752415378527246216Source: CSDS (University of Zimbabwe 1990)Age: For both modern and traditional methods, young women (aged 15-34)reported higher ever-use levels than older women (aged 35-49). This couldbe due to the greater likelihood of younger women being in formal sectoremployment, which may be incompatible with child-bearing. Thus they are Łmore likely than older women to use contraceptive methods, specifically tospace their children. Another contributing factor could be that young womenare more educated than old women and hence are more receptive andlikely to approve and use contraception. Older women may also maintainthe traditional value of large families, hence the low levels of family planningever-use.Marital Status: Ever-married women reported higher levels of ever-use offamily planning than never-married women, for both modern and traditional242 Family Planning Prevalence, Acceptance and Use in Chitungwizamethods. This may be due to married women's higher risk of pregnancy.Escalating costs of living and child-rearing contribute to ever-marriedwomen using family planning methods specifically to limit family size.Among ever-married women, those who are separated, widowed anddivorced are likely to contribute to the high level of contraception ever-usebecause of the social stigma attached to people who have children outsidemarriage. For the same reason, it could also be argued, never-marriedwomen should have reported the highest level of ever-use of family planningmethods. None of the never-married women have ever used 'other' methods,whilst only 0.4% of the ever Tarried women reported ever having usedthem.Level of Education: Women who have never attended school indicatedlower levels of ever-use of both modern (56.7%) and traditional (77.6%)methods than women who have received formal education. Women withsecondary or higher education rep jrted the highest ever-use of both modernand traditional methods. Educated -vomen are more likely to adopt familyplanning because they are more aware of its benefits in terms of the healthof both mother and child than are uneducated women. Furthermore,educated women are likely to be earning an income which enables them tobuy modern contraceptives.Religion: Religious groups in Zimbabwe are not against the principle offamily planning, as can be seen from Table 6. Also evident is a preferencefor modern over traditional methods. For all religious groups, ever-use ofmodern methods is 60.0% and of 'other' methods is less than 2.0%. SinceApostolics have strong pronatalist beliefs, they are e/pected to have thelowest contraception ever-use levels, but the survey results show Muslimsto have the lowest. The results also indicate that Catholics do not strictlyadhere to the doctrine which advocates the use of traditional rather thanmodern methods. Of the 378 Catholic women interviewed, 76.7% indicatedever-use of modern methods, whereas 17.9% reported ever-use of traditionalmethods.Current Use of Family PlanningTo obtain information on current use of contraception, respondents wereasked whether they were using any contraception at the time of the survey.Current-use levels of contraceptives are a good measure for assessing andevaluating the success of family planning programmes. Current use ofiimiiy planning in Chitungwiza is not substantial, as shown in Table 7which again indicates the use of modern methods to be higher (67.5%) thanthe traditional methods (20.0%).With regard to specific methods, the pill is currently used by the majority(49.3%) of married women in Chitungwiza. Current use of other modernF. MUPAMBIREYI and E. ZIRAMBA 243methods is minimal, particularly of the diaphragm (0.6%), the injection(1.0%) and foam or jelly or foaming tablets (1.0%). The withdrawal methodis preferred to all other methods, with the exception of the pill.Contrary to the results in Table 7, the current use of condoms is expectedto be high for the reasons mentioned earlier as well as the fact that it can beused without following instructions or elaborate preparation before sexualintercourse.Table 7: Percent Distribution of Current Contraceptive Use by CurrentlyMarried WomenContraceptive Method CSDS (1990)Any method 34.0Modern methods 67.5Traditional methods 20.0Others 0.5Pill 49.3Loop 1.9Injection 1.0Condom 3.1Diaphragm 0.6Foam or jelly or foaming tablets 1.0Withdrawal 4.0Number of Women 1 235Source: CSDS (University of Zimbabwe 1990)Current Use of Family Planning/Background CharacteristicsTable 8 presents the proportion of currently married women who wereusing contraception at the time of the survey by selected backgroundcharacteristics.Age: The results indicate that modern contraceptive use in Chitungwiza ismore widespread among women aged 15-34 