Original Article
Acta Medica Anatolia
Volume 2 Issue 1 2014
General view of women in reproductive age about contraception in
Hatay: a questionnaire study
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Raziye Keskin Kurt , Ayşe Güler , Ali Ulvi Hakverdi , Ayşe Neslin Akkoca , Kenan Serdar Dolapcıoğlu , Arif Güngören , Atilla
Karateke
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Department of Obstetrics and Gynecology, Mustafa Kemal University Medical School, Hatay, Turkey
Department of Family Medicine, Mustafa Kemal University Medical School, Hatay, Turkey
Abstract
Objectives: The present study has been conducted to investigate the general perspective on family planning methods and
reasons for preference regarding family planning methods among women aged 15-49 years in the city of Hatay.
Methods: 800 female participants admitted to Hatay Mustafa Kemal University Faculty of Medicine between August 2013 October 2013 were included in the study. The volunteered participants filled out the questionnaire form prepared by the
investigators. Data were evaluated in computer environment.
Results: While 49% (n: 392) of the women were using a modern method, 35% (n: 280) were using a traditional method, 16%
(n: 128) were not using contraception. The rate of modern contraceptive use correlated with increasing educational level.
Sixty percent of the women with unintended pregnancies reported becoming pregnant while using a traditional method.
Conclusions: In the city of Hatay, 84% of the women in reproductive age use a family planning method, and modern methods
are widely preferred. Another important finding of the present study is the fact that women with unintended pregnancies
had conceived while using traditional methods. We believe that this rate can be further improved by improving awareness
about modern contraception, increasing socioeconomic level, and providing convenient access to these methods.
Keywords: Contraception, family planning methods, unintended pregnancy.
Received: 09.01.2014
Accepted: 20.01.2014
Acta Medica Anatolia
Introduction
Family planning is defined as the decision of all
individuals to have as many children as they desire on
the basis of freewill and responsibility, and to have
the relevant information, education and tools serving
this purpose. Family planning decreases the number
of unintended pregnancies and thereby protects
women's life against the risks associated with unsafe
abortion methods (1). It also decreases maternal and
neonatal mortality and morbidity (2, 3). Improved
family planning programs are expected to decrease
maternal death by 40% and neonatal death by 20%
(4) . A review has shown a worldwide contraception
prevalence of 63% among women of reproductive
age (married or in a relationship) (5). According to the
TNSA 2008 study, 71.1% of the women in our country
use contraception. While 46% of these women use
modern contraceptive methods, 27.1% prefer
traditional methods. The rate of women using
modern methods, which was 31% in 1988, has
increased to 46% in 2008 (6). In our country,
improved communication methods, increased
educational level among women, the increased
number of employed women and the actions of the
Ministry of Health have led to a more effective use of
family planning methods. Despite this improvement,
unintended pregnancies remain an important
healthcare problem. In order to overcome this
situation also referred to as the unmet need for
family planning, women of childbearing potential in
reproductive age who do not desire to have children
yet do not use contraception should be encouraged
about modern contraceptive methods (7).
Figure-1:
Reasons
contraception methods
for
choosing
modern
The aim of the present study is to investigate the use
of family planning methods, the factors that influence
method preference, the reasons for not using modern
methods, and to determine whether the use of
modern contraceptive methods increases in women
Correspondence: Raziye Keskin Kurt MD, Mustafa Kemal University, Department of Obstetrics and Gynecology, Hatay, Turkey.
[email protected]
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Original Article
Kekin Kurt R et al.
with previous unintended pregnancy among women
aged 15-45 years in the city of Hatay.
Materials and Methods
Between August 2013-October 2013, 800 women of
15-49 years of age who admitted to Mustafa Kemal
University Faculty of Medicine were included in the
present study. The subjects participating in the
present study were interviewed face to face, and
filled out the questionnaire form previously prepared.
