The determinants of withdrawal use in Turkey: a husband's imposition or a woman's choice?

Reasons for high prevalence of contraceptive withdrawal in Tehran, Iran

This study explores reasons for withdrawal use that is highly prevalent in Iran. A face-to-face semi-structured survey questionnaire was designed and 79 married women aged 15-49, who were only using withdrawal when attending five primary healthcare centers in Tehran during September-October 2021 were interviewed. Results showed that withdrawal mostly was chosen by the couple (67%), and partly by the woman alone (19%) or by the husband alone (14%). Participants evaluated withdrawal positively that has no side effect and cost, is easy to use and accessible, and increases sexual pleasure and intimacy. Most women agreed that husbands use withdrawal to protect their wife's health (76%). Women obtained contraceptive information primarily from gynecologists (42%), the internet (21%), midwives in public health centers (19%), and social networks (18%). "Side effects of modern methods" (37%), "fear of side effects" (16%), and "reduction in sexual pleasure" (14%) were the major reasons reported for using withdrawal. While 'side effects' was given mostly by women who alone or with their husband chose withdrawal (52%, 38%), 'reduction in sexual pleasure' and 'fear of side effects' were mostly reported by women whose husband was the sole decision maker in choosing withdrawal (28%, 25%). The 'fear of side effects' was reported mostly by women who had lower education (21%), used the internet for contraceptive information (23%), and whose husband alone chose withdrawal (25%). Cost of modern methods was a trivial reason for using withdrawal. Most withdrawal users (75%) would not switch to modern methods even if they were freely accessible. More educated women and their husbands would be less likely to switch to modern methods even they were provided freely (OR 0.28, CI 0.10-0.80; OR 0.20, CI 0.07-0.59). However, women who were using modern methods before, and those who alone chose withdrawal would be more likely to switch to modern methods (OR 6.4, CI 2.0-20.2; OR 3.4, CI 1.1-11.2). Access to regular contraceptive counselling and public health campaigns could help women to deal with fears of side effects of modern methods, learn their proper use, and to receive education on how to use withdrawal more effectively to avoid unintended pregnancies.

Childhood Origins, Migration, and First Modern Contraceptive Use in Turkey

This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration is positively associated with age of first modern contraceptive use. As women's migration is quickly followed by family formation, women also take up modern contraception after first childbirth, likely due to new encounters with medical professionals, differing contraceptive access and other social exposures. We also find that women whose childhoods were spent in urban areas have a higher risk of first modern contraception relative to women from rural areas, thus suggesting the enduring importance of socialization. These results show how selection processes, life-cycle factors, and sociocultural norms jointly shape modern contraceptive behavior in Turkey. Our results also demonstrate a need for increased reproductive care in rural areas and suggest continued fertility decline with urban migration.

Does cosmopolitan culture weaken ethnic and regional diversity: contraceptive behaviours of women in Istanbul, Turkey

OBJECTIVE

The primary aim of the study was to examine the relationship between self-reported ethnic identity, region of birth and contraceptive use, in Istanbul, Turkey.

METHODS

Cross-sectional data from a random sample of 3038 married women of reproductive age living in two urban districts of Istanbul were used in a series of logistic regression models to assess key relationships.

RESULTS

Kurdish ethnic minority women were less likely than Turkish ethnic majority women to use traditional contraceptive methods over no method (relative risk ratio [RRR] 0.69; 95% confidence interval [CI] 0.50, 0.96). However, there were no significant differences between ethnicities (i.e., Turkish, Kurdish and other) and modern method use. Among Turkish women, those born in regions farther away from the western region were more likely to use traditional methods (RRR_northern 2.06; 95% CI 1.31, 3.22).

CONCLUSION

While Kurdish ethnic minority women were less likely to use traditional methods, compared with Turkish ethnic majority women, the difference might have been due to the length of time living in a neighbourhood. Regional variations in contraceptive use were concentrated only among Turkish ethnic majority women and for traditional methods. Regional norms of traditional method use may be a barrier to modern contraceptive use in Turkey.

