Contraception: Attitudes and Experiences of Saudi Arabian Women

Qualitative insights into the need for a contraception protocol from obstetricians' and gynecologists' perspectives

BACKGROUND

Studies on the use of contraception in the Saudi community highlight the need for improving community knowledge about contraception, implementing guidelines, and restricting contraception dispensing. However, there is a lack of studies assessing the need for contraception protocols from obstetricians' and gynecologists' (Ob/Gyn) perspectives. This study aimed to assess the need for a contraception protocol from the perspectives of Ob/Gyn physicians.

METHODS

Qualitative in depth, semi-structured interviews were conducted with a convenience sample that comprised physicians from the Department of Obstetrics and Gynecology in a tertiary teaching hospital. Interviews were audio recorded and transcribed verbatim and then analyzed using NVivo (QSR International) software.

RESULTS

A total of 12 interviews were conducted and analyzed. Participants indicated a lack of prescribing restrictions and highlighted issues of low contraception literacy in Saudi communities, self-prescribing behaviors, health system organization, and physicians' knowledge. Participants perceived the need for a contraception protocol guiding the prescribing process and patient counseling without restricting prescribing. Moreover, participants highlighted a number of factors affecting the development and implementation of such a protocol, including the availability of contraception, the need for research by physicians, patient factors, and the expected increased load on the hospital.

CONCLUSIONS

This research described current practices, showed the need for a contraception protocol, and highlighted the factors affecting the development and implementation of such a protocol.

Knowledge, Attitude, and Practice of Family Planning Among Saudi Primary Health Care Attendees in Al-Ahsa, Kingdom of Saudi Arabia

BACKGROUND

 Assessing community awareness and practice of the significance and methods of family planning is critical for improving the effectiveness and quality of services, policies, and planning, which has a positive impact on the health and quality of life of women, children, families, and communities.

OBJECTIVE

 This study aims to determine Saudi population's knowledge, attitude, and practice of family planning in Al-Ahsa, Kingdom of Saudi Arabia.

METHODOLOGY

 A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia. The study included randomly selected participants (male and female Saudi primary health care attendees). All adult Saudi individuals of both genders attending primary health care centers were eligible for inclusion in this study. Data were analyzed using IBM SPSS Statistics for Windows, Version 15 (Released 2006; IBM Corp., Armonk, New York, United States). Descriptive statistics for the prevalence and quantitative variables was used.  Results: The study included 672 participants; 78.6% of them were females and 21.4% were males. 23.8% of participants aged between 20 and 30 years old. 73.8% of participants heard of family planning before. The source of information about family planning was reported as 36.9% from the Internet, 27.4% from relatives, 21.4% from the doctor, and 14.3% from books. 21.4% think that long-term contraceptive use led to permanent infertility. 81.0% of the participants said that they tend to use family planning methods. 78.6% of the participants have used a family planning method before, where 25.8% of the participants used natural contraception methods, 21.2% used surgical contraception, 27.3% used condoms, and 12.1% used hormonal tablets, while 13.6% used nothing. However, 65.2% currently use contraceptives. 31.8% use the natural method of family planning currently, 21.2% use surgical methods, and 6.1% use condoms.

CONCLUSION

 In comparison to many studies previously mentioned, the rate of family planning utilization was average, as was the level of knowledge and attitude toward family planning. However, there were some mistaken beliefs among participants regarding contraceptives. Age, gender, the duration of a marriage, education level, working status, and monthly income were all found to be significantly associated with knowledge of family planning.

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

More than half of all patients with multiple sclerosis (MS) in the Kingdom of Saudi Arabia (KSA) are women of childbearing age. Raising a family is an important life goal for women in our region of the world. However, fears and misconceptions about the clinical course of relapsing-remitting MS (RRMS) and the effects of disease-modifying drugs (DMDs) on the foetus have led many women to reduce their expectations of raising a family, sometimes even to the point of avoiding pregnancy altogether. The increase in the number of DMDs available to manage RRMS and recent studies on their effects in pregnancy have broadened management options for these women. Interferon beta now has an indication in Europe for use during pregnancy (according to clinical need) and can be used during breastfeeding. Glatiramer acetate is a further possible option for women with lower levels of RRMS disease activity who are, or about to become, pregnant; natalizumab may be used up to 30 weeks in patients with higher levels of disease activity. Where possible, physicians need to support and encourage women to pursue their dream of a fulfilling family life, supported where necessary by active interventions for RRMS that are increasingly evidence based.

