Que por las condiciones personales del imputado y circunstancias del caso no exista riesgo para la comunidad

Although calendar data are an improvement of the way contraceptive use data is collected in developing countries (Strickler et al. 1997) compared to earlier data collection techniques such as the collection of contraceptive use within a birth interval (Goldman et al. 1989b), the procedure is not free of bias, or error. Error may arise from the considerable burden placed on women to recall events retrospectively. Such an exercise leads to a likelihood of some events not being reported, or over-reported (and even misplaced), leading to duration heaping and inconsistencies (Ali et al. 2003). Inconsistencies would be identifiable if the estimates from current-status data and calendar data are not the same.

Since it is inevitable for discrepancies to emerge from two different means of collecting similar information, it is important to note that estimates from both sources (current contraceptive use and in the calendar data) should be comparable for the data to be of meaningful use.29

Following Curtis and Hammerslough’s procedure, consistency in reporting of calendar data is assessed by comparing current contraceptive use of women in the latest and the previous survey. Because the samples considered for analysis are representative of the total population, the estimates generated represent the composition of the population at a point in time. To ensure comparability, the samples considered in generating contraceptive prevalence estimates from the current-status data (previous survey) and the calendar data (latest survey) constitute all women. The reason for adopting this criterion is because marital status is likely to change between dates (Curtis and Hammerslough 1995). By doing so, it is assumed that a change in marital status during the period of investigation would not lead to changes in estimates and conclusions since all women in the two samples were considered.

Table 3.4 compares estimates of current contraceptive use from an earlier survey to estimates of contraceptive use in a later survey at a corresponding point in time. Following Curtis and Hammerslough (1995), women aged 20-49 years in a later survey would be younger in an earlier survey by the difference in years between the two surveys. For example, if the 2011 Uganda DHS and 2006 Uganda DHS survey dates were September 2011 and July 2006 respectively, it means that the exact number of years between the two surveys is 5.17 years. The implication is that women aged 15-44 years in an earlier survey (2006) in Uganda would be aged 20-49 years in a survey conducted 5.17 years later in 2011.

29

For the estimates to be comparable it means that the two data sources should have similar characteristics in terms of composition. To achieve this, all women were considered in the two data sources irrespective of the marital status.

Table 3.4 Percentage of all women using any method of contraception from an earlier survey (current-status data) and from calendar data from the same cohort of women reported in an earlier survey

Ethiopia Kenya Rwanda Tanzania Uganda

Calendar data 2011 CS data 2005 Calendar data 2014 CS data 2008/09 Calendar data 2014/15 CS data 2010 Calendar data 2015/16 CS data 2010 Calendar data 2011 CS data 2006 Method/Ages 20-49 14-43 20-49 15-44 20-49 16-45 20-49 14-43 20-49 15-44 Pill 1.0 2.0 5.3 4.4 4.6 3.8 3.7 4.9 2.0 2.3 IUD Norplant 0.2 2.1 0.1 0.1 2.1 6.8 0.9 1.2 4.6 0.7 0.2 3.4 0.7 4.9 0.4 1.8 0.3 1.6 0.1 0.3 Injectable 12.6 6.4 16.6 14.3 13.5 14.1 8.6 8.1 9.3 7.4 Condom 0.3 0.3 3.0 2.4 1.7 1.8 2.9 4.1 2.3 3.1 Sterilisation 0.4 0.1 2.3 2.3 0.8 0.4 2.5 1.5 2.1 1.3 Traditional 0.8 0.7 3.4 4.0 3.0 3.0 5.0 5.6 2.4 3.3 Othermodern 0.0 0.0 0.1 0.0 0.0 0.3 0.0 0.0 0.3 0.5 Total DHS (15-49) N (between surveys) in years 17.2 19.6 5.67 9.7 10.3 39.6 42.6 5.50 29.5 32.0 28.9 30.9 4.08 27.1 28.6 28.4 35.9 5.67 26.5 28.8 20.4 23.6 5.17 18.3 19.6

Note: CS=Current-status. The category ‘traditional methods’ includes abstinence, withdrawal, and lactational amenorrhea. The condom and sterilisation methods are for both female and male.

Table 3.4 that shows consistency in reporting of calendar data indicates that respondents tended to slightly under-report current-status data especially for methods such as the injectable (in all countries but Rwanda), IUD (in all countries), and sterilisation (except for Kenya) than in the calendar. The results from the calendar data and current-status data from Rwanda, Tanzania, and Uganda are almost in perfect agreement with about a two-percentage point difference.

