Identifying Factors Of Influence On Family Planning Practices

IDENTIFYING FACTORS OF INFLUENCE ON FAMILY PLANNING PRACTICES AMONG RURAL HAITIAN WOMEN
by Elizabeth J. Mason BS of Health Science, Slippery Rock University, 2005
Submitted to the Graduate Faculty of Graduate School Of Public Health in partial fulfillment
of the requirements for the degree of Master of Public Health
University of Pittsburgh 2010

UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH
This thesis was presented
by
Elizabeth J. Mason
It was defended on March 18, 2010 and approved by
Committee Chair: Martha Ann Terry, BA, MA, PhD, Assistant Professor, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of
Pittsburgh Craig Fryer, DrPH, Assistant Professor, Department of Behavioral and Community Health
Sciences, Graduate School of Public Health, University of Pittsburgh Michael Siegel, PhD, Assistant Professor, Department of Anthropology, School of Arts and
Sciences, University of Pittsburgh Wesley Rohrer, PhD, Assistant Professor, Department of Health Policy & Management, Department of Health Information Management, Graduate School of Public Health, School of
Health and Rehabilitation Sciences, University of Pittsburgh
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Copyright © by Elizabeth J. Mason 2010
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IDENTIFYING FACTORS OF INFLUENCE ON FAMILY PLANNING PRACTICES AMONG RURAL HAITIAN WOMEN
Elizabeth J. Mason, MPH University of Pittsburgh, 2010
Haiti, a country located in the Caribbean, is considered to be the poorest country in the Western hemisphere. With a population of more than eight million, Haiti is amongst the poorest of the poor with majority of the population living in abject poverty. In Haiti, a large majority of women have unmet needs for family planning or child-spacing which inevitably leads to high maternal mortality. In Haiti, most births occur at home without trained health care personnel, and the country has the highest prevalence of HIV/AIDs in the region. Increasing access to reproductive health services, including family planning, to women who want them is of critical public health concern. The purpose of this thesis is to examine factors that may affect rural Haitian women’s choice in utilizing family planning services by using the Social Ecological Framework as a guide. A comprehensive literature search was conducted through multiple search engines and two themes were identified as factors of influence including contraceptive use and desired family size. Increasing the availability of family planning services to women who want them would increase the likelihood of saving lives and improving the overall health of women in rural Haiti by increasing socio-economic status, empowerment, education, and reproductive health.
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TABLE OF CONTENTS

ACKNOWLEDGEMENTS ....................................................................................................... IX

PREFACE..................................................................................................................................... X

1.0

INTRODUCTION........................................................................................................ 1

1.1

PROBLEM IDENTIFICATION ........................................................................ 2

1.2

PURPOSE AND OBJECTIVES OF THESIS................................................... 3

2.0

BACKGROUND .......................................................................................................... 5

2.1

FAMILY PLANNING WORLDWIDE ............................................................. 6

2.2

PROFILE OF HAITI ........................................................................................ 11

2.3

FERTILITY AND FAMILY PLANNING IN HAITI .................................... 14

2.4

FAMILY PLANNING INITIATIVES IN HAITI .......................................... 17

2.5

THE SOCIAL ECOLOGICAL FRAMEWORK ........................................... 19

2.5.1 The Individual Level ..................................................................................... 20

2.5.2 The Interpersonal Level ................................................................................ 20

2.5.3 The Community Level................................................................................... 21

2.5.4 The Institutional Level .................................................................................. 21

2.5.5 The Societal Level .......................................................................................... 22

3.0

METHODS ................................................................................................................. 23

3.1

THE LITERATURE SEARCH........................................................................ 23

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3.2

DECISIONS REGARDING RELEVANCY ................................................... 24

3.3

LIMITATIONS.................................................................................................. 25

4.0

RESULTS ................................................................................................................... 26

4.1

CONTRACEPTIVE USE ................................................................................. 26

4.2

DESIRED FAMILY SIZE ................................................................................ 31

5.0

DISCUSSION ............................................................................................................. 36

5.1

APPLYING THE SOCIAL ECOLOGICAL FRAMEWORK ..................... 36

5.1.1 The Individual Level ..................................................................................... 37

5.1.2 The Interpersonal Level ................................................................................ 38

5.1.3 The Community Level................................................................................... 39

5.1.4 The Institutional Level .................................................................................. 41

5.1.5 The Societal Level .......................................................................................... 43

6.0

CONCLUSION........................................................................................................... 45

6.1

LIMITATIONS OF THE STUDY ................................................................... 45

6.2

RECOMMENDATIONS .................................................................................. 46

6.3

FUTURE RESEARCH...................................................................................... 49

6.3.1 Focus Group Proposal................................................................................... 50

6.4

FINAL THOUGHTS ......................................................................................... 53

BIBLIOGRAPHY ....................................................................................................................... 54

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LIST OF TABLES Table 1: Percentage of Distribution of Women Surveyed, By Highest Education Level Attained, According to Residence 1995-2000.............................................................................................. 13 Table 2: Totals for Haiti, Dominican Republic, and difference between them, 1995-2000......... 16 Table 3: Current Contraceptive Use in Haiti ................................................................................ 28 Table 4: Characteristics of Union Types, 1995. ........................................................................... 30 Table 5: Percent who Distinguished Differences of Photos, Stycos 1964................................... 33
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LIST OF FIGURES Figure 1: Map of Haiti .................................................................................................................... 2 Figure 2: Factors of Influence within the Social Ecological Framework ..................................... 37 Figure 3: Cycle-Beads................................................................................................................... 48
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ACKNOWLEDGEMENTS I would like to first send genuine appreciation to Dr. Martha Ann Terry, who helped me throughout the process of writing a solid thesis. I would also like to extend gratitude to the other members of my committee; Dr. Craig Fryer, Dr. Wesley Rohrer, and Dr. Michael Siegel. To my Haitian family and friends, thank you for being the driving force that pushed me to write this thesis. To my parents, who helped shape me into the person that I am today, and my partner Donnie I would like to extend my love and appreciation for their everlasting love and support.
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PREFACE In March of 2008 and 2009, I traveled to and stayed in both urban and rural parts of Haiti. The stay in both Port-au-Prince (urban) and Hermitage (rural) were life changing events that assisted in defining the purpose, and driving force, of my thesis. Because of these experiences, personal expertise will be presented throughout the thesis. I may have the opportunity to travel back to Haiti within the next few years to do field research in the Arbonite Region of Haiti where I will facilitate focus groups among rural Haitian women to identify factors of influence on family planning practices.
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