Determinants of fertility and the impact of maternal and child health services on contraceptive use in the Gaza Stri

This study has four aims: (1) To examine the main determinants of fertility among Palestinians in the Gaza Strip, as measured by the number of children ever born to a woman, (2) To identify the main factors that determine the utilization of family planning services and contraception use, (3) To identify the main barriers to contraceptive use, and (4) To examine the impact of intense previous utilization of maternal and child health (MCH) services on the subsequent use of contraceptives.;Aim 1 multivariate OLS regression results showed that: (1) Higher levels of maternal and paternal education were associated with significantly lower fertility; in terms of magnitude, maternal education had three times the impact on fertility (OLS coefficient -0.70) compared to paternal education (OLS coefficients of -0.70, p < 0.01; -.23, p < 0.01, respectively). (2) Employed and higher income women have fewer children than women who are not employed and/or lower income (OLS coefficients of -.66, p < 0.01; -.43, p < 0.01, respectively). (3) Fertility was higher among women who had experienced the death of a child. The magnitude of the coefficient implies a quite high replacement rate (OLS coefficient of 1.51, p < 0.01).;Aim 2 results from multivariate logistic regression demonstrated that: (1) Contraceptive use was significantly higher among women aged ≥ 35 years than among women aged < 25 years (odds ratio 1.79; 95% CI 1.12- 2.86). (2) The odds of using contraceptive methods among women who had three children or more were more than three times those of women who had ≤ 2 children (odds ratio 3.56; 95% CI 2.36-5.39). (3) Women who received prenatal care services in a health center that offered MCH and family planning services have odds of using contraceptives that were 1.35 times those of women who received prenatal care in a health center that did not offer family planning (odds ratio 1.35; 95% CI 1.04- 1.76). (4) A history of dead children decreased the odds of contraceptive use by 41% (odds ratio 0.59; 95% CI.41- .85).;Aim 3 results from the qualitative analysis verified that: (1) The lack of social security policies and welfare services for elderly people encouraged parents to have many children to secure old age support. (2) The current Israeli-Palestinian conflict was a driving force for fertility. Women desire more children as insurance against expected deaths due to the ongoing conflict. (3) Unemployment among women was a motivating factor for women to have more children. (4) Although family planning services are both accessible and acceptable to most women in the Gaza Strip, the study showed significant evidence of an unmet need for family planning.;Aim 4 results from multivariate logistic regression revealed that there was no relationship between the intensity of utilization of MCH services and subsequent use of contraceptives. However, the availability of MCH and family planning services at the same health center was associated with a higher rate of contraceptive use.;The findings of this research suggest: (1) The Palestinian National Authority should implement strategies to increase women's labor force participation rate; a numerical simulation using the regression results on the determinants of fertility behavior showed that the fertility rate could be reduced to 5.0 births per woman or to 4.8 births per woman if the rates of women's participation rate increased from the current rate (7%) to 15% or 40%, respectively. (2) There is an urgent need to establish a social security system to provide income and other social welfare services to needy elderly people. (3) Given the facts that most of the MCH centers are well established and integrated programs are highly cost-effective, the addition of family planning services to the bundle of all MCH centers would be an effective, feasible, and cost-effective policy option. (4) Increased knowledge about the availability and best practices of contraceptive methods is an important policy goal. Given the high utilization rate of MCH services, a woman's visit to a primary healthcare center should be treated as opportunity to educate her on contraceptives use. Thus, the MoH and UNRWA-MCH clinics should include education on contraceptive use as an integral part of their health services. (Abstract shortened by UMI.).