Factors influencing contraceptive use in Tehran

A qualitative study of influences on the uptake of contraceptive services among people of reproductive age in Uganda

BACKGROUND

Uganda has registered an increased investment in family planning (FP) programs, which has contributed to improvement in knowledge of modern contraceptive methods being nearly universal. However, this has not matched the uptake of modern methods or the reduction in the unmet need for FP. This may be explained by the different influences which include health workers, family, and friends. Due to the limited uptake of contraceptive methods, a program on improving awareness, access to, and uptake of modern contraceptives is being implemented in selected regions in Uganda. We, therefore, conducted a formative study to determine the influences on contraceptive uptake at the onset of this program.

METHODS

Using a qualitative study design, we conducted thirty-two focus group discussions and twenty-one in-depth interviews involving men and women of reproductive age. We also carried out twenty-one key informant interviews with people involved in FP service delivery. Data was collected in four districts where implementation of the program was to take place. Audio recorders were used to collect data and tools were translated into local languages. A codebook was developed, and transcripts were coded in vivo using the computer software Atlas-ti version 7 before analysis. Ethical clearance was obtained from institutional review boards and informed consent was sought from all participants.

RESULTS

From the study, most married people mentioned health workers as their main influence while adolescents reported their peers and friends. Religious leaders and mothers-in-law were reported to mainly discourage people from taking up modern contraceptive methods. The cultural value attached to having many children influenced the contraceptive use decision among people in rural settings. Other influences included a person's experience and housing.

CONCLUSIONS

Health workers, religious leaders, and mothers determine the uptake of contraceptive services. The study recommends the consideration of the role of these influences in the design of FP program interventions as well as more involvement of health workers in sensitization of communities about contraceptive methods.

Investigating changes in unintended pregnancies before and after the changes in the family planning policies in Iran: A multivariate decomposition analysis

Background: Unintended pregnancy is a global public health problem that has adverse health, economic, and social consequences for families and societies. This study aimed to measure levels of and analyze changes in unintended pregnancies before and after the changes in the family planning policies in Iran.

Methods: Data were extracted from Iran's Demographic and Health Surveys in 2000, 2010, and 2015. The study population consisted of married pregnant women aged 15-49 years. In this study, the data of 112 400, 29 609, and 32 264 households and 4976, 1123, and 900 married pregnant women in 2000, 2010 and 2015, respectively, were used. Logistic regression model was applied to estimate effect of the study explanatory variables on unintended pregnancy in each year, and contribution of different factors to the changes in unintended pregnancies was investigated using multivariate decomposition method. All the study analyses were performed using the Stata software, with the statistical significance level of 0.05.

Results: The rate of unintended pregnancies decreased by 13% in 2000-2010 and by 1.3% in 2010-2015. Changes in women's likelihood of experiencing unintended pregnancy positively contributed to unintended pregnancy reduction in 2000-2010 and 2010- 2015; however, the change patterns were different. Changes in the distribution of women's characteristics had positive and negative contributions in 2000-10 and 2010-15, respectively. An increase in pregnant women's parity was the main factor with counteracting effect on unintended pregnancy reduction in 2010-2015.

Conclusion: Unintended pregnancies decreased among Iranian married women over the study years, but its reduction was slowed down after the changes in the family planning policies. Policy actions in health and other socioeconomic sectors aiming to encourage nulliparous women to become pregnant and help nulliparous women, women with the parity of more than 2, and women in the middle and late reproductive ages to reduce their risk of unintended pregnancy, can accelerate the trend of unintended pregnancy reduction in the future.

Barriers to Use of Family Planning Methods Among Heterosexual Mexican Couples

BACKGROUND

Family planning has become increasingly important as a fundamental component of sexual health and as such is offered via public health systems worldwide. Identification of barriers to use of family planning methods among heterosexual couples living in Mexico is indicated to facilitate access to family planning methods.

METHODS

Barriers to family planning methods were assessed among Mexican heterosexual, sexually active males and females of reproductive age, using a modified Spanish version of the Barriers to the Use of Family Planning Methods scale (Cronbach's alpha = .89, subscales ranging from .53 to .87). Participants were recruited via convenience sampling in ambulatory care clinics within a metropolitan area in Central Mexico.