Utilization pattern and side effect profile of oral anticonceptives: A community-based cross-sectional study among Saudi women

BACKGROUND

The rapid change in the socio-demographic pattern and changing beliefs toward fertility and birth spacing have resulted in a notable increase in the use of oral anticonceptives in the Saudi Arabian community. However, information on the current utilization of oral anticonceptives and attitudes toward their use remains sparse.

OBJECTIVE

The present study evaluated the utilization pattern of oral anticonceptives, attitude toward pill use, and incidence of side effects among Saudi women.

SETTING

The study was conducted in a community setting in Jazan, Kingdom of Saudi Arabia.

METHODS

Eligible Saudi women routinely using oral anticonceptive pills were invited to participate in this prospective, cross-sectional survey. Data were collected using a standardized, pretested, semi-structured questionnaire. Jazan was selected as it recorded the highest number of women using contraceptives in Saudi Arabia.

MAIN OUTCOME MEASURE

The pattern of pill utilization, attitude toward pill use, and incidence of side effects.

RESULTS

A total of 496 women consented to participate in this study. Most of the respondents (87.5%) were using or had used oral anticonceptives for birth control. In nearly half (49.2%) of participants, oral pills were advised by a gynaecologist, and approximately two-thirds (69.0%) were using or had used combined oral anticonceptives. Nearly two-thirds (63.1%) of respondents preferred pills over other contraception methods due to their ease of use. More than one-third (39.3%) of participants agreed that oral pills are safe. Approximately half (53.2%) of participants were aware that a missed pill must be taken immediately after recalling that a dose was missed. A total of 69.6% of participants experienced at least one side effect, of which mood swings (61.1%), weight gain or increase appetite (42.2%), decreased libido (34.1%), and nausea (31.2%) were most common.

CONCLUSION

Saudi women had a high acceptance rate for oral anticonceptives as a legitimate method to prevent unintended pregnancy. This was associated with a modest degree of understanding about their risks and benefits. Pharmacists should provide up-to-date information and counsel patients about the use and side effects of oral anticonceptives.

Factors influencing sexual and reproductive health of Muslim women: a systematic review

BACKGROUND

In Islamic societies, issues related to sexual and reproductive health (SRH) are rarely discussed and considered sensitive subjects. This review aimed to identify any personal, religious, cultural, or structural barriers to SRH service and education among Muslim women worldwide.

METHODS

A search for qualitative and quantitative studies was conducted on seven electronic databases. A narrative synthesis using thematic analysis was conducted.

RESULTS

Fifty-nine studies were included from 22 countries: 19 qualitative, 38 quantitative and two mixed methods. Many Muslim women have poor SRH knowledge, and negative attitudes which influence their access to, and use of SRH services. Barriers to contraception use among Muslim women included a lack of basic reproductive knowledge, insufficient knowledge about contraception, misconceptions, and negative attitudes. Women had negative attitudes towards family planning for limiting the number of children but not for child spacing, which reflected religious views towards family planning. Religious and cultural beliefs were barriers to contraception use and access to SRH services and information. Family and the community have a significant impact on women's contraceptive use and access to SRH services. Husband and family opposition played a significant role in contraception access and use. Fear of stigmatization and being labelled as having pre-marital sexual relations among unmarried women acted as the main barrier to accessing contraception and seeking SRH information and services.

CONCLUSION

The findings reveal that there are multiple levels of factors that influence Muslim women's SRH. Poor SRH knowledge and practices among Muslim women is complex matter that is affected by personal, community, cultural, religious factors and existing policies and regulations. All these factors overlap and are affected by each other. There is an urgent need for interventions addressing modifiable barriers to SRH education and services to improve knowledge, informed choice and access to services to facilitate better sexual and reproductive wellbeing for Muslim women. It is important to note that while this review aimed to report findings on Muslim women, we acknowledge that significant variations exist within every culture and religion.

