The 1985 Sri Lanka Contraceptive Survey is a follow- up of the Contraceptive Prevalence Survey (CPS) of 1982. This survey addresses some of the major issues raised by the 1982 and the 1975 World Fertility Survey (WFS).
The Department of Census and Statistics (DCS) of the Ministry of Plan Implementation collaborated with Family Health International (FHI) in this venture. PHI provided financial support and technical assistance to the DCS to ensure that the practice of contraception was measured as completely and as accurately as possible and a new approach was developed and adopted by an enthusiastic team of DCS staff.
The Sri Lanka Contraceptive Prevalence Survey , on the other hand, was one of a series of surveys conducted in a number of countries under the sponsorship of the Westinghouse Health Systems of the U.S.A. The Sponsor's proposal to conduct the, survey came at a time when the country's family planning and population policy programs were reaching maturity and the need for measures of contraceptive prevalence to evaluate the programs was strong.
Between WFS and CPS, a period of 7 years, use of traditional methods increased by 11 percentage points. Yet in the CPS and Family Health Impact Survey (FHIS) both conducted in 1982, the estimated prevalence of traditional contraceptive use differed substantially - from 24% in the CPS to only 14% in the FHIS.
Of immediate concern was whether CPS had overestimated the prevalence of traditional methods. A second issue was caused Sri Lankan couples to adopt these traditional methods in preference to modern temporary methods. The issues have a decisive bearing on how information and education programs should be structured to whom they should be directed, and on the delivery of services to motivated couples.
These concerns were voiced at several meetings following the release of CPS findings by the personnel
at the helm of Government's population programs and managers of non-governmental programs and they led to the decision to further investigate the situation.
The purpose of the 1985 Sri Lanka Contraceptive Survey (SLCS) was to provide a detailed examination of the knowledge and use of traditional and modern contraceptive methods in Sri Lanka, and to document changes in these practices over time. Both qualitative and quantitative data collection methodologies were employed to achieve these goals. A series of qualitative in-depth interviews with urban and rural couples and grass root level family planning workers were conducted as the initial data collection phase of this project, followed by a more standard quantitative survey.
The 1985 SLCS followed-up respondents to the 1982 Contraceptive Prevalence Survey. Its coverage was restricted to 17 Districts in the West, South and Central regions of Sri Lanka and included only those respondents to the 1982 CPS who were still currently married and under 50 years of age in 1985. In all, 2,310 women and a subsample of 577 of their husbands were interviewed.
Although the study documents the widespread awareness and use of contraception across all sectors of Sri Lankan society, it also points to serious insufficiencies and misconceptions in couples' knowledge of how to correctly use methods such as rhythm and the pill and how the methods work. The 1985 SLCS confirms the high reported prevalence in the 1982 CPS of the use of traditional contraception and sterilization in Sri Lanka and provides some of the major reasons for these contraceptive use patterns.
Use of both rhythm and withdrawal is widespread and has contributed to the significant decline in Sri Lankan fertility in recent years. Modern temporary methods such as oral contraceptives, IUDs, and injectables appear to be 'not too readily accepted' by many Sri Lankan couples. For most methods used it appears that both the husband and the wife play an important role in the contraceptive decision-making process.
Preliminary results from the 1985 SLCS reveal that there continues to be an important need in at least two areas of family planning service delivery in Sri Lanka -- one relates to traditional mathods and the other to modern temporary methods. Although the prevalence of use of the rhythm method is quite high in Sri Lanka, knowledge of the correct 'safe and unsafe' periods in a woman's menstrual cycle appears to be lacking and incomplete. Dissemination of information on methods involving periodic abstinence, and the provision of counseling services are needed. The main reasons couples gave for choosing traditional methods are plausible (i.e., convenience of use and absence of side effects).
Use of modern temporary methods in Sri Lanka continues to be low, even though a high proportion of both wives and husbands expressed interest in learning more about these methods. Concerns about side effects appear to be a major motivating force behind the nonuse or discontinuation of modern temporary methods such as the pill, IUD and injectables. Actions taken to improve the dissemination of information and to provide counseling services for all temporary methods are likely to increase contraceptive prevalence, user satisfaction and method-use effectiveness.