RESULTS

Participants included 52 heterosexual couples aged 18-35 years (N = 104). Sociodemographic comparisons by gender identified older age and higher education, income, and numbers of sexual partners among men than women. More men (50%) than women (25%) were currently using family planning methods; however, 80% overall indicated intentions for its use. Overall, male condoms were used and intended for use most often by men than women. Significant gender-specific differences were found, with men (71.15%) reporting no family planning barriers, whereas women (55.66%) reported barriers including low socioeconomic status, medical concerns, and stigma.

IMPLICATIONS FOR PRACTICE

The modified Spanish translation demonstrated usefulness for measuring barriers to family planning methods use in Mexico among heterosexual males and females of reproductive age. Barriers identified by Mexican women in this study may be addressed to reduce potential barriers to family planning among Mexican populations.

Awareness and Determinants of Contraceptive use among Nursing Mothers in Bellary, Karnataka

INTRODUCTION

The nursing mothers, who have already delivered a child in recent period, may prefer to avoid or delay future pregnancy, or may not even have given a thought about it. Among those who prefer to delay next pregnancy, many are unaware of family planning practices. This is mainly influenced by the prevailing sociodemographic factors in their families.

AIM

To study the prevailing Knowledge, Attitude and Practice of contraception and the influence of sociodemographic factors on family planning practices among the healthy nursing mothers.

MATERIALS AND METHODS

A cross-sectional study was conducted among 2500 healthy breast feeding mothers who delivered at Medical College Hospital (MCH), Vijayanagara Institute of Medical Sciences(VIMS), Bellary during Dec 2011 to Nov 2013. They were interviewed using a pre structured questionnaire in the post natal wards on 2(nd) to 7(th) postpartum day. Later these mothers were educated and counseled regarding various suitable contraceptive methods. The data collected were analysed using percentage and chi- square test.

RESULTS

The proportion of willingness for contraception is more among women in the age group 19-29 years, among literate husband and wife, among women belonging to nuclear families and with higher socioeconomic status. Muslim women were least receptive to contraceptive advice. Regarding awareness of contraceptive methods only 46% had knowledge regarding family planning methods. A total of 43% mothers opted to limit family size. Among 16% of mothers who did not want to limit family size, 70% had no male child. In most of the families, final decision regarding family planning method was taken by husband alone or by elders. The most important reason for lack of family planning practices was lack of awareness (57.2%).

CONCLUSION

Many of the nursing mothers are not aware of contraceptive practices. But these women are very receptive to contraceptive advice. Also, the decision of family planning depends not only on the couples but even on elders of the family. Hence, a combined family approach to educate and counsel the entire family including elders is needed. The major determinant is education of the entire family regarding family planning practices.

Woman's contraceptive needs and preferences in the postpartum period: an Italian study

AIMS AND OBJECTIVES

To describe what puerperal women know about postpartum contraception and to identify their related needs and expectations.

BACKGROUND

Puerperal women face the problem of beginning or resuming contraception, the choice of the right method of contraception and the right time to start it. This choice becomes particularly important in case they breastfeed since the contraceptive method should not interfere with breastfeeding. Different factors, such as the level of knowledge women have about various contraceptive methods, their individual preferences or their desire to have a baby, can strongly influence this choice.

DESIGN

A cross-sectional study had been carried out within the period of six months, from November 2011-February 2012.

METHODS

Three hundred puerperal women were interviewed before their discharge from a Maternity Home. The women were asked for their personal characteristics, their maternity history, the information they had received, their knowledge and expectations about postpartum contraception and their intention to use contraception.

RESULTS

During pregnancy and postpartum, 45.5% of the women reported that they had received adequate information about contraception. Of these ones, 64.3% reported their intention to use contraception either to avoid pregnancy or to space out future births, even if they did not always have appropriate knowledge about fertility and the use of contraceptive methods during postpartum. During this study, we also discovered that women's intention to use contraception was proportional to their level of education.

CONCLUSION

Women need more and appropriate information about postpartum contraception, to make a conscious choice in relation to their needs and without putting their health at risk.

RELEVANCE TO CLINICAL PRACTICE

To promote awareness of the choices related to postpartum contraception, it is important to understand the personal characteristics that influence or hinder this choice. Midwives can play a very important role in informing women and in developing educational interventions to support a safe contraceptive choice.

Factors that influence contraceptive use amongst women in Vanga health district, Democratic Republic of Congo

Background

Contraception is often necessary in order to plan for children and without it there is a risk of unplanned pregnancies. In the Democratic Republic of Congo, this often results in abortions by untrained persons with resultant morbidity and mortality.