years (59.3%) than amongthose aged 35-49 years (42.6%). The concentration of current users of moderncontraceptive methods in the younger age group (15-34) may be due toyounger women being more receptive to family planning messages. Withtraditional methods, older women reported slightly higher levels (5.8%) ofcurrent use than younger women (4.3%). This is probably because olderwomen are more likely to maintain the belief that traditional methodsconform to their societal and cultural values and norms.Level of Education: The results in Table 8 show that family planning use isrelated to women's level of education, especially with regard to moderncontraceptive methods. For example, 58.8% of women with secondary and244 Family Planning Prevalence, Acceptance and Use in ChitungwizaTable 8: Percentage Distribution of Current Use of Contraceptive Use bySelected Background CharacteristicsBackgroundCharacteristicAge15-34 years35-49 yearsLevel of EducationNever attendedPrimarySecondary or higherLiving ChildrenNone1-23-5>5AnyMethod52.940.431.347.851.534.441.838.235.4ModemMethods59.342.637.351.258.850.556.052.947.7TraditionalMethods4.35.84.56.04.14.68.95.04.6NumberMethods979324677775242628522186Source: CSDS (University of Zimbabwe 1990)higher education are current users of modern contraceptive methodscompared with 37.3% of those who never attended school. Educated womenare less likely to regard children as assets, which will yield dividends in thefuture, hence they are more motivated to practise contraception thanuneducated women. Educated women are also more conscious of the healthand cost of children and as such tend to use contraception in order to erodesome traditional pronatalist tendencies, explaining higher contraceptiveuse among women who have been to school. In Zimbabwe, pregnantschoolgirls are expelled. There is no uniform pattern in the variation in thepercentage of current users of traditional methods by level of education.Number of Living Children: Contraceptive use is lower among womenwho have no living children than those who have more than five children.These results suggest that people prefer to use contraception only after theyhave a living child. The reason for this could be the fear of failure to havechildren. As regards modern methods, the majority of the current users(56.0%) have one to two living children.Problems with Family Planning MethodsCurrent users were asked about the problems, if any, that they wereexperiencing with their family planning methods at the time of the survey.Only four methods (pill, injection, condom and withdrawal) and theirF. MUPAMBIREYI and E. ZIRAMBA 245related problems are analysed since very few respondents were usingmethods such as the diaphragm, the loop and foam or jelly or foamingtablets. Some of the problems experienced by respondents are presented inTable 9. These suggest why the levels of contraceptive current use are lowerthan those of ever-use. The problems associated with some methods canlead to the abandonment of contraception.The majority of current pill users (49.1%) reported health-related problemssuch as bleeding, headache, swollen breasts, rashes and itching. Althoughwomen complained about the side effects of the pill, very few (3.3%)considered it to be an ineffective method. With the injection, more than halfthe current users reported 'others' as the main problems they areexperiencing in using this method. Ineffectiveness was cited as the mainproblem associated with the condom and withdrawal methods. Theineffectiveness of the condom lies in the fact that it can burst or can spillsemen into the vagina. Failure to self-control is the main reason for thewithdrawal method's ineffectiveness. Interference with sexual pleasure isassociated with both the condom and withdrawal methods.Table 9: Percentage Distribution of the Problems Associated with SelectedFamily PlanningProblemNoneHealth concernsIneffectiveInterference withsexual pleasureOthers-TotalPill30.449.13.30.017.2100.0Injection0.031.315.60.053.1100.0Condom7.70.072.419.90.0100.0Withdrawal20.30.076.82.90.0100.0* Includes such problems as damage of reproductive organs and failure to havechildrenSource: CSDS (University of Zimbabwe 1990)Reasons for DiscontinuationWomen who were no longer using contraception were asked why they hadstopped. Of the 144 women who had stopped using the pill, 68.1% hadabandoned it because of health problems. For the injection, health problemsalso dominated other reasons for discontinuation. The 'other' reasons citedfor these two methods were the desire for another child or pregnancy. Thecondom and withdrawal methods were abandoned mainly because of theirineffectiveness.246 Family Planning Prevalence, Acceptance and Use in ChitungwizaTable 