Contraception and gender empowerment in our sample The demographic profile of contraceptive users

Turning to demographic variables associated with different types of method, we observe that around 60% of abstainers and of women who use modern methods claim that becoming pregnant would not constitute a problem, compared to about 40% of women using traditional methods only (which mostly are breastfeeding and thus eager to space their pregnancies). These declarations are somewhat counter-intuitive as one would imagine that women using the most effective methods (i.e., modern contraception) would be more eager to avoid a pregnancy than "abstainers" (often using a constellation of methods among which low coital frequency) and "traditional methods users" (breastfeeding mainly). These results underline the great acceptance of and willingness to bear children throughout one’s life in Niger (Table 15).

Abstainers seem to be slightly younger and with fewer children than the general profile of our sample, as well as compared to women resorting to modern contraception.

However, due to the low frequencies of women practicing abstinence in Niger, it is difficult to conclude in that respect. Finally, women who resort to abstinence appear to be more often monogamous. Modern method users in the CC surveys are as often monogamous as the entire sample (Table 15).

Table 15. Relative distributions of contraceptive use, by problem if found out about pregnancy, age of the respondent, parity, among married women. Camber Collective data, Niger (2014).

(unweighted data)

The socioeconomic profile of different contraceptive users

If we now look at the socioeconomic profile of the different contraceptive users in our CC sample, we notice that abstainers have an overwhelmingly "modern" profile, even more so than modern contraceptive users. Indeed, 49% of abstainers live in urban areas compared to 17% of married women in our Nigerien data and 30% for modern methods users; fewer of them have no education: 51% compared to 64.4% in the overall sample and 58% for modern method users. Finally 39% of them are among the wealthiest quintile, compared to 15% of married women in our sample, and 23% among modern method users. We also notice that overall, women who use birth control (traditional or modern or abstinence) tend to have more education and are also wealthier than the

Table 16. Relative distributions of contraceptive use, by area of residency, education, work in last year and wealth quintiles, among married women. Camber Collective data, Niger (2014).

(unweighted data)

Women who use traditional methods tend to live more in rural areas, while women who resort to modern methods (and abstainers) tend to live more in urban areas. Interestingly, even though the socioeconomic status appears to be a discriminant factor regarding contraceptive use in our sample, being active in the labor market (i.e., having worked in the last 12 months) does not appear to be much related to contraceptive use (Table 16).

Although, this result might be related to the fact that most women who work in Niger are likely to be active in the agricultural sector. In essence, wealth and education seem to be associated with using a means of birth control (whatever it is), and the area of residency appears to be more related to the type of fertility regulation.

If we look at the educational differences within the couple in the CC data, we observe that abstinence as a means of family planning and traditional methods tend to be more used among couples where women have an equal or higher education than their husband. Modern methods are more used by couples where the husband has higher educational levels than his wife (Table 16).

Variable

Same level of education 59.2 54.9 52.9 62.5 60.2

Female has more education 26.5 30.6 19.7 19.5 20.9

Male has more education 14.3 14.5 27.4 18.0 18.9

Total 100.0 100.0 100.0 100.0 100.0

From the analysis above and despite the uncertainties linked to the sample of the CC survey (overrepresentation of educated women and of contraceptive users among the less educated), we can draw a number of conclusions on abstinence as a means of birth control. First, we noticed that abstinence as a method is in all likelihood numerically speaking a marginal phenomenon in Niger (and perhaps in other countries of the region), since only 10% of contraceptive users declared using this method in the CC survey which contained an adequate question to measure it. If we translate this proportion to the 14% using contraception in the DHS, we can guess that between 1%

and 2% of all married women would have declared abstinence as a method if someone had asked them. This is not much, compared to the 30% who declared being sexually inactive in the previous month, still according to the DHS (Table 12). Interestingly, other traditional methods (periodic abstinence, withdrawal, conscious use of breastfeeding as a method) are apparently marginally used as well in Niger. Second, we found that the overwhelming majority of women who use "abstinence as a method" (about 70%) are not practicing postpartum abstinence and are cohabiting with their partner: so, with the question used in the CC survey, we do seem to be capturing a deliberate birth control choice. Third, half of these "abstainers" are sexually active and the vast majority uses another method as well: abstinence seems to be an additional precaution in a mosaic of methods (Marston et al. 2017). Fourth, almost half of these "abstainers for birth control"

live in urban areas, half of them have at least some level of education, and about 40%

belong to the wealthiest quintile. For a country like Niger, this profile exudes important levels of modernity. We therefore expect that this profile will stand out regarding its decision-making power.

Decision-making power and contraceptive use

Not surprisingly, some of the tendencies observed using indirect measures of gender empowerment (i.e., education, wealth, area of residence) are confirmed through direct measures of autonomy (i.e., decision-making power within the couple). Overall, the group appearing to have the most decision-making power in our sample is formed by women resorting to abstinence. The answers allow for two levels of agency: one that is negotiated (participating to the decision) and another one which is individual (deciding alone). About 80% of women resorting to abstinence declare they have a negotiated kind of agency concerning household purchases and in decisions related to their own health.

