Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.

The influence of gender norms on women's family planning experiences is a finding that cuts across numerous studies included in Family Health International's multi-country "'omen's Studies Project. This paper e". . plores findings from one of these studies on the mediating influence of beliefs about gender norms on the relationship between fertility behavior and psychological well-being. Using cross-sectional survey data from 4,908 Egyptian women, hierarchical multiple regression models were tested with depression and anxiety as tile dependent variables. Independent variables included three demographic variables, two measures of beliefs about gender nonns developed from sun.'ey items using exploratory factor analytic techniques, and two fertility beha\·ior variables-use of family planning and number of cbildren. Gender nonn befiefs predicted both anxiety and depreSSion. The statistical anal}~es demonstrated a separate effect of family planning use on anxiety, independent of gender nonn beliefs, but the effect of family planning behaviors on depression disappeared when gender norm beliefs were included in the regression model, which indicates a mediating effect of gender nonn beliefs. Although cross-sectional data do not allow for the detennination of causality among the three types ofvariables, a conceptual framework is offered for the possible causal mechanisms for the identified relationships.The influence of gender norms on women's family planning experiences is a finding that cuts across numerous field-driven studies that were conducted as part of Family Health International's Women's Studies Project (WSP; Barnett & Stein, 1998). Project studies began in 1993 and were conducted in nine developing countries. All studies were designed to determine the impact of family planning On women's lives. The relationships that emerged were not alI direct nor were they alI positive. The ability to control one's fertility is often a mixed blessing, mitigated by COntextual factors such as gender norms. Traditional gender norms may limit a woman's ability to use family planning if she perceives herself as being bound to cultural e'l'ectations or the will of her husband, Or, they may reduce her motivation to limit her family size if she does not have the opportunity to step outside her role as wife and mother into the world ofwork or community service. Therefore, it is pOSSible that the potential psycholOgical benefits of using family planning may be reduced by inequitable gender norms that result in fear of abuse or desertion by an angry husband and/or stigmatization by one's community. As part of the WSP, a household survey was conducted in Egypt to determine the impact of family planning on several aspects of the lives of Egyptian women (Saleh & Heisel, 1998), including psychological stress. Results from a preliminary analysis of these data (Severy et al. 1999) demonstrated a relationship between family planning use and women's psycholOgical stress measured as anxiety and depression. This paper presents an enhanced ana...

Researchers surveyed the psychological well-being of 795 women of reproductive age from Menoufiya, Egypt. Five years earlier, these women had provided data relevant to their family planning behavior. This analysis links these data sets to investigate the impact of family planning on women's sense of well-being, within the context of beliefs about appropriate gender-related behaviors. Well-being measures are derived for trait and state dimensions. Use of family planning and number of children born within the preceding 5 years predicted state ratings of happiness, and number of children predicted anxious pride. Neither are related to any of the trait ratings. Further, 3 different gender-role attitudes are vital to the explanation of how women define and feel good about themselves.

Currently, the pill and IUD account for 83% of contraceptive use in Egypt; Norplant will be an important complement to those methods of family planning. In Egypt where childbearing begins early, and closely spaced pregnancies are the norm, the long duration of Norplant's effectiveness and its relative ease of use should be appealing. The Egyptian Fertility Care Society (EFCS) initiated a study in 1988 on the acceptability of Norplant in Egypt to study the clientele of the EFCS clinical trial in the five university teaching hospitals. The clinical trial participants were women in their thirties who had an average of four children. Most had used a method of family planning before Norplant, and were anxious to maintain contraceptive protection as most wanted no more children. Satisfaction with Norplant among users was high. In the survey, 93% of the women expressed satisfaction with the method. More than half (67%) of the women said they would consider using Norplant again in the future, and another 22% were undecided. Eighty-seven percent of the women who had not discontinued were planning to continue with their current Norplant set for the full five years. Egyptian women like Norplant because of its long duration of effectiveness, the site of insertion, its ease of use, and its relative lack of perceived side-effects compared to the pill and IUD. In Egypt where a reliable, long-term, but not permanent method of contraception is badly needed, Norplant should become a popular method of family planning.

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