10: Percentage Distribution of Discontinuation of Selected FamilyPlanning MethodsReasonWanted another childPregnantHealth problemsIneffectiveTotalNumber of WomenPill14.615.368.12.0100.0144Injection31.314.445.58.8100.048Condom15.00.00.085.0100.020Withdrawal21.85.40.072.8100.055Source: CSDS (University of Zimbabwe 1990)Reasons for 'Never-use' of ContraceptionSummary data on the reasons for never-use of selected family planningmethods is presented in Table 11. The reasons vary from lack of knowledgeof the method and source to perceived problems (side-effects) associatedwith some contraceptive methods. With regard to the pill, 54.2% of womenwho have never used it cited the desire to have more children as the mainreason. Only 3.3% indicated that they were unaware of the method.Husbands in Chitungwiza do not want their wives to use the loop asevidenced by 38.7% of the women citing husband's disapproval as thereason why they had never used the loop. Lack of knowledge of the methodis highest for the diaphragm (77,4%) and foam or jelly or foaming tablets(73,7%). Withdrawal is not a common method in Chitungwiza. 71.4% of thenever-users indicated a lack of knowledge of the method.Table 11: Percentage Distribution of Reasons for Never-use of SelectedFamily Planning MethodsReasonMethod not knownSource not knownHusband disapprovesNeed more childrenSide-effectsOthersTotalNumber of WomenPill3.37.98.254.221.15.3100.038Loop14.25.938.719.613.77.9100.051Diaphragm77.43.81.06.78.22.9100.0105Foam*73.710.92.45.35.42.3100.0129Withdrawal71.40.025.43.20.00.0100.067Source: CSDS (University of Zimbabwe 1990)F. MUPAMBIREYI and E. ZIRAMBA 247Sources of Family Planning InformationThere are a number of ways that family planning information is disseminatedin Chitungwiza. These include television and radio programmes, pamphlets,newspapers, health workers and hospitals or clinics. Respondents whowere aware of family planning methods were asked how they came toknow about that method. The most common source of contraceptioninformation is health workers. From Table 12 it can be seen that more thanhalf of the respondents had heard about modern family planning methodsthrough health workers. Hospitals and clinics are also vital sources offamily planning information in Chitungwiza. Approximately 20.0% of thewomen indicated that they had heard about contraceptive methods athospitals or clinics. Television, newspapers and pamphlets are the effectivedissemination methods. Television was the source of information for 2.3%of the women who know about the pill, 0.5% for the loop, 0.9% for theinjection and 0.9 for the condom. This is probably because the majority ofthe women do not have television sets or buy newspapers.Table 12: Percentage Distribution of Sources of Family PlanningInformationInformation SourceTelevisionNewspaperPamphletsRadioHealth workerClinic/hospitalOthersTotalNumber of WomenPill2.31.11.113.161.920.30.0100.01327Loop0.51.22.218.056.820.50.8100.01167Injection0.91.23.013.755.624.31.3100.01192Condom0.93.54.219.151.219.21.9100.01210Foam*1.53.95.310.652.724.31.7100.0409Withdrawal0.81.73.114.253.50.026.7100.01012* Foam or jelly or foaming tabletsSource: CSDS (University of Zimbabwe 1990)Fertility PreferencesOne of the major goals of family planning programmes is to encouragecouples to determine their desired child spacing and number of children.The preferred ideal number of children, the reasons for preferred familysizes and the occurrence of family planning discussions between spousesare examined in the following section. The CSDS questionnaire did notinclude questions on the desire for additional children or child spacingfrequencies hence it is not possible to analyse the need for contraception.Problems were envisaged in the interpretation of women's fertilitypreferences since these can change with time and can be influenced by248 Family Planning Prevalence, Acceptance and Use in Chitungwizaother people. For instance, a husband's attitude towards family planningcan significantly affect a woman's fertility preferences. Furthermore,preferences can also be biased towards the number of living children.When asked to imagine restarting the fertility cycle, women may be reluctantto admit to wanting fewer children than they actually have, as that seemslike rejecting them.Ideal Number of ChildrenTo determine the ideal number of children among Chitungwiza women,respondents were asked to consider a hypothetical situation and suggestthe exact number of children they would want to have. Nearly allChitungwiza women included in the survey have an idea of the number ofchildren they would like to have since only 0.4% presents the distributionof the ideal number of children according to the number of living children.In many African societies children are regarded as symbols of prosperityand prestige and as such childlessness is abhorred. In Chitungwiza thisview is confirmed by the fact that none of the interviewed women desiredto have no children. The most commonly reported ideal family size amongall women respondents is four children. 