Community-level determinants of contraceptive use in the Philippines: A structural analysis

Abstract

We use household and community data from the Philippines to estimate a multilevel model of contraceptive use. We go beyond previous efforts in this field by developing a structural model that recognizes joint endogeneity and the temporal ordering of variables. by considering a wider range of community influences on fertility behavior, and by employing an econometric procedure allowing for a multilevel error structure. The results suggest that there are significant effects on fertility behavior of community-level family planning services, labor-conditions, and infrastructure development. These results provide insights regarding the structural determinants of contraceptive use and fertility that are useful for drawing policy implications.

Contextual Influences on the Use of Health Facilities for Childbirth in Africa

“…Recently there has been growing interest in examining community influences on health outcomes, so as to put health in its socioeconomic environment (see for example [12][13][14][15][16][17][18][19][20][21][22][23], a product of the recognition that the determinants of individual health extend beyond individual and household risk factors. Such studies relate individual health outcomes to socioeconomic characteristics of the community (e.g.…”

“…In the context of reproductive health, studies of community effects have focused predominantly on fertility behavior (see for example, 12,13,14,21,29), although some studies have examined maternal health outcomes (6,18). Results indicate that the presence and quality of reproductive health services (13,14,21), levels of economic development (14,21), levels of school participation (21), economic roles of children (6,29), and community fertility norms (30,31) all influence individual reproductive behavior.…”

“…Results indicate that the presence and quality of reproductive health services (13,14,21), levels of economic development (14,21), levels of school participation (21), economic roles of children (6,29), and community fertility norms (30,31) all influence individual reproductive behavior. These studies have examined community influences on reproductive health in single country settings, and there is a dearth of studies that have quantified and compared community influences on health outcomes across several countries.…”

The interrelationship of fertility, family maintenance and Mexico-U.S. Migration

“…The community context in Mexico, as in the United States, plays a fundamental role in the formation of family size ideals, in providing opportunities for family maintenance and socio-economic advancement, and in presenting opportunities for solo and family migration to the United States. Studies of fertility identify reproductive norms and practices in communities of origin as playing an important role in early socialization and in the formation of family size goals (Degraff, Bilsborrow and Guilkey 1997, Guilmoto and Rajan 2001, Kirby, Coyle, and Gould 2001. The emphasis on early socialization does not discount the influence of adult experiences, particularly in migrant destinations, on marital fertility, but rather it underscores the cultural clashes that rural-urban and international migrants experience as they circulate between origin and destination environments (Rundquist and Brown 1989).…”

Appropriate Methods for Analyzing the Effect of Method Choice on Contraceptive Discontinuation

“…Multilevel versions of these models have been proposed by several authors (Angeles, Guilkey and Mroz 1998;De Graff, Bilsborrow and Guilkey 1997;Lillard, Brien and Waite 1995;Lillard 1994). De Graff et al (1997) use a system of three equations involving a mixture of continuous and binary outcomes relating to fertility and contraceptive use.…”