The major objectives of this study were:
- to find out the reasons why use of traditional contraceptive methods in Sri Lanka is so high compared to use of modern temporary methods;
- to determine how rates of traditional and modern contraceptive use have changed over time;
- to asses the depth of knowledge about traditional and modern contraceptive methods in terms of how to use the method, how they work, and where to obtain them;
- to examine husbands' attitudes towards and reported practice of family planning and to determine the consistency of husband and wife reporting of contraceptive use;
- to determine the extent of husband and wife communication in family planning matters, to explore the contraceptive decision making process, and to consider how both of these processes vary according to fertility desires and the methods used;
- to examine the reasons for using not using or discontinuing various methods of contraception and to explore the patterns of method switching from temporary to permanent methods, and between traditional and modern temporary methods;
- to estimate the prevalence of side effects of modern temporary and permanent methods;
- to assess the level of satisfaction of husbands and wives with various methods, and to explore the role of contraceptives in motivating others to try various methods;
- to construct sociodemographic profile of traditional and modern contraceptive users.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
This survey was a follow-up survey of the 1982 Contraceptive Prevalence Survey (CPS82) respondents and a subsample of their husbands. In CPS 82 all ever-married women 15-49 years old living in housing units one of which is defined as a place of residence separate from the other places of residence and with an independent access. (One or more households could occupy one housing units). The population living in places other than housing units such as institutions were excluded.
v1.0: Full edited dataset, for internal DPD Use
The scope of the survey were:
- use of traditional contraceptive methods in Sri Lanka, use of modern temporary methods;
- depth of knowledge about traditional and modern contraceptive methods;
- attitudes towards family planning, consistency of husband and wife's reporting of contraceptive use;
- contraceptive decision making, fertility desires and methods used;
- patterns of method switching from temporary to permanent methods,
- prevalence of side effects of modern temporary and permanent methods;
- level of satisfaction of husbands and wives with various methods,
- role of contraceptives in motivating others to try various methods;
The coverage of the survey was restricted to 17 Districts in the West, South and Central regions of Sri Lanka and included only those respondents (women) to the CPS82 who were still currently married and under 50 years of age in 1985.
Respondents of CPS82 who were still currently married women and under 50 years of age in 1985.
Producers and sponsors
Department of Census and Statistics
Ministry of Finance and planning
Family Health International
US Agency for International Development
Financial support and Technical assistance
Family Health International
The 1985 SLCS was a follow-up survey of respondents to the 1982 CPS and a subsample of their husbands. The sampling procedures used in the 1982 CPS are outlined in Sri Lanka Contraceptive Prevalence Survey Report: 1982. The sample was a nationally representative probability sample drawn from a two stage design. In the first stage, the country was stratified into 2 strata: urban and
rural. A sample of census blocks was drawn from the urban and rural strata with probability proportional to the stratum population which was defined as the female population age 15-49. The required number of census blocks within each stratum was then selected from among the 24 administrative districts being proportional to the stratum population within the district.
The second stage consisted of selecting households from up-dated lists of housing units - In urban census blocks, a systematic sample of 15 housing units was selected from lists of such units. In the rural census blocks, clusters of approximately ten housing units were formed and one cluster was
selected at random from each block. Whenever there was more than one household per unit, all households in every housing unit were selected into the sample. Unfortunately, due to socio-political problems in some northern and eastern districts, seven districts in that area of the country were excluded from the follow-up study.
The sample for the 1985 SLCS was defined to consist of all CPS respondents meeting the following criteria: a) living in the sample districts; b) married at the time of 1982 CPS and at the time of 1985 survey; c) less than 50 years of age. In addition to the seven districts in the north and the east, two census blocks were also excluded, one because of flooding during the fieldwork stage, and the other -because it had been submerged in the construction of the Kothmale reservoir. As a result of this selection procedure the women in the SLCS sample have necessarily been married for at least 3 years and are 18 or more years of age.
Within every census block included in the follow-up survey an attempt was made to interview every third female respondent's husband. Because some husbands were unable to be contacted after two return visits, only about one-fourth of the female respondents' husbands were actually
interviewed, instead of the one-third originally planned.
Note on Contraceptive Prevalence Survey 1982 (CPS82)
The sample was a nationally representative probability sample drawn from a two stage design. In the first stage, a sample of Census Blocks was drawn from the predetermined strata. In the second stage a sample of housing units was drawn from each selected Census Block. All ever-married women aged 15-49 who lived in the selected housing units or who spent the
previous night in the unit were interviewed in detail.
First Stage Selection
The country was stratified into 2 strata as urban and rural areas. It was decided to select a sample of about 4,500 respondents spread out in 540 Census Blocks. A Census Block is an area assigned to an enumerator at the 1981 Census of Population and Housing for the purpose of enumeration. The Survey estimates were required at the national level and hence it was decided to allocate the sample proportional to the stratum population which was defind as the female population aged 15-49. This made it necessary to select 90 Census Blocks from the Urban Stratum and 450 from the rural stratum. The required number of blocks within each stratum was then selected from among the 24 administrative districts, the number selected from each district being proportional to the stratum population within the district.
