Abstract:
Recent follow-up mixed-methods studies
undertaken by The Demographic and Health
Surveys (DHS) Program in Ghana and Nepal
sought to better understand the reasons
behind unmet need and barriers to
contraceptive use. Both studies, the first of
their kind at The DHS Program, re-interviewed
a selected number of respondents from a
parent DHS survey: the 2014 Ghana DHS and the
2016 Nepal DHS, respectively. As such, in
addition to their substantive findings, these
follow-up studies also provide unique
insights into measurement issues, themes not
well captured by existing questionnaires, and
reflections on the DHS survey process that
could potentially benefit future DHS
questionnaires and fieldwork procedures.
The purpose of the project on which this
report is based was threefold: first, to
share the Ghana and Nepal studies with a
technical review panel of DHS survey
management and questionnaire experts, who may
find ways to translate the studies into
revisions of DHS questionnaires or fieldwork
procedures; second, for the report authors to
propose specific changes to DHS
questionnaires and fieldwork procedures for
the panel to review after reading both
reports; and third, after meeting with the
panel, to revise proposals, circulate a draft
report to panel members for additional
feedback, revise again, and then make our
recommendations public.
This report contains eight proposals, four
that earned support for possible inclusion in
the DHS Woman’s Questionnaire, and four that
garnered varying levels of support for
testing or inclusion in specific country
contexts where the issue is relevant. The
four potential additions to the core
questionnaire are: ways to improve the
accuracy of current family planning method
reporting; questions about receipt of family
planning counseling around the time of the
most recent birth; questions to gauge
proximal fertility intention concordance with
partner—which sets the stage for potential
fertility empowerment questions; and flags to
indicate field estimation of ages and dates.
The four proposals for inclusion in specific
country contexts where the issue is relevant
are: follow-up questions on fear of side
effects and health concerns, questions about
postabortion family planning counseling and
use, questions to capture prolonged and
postpartum abstinence as a method to regulate
fertility risk, and questions about
contraceptive preparedness during extended
periods of marital abstinence. For each
proposal, we provide a brief description of
the issue it addresses, the proposal itself,
panel discussion and feedback, advantages and
disadvantages, and recommended next steps
with policy and programmatic implications.