44.4% of the women stated an idealnumber of four children, approximately 20% preferred six or more children,15.2% regarded three children as the ideal number, only 0.3% preferred onechild as the ideal family size.Table 13 also shows the mean ideal number of children for all and forcurrently married women. The mean ideal number of children among allwomen is 4.3 and among currently married women is 4.4.Table 13: Percentage Distribution of all and Currently Married Women byIdeal Number of Children and Mean ideal Number of Children, Accordingto Number of Living ChildrenIdeal Numberof ChildrenNone12345>6Non-numeric responsesTotalNumber of WomenMean (AW)Mean (CMW)None0.00.03.811.550.07.727.00.0100264.54.710.00.08.716.849.05.419.50.61001494.34.520.00.78.114.847.49.719.30.01001354.34.3Living30.00.916.812.140.210.317.81.91001054.54.2Children*40.00.010.121.525.38.934.20.0100793.94.350.00.04.312.853.38.521.10.0100474.94.5>60.00.09.113.048.110.319.50.0100774.34.4Total0.00.39.715.244.18.521.50.41006204.34.4Source: CSDS (University of Zimbabwe 1990)F. MUPAMBIREYI and E. ZIRAMBA 249While several studies have indicated a strong association between idealand actual number of living children (Pullim 1980, McClelland 1983), this isnot noticeable in Chitungwiza. In fact, the number of living children awoman has seems to have little impact on the ideal number of children. Forall women and for currently married women, the mean ideal number ofchildren remains almost the same as the number of living children increases.This may be an indication that women who want more children may notnecessarily achieve the number. It is also possible that Chitungwiza womendo not rationalise the number of children they have and the number theywant.Respondents gave various reasons for their preferred family sizes. Thetwo dominant reasons are manageable number of children and cost ofrearing children. Table 14 shows that 39.6% of all women respondents gavethe expense of childrearing as their reasons for choosing their respectiveideal family size. Women who have ideal family sizes of six or morechildren want old-age support. Since there is a move towards nuclear asopposed to extended families, having many children does not alwaysguarantee old-age support. The desire for financial support was the reasongiven by 6.5% of women. 11.9% have 'other' reasons for their preferredfamily sizes.Table 14: Percentage Distribution of all Women Ideal Family Size byReasonReasonExistence of familyFinancial supportOld age helpChildren are expensiveManageable numberHealth reasonsOthers10.00.00.066.70.00.033.3Ideal20.06.90.853.130.80.08.4Number of Children33.25.31.150.028.72.29.542.36.52.041.437.21.69.053.43.41.733.642.21.913.8>64.48.122.222.635.10.76.9Total2.76.52.639.635.51.211.9Source: CSDS (University of Zimbabwe 1990)Ideal Number of Children/Background CharacteristicsTable 15 presents the ideal number of children by the backgroundcharacteristics of women's age, marital status and education level. Fourchildren is considered the ideal number by Chitungwiza women, irrespectiveof their backgrounds. The ideal number of children rises from one child,peaks on four children and then declines.250 Family Planning Prevalence, Acceptance and Use in ChitungwizaTable 15: Percentage Distribution of all Women Ideal Number of ChildrenSelected Background CharacteristicsBackgroundCharacteristicAge15-39 years35-49 yearsMarital StatusNever marriedEver marriedEducationNever attendedPrimarySecondary or higherNone0.00.00.00.00.00.00.0Desired Ideal Number of Children10.40.52.20.00.00.30.2211.19.117.89.46.57.513.3317.27.011.113.111.311.017.9446.642.651.147.932.349.149.059.010.18.99.122.69.66.0>615.730.78.920.527.322.513.6Total100.0100.0100.0100.0100.0100.0100.0No ofWomen97932445134676777524Source: CSDS (University of Zimbabwe 1990)Age: The majority of women in both age groups (15-34 and 35-49) considerthe ideal family size to be four children. More older women (30.7%) thinksix or more children is the ideal number than younger women (15.7%). Thispattern supports the supposition that older women tend to prefer largerfamily sizes than younger women do.Marital Status: Women who never married want smaller families than doever-married women. Of the never-married women, 17.8% regard twochildren as the ideal number whereas 9.4% of the ever-married womenconsider two children as ideal compared with 20% of ever-married women.It is possible that never-married women are more aware of the high cost ofrearing children or that they have other priorities, such as careerdevelopment, which have led to their preference for small families.Level of Education: women who never attended school reported higherideal numbers of children than those who have been to school. 