Second Stage Selection
The Second' Stage consisted of selecting households from lists of housing units. These lists were obtained from the Pre-listing Forms prepared for the 1981 Census and were updated by the procedure outlined in the next section. The procedure for selection of households was as follows.
In the urban Census Blocks, a systematic sample of 15 housing units was selected from a list of such units. That is, starting from a randomly selected unit every unit at the end of an interval equal to one fifteenth the number of units in the block was selected in to the sample. In the rural Census Blocks, clusters of approximately ten housing units were formed and one cluster was selected at random from each block. All households in every housing unit whenever there was more than one in a unit were selected into the Sample.
Listing of Housing Units
The target population of the survey was all ever-married women 15-49 years old living in housing units. A housing unit was defined as a place of residence and with an independent access. One or more households could occupy one housing unit.
The population living in places other than housing units such as institutions were excluded. The effect of this exclusion the survey estimates was considered to be small as the population living in non-housing units at he 1981 census was a very small proportion of approximately 2 per cent. The sample frame for the survey was the prelisting Forms of the 1981 Census. A prelisting form was prepared for each Census Block and it contained a list of all housing units and non-housing units in the Census Block. The Pre-listing Forms of the selected Census Blocks were updated by the range Statistical Investigators of the Department. These officers were also the ones who prepared and later updated the lists initially for the Census and were quite familiar with the updating procedures. However, they were given specific instructions on updating by asking to delete the demolished and vacant units and to insert in the proper place any new units that had come up since the Census.
While the Survey was going on, it was found that some selected housing units were vacant, some were non-existent, and some could not be located by their addresses. However, the proportion of such units was quite small, only 2.7% and is unlikely to have caused a bias in the selection procedure.
There were actually 3,022 eligible respondents, i.e., currently married women below 50 years of age, married at the time of 1982 CPS and resident in the 17 districts covered in the survey. Of these, interviews were completed for 2,310 women, 76 percent of the eligible respondents. The following is a breakdown of the follow-up efforts in the 17 Districts included in the survey:
Completed interview 2310 76.4%
Refused 20 0.7%
Not at home 203 6.7%
Left to reside elsewhere 389 12.9%
Other (inaccessible due to floods; 100 3.3%
Total 3022 100%
(A total of 577 husbands were interviewed.)
Dates of Data Collection
Data Collection Mode
The survey organization was headed by a National Director who was the Director of the Department of Census and Statistics. A Deputy Director of the Department served as Project Manager and an Assistant Director as the
Assistant Project Manager. A core staff of three statisticians assisted in the organization and implementation of all survey activities from the design to the publication of the results. Other staff were added as necessary.
Field work was carried out by 25 interviewers organized in five teams, with each team led by a supervisor. All interviewers were Statistical Investigators of the Department; the large majority of them had interviewing
experience from either the WFS or the CPS. Technical assistance was provided by FHI research staff and consultants in the design of the questionnaires and the data analysis.
Data Collection Notes
The survey had two phases. The first phase was a qualitative study consisting of a series of unstructured. in-depth interviews with married women and men. An exploratory study was carried out prior to the major
survey to determine a suitable approach for assessing knowledge attitudes and use patterns of contraceptives. This study was an anthropological inquiry into the subject of contraceptives and the associated semantics to find an appropriate starting point for a conversation on the subject paths of progress. etc. The study was designed in consultation with an anthropologist and a team of senior officers of the Department comprised of two statisticians who functioned as core team members two team supervisors and several interviewers with considerable experience in previous fertility surveys.
These officers spent several days in selected localities interviewing people in free conversation guided by predetermined themes. There was no structured questionnaire. General information was obtained from the approximately 200 respondents on knowledge and attitudes toward various family planning methods and practices as well as their contraceptive decision making and behaviour. The qualitative phase also unveiled local expressions commonly used to refer to methods such as periodic abstinence ("being careful") and withdrawal ("moving out"). These interviews led to the discovery that many couples do not think of traditional methods as methods per se but as habits or practices that originated in their daily routine and not from information or counseling provided by health professionals. Issues and common terminology used in family planning discussions that were identified in the qualitative study (Phase One) were then incorporated into the main survey questionnaire.