However, they seem to decide more often alone about contraception. Indeed, about half of contraceptive users declare negotiating with their partner regarding contraceptive use, and the other half declares choosing their contraceptive method alone. This finding is coherent with the fact that almost half of women declaring abstinence as a means of family planning do state that they can refuse sexual intercourse (Table 17).

By contrast, about half of the women in the overall CC sample declare having no decision-making power regarding household purchases and in relation to the respondent’s health. The vast majority (90%) of women in the sample declare being capable of deciding on contraceptive use, of which 70% is negotiated within the

household, and 20% is individual; but almost 90% of the sample declares not having the right to refuse sexual intercourse. Women who are not using contraception in our CC sample have slightly less decision-making power than the average woman, while women who use traditional methods have slightly more decision-making power on those four dimensions. Finally, modern users in our sample have differing levels of autonomy.

Indeed, they tend to have less decision-making power regarding household purchases and in health related matters than the average woman. Interestingly, however, although modern users in the below table do declare they have a negotiated kind of conjugal power regarding the choice of contraceptives, only 9% of them state they have the right to refuse sexual intercourse (Table 17).

Table 17. Relative distributions of contraceptive use, by decision-making power in the couple (household purchases, respondent’s health, contraceptive use, right to refuse intercourse), among married women. Camber Collective data, Niger (2014).

(unweighted data)

These results regarding modern contraceptive users are likely to be an artifact, as explained by the atypical profile of modern users in the CC sample. Indeed, as noted earlier (Appendix chapter 5: Table 5.3), the Camber Collective survey seems to have over-sampled modern users with no education. However, these observations could also be related to the fact that abstainers who were also using modern methods were (by construction) excluded from the pool of modern contraceptors. If we perform additional tests in comparable samples (i.e., with couples with the same level of education) and contrast modern users to non-users in the CC to the ones of the DHS (using the same definition for both samples i.e., re-including abstainers who are also using modern contraception in the modern users pool), we note that educated modern contraceptors in

Variable

No decision power 22.4 50.9 52.7 51.4 50.7

Combined (with husband or other) 75.5 45.7 43.1 43.5 44.6

Alone 2.1 3.4 4.2 5.1 4.7

Total 100.0 100.0 100.0 100.0 100.0

Total (N=) 49 173 262 1252 1736

Decision power regarding the respondent's health

No decision power 16.3 40.5 50.4 47.4 46.3

Combined (with husband or other) 81.6 54.9 45.4 46.9 48.4

Alone 2.1 4.6 4.2 5.7 5.3

Total 100.0 100.0 100.0 100.0 100.0

Total (N=) 49 173 262 1252 1736

Decision power regarding the respondent's contraceptive use

No decision power 2.4 7.3 7.5 11.3 9.6

Combined (with husband or other) 48.8 74.7 75.6 68.3 70.0

Alone 48.8 18.0 16.9 20.4 20.4

the CC sample have more household and health power than the average educated female like in the Demographic and Health Survey. However, unlike in the DHS, educated ⁷⁰ modern users remain having lower levels of sexual negotiating power.

On a final note, these last findings could perhaps indicate to a largely hidden situation, in which some modern users, at the dawn of the fertility transition and contraceptive revolution, in their country, might have an easier time negotiating daily decision-making but still struggle to exert power in terms of intimacy. As noted earlier in our thesis, the arrival of the pill in the Western World was not necessarily a synonymous of empowerment for everyone, as some women felt they had no excuses to refuse coitus to their partners since falling pregnant was no longer a risk. However, we did confirm in this chapter that abstainers (although marginal in numbers) do embody important elements of modernity and gender empowerment in Niger.

5.5 DISCUSSION

From a descriptive point of view, our results regarding the use of abstinence as a means of fertility regulation in Niger goes in the same direction as previous literature regarding the use of traditional contraception amongst the urban, wealthier and most educated women in West and Middle Africa (Johnson Hanks 2002; Machiyama & Cleland 2014;

Rossier & Corker 2017; Marston et al. 2017). We now know that this group of women does exist, even in Niger, a country at its very early stages of fertility transition.

However, this category of traditional methods used by modern women constitutes a very niche group. A study on educated women in Niamey would provide the maximum potential of abstainers in the country.

The CC data also allowed us to get a more all-encompassing vision of modernity in Niger; in the DHS we noticed that, invariably, modern contraceptors constitute by far the most modern group in this country. However, when trying to measure other methods to their full extent (i.e., abstinence as a method, and other traditional ones) we see that there other methods are alternative "modern" choices, and this is true not only in socio-economic terms but also regarding the levels of decision-making power.