In contrast, the estimates in Table 3.4 point to under-reporting of some events in the calendar than in current-status data. The pill was slightly under-reported in the calendar for

Ethiopia, Tanzania, and Uganda. Similarly, traditional methods were underreported in the calendar in Kenya, Tanzania, and Uganda. Whereas reporting of condom use appears to be the same for Ethiopia and Rwanda, there was slight underreporting in the calendar for Tanzania and Uganda. Underreporting of contraceptive episodes in the calendar is likely to be caused by the failure of respondents to keep track of all episodes (especially user-dependent contraceptive methods) of use (and when they occurred) – thereby leaving out some episodes unreported. The implication of underreporting of events in the calendar is that the resulting estimates may be underestimated thereby leading to erroneous conclusions.

3.7.1 Heaping of episodes

Heaping in the reporting of events in the calendar was investigated as a way of verifying the consistency of reported data in the calendar. As women retrospectively report events as they occurred for every month, heaping may occur. Heaping arises when respondents report the duration of contraceptive use on preferred digits such as 3, 6, 12 months and is often caused by an inability to recall events precisely as they occurred. The problem of recall error is made worse in

societies with no record and date keeping and where documents about demographic events such as birth and deaths is not a requirement (Magadi et al. 2001).30

Figure 3.4 shows heaping of contraceptive episodes on selected preferred digits in all countries and for all contraceptive methods, other than sterilisation.31 Heaping of contraceptive episodes as shown in Figure 3.4 is more significant for durations of use of 3, 6, and 12 months just before the survey than for longer durations, although the proportion of women reporting

contraceptive use for a duration of 12 months is less than for durations of 3 and 6 months. Figure 3.4 Distributions of reported durations of contraceptive episodes, five countries,

2011-2015/16 DHSs

3.7.2 Indices of heaping

Another approach to investigating the issue of heaping is to derive indices of heaping of contraceptive episodes. Curtis (1997) suggests one such index:

Index= ) ( 4 2 1 1 2      x  x  x x x N N N N N Equation 3

Where

N

An index equivalent to one indicates no heaping in the data while an index that is greater than one points to heaping of contraceptive episodes on preferred digits (Curtis 1997). Table 3.5 shows the index on selected digits reveals more heaping on digits 3, 6, and 9 months, in all countries. This observation confirms that because the information in the calendar is reported

30

It is important to note that with the expansion of primary schooling and increased numeracy in developing countries, problems regarding record and date keeping of important documents concerning demographic events are increasingly less important.

31

retrospectively, respondents may be unable to report all events as they occurred in the past, due to recall bias.

Table 3.5 Indices of heaping on selected digits, five countries, 2011-2015/16 DHSs

Indices of heaping on preferred digits

Country/ Year months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12

Ethiopia 2011 1.844 0.583 0.930 1.483 0.604 1.319 1.019 0.695 1.249 0.882

Kenya 2014 1.622 0.826 0.659 1.674 0.868 0.693 1.412 0.813 0.715 1.269

Rwanda 2014/15 2.085 0.732 0.628 1.838 0.759 0.684 1.418 1.025 0.689 1.246

Tanzania 2015/16 1.429 1.012 0.718 1.410 0.868 0.802 1.120 1.108 0.774 1.204

Uganda 2011 1.974 0.856 0.540 1.590 1.011 0.583 1.450 0.662 0.744 1.777

Consequently, some durations of use of contraceptive episodes are likely to be reported on preferred digits. The implication of such a behaviour is that contraceptive use in the calendar, to include either adoption, or switching, may be more pronounced on some digits such as 3, 6, or 9 months compared to other digits. Thus, considering the durations of contraceptive use for each month, heaping would be visible on durations of contraceptive use that are mostly preferred.

4 QUALITY IN PROVISION AND USE OF CONTRACEPTION

The analyses presented in this chapter set out to achieve the first two objectives of the thesis: 1) to examine method skew as a measure of contraceptive method availability and quality in the

provision of family planning services; and 2) to assess whether contraceptive use is dependent on information exchange between family planning service providers and clients. These objectives will be achieved by examining the patterns of current contraceptive use and method mix of women using current-status data, and by examining the information solicited from the three questions regarding receiving knowledge on the availability of other contraceptive methods, possible side effects, and how they can be managed. Section 4.1 provides a socio-economic and demographic profile of respondents included in the study. The next section, Section 4.2, examines trends in contraceptive use over time. Section 4.3 examines method skew and Section 4.4 examines method information exchange as proxy measures used in assessing quality in the provision of family planning services. In the concluding section (Section 4.5), an overview of the way respondents are stratified by use of contraception as well as a discussion of the quality in the provision of family planning services is offered.