Hukin, Eleanor
(2012)
Contraception in Cambodia: explaining unmet need.
PhD thesis, London School of Economics and Political Science.
Abstract
This thesis aims to explain why there is a high level of unmet need for contraception
in Cambodia - a country where effective methods of birth control are cheaply
available and morally acceptable. The research design takes a mixed methods
approach, initially using data from the Cambodian Demographic and Health Surveys
of 2000 and 2005 to assess trends in contraceptive use. Multivariate logistic
regression is used to analyse factors associated with, firstly, unmet need, and
secondly, use of traditional contraceptive methods. The likelihood of having an
unmet need for contraception increased as education and wealth levels decreased;
urban or rural residence had no significant effect. However, the likelihood of using
traditional methods, rather than modern methods, increased as education and wealth
increased. Taking these findings and the questions they raise as a departure point, 21
months of ethnographic fieldwork was conducted in one urban and one rural site in
Northwest Cambodia between 2008 and 2010.
The study looks at women’s and men’s reproductive decision making with a focus on
their experiences of and meanings given to contraception, situating these
understandings within the broader social context. Fear of side effects, stemming from
both contraceptive experiences and notions of health and the body, was found to be
the greatest obstacle to use of modern contraceptives. This related more broadly to
the pluralistic medical systems operating simultaneously and the varying levels of
medicalization and trust in both biomedicine and the Cambodian health system.
Behaviour that seemed counter-intuitive at the outset - not wanting to become
pregnant but not using contraception, and wealthy educated women choosing
traditional over modern methods – becomes understandable in light of the context
and meanings highlighted by the ethnographic data. This thesis provides a unique
empirical study which contributes to the emerging field of anthropological
demography. By bringing approaches and methods from medical anthropology to the
typically demographic phenomenon of unmet need, the study provides a new insight
for social policies regarding reproductive health as well as contributing to the body
of ethnographic literature on Cambodia.
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