Knowledge of contraception among migrants. In general, the urban poor, many of whom are migrants, know less than other urban residents about family planning and modern contraceptives (108, 192). According to DHS data, in 19 of 22 countries studied, rural-to-urban migrants were less able than urban nonmigrants to name at least one modern contraceptive method. In most of these countries the differences were quite small, and in all countries at least two-thirds of migrants knew about a modern method.

In all but 2 of the 22 countries, rural-to-urban migrants could name fewer contraceptive methods than could urban nonmigrants. Knowledge of a greater number of methods is closely correlated with contraceptive use (31) and inversely correlated with levels of unmet need for family planning (247). Also, in most of the countries studied, a lower percentage of rural-to-urban migrants than of urban nonmigrants knew where to obtain a modern contraceptive method.

Awareness of modern contraceptive methods has become widespread even in rural areas in many countries. In 10 of the 22 countries studied using DHS data, more than 90% of rural women knew at least one modern contraceptive. Still, in some cases, awareness of contraception is substantially lower in rural areas than in urban areas. In 9 of the 22 countries studied, the percentage of rural women of reproductive age who could name a modern family planning method was at least 20 points below the comparable percentage of urban women. Where family planning programs are as strong in the countryside as in big cities, however, the level of contraceptive knowledge among rural-to-urban migrants can be as high as that of urban nonmigrants—as in Indonesia (179).

Use of contraception among migrants. In general, rural-to-urban migrants are less likely than other urban residents to use contraception. This was the case in 17 of the 22 countries analyzed on the basis of DHS data. Usually, the differences are small—less than 6 percentage points (see Figure 3). Another study of DHS data for Bolivia and Peru found that native urban residents used modern methods of contraception most, followed first by long-term rural-to-urban migrants, then recent migrants, and finally rural residents who had not migrated. This pattern held true when the study controlled statistically for marital status, age at marriage, and women's education (272).

Rural-to-urban migrants also are less likely than urban nonmigrants ever to have used modern contraceptives. For example, in Malaysia 53% of urban nonmigrants had ever used contraception compared with 38% of migrants (345). Also, in 17 of 22 countries studied with DHS data, a smaller percentage of migrants than of nonmigrants in urban areas had ever used contraception.

Knowledge and use by migrants' length of residence. Grouping all migrants together masks crucial distinctions among migrants themselves, both because of the process of adaptation and because of differences in age and family status among migrant groups. On average, long-term migrants are older and more likely to be married or to have been married. They have had more time and more reason to learn about and use contraception.

In some countries long-term migrants (those who have lived in the urban area for at least 10 years) are more aware of modern contraceptives than recent migrants (those who have lived in the urban area four years or less). In 6 of 18 countries analyzed with DHS data—Burkina Faso, Ghana, Nigeria, Pakistan, Peru, and Senegal—long-term migrants were more likely than short-term migrants to be aware of at least one modern contraceptive method by a margin of at least 10 percentage points. Awareness was generally high for both groups, however. Long-term migrants also tended to know more about how to find contraception.

The longer that migrants from rural areas live in urban areas, the more likely they are to use modern contraception. This is the case in 17 of 18 countries studied using DHS data. Differences in contraceptive use by length of residence often are dramatic. In the Dominican Republic, for example, 50% of long-term migrants were using modern contraceptives compared with 26% of recent migrants (see Figure 4).

Refugees and internally displaced persons. Little is known about contraceptive knowledge and use among refugees and internally displaced persons. A study in Sri Lanka found that internally displaced persons had relatively little knowledge and low rates of contraceptive use compared with the general population. While awareness of at least one contraceptive method was fairly common among these displaced persons, accurate knowledge about different methods was rare (225).

The family planning status of refugees and internally displaced persons is likely to reflect the state of family planning programs in their home communities, which may be different from the facilities available in and around camps. Thus information about family planning and other reproductive health programs in the areas from which refugees come is important to meeting the needs of these groups (280). For example, refugees who are using IUDs or Norplant implants may face problems when they want these methods removed. Others may run low on supplies of oral contraceptives or condoms and have no place to go for resupply, may not know where to go, may be unable to speak the language, or may fear male providers.