Effects of Family Planning and Baby Care Behavior on Stunting in Early Married Couples

BACKGROUND: District with the highest stunting prevalence in Central Sulawesi province is Sigi District by about 43.0%. Its birthrate is 3.2 and the first marriage age is 19.9 years old. AIM: This study analyzed various relationships between family planning behaviors of early married couples with births and stunting, as well as its connection with baby care (colostrum, exclusive breastfeeding, completeness of immunization, supplementary feeding, and breastfeeding for up to 2 years old). In addition, it will describe family planning behaviors and baby care in a gender perspective as well. METHODS: The sample of this study was 40 early married couples in the last 3 years in the area of Marawola Health Center in Sigi District. Data analysis used Chi-square and Mouser to see the gender relationship gap in the choice of contraception and baby care. RESULTS: There was a relationship between family planning behavior and birth with p = 0.001, a large parity with the incidence of stunting with p = 0.002. Likewise, there was also a relationship between baby care (colostrum of p = 0.0016, exclusive breastfeeding of p = 0.003, completeness of immunization of p = 0.003, supplementary feeding of p = 0.00, and breast milk up to 2 years of p = 0.00) and the occurrence of stunting in early married couples. The idea of family planning and child care is still dominated by wives, from the stages of planning, decision making, and implementation. Gaps occur because of unbalanced power relations. CONCLUSION: Family planning behavior and baby care (colostrum, exclusive breastfeeding, completeness of immunization, supplementary feeding, and breastfeeding for up to 2 years) affect the incidence of stunting in early married couples. The use of family planning and child care is still a gender gap which is dominated by wives.

Explaining withdrawal's persistence: correlates of withdrawal use in Albania, Armenia, Jordan, and Turkey observed in a cross-sectional study

Background: Withdrawal dominates the contraceptive method mix in a geographical cluster of countries in South-Eastern Europe and Western Asia that have, in part, reached low fertility. This study examines the socio-demographic determinants associated with withdrawal use in Armenia, Albania, Jordan and Turkey that could explain withdrawal’s persistence and inform contraceptive programs in these unique settings.

Methods: Cross-sectional data on 31,569 married women 15 to 49 years were drawn from the Demographic and Health Surveys in Albania (2017-2018), Armenia (2015-2016), Jordan (2017-2018), and Turkey (2013). For each country, multinomial regression models estimating withdrawal use among all women and logistic regression models estimating withdrawal use among contraceptive users were used to evaluate the association with age, marital duration, parity, education, residence, and household wealth.

Results: The socio-demographic determinants associated with withdrawal use varied by country among all women and among all contraceptive users. While these associations were not all significant for all four countries general trends included that women were more likely to use withdrawal than not use contraception, but less likely to use withdrawal than other methods with increasing parity, higher education, and greater household wealth. Measures of association are reported by country for each correlate.

Conclusions: Despite the similar contraceptive mix in these four countries, no single set of factors was found to explain withdrawal’s persistence. Withdrawal’s prevalence in this geographical cluster may instead result from different balances of intertwined circumstances that include couples’ fertility decisions, access to modern contraception and availability of abortion services.

Women’s socioeconomic status and choice of birth control method: an investigation for the case of Turkey

This study investigated whether woman’s education, labour market status and the status within the household have any impact on their birth control behaviour in Turkey. Empirical analyses were implemented using the 2013 Demographic and Health Survey dataset, which includes information on women’s socioeconomic status and their current choice of contraceptives: whether they used any method, and if so, what method they used. Using a bivariate probit model with selection to control for any possible selection bias, the results suggest that whether a woman uses any birth control method, and whether the woman chooses modern methods over traditional methods, are primarily explained by education level and urban/rural residence, and that the determinants of contraceptive use vary across college-educated and non-college-educated women. The results also indicate that non-employed women are less likely to use any birth control method compared with women with regular, full-time jobs. However the effect was statistically insignificant.

Prevalence and socio-economic factors determining use of modern contraception among married men in Kyrgyzstan: evidence from a demographic and health survey

OBJECTIVES

This study aimed to estimate the prevalence of modern contraceptive use (MCU), and to identify socio-economic factors that are associated with MCU among married men in Kyrgyzstan.