13.3% ofwomen who have secondary or higher education prefer an ideal family sizeof two children compared with 6.5% of those who have never attendedschool. More women who have never been to school (22.6%) reported anideal family size of five children than those with primary (9.6%) andsecondary or higher (6.0%) education. In general, education exerts a negativeinfluence on the desired number of children, probably due to delayed entryinto marital union. Uneducated women are more likely to believe that Goddecides on the number of children a couple is supposed to have.F. MUPAMBIREYI and E. ZIRAMBA 251Ideal Family Size Discussion/Background CharacteristicsCouples in Chitungwiza often discuss the number of children they desire tohave. Summary data on the number of times couples have discussed thenumber of children they desire by age, level of education and religion ispresented in Table 16.Table 16: Parentage Distribution of all Women by Number of Times TheyHave Discussed Ideal Family Size by Background CharacteristicsBackgroundCharacteristicAge15-34 years35-49 yearEducation LevelNever attendedPrimarySecondary or higherReligionMuslimCatholicProtestantApostolicTraditional & OthersNumber of Times Couples Hav<None18.825.838.925.917.823.122.021.025.028.318.33.35.64.74.87.74.83.96.35.122.16.53.72.42.90.01.62.42.25.635.829.05.66.74.00.06.46.64.93.5; Discussed>365.035.446.260.370.569.265.266.161.657.5Total100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0No. ofWomen9793246777752415378527246216Source: CSDS (University of Zimbabwe 1990)Age: both young and old women have discussed the ideal number ofchildren with their spouses. The highest percentage of couples discussingthe issue more than three times is reported by women aged 15-34 years(65.0%) and the lowest by women aged 35-49 years (35.4%). This is probablybecause most women in the older age group have reached their desiredfamily sizes and no longer need to discuss the issue. There are women inboth age groups who have never discussed the ideal number of childrenwith their spouses. This may be because all decisions in these householdsare made by husbands, who oppose family planning.Level of Education: Women who have never attended school reported ahigher level of non-discussion (38-9%) than those with secondary or highereducation (17.8%). Of the 524 women with secondary or higher education,70.5% reported having discussed the ideal number of children with theirspouses more than three times compared with 46.2% of the 67 women who252 Family Planning Prevalence, Acceptance and Use in Chitungwizanever attended school. Educated women are more likely to be employedand in equal partnership with their husbands in household decision-making,and hence freer to discuss family planning than uneducated women are.Religion: The need to discuss ideal family sizes has also penetrated everyreligious sect. Almost 60% of women in every religious group have discussedthe ideal number of children with their spouses more than three times.Traditional and 'other' religious groups reported the highest level of non-discussion (28.3%). This may be a result of husbands' negative attitudestowards family planning.Summary and ConclusionsThis study shows that there is a substantial level of knowledge of familyplanning methods among Chitungwiza women, irrespective of theirbackground. The level of knowledge of modern methods are higher thanthose of traditional methods. The modern methods, which are most widelyknown, are the pill, loop, injection and condom. This high level of knowledgecan be attributed to the family planning awareness campaigns of theZimbabwe National Family Planning Council, the government and non-governmental organisations. Since Chitungwiza is an urban area, highlevels of contraceptive knowledge are expected because the population hasaccess to mass media facilities such as radio, television and written materials.There is a large gap between the levels of knowledge and actual use ofcontraception. Whilst nearly every woman in Chitungwiza is aware offamily planning methods, only a small proportion of them were usingcontraception at the time of the survey. There are also distinct differencesbetween the levels of ever-use and current use. People discontinuecontraceptive use for various reasons. The need for another child andpregnancy are the main reasons given for temporarily ceasing to usecontraceptives, while