Aim

To investigate the factors that influence contraceptive use amongst women of childbearing age in the Vanga health zone.

Methods

Cross-sectional survey using interviewer-administered questionnaires.

Results

Of the 384 women recruited, a majority (46.1%) were in the 31–40 year age group; 52% had reached primary school and 88% did not have formal employment. One hundred and forty of the participants reported current use of contraception, with 60% of them using modern methods of contraception; 36.1% of them had begun using contraception before the age of 20; and the most common methods were oral contraceptive pills and injection, each accounting for 22.9%. There was variation in the duration of contraceptive use and the main reason for using contraception was to space children. Of the participants, 20.7% had been using contraception for more than two years. Seventy-seven (31.5%) of the women reported they did not use contraception because of a fear of side effects. Forty-four (18%) reported that they are unable to afford contraception, 38 (15.6%) had husbands who disapproved of contraceptive usage, 26 (10.6%) had a fear of infertility, 18 (7.4%) practised a religion that did not allow them to use contraception and 12 of the women (4.9%) did not use contraception because it was unavailable to them.

Conclusion

Barriers to contraception in our study were fears of side effects and infertility, cost, male partner's objection, unavailability of contraception and religious beliefs.

Intended postpartum contraceptive use among pregnant and puerperal women at a university teaching hospital

OBJECTIVE

To assess the intention to use postpartum contraceptives and factors influencing use.

METHOD

A total of 423 consecutive consenting women attending the pregnancy and puerperal clinics at a university teaching hospital were interviewed using structured questionnaire.

RESULTS

The prevalence of previous contraceptive use was 35.5%. Fifty-four percent of the respondents intended to use contraceptives after delivery, though 3% were yet to decide. Condoms (38.3%) followed by intrauterine contraceptive device (IUCD) 11.5%, were the most preferred choice of postpartum contraceptives. However, spermicide (0.4%) was the least preferred. Advanced age and high parity significantly predicted intention to use postpartum contraceptives (P = 0.02 and 0.01, respectively). Also high level of respondent's education and family planning counseling by doctors and nurses increased the intention to use postpartum contraceptives (P = 0.03 and 0.01, respectively).

CONCLUSION

Family planning counseling and education play a vital role in increasing the use of contraceptives in the postpartum period.

Factors associated with contraceptive use in Tehran, Iran

OBJECTIVES

In spite of the government's efforts, the prevalence of contraceptive use in Iran is only 55.4%. Health concerns, side effects, failure of the methods and some demographic issues, among which education, age, and number of daughters, have a great influence on the enforcement of contraceptive measures. The aim of the present study was to identify factors affecting contraceptive use in Iran.

METHODS

Data from the project 'The study of contraceptive practice in Tehran, 1999-2000' were analyzed with regard to the factors associated with contraceptive use by Iranian couples. A total of 4042 women at reproductive ages who had delivered in one of the 12 teaching hospitals of Tehran and had at least one child that lived for at least 24 hours after birth, were interviewed using a questionnaire that gathered information about their socio-demographic status, fertility history, and other characteristics.

RESULTS

Using a multinomial logistic regression, it was found that the woman's age, her own or her husband's level of education, previous awareness about contraceptive methods, number of abortions, and number of sons and daughters were factors that were significantly associated with contraceptive use.

CONCLUSIONS

A number of factors affect the application of contraceptive measures. It is essential that health policy makers be aware of these to promote contraception and population control.

Contraception within six-month postpartum in rural Vietnam: implications on family planning and maternity services

OBJECTIVES

This longitudinal study documents contraception practice and factors influencing contraception decision within the first six months postpartum, amongst women residing in the rural Northern Central region of Vietnam.

METHODS

A sample of 463 rural women who gave birth during August-October 2002 were recruited and interviewed at one, 16 and 24 weeks postpartum.

RESULTS

The proportion of contraceptive users at weeks 16 and 24 were 17% and 43% respectively. At week 24, of contraceptive users, 57% used IUD, 25% used condom, and 14% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision.

CONCLUSIONS

In order to improve the situation, health authorities should be encouraged to provide counselling on postpartum contraceptive methods during ante- and postnatal care visits. Health education on family planning and breastfeeding should also involve the husband/partner group taking into account local socio-cultural features.