The second phase was the follow-up of selected women and a sample of their husbands from the 1982 CPS. The 1985 SLCS, carried out by the Department of Census and Statistics (DCS) in collaboration with FHI , generated a wide variety of opportunities to explore various aspects of contraceptive behavior. Interviewing both wives and husbands offered the opportunity to compare a woman's fertility awareness, behavior and reporting with that of her spouse. Furthermore, because the 1985 SLCS was also a follow-up of female respondents from the 1982 CPS, there was essentially a built-in panel study in which changes in attitudes, fertility desires, and contraceptive and fertility behavior of the same women
could be observed over a three-year period. The 1985 follow-up interviews of the CPS respondents also allowed us to compare the reported use of traditional and modern methods for the same women obtained from two very different data collection instruments. Special modules were designed for each contraceptive method so that very detailed method-specific information could be obtained from respondents. Information was obtained on the respondents' knowledge of a method how it worked; how to correctly use it; knowledge of and experience with side effects; satisfaction with a method; reasons for using; not using or discontinuing a method; perceived advantages; the extent and patterns of husband wife family planning communication and decision making; and method switching patterns and method failures.
In the WFS and CPS, knowledge and use were measured by asking the respondent what methods
they had heard of, if any, and what methods they had used or were using at the time. This was usually followed by a probing: each method not mentioned by a respondent was then referred to by the interviewer by name of method, only, in the CPS, but with a short, descriptive statement in the WFS, and the respondent was asked if she had heard of it and, if so, whether she had ever used it. The SLCS team felt that this may not be the best way to elicit information on contraceptive behavior that may have spanned many years. Furthermore, it had been observed that the measurement of prevalence,
particularly of traditional methods, differed from one survey to another.
The results of the qualitative interviews served as the basis for designing the survey instrument for the second phase. The main survey interviews commenced with a general inquiry of usual background characteristics of the woman, moving gradually to the subject of pregnancy and delaying pregnancy. At this point she was asked if she expected to have any (more) children in the future, thereafter, designed to ascertain the respondent's status with respect to i) current use, ii) past use, and iii) intended future use of contraception. Women who did not want more children and those who wanted more but later were
asked what they were doing to delay or prevent pregnancy. Past use was identified by asking each woman whether at any time in the past she did anything to delay or prevent a pregnancy. Finally, women were asked a hypothetical question: What would you do, if the need arises in the future, to delay or prevent a pregnancy?
This information was gathered in the background section of the questionnaire, at the end of which all methods the respondent had used in the past, was currently using, expecting to use, and never had used were known as a result of these preliminary but probing questions. This information was recorded in a chart indicating use status with respect to each method. This chart was printed on the inside front cover of the questionnaire and served as a guide for the rest of the interview. The remainder of the interview consisted of a series of questions on contraceptive methods: the pill, IUD, condom, injection, female sterilization, male sterilization, withdrawal, rhythm, abstinence, plus other practices named by the respondent.
The section for each method was structured into three segments: (1) never users, (2) current users, and (3) past users. The interviewer, by reference to the Use Status Chart, directed the respondent to ,the segment relevant to her for each method. The sequence of questions under segments for never use, current use or past use began by reaffirming that particular use status. The sequence for never users was initiated by inquiring whether she had ever heard of the method. If yes, this was followed by a question which
probed whether she had at any time or even for a short period used ,that method. If, after probing, it was discovered that the respondent had actually used the methods, the interviewer shifted to the appropriate use status category (i.e., current or past use) and proceeded from there. The remaining questions progressed in the following sequence: source of information, source of supply, how to use the method, how the method prevents conception, who advised her to use the method, duration of use, side effects
experienced and remedial action taken, knowledge of other side effects, reasons for selection of method, accessibility and availability, intention to continue or discontinue, expected future use, pregnancy while using, respondent and spouse's satisfaction with the method, and role as a motivator
Department of Census and Statistics
Ministry of Finance and Planning
The questionnaire has two main sections:
1. For female respondents
2. For male partners of the female respondents
The Questionnaire for the female respondents covered aspects such as:-
Basic details on demography, education, employment, ethnicity and religion of both the respondent and her female partner
Her biological details, pregnancy details
Awareness and usage of contraceptive methods
Husband-wife communation (relations)
The questionnaire for the male partners covered aspects such as:-
Basic details on demography, education, employment, ethnicity and religion of both male and female partners
Awareness and usage of contraceptive methods
Husband-wife communation (relations)
Information Unit (Department of Census and Statistics)
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Note - [Department = The Department of Census and Statistics (DCS)]
Source : http://www.statistics.gov.lk/databases/data%20dissemination/DataDissaPolicy_2007Oct26n.pdf
Department of Census and Statistics, Sri Lanka Contraceptive Survey 1985 [SLCS1985], Version 1.0 of the public use dataset (October,2009), provided by the National Data Archive, Data Processing Division, www.statistics.gov.lk
Director General (Department of Census and Statistics)