Natural contraceptive use in a modern population: correlates, fertility timing and efficacy among users in Moldova

Abstract

This thesis investigates the dynamics of natural contraceptive method use in a low fertility setting in contemporary Eastern Europe. Natural contraception was one of the key drivers of European fertility transition and still accounts for a large proportion of current method use in the developing world as well as in the Eastern Europe. Nonetheless, little systematic research on natural method use exists in contemporary demographic literature. This thesis focuses on the post-Socialist republic of Moldova- the poorest country in Europe. The Moldovan contraceptive regime, as observed elsewhere in Eastern Europe, is characterised by limited uptake of modern contraception and widespread use of induced abortion. Under the Moldovan Socialist government, social pressures including the requirement of children to obtain housing led to an almost homogenous pattern of early low fertility. In examining natural method use in the Moldova, this thesis addresses not only the limited understanding of natural method use in contemporary societies, but also contributes to unravelling the potential interaction between contraception and abortion in a low fertility setting.
The main aims of this thesis are to: (i) provide a quantitative evaluation of the dynamics of natural contraceptive use in a low fertility setting and (ii) explore the changing fertility situation in Moldova. These aims are accomplished using data from the first ever Demographic and Health Survey (DHS) conducted in Moldova during 2005. The thesis comprises four research chapters as well as an introduction and conclusion.

The introduction chapter examines the significance of natural methods in historical and contemporary societies, and provides context on the Moldovan demographic and socio-economic context. The second chapter examines the factors influencing the use of natural contraceptive methods. Specifically, the effect of economic hardship on the persistence of natural contraceptive use is examined. The analysis also evaluates the impact of FP programmes designed to reduce reliance on natural methods at a regional level. It contributes direct policy relevance by improving understanding of the efficacy of reproductive health interventions. In particular, the chapter identifies an impact of uneven coverage of health infrastructure on contraceptive choice and switching patterns. The second and third chapters evaluate the fertility timing patterns associated with natural method use – specifically the effect of contraceptive confidence on the interval between marriage and first birth and all subsequent birth intervals. These analyses also expand the understanding of contraceptive confidence by examining the interaction between natural method use and induced abortion. The fourth chapter tests the hypothesis that natural method use is in fact less effective than modern method use. This is pertinent to the peculiar demographic situation in Moldova, where low fertility occurs concurrently with a high prevalence of natural method use. The analysis evaluates the determinants of contraceptive discontinuation using the contraceptive histories recorded in the DHS contraceptive calendar. Key results are the high failure rates of natural contraceptives, and the high propensity of modern reversible method users to abandon use- hence exposing them to unwanted pregnancy. The final chapter summarises the key findings from each paper and addresses the policy implications as well as limitations of the thesis. Areas for future research are also identified.

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Identifiers

ORCID for Sabu S. Padmadas: orcid.org/0000-0002-6538-9374

ORCID for Gabriele B. Durrant: orcid.org/0009-0001-3436-1512

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