STUDY DESIGN

A cross-sectional study based on the 2012 Kyrgyzstan Demographic and Health Survey data.

METHODS

This study used data from 460 married men aged 20-49 years. Descriptive statistics, Pearson's Chi-squared test and logistic regression were used to estimate the prevalence of MCU, and to define factors that influence MCU among married men in Kyrgyzstan.

RESULTS

The prevalence of MCU among married men aged 20-49 years was 22.2%. Men in the richer quintile were less likely to use modern contraceptives than men in the poorest quintile (adjusted odds ratio [aOR] 0.267, 95% confidence interval [CI] 0.100-0.715). Men with three living children had higher odds of MCU than men with no children or one child (aOR 3.534, 95% CI 1.221-10.229). Men who were unemployed were more likely to use modern contraceptives than men who were employed as manual labourers (aOR 4.511, 95% CI 1.104-18.442).

CONCLUSION

Top priority should be given to strengthening family planning communication programmes among married men and male education. There is a need to pay attention to the socio-economic determinants of MCU among men in the development of family planning programmes. Emphasis should be placed on increasing MCU among men with high socio-economic status.

Understanding unmet contraceptive needs among rural Khasi men and women in Meghalaya

There is a global push for increased access to contraception to respond to unmet contraceptive needs. Meghalaya state, with a majority of Indigenous people, has one of the highest unmet contraceptive needs and the lowest contraceptive prevalence rates in India. This qualitative study explores the reasons for the low uptake of contraceptives among Khasi people in a rural district. While policy makers assume that individuals may not be practising family planning because of religion and lack of education, couples actually do use a variety of 'natural' or 'traditional' contraceptive methods to obtain their desired family composition and size. Health providers focus on the provision of hormonal contraceptives, such as the pill, and on technologies such as IUDs and tubectomies that require regular follow-ups by trained medical staff. Health concerns, distrust of contraceptive technologies, the inadequate local health system and a desire to have more than two children are important factors in the low uptake of available contraceptive technologies. Contraceptive choices in rural areas are shaped by the historically problematic political engagement of Indigenous people with the central state, with policy implementation taking place on the basis of widespread assumptions rather than on evidence from contextually relevant behavioural sciences research.

The use of withdrawal among birth limiters in Iran and Turkey

Despite a decline infertility, an increase in contraceptive prevalence, and a wide expansion of family planning programs in Iran and Turkey, a large proportion of "birth limiters" rely on withdrawal to avoid pregnancy. Adopting a comparative approach, this study draws on data from the 2000 Iran DHS and 2003 Turkey DHS to examine the determinants of the practice of withdrawal among birth limiters. Multivariate logistic regression analyses were employed to estimate the likelihood of withdrawal use among two representative samples of birth limiters. Higher education and wealth were associated with greater likelihood of withdrawal use among birth limiters in Iran, while an inverse association was found in Turkey. Older age was positively associated with withdrawal in both countries, whereas having more than four children was inversely related to use. Study results suggest that family planning and reproductive health programs in Iran and Turkey should be aware of the groups that have high rates of withdrawal use, should educate couples in the effective use of withdrawal, and should encourage the use of more effective modern methods and emergency contraceptives when appropriate.

State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning

Despite the popularity of 'modern' contraceptives, natural family planning (NFP), including fertility awareness-based (FAB) methods and withdrawal, are practised in most countries. Worldwide FAB methods and withdrawal are used, respectively, by about 3.6% and 2.9% of all couples of reproductive age. This article describes the underpinnings of the different NFP methods, their rationales, histories, rules for use, efficacy and in broad categories their prevalence. Pregnancy rates of FAB methods with perfect use have ranged between 0.3 and 5.0 per 100 users per year, but typical use rates rises into the teens or higher. Withdrawal requires the male partner to be aware of his impending climax and to pull out of the vagina before ejaculation. Perfect use and typical pregnancy rates for withdrawal are estimated to be 4 and 27 per 100 per year, respectively. Many couples find NFP in accord with their own beliefs, satisfactory in its effectiveness and useful in planning a desired pregnancy. Many prize their self-control in practising NFP or withdrawal. In our research we used Medline, Popline and the Cochrane Library search engines in English, local institutional libraries, our own files in our native languages, the literature references contained therein, and source recommendations from colleagues.

