Reproductive behavior is linkedto work autonomy, not to employment itself

International Family Planning Perspectives, Mar 1999 by Estrin, D J

The type of job a woman holds may be more important than employment itself in influencing her use of contraceptives and prenatal care. In a study conducted in the Philippines, pregnant women who worked in professional or white-collar jobs were more than twice as likely as women who did not work for pay to have obtained early prenatal care. Among women who were not pregnant a year after their baby's birth, those who were self-employed were half again as likely to be using a family planning method as were those who were not employed for pay.'

The data for this analysis come from 1,942 urban mothers who participated in the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in 1983 and 1984. The women were interviewed during their third trimester of pregnancy, within three days of childbirth and bimonthly thereafter for two years following delivery. The interviewers collected demographic, socioeconomic, nutritional and health-related information on the mothers and their infants, as well as household and community-level data.

At baseline, the majority (58%) of the women were not working for pay, while 18% were self-employed, 9% did piecework, 7% held professional or white-collar positions and 7% were blue-collar workers. About half (49%) had little or no schooling, 33% had a primary education and 18% had a secondary or higher education.

Overall, 24% of the women had made two or more visits for prenatal care in their first five months of pregnancy. White-collar workers were the most likely to have done so (57%), followed by women who were not working for pay (23%), self-employed or blue-collar workers (22% each) and pieceworkers (15%).

In a multivariate regression analysis that accounted for the effects of background variables, professional and whitecollar wage workers were twice as likely as women who did not work for pay to have made two or more prenatal care visits within their first five months of pregnancy (odds ratio of 2.4). Tests of interactions between type of employment and cost of care indicated that white-collar workers were not more likely to obtain prenatal care because of higher earnings. Blue-collar wage workers, the self-employed and pieceworkers were no more likely to have obtained prenatal care than women who did not work for pay.

Among the 1,556 women who were not pregnant at their one-year postpartum interview, 50% were not practicing contraception, 23% were relying on a traditional method and 27% were using a modem method. Levels of use varied by employment: White-collar workers and self-employed women were most likely to be using a method (63% and 59%, respectively), while blue-collar workers were least likely to be doing so (38%). All groups except pieceworkers were more likely to use modem contraceptives than to rely on traditional methods. When the effects of background variables were controlled in a multivariate analysis, self-employed women were 40% more likely than women who did not work for pay to use a traditional contraceptive method instead of no method and 50% more likely to use a modem method.

In discussing their findings, the investigators point out that blue-collar workers and pieceworkers were not significantly more likely to obtain prenatal care or to practice contraception than were women who did not work for pay. They conclude, therefore, that "employment in jobs that allow greater autonomy is associated with a greater likelihood of contraceptive and health service use, whereas employment in jobs that allow the worker little control over the scheduling and pace of her work is not."-D.J. Estrin

Reference

1. Miles-Doan R and Brewster KL, The impact of type of employment on women's use of prenatal-care services and family planning in urban Cebu, the Philippines, Studies in Family Planning, 1998, 29(1):69-77.