Contraceptive use as limiters and spacers among women of reproductive age in southwestern, Saudi Arabia

Objectives:

To examine the prevalence, socioeconomic, and demographic determinants of contraceptive use among women of reproductive age residing in Abha, Kingdom of Saudi Arabia.

Methods:

The data of this study was collected through a cross sectional survey conducted on unmet need for family planning in Abha, Kingdom of Saudi Arabia, between March and May 2016. Three hundred and seventy-four married women were recruited from 6 primary health care centers by a consecutive sampling technique. Data was collected via an interviewer-administered questionnaire. Chi-square test was carried out to identify the factors associated with contraceptive use.

Results:

The prevalence of contraceptive use rate was 58.8%. Among users, 60% were spacers and 40% were limiters. Among more than two-thirds of the women, the decision to use a family planning method was a joint decision of the couple; and 25% reported it as their own decision. Oral pills and intrauterine contraceptive device (IUCD) were the most popular methods. The most significant associated factors were age, education of women, gravida, number of living children, gender, and age of the last child. Younger age was related with the spacers and older age with birth limiting. Woman’s education level showed a significant positive association with birth spacing.

Conclusion:

This study demonstrated that a sizable percentage of women in Abha, Kingdom of Saudi Arabia, are using contraceptions. This finding indicates the need of comprehensive family planning program in the region.

Knowledge, attitude, and practice among Saudi primary health care attendees about family planning in Abha, Kingdom of Saudi Arabia

Background:

Knowledge, attitude, and practice (KAP) of contraception are influenced by a host of interdependent demographic, cultural, economic, and social factors, therefore, KAP vary not only in different countries but also from region to region in a country. A cross-sectional study was carried out among Saudi primary health care attendees at Abha city, Saudi Arabia, with the aim to help in developing strategies that may enhance family planning in Abha.

Methods:

A structured questionnaire was designed by the researcher to obtain the necessary information from all reproductive age group patients who attended primary health care centers in Abha for a period of 1 month (July to August 2017). Statistical analysis was done using two-tailed tests and alpha error of 0.05. P value less than or equal to 0.05 was considered to be significant.

Results:

The study included 314 participants, with age ranging from 18 to 55 years. Among them, 70.4% were female, and 56.1% of the sample were university graduates. Approximately 80.6% of the participants knew about family planning, and 68.1% correctly defined family planning. Hormonal pills were recognized by 53.2% of the participants followed with intrauterine devices. Family members were the most common source of information (51.8%), followed by internet reading (37.5%) and healthcare workers (21.8%). The attitude of the studied group varied. Most of them only wanted to use family planning in agreement with their spouses, and 11.8% had negative attitude due to their fear of side-effects. Currently, 29.6% of the participants were using family planning methods whereas 53.5% had used contraception in the past. Oral contraception was the most commonly used method (49.5%), followed by surgical methods (30.1%) and natural methods (16.1%).

Conclusions:

The present study reveals that a significantly higher proportion of respondents know about contraception and more than half had good knowledge about contraception. However, the current practice of contraception methods is lower than many regions in the country. The selection of oral contraception as the method of choice is similar to other studies.

The effects of oral contraceptive usage on thrombin generation and activated protein C resistance in Saudi women, with a possible impact of the body mass index

BACKGROUND AND OBJECTIVES

The effect of oral contraceptive (OC) usage on coagulation has been studied worldwide. However, no such studies have been conducted in Saudi Arabia on Saudi women using OCs. The aim of this study was to investigate the effects of OC-induced changes of thrombin generation (TG) in the absence and presence of activated protein C (APC) or thrombomodulin (TM) in Saudi women.

METHODS

A total of 115 adult women, 47 on oral contraception (OC users) and 68 controls (not using OCs) were recruited from the obstetrics-gynecology outpatient clinic in Saudi Arabia. OCs that were used in this study include the following: Marvelon, Gynera, Cerrazetem, Yasmine, Microlut, Gracial and Diane. The plasma calibrated automated thrombinography (CAT) was used to determine TG which was expressed as endogenous thrombin potential (ETP; nM/min), lag time (min), peak (nM) and time-to-peak (ttpeak; min). In the presence of TM or APC, TG parameters were expressed relative to the parameters in the absence of TM or APC.