Withdrawal users' experiences of and attitudes to contraceptive methods: a study from Eastern district of Tehran, Iran

BACKGROUND

The aim of this study was to explore withdrawal users' experiences of and attitudes to contraceptive methods in Tehran, Iran.

METHODS

This was a cross-sectional study. A sample of women attending a health care center in Tehran, Iran was entered into the study. To collect data structured interviews were conducted.

RESULTS

In all 300 women who were using withdrawal took part in the study. Of these, 210 women (70%) indicated that they were used modern contraceptive methods previously. The mean duration for withdrawal use was 6.5 (SD = 4.9) and for modern contraceptive it was 2.3 (SD = 2.9) years. The most common reasons for using withdrawal were: no cost involvement, did not need medical advice, having fewer side effects and easier to use than other methods. The main obstacles to use modern contraceptives were: health concerns, fear of side effects, misinformation, lack of confidence and sexual dissatisfaction.

CONCLUSION

The study results suggest that withdrawal users carry misconceptions about modern contraception and exaggerate its related health problems. Indeed these are important issues for the understanding of attitudes and experiences of women in Iran. The findings from this study might be essential for making evidence-based policy decisions, and for planning, monitoring and evaluating reproductive health programs in Iran and elsewhere.

Why Iranian married women use withdrawal instead of oral contraceptives? A qualitative study from Iran

BACKGROUND

Withdrawal as a method of birth control is still used in Iran. The aim of this study was to explore married women's perspectives and attitudes on withdrawal use instead of oral contraceptive (OC) in Tehran, Iran.

METHODS

This was a qualitative study. Participants were 50 married women, not currently pregnant, not desiring pregnancy and who had been using withdrawal for contraception. Face-to face interviews were conducted to collect data. Content analysis was performed to analyze the data.

RESULTS

Four major themes were extracted from the interviews: advantages, disadvantages, barriers for OC use, and husband-related factors. Advantages of withdrawal use were identified as: easy to use, convenient, ease of access, natural. Even those participants who had experienced unwanted pregnancy while using withdrawal, relied on withdrawal as their contraceptive method. Disadvantages of OC included concerns about side effects. Barriers related to use of OC included the need for medical advice, vaginal examination and daily use. Husband-related factors included: the husband wanted to be the primary decision maker on the number of children and that he preferred withdrawal.

CONCLUSION

Health providers should address misunderstandings that exist about OC and highlight the non-contraceptive health benefits of OC to balance the information provided for women. We suggest that not only women but also their spouses be advised in family planning programs.

Coitus interruptus as a contraceptive method: Turkish women's perceptions and experiences

AIM

This paper is a report of a study conducted to determine the perceptions and experiences of coitus interruptus as a contraceptive method used by married women in Turkey.

BACKGROUND

Various factors affect women's choice of contraceptive methods. One of these factors is socioeconomic status, which may have an effect on the practice of coitus interruptus by women. Socioeconomic status refers to the relative position of a family or individual in a hierarchical social structure based on their access to or control over wealth, prestige and power.

METHODS

The study population consisted of married Turkish women from two different socioeconomic status groups in Turkey who were currently using coitus interruptus. Structured interviews on their demographic characteristics and perceptions and experiences of coitus interruptus were carried out between August 2004 and August 2005 with a convenience sample of 422 women (response rate 97.2%).

FINDINGS

Most participants were satisfied with the practice of coitus interruptus. Conception was the most common reason for discontinuing practice of the method. Age and educational level of participants did not affect failure in coitus interruptus practice in women of either socioeconomic status. The majority of the women of both socioeconomic statuses began practising coitus interruptus again after having stopped.

CONCLUSIONS

Women generally favoured coitus interruptus, believing in its efficacy and safety, and stated that both women and their husbands preferred to use it. Nurses and midwives should promote knowledge of all effective methods for fertility regulation while women are in the fertile ages.