some abandon contraceptives completely because ofhealth problems (bleeding, headache, swollen breasts and so on). Somewomen have never used contraception, either because of ignorance ofsources or because their husbands do not approve of family planning.The study established that health workers are the main providers offamily planning information in Chitungwiza, followed by hospitals andclinics. Since health workers are local people, clients tend to trust them andto believe that they assure greater privacy than other sources of familyplanning information.In Chitungwiza, the majority of women are free to discuss family planningwith their spouses and this is reflected by the number of times (that is, morethan three times) couples have discussed family planning. This indicatesthat the need to decide the number of children in a family is recognisedrather than 'leaving everything to God'.F. MUPAMBIREYI and E. ZIRAMBA 253An ideal family size of four children is preferred among Chitungwizawomen. Evidence from this study suggests that younger, educated women(primary and higher education) are more likely to use contraception andprefer smaller families than older women. Younger women tend to prefertemporary family planning methods such as oral contraceptives whereasolder women, who have usually reached their desired family size, tend toprefer more reliable and permanent methods to avoid further pregnancies.RecommendationsUser Perspective: Family planning designers and implementers should beaware of the cultural and social environment in which people live. Theymust respect the values and traditions of the user and potential user. Themethods'advocated should not undermine the user's attitudes, needs andproblems as these affect the approval and use of contraception. The lowlevel of contraceptive use in Chitungwiza may be a result of the lack ofconsideration of cultural values by the advocates of family planning andthe fact that some of the contraceptive methods on offer do not conformwith the social and cultural norms of the respondents.Method Mix: There needs to be a variety of methods from which peoplecan choose the one best suited to their needs. All available methods inChitungwiza should be given equal publicity. The choice of an appropriateand affordable method should be the responsibility of the potential user.The popularity of the pill, loop, injection and condom can be attributed tothe fact that these methods are the most widely advertised in Chitungwiza.Cost: Contraceptives should be made available at an affordable cost forlow-income earners. While the level of contraceptive knowledge inChitungwiza is high, the cost of some contraceptives (IUD, Norplant) isprohibitive. Contraceptives should be easily accessible in terms of thedistance to the nearest hospital, clinic or health centre.Advantages and Disadvantages: Providers of family planning servicesshould be frank in discussing contraception methods, particularly the sideeffects, efficiency and problems of misuse. People who are left to discovercontraceptive side effects after having adopted a method are likely to bediscouraged from using other methods, and are likely to discourage otherpotential adopters of family planning.ReferencesBOTSWANA, CENTRAL STATISTICAL OFFICE (CSO) 1988, Health Survey 11 (BHS II),Gaborone: Ministry of Finance and Development Planning.CENTRAL STATISTICAL OFFICE (CSO) 1989, Zimbabive Demographic ami HealthSurvey (ZDHS), Harare: CSO.254 Family Planning Prevalence, Acceptance and Use in ChitungwizaGOLIBER, THOMAS J. Nov. 1989, 'Africa's expanding population: Old problems,New policies', in Population Bulletin, 44 (iii), Washington D.C.: PopulationReference Bureau.GHANA STATISTICAL SERVICE 1988, Liberia Demographic and Health Survey (LDHS),Monrovia: Ministry of Planning and Economic Affairs.MCCLELLAND, G. H. 1983, 'Family size desires as a measure of demand', in R.D. Bulatao and R. D. Lee eds, Determinants of Fertility in Developing Countries:A Summary Knowledge, Washington D.C.: Natural Academy Press.PULLIM, T. W. 1980, 'Illustrate analysis: Fertility preferences in Sri-Lanka',Scientific Report WFS, No. 9.SOMALIA FAMILY PLANNING DIVISION 1983, Fertility and Family Planning in UrbanSomalia, Mogadishu: Ministry of Health.UGANDA STATISTICAL OFFICE 1989, Uganda Demographic and Health Survey(UDHS), Entebbe: Ministry of Health.UNITED NATIONS 1980, Selected Factors Affecting Fertility Preferences in DevelopingCountries. Evidence From the Fifteen EFS 2, London: UN.UNIVERSITY OF ZIMBABWE DEMOGRAPHIC UNIT 1990, Chitungwiza Socio-Demographic Survey (CSDS), Harare: University of Zimbabwe.ZIMBABWE NATIONAL FAMILY PLANNING COUNCIL (ZNFPC) 1985, ZimbabweReproductive Health Survey (ZRHS), Harare: ZNFPC.