In this chapter, we have noticed that the group of women that withholds the most resources and agency to challenge tradition and make autonomous decisions are women who are using modern contraception (i.e., namely through the DHS data), as well as a very marginal minority of the women who reduce their sexual activity or combine low coitus with other means of family planning. Interestingly, these results in Niger are different from what has been observed in contexts such as Sicily and Cameroon. In both contexts, respectively, coitus interruptus and periodic abstinence are amongst the most widespread means of fertility regulation; and also in these two situations, it looks like the symbolic value of the contraceptive method takes a greater importance than its

We could not include contraceptive decision-making as the DHS asks only contraceptive users about

70

who has the final say regarding family planning use (whereas the CC survey asks all women).

effectiveness (Johnson-Hanks 2002; Gribaldo et al. 2009). But good methods of contraception were still difficult to find in Cameroon in the late 1990s and even more in Australia in the 1960s. In Niger, as we saw, abstinence appear to be an exceedingly marginal method, and periodic abstinence and withdrawal even more so; modernity seems to be overwhelmingly represented by the use of modern contraception; and the ease of access to modern methods (Potts et al. 2012) certainly plays a key role.

In essence, modernity can take different shapes. Traditional means of fertility regulation can be used as a tool to advance in modernity, while at the same time remaining loyal to one’s cultural and personal values. Abstinence as a means of fertility regulation, albeit numerically marginal in Niger, appears to be coherent with the concept of multiple modernities. However, this chapter also seems to indicate that in Niger today, modernity in fertility regulation seems to be carried overwhelmingly through the adoption of modern methods, just because modern users are much more numerous than abstainers or traditional method users. In the particular pre-transitional Nigerien context, we believe it would be interesting to find out about the underlying values pushing couples to opt for modern methods, rather than adopting traditional ones (periodic abstinence) as it is frequently done in other Western and Middle African countries. We know that in Eastern and Southern Africa, early implementation of family planning programs have helped to rapidly impose the practice of modern contraception, and that traditional contraception (and probably abstinence as a method) does not seem to be often chosen there (Rossier

& Corker 2017). However, pioneer programs existed in Ghana as well in the 1970s and they did not seem to have discouraged elite women from resorting to traditional means of family planning there. Modern contraceptive use itself may be a way in which multiple modernities manifest itself in Niger, in the sense that modern methods are still overwhelmingly used for spacing in that context: women and couples seem to find a coherence between their traditional values and modern technologies by sticking to their initial reproductive objectives. In that sense, the situation in Niger bears some similarity with that described by Bledsoe et al. (1998) for rural Gambia: they showed how the first modern contraceptive users had decided to space to improve their health in order – ultimately – to bear more children.

It is important to remind that the CC sample that does not allow to portray Niger in a representative light. First, it is composed of women who are overall younger, more urban, and more educated than in the DHS sample. Not only are they more educated, but more of them have reached a higher degree than their husband. Second, our CC sample has twice more contraceptive users than the DHS. If we narrow our samples to couples with the same level of education, we notice that the share of women using (modern) contraception among the educated ones was virtually identical in both samples. Large differences stemmed essentially from (modern) contraceptive users with no education, that seemed to be over-represented in the CC sample. Since the households were selected through random walks, this method could have attracted non educated women who were particularly interested in discussing family planning. Over-declaration of

modern contraception by less educated women due to probing is another possible explanation.

Altogether, we deem that this chapter managed to raise other interesting interrogations regarding the measurement of contraception. We believe in the importance to more adequately measure all strategies through which couples do regulate their fertility, because of their programmatic implications (users of less effective methods do not constitute the same target for policy makers and health workers as non users). As noted in our previous chapter, since postpartum abstinence is declining, we should consider the possibility that in some settings, abstinence or Careful Love are possibly used as one amongst other means of fertility regulation. However, adequately measuring the different alternative fertility regulation strategies accurately seem also important, so as to better capture possibly frequent contraceptive mosaics (Marston et al. 2017).

Having a panorama of all traditional methods will be key to better quantitatively assess the different kinds of methods used by the varied population groups. However, as of now in the DHS, only modern methods seem to be captured adequately, leaving many researchers to speculate how women regulate their fertility in countries with low modern contraceptive prevalence. Indeed, it seems be a good idea to probe only for traditional and natural methods (i.e., abstinence, calendar method, withdrawal, etc.) and coitus related modern methods (i.e., condoms, diaphragm, spermicide, etc.) in order to tackle under-declaration. Moreover, setting an exact time-frame (i.e., in the last 30 days) for these methods could not only help to address the under-reporting issue, but as suggested by Marston et al. (2017), could also constitute a way to take into account the different mix within a defined window.

Finally, more research is needed to understand the reasons behind the choice for different types of methods. Indeed, women using the same types of contraception might have different motivations and values guiding their contraceptive choices. As for now, for example, qualitative literature (Jonson-Hanks 2002; Marston et al. 2017) has allowed to provide more clarity into the underlying reasons behind the traditional use of family planning. However, we are unable to provide more insight into these dynamics at a larger scale. The reasons and values guiding women towards modern methods would also be necessary to better understand the choice of alternative methods. We are unaware, as of now, of the different profiles of highly effective contraceptive users, namely if there are women who are mainly motivated by the sexual freedom it can afford, or others who could be primarily looking for means of fertility regulation that leave a minimal margin for error. This type of knowledge would allow us to understand more clearly women’s individual perceptions of the costs and benefits of different method, which may be key to further progress in terms of effective prevention from unintended pregnancies in the region.

CHAPTER 6

SEXUAL INACTIVITY IN