Determinants of choosing withdrawal over modern contraceptive methods in Turkey

OBJECTIVES

The determinants of the use of withdrawal in Turkey are examined using a multinomial logistic model.

METHODS

Data were drawn from a nation-wide population-based cross-sectional study, the Turkish Demographic Health Surveys that took place in 1998 and 2003. Detailed interviews were conducted with 8576 women aged 15-49 and analysed using SPSS.

RESULTS

Contextual, cultural and demographic characteristics define women's choice of withdrawal over modern methods. Socio-economic status, education, employment status, and past fertility behaviour are among key determinants. First-ever used contraception method has a very strong impact on later choices. Urban women, the more educated, those with better socioeconomic status, and those living in less crowded households resort less to withdrawal. Experience and empowerment positively linked to modern contraceptive use among women in Turkey.

CONCLUSIONS

The use of contraceptive methods in Turkey differs greatly. Empowerment of women in terms of better socioeconomic status, better education, modern and liberal attitudes towards women and family planning seem to reduce withdrawal use as the main method of contraception. The results suggest the need for education (particularly targeting young women and couples), information and provision of modern contraceptive services particularly for disadvantaged groups.

The effects of temperament and character on the choice of contraceptive methods

OBJECTIVES

To identify the effects of temperament and character on the selection of contraceptive methods.

METHODS

Cross-sectional study carried out in June 2005 at the Ondokuz Mayis University Samsun Health College with the participation of 102 young women. The participants were asked to complete the Contraception Choice Questionnaire devised by the researchers, and the Cloninger Temperament and Character Inventory.

RESULTS

The mean age of the participants was 22.30 +/- 1.27 years; 39 participants (38.2%) mentioned Norplant, 30 (29.4%) condoms, 17 (16.6%) intrauterine devices (IUDs) and 16 (15.7%) oral contraceptives (OCs) as the method they would consider using in the future. The mean scores of self-directedness and self-transcendence of the groups differed significantly (p < 0.05). Students who indicated they would choose OCs had higher average scores for self-directedness than those choosing IUDs; the mean self-transcendence scores of students choosing IUDs were significantly higher than the scores of those selecting condoms (p < 0.01). Subjects choosing Norplant cited ease of use; those choosing condoms cited their eliciting fewer side effects; those choosing IUDs cited their high levels of safety; and those choosing OCs cited ease of use and high reliability as the reasons for their choices.

CONCLUSIONS

We think that identifying the roles of temperament and character in the selection process of a contraceptive method will help in achieving a wider application of contraception.

The socioeconomic characteristics of risky sexual behaviour among reproductive-age women in St Petersburg

AIMS

To examine the sexual behaviour of reproductive age women in St Petersburg and its variation according to socio-demographic characteristics.

METHODS

A cross-sectional survey with a self-administered questionnaire. A random sample of women aged 18-44 in two districts in St Petersburg in 2004 were invited to a woman's clinic to complete a questionnaire. Of those women who were contacted (n=1719), 67% completed the anonymous questionnaire either in a clinic or at home. Results were analyzed according to three age-groups (18-24, 25-34, 35-44 years). Predictive characteristics were studied by use of multivariate models.

RESULTS

Younger respondents had on average started sexual life much earlier than the oldest (mean age 17.6 and 19.7 years respectively). The use of contraception at first coitus had become more common for each consecutive generation, though 25% of women aged 18-25 used no contraception, and only 45% used reliable contraception at first intercourse. Around 16% of the women had had two or more sex partners during the previous year, 55% of the youngest and 43% of the oldest had used reliable contraceptive methods. Older women were less likely to use contraceptives in last intercourse. High personal income, having children and low education were related to early age at first intercourse. Being single (women over 24 years) or having high income (women in all ages) was correlated with having had multiple sexual partners.

CONCLUSIONS

In addition to youth, sexual education should be targeted to older women, many of whom practice risky sexual behaviour.

