London School of Hygiene & Tropical Medicine.
University of Amsterdam.
Int Perspect Sex Reprod Health. 2017 Sep 1;43(3):111-119. doi: 10.1363/43e4517.
According to Demographic and Health Survey (DHS) data, highly educated urban women in some West African countries simultaneously have low rates of both contraceptive use and fertility-suggesting that the DHS may not be capturing a complete picture of women's contraceptive practices.
Individual in-depth interviews and focus group discussions were conducted with a total of 48 women aged 18-49 in Accra, Ghana, who had at least a secondary education to explore their reproductive lives and relationships, and their views on and use of fertility regulation strategies. Data were analyzed using iterative thematic techniques.
Women commonly reported using combinations of contraceptive methods, including "counting days" (using a calendar and the date of one's last menstrual period to estimate "unsafe" days-those on which the risk of conception is high), as well as withdrawal, condoms and frequent use of emergency contraceptive pills. Women described practicing "periodic contraception": for example, counting days to determine unsafe days and practicing contraception ad hoc on such days. Method use combinations varied from cycle to cycle-forming a "mosaic" of method use combinations over time.
The fertility control strategies commonly reported by the study respondents-periodic contraception, and frequent use of traditional methods and emergency contraceptive pills-are likely not adequately captured in general surveys such as the DHS. Such surveys are also not well suited to measuring combinations of methods and mosaics of method combinations. New ways of capturing women's fertility regulation practices should be considered, including additional survey items, new question modules and specialist studies.
根据人口与健康调查（DHS）数据，一些西非国家受过高等教育的城市女性同时具有较低的避孕使用率和生育率——这表明 DHS 可能没有捕捉到女性避孕措施的全貌。
对加纳阿克拉的 48 名年龄在 18 至 49 岁之间的受过至少中等教育的妇女进行了个人深入访谈和焦点小组讨论，以探讨她们的生育生活和关系，以及她们对生育调节策略的看法和使用情况。使用迭代主题技术对数据进行了分析。
妇女通常报告使用多种避孕方法的组合，包括“数日子”（使用日历和上次月经的日期来估算“不安全”的日子——受孕风险高的日子），以及撤出、避孕套和频繁使用紧急避孕药。妇女们描述了实行“定期避孕”：例如，通过数日子来确定不安全的日子，并在这些日子里临时采取避孕措施。方法使用组合从一个周期到另一个周期变化——形成了随着时间推移的方法使用组合的“马赛克”。
研究受访者普遍报告的生育控制策略——定期避孕、频繁使用传统方法和紧急避孕药——在 DHS 等一般调查中可能没有得到充分反映。此类调查也不适合衡量方法组合和方法组合的马赛克。应该考虑采用新的方法来捕捉女性的生育调节实践，包括增加调查项目、新的问题模块和专业研究。