RESULTS AND CONCLUSION

As in other populations, our study demonstrated that OC usage induced prothrombotic changes in plasma of Saudi women, including resistance to the inhibitory actions of TM and APC. More specifically, OC usage in our population predominantly influenced TG and APC/TM sensitivity in overweight and obese individuals, a finding that needs confirmation in large cohort studies. The effects of APC and TM on TG parameters showed a positive association, and the correlation coefficients were higher in OC users for both ETP and peak values.

Fertility behaviour of working women in Saudi Arabia: a special case of King Saud University, Riyadh

Fertility levels and their determinants in Saudi Arabia have not been studied sufficiently for formulating family policy, although some attention has been paid to rapid fertility transitions in the context of socioeconomic and cultural change. This study focused on the fertility of a particular occupational category in the Kingdom of Saudi Arabia to assess determinants of fertility, measured as the number of children. The sample was drawn from the King Saud University staff - ever-married Saudi Arabian women. Results found that proximate factors (age, age at first marriage, intended number of children, length of marriage and contraceptive use) were significant in predicting fertility behaviour, whereas geographic, social and economic factors were insignificant. Thus, the fertility behaviour of this occupational group seems unique. This might be due to the special characteristics and lifestyle of this particular occupational group. The effect of the intended number of children on the actual number signified the fertility behaviour of this group of women. This, expectedly, should improve the influence of social and economic factors on fertility behaviour, in the future. Thus, advocates, policies and programmes (population and public health) at the societal and familial levels, should consider the demographic change in the social and economic context.

Validation of a pregnancy planning measure for Arabic-speaking women

Background

The prevalence of unplanned pregnancy in Saudi Arabia has not been thoroughly investigated.

Objective

To conduct a psychometric evaluation study of the Arabic version of the London Measure of Unplanned Pregnancy (LMUP).

Methods

To evaluate the psychometric properties of the LMUP, we conducted a self-administered online survey among 796 ever-married Saudi women aged 20–49 years, and a re-test survey among 24 women. The psychometric properties evaluated included content validity measured by content validity index (CVI), structural validity assessed by exploratory factor analysis (EFA), substantive validity assessed by hypothesis testing, contextual stability for the test-retest assessed by weighted Kappa, and internal consistency assessed by Cronbach’s alpha.

Results

The psychometric analysis of the Arabic version of LMUP exhibited valid and reliable properties. The CVIs for individual items and at the scale level were >0.7. EFA confirmed a unidimensional extraction of the scale item. Hypothesis testing confirmed expected associations. The tool was stable with weighted kappa = 0.78 and Cronbach’s alpha = 0.88.

Conclusion and recommendations

In this study, the validity and reliability of the Arabic version of the LMUP were confirmed according to well-known psychometric criteria. This LMUP version can be used in research studies among Arabic-speaking women to measure unplanned pregnancy and investigate correlates and outcomes related to unplanned pregnancy.

Knowledge about missed contraceptive pills among married women at King Abdulaziz University Hospital

BACKGROUND

Oral contraceptive pills (OCPs) are one of the most reliable methods of contraception. However, lack of knowledge about oral contraceptive use and inconsistent pill-taking might result in decreased efficacy. The study reported here aimed to explore women's knowledge about oral contraceptive use and assess the factors associated with knowledge about OCPs among users.

METHODS

This cross-sectional survey was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between April and June 2014. We included married, non-pregnant women >18 years old who had used a combined 21-day OCP for at least 3 months prior to recruitment. A questionnaire was used to collect the participants' demographic information. It also assessed their knowledge about OCPs. Data were entered into and analyzed using SPSS software.

RESULTS

A total of 357 women were recruited. Of these, 57.7% reported they knew what to do after missing one or two pills, but only 18.3% knew exactly what to do after missing more than two pills consecutively. Postgraduate women had a significantly higher knowledge score than illiterate women (P=0.002) and those who had completed at least primary education (P=0.001). Conversely, there was no difference in knowledge scores between Saudi and expatriate women (P=0.2). Monthly incomes (P=0.2) and mode of OCP selection (P=0.2) were also not significantly associated with knowledge scores.

CONCLUSION

Women had poor knowledge about OCP use. Appropriate measures should be taken to educate women about proper oral contraceptive use.