Contraceptive discontinuation and failure and subsequent abortion in Romania: 1994-99

This study examines the levels and correlates of contraceptive failure and discontinuation in Romania, together with the consequences of contraceptive method failure in terms of induced abortion. Of special interest are women who rely on the traditional method of withdrawal and the proportion of withdrawal failures resulting in abortion. Our analysis is based on multiyear calendar data concerning women's contraceptive use and monthly reproductive behaviors collected in the 1999 Romanian Reproductive Health Survey. Weibull regression models are estimated to analyze the determinants of discontinuation and failure for all methods combined and for withdrawal. Overall, 19 and 28 percent of women became pregnant within the first year of using any contraceptive method and of practicing withdrawal, respectively. About 57 and 59 percent of failures from use of all methods and from withdrawal ended in abortion, accounting for 30 percent and 22 percent, respectively, of all abortions reported between 1994 and 1999. These findings suggest that high rates of contraceptive discontinuation and failure contributed significantly to the widespread reliance on induced abortion among Romanian women during this period.

Distribution of contraceptive use in a Turkish population

OBJECTIVE

This study is designed to estimate the distribution of contraceptive use among reproductive age women in a Turkish population (Turkey).

STUDY DESIGN

We included 2365 women of reproductive age in this study. Women were given a questionnaire via a face-to-face interview.

RESULTS

During the time period just after marriage, 1914 women (80.9%) declared that they did not use any type of contraception. Among 451 women who had used a contraceptive method just after marriage, the most commonly used method was condoms (34.2%), followed by oral contraceptives (31.2%) and coitus interruptus (25.9%). When their history of contraceptive use was asked, 1903 women (80.2%) stated that they used a method of contraception while 462 women (19.5%) had never used any type of contraceptive. Distribution of contraceptive methods among women was analyzed and intrauterine devices were detected to be the most commonly used method (n=1046, 55%).

CONCLUSION

A point that should be emphasized is that there is a marked increase in contraceptive prevalence, and expansion of family planning activities in Turkey. This change, we believe, is due to improvements in health services of Turkey, realized in recent years.

Withdrawal users' perceptions of and experience with contraceptive methods in Manisa, Turkey

OBJECTIVE

To gain an understanding of the knowledge, perceptions and experiences of using contraceptive methods among Turkish withdrawal users.

DESIGN

Population-based, cross-sectional and descriptive study using a questionnaire conducted face to face.

SETTING

Women who live in the Number 6 primary health unit area in Manisa, Turkey.

PARTICIPANTS

276 women who used the 'withdrawal' method for contraception.

MEASUREMENTS AND FINDINGS

Almost all women were aware of modern contraceptive methods. The condom, intrauterine contraceptive device (IUCD) and oral contraceptives were the most known methods. The most common reasons for using 'withdrawal' were that this method was reliable, husbands preferred it, it was healthier, easier to use or more convenient than other methods.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

It is important for midwives and nurses to recognise the effects of cultural beliefs on women's contraceptive use. Educational programmes should be individualised to meet the specific needs of women and their partners.

The Sociocultural Context of Condom Use Within Marriage in Rural Lebanon

Prevalence rates for condom use are low across the Middle East despite limited alternate contraceptive options and growing awareness of sexually transmitted diseases (STDs) and HIV/AIDS. Virtually no research exists to explain this situation and to guide policy development or effective interventions. An analysis of 25 focus-group discussions with married women and men, interviews with service providers, and a survey of 589 women of childbearing age in a rural district of southern Lebanon reveal that a broad and complex set of sociocultural factors influence condom use. In the study area, 7 percent of married women currently use condoms, 24 percent reported ever use, and inconsistent use is common. Condoms are preferred primarily for their lack of physiological side effects. Five factors were found to impede method adoption and sustained use. These include various encumbering beliefs, reduced sexual pleasure, adverse experiences, gender-related fears and tensions, and a residual social stigma attached to condoms. Several strategies are suggested to increase and improve condom use. These issues will assume greater importance as fertility declines further in the region, demand for contraception continues to increase, and STDs and HIV/AIDS become more deeply rooted, as has occurred in other parts of the world.