The questionnaire consisted of questions prepared to
evaluate demographic characteristics, contraceptive
method used by the participant, and their perspective
on modern contraception. Educational level among
women was categorized into 4 groups: Illiterate,
primary school graduate, secondary-high school, and
university.
association with embolization, association with
weight
gain,
association
with
infertility,
inconvenience of taking pills on a daily basis, and
other reason. The reasons of not using IUD were
categorized in 6 groups: concern of IUD shift,
association with vaginal discharge, association with
increased bleeding, partner's/husband's discomfort
during intercourse, concern of pregnancy while using
IUD, and other reason. The participants were
interrogated about previous unintended pregnancy,
and those who had such an experience were asked
which contraceptive method was used at the time.
SPSS 17.0 was used for data analysis.
Figure-3: Reasons for not using any contraception
methods
Statistics
Figure-2: Reasons for
contraception methods
choosing
traditional
Oral contraceptives (OCs), injection, intrauterine
device (IUD), norplant, diaphragm, condoms, tube
ligation and vasectomy were classified as modern
methods while calendar method, withdrawal method
and vaginal douche were classified as traditional
methods. The participants using any form of
contraception were asked why they preferred that
given method. The answers were grouped in 7
categories:
recommendation
by
healthcare
professional, friend advice, convenience of use,
durability, choice of the partner/husband, considered
to offer better protection, and other reason.
Participants not using contraception were asked for
the reason and the answers were grouped in 7
categories: considered as a sin, concerns of cancer,
association with infertility, partner's/husband's
discomfort during intercourse, partner's/husband's
desire to not use contraception, desire to have
children and other reason. The reason of not
preferring was interrogated for each modern method.
The reasons of not using birth control pills were
classified in 6 groups: association with cancer,
Acta Med Anatol 2014;2(1):9-13
Data analysis was performed by using SPSS for
Windows 17 statistical software (SPSS Inc, Chicago,
Illinois). Normal and continuous variables were
described by means and standard deviations;
whereas categorical variables were summarized as
the number of patients and percentages. Statistical
significance was accepted for p<0. 05. Student’s t test
and Mann-Whitney U test were used to compare
differences between continues variables. Chi-square
test was used to compare differences between
categorical variables.
Figure-4: Reasons of not using oral contraceptives
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Original Article
Kekin Kurt R et al.
Table-1: Baseline demographic characteristics of the
study population
Age ( mean +standard deviation)
31+8.9
Gravida (median, minimum3.2 (0-6)
maximum)
Abortus (median, minimum2.2 (0-5)
maximum)
Educational Levels (%)
Illiterate
15
primary school
40
secondary-high school
30
university
15
Contraception methods (%)
Not using
16
Traditional
35
Modern
49
Modern contraception methods (%)
Inrauterine device
20
Condom
15
Tube ligation
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Oral contraceptives
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partner's/husband's choice (26%, n: 102), convenience
of use (20%, n: 78), friend advice (11%, n: 43),
recommendation by healthcare professional (5%, n:
20), durability (5%, n: 20) and other reason (1%, n: 4)
(figure-1).
Results
The reasons for not using IUD were concerns of IUD
shift (38%), concern of becoming pregnant while using
IUD (27%), partner's/husband's discomfort during
intercourse (18%), association with increased bleeding
(10%), association with vaginal discharge (%6), and
other reason (1%) (Figure-5).
Use of modern
contraception correlated with increasing educational
level (figure-6). Thirty percent of the participants had
history of unintended pregnancy. During the
questionnaire, 60% of women with previous
unintended pregnancies were using modern
contraception. 60% of women with previous
unintended pregnancies reported becoming pregnant
while using traditional methods, 35% while not using
contraception, and 5% while using modern methods
(condoms, OC, IUD, respectively). While 60% of these
women continued with pregnancy, 40% had preferred
legal abortion.
Mean age of the participants was 31± 8.9 (15-49)
years. Gravida was 3.2 (0- 6), parity was 2.2 (0-5),
abortus was 0.8 (0-4). Besides, 15% (n: 121) of the
participants were illiterate, 40% (n: 320) were primary
school graduates, 30% (n: 240) were secondary-high
school graduates, and %15 (n: 119) had education at
university level. While 49% (n: 392) of the women
were using a modern method, 35% (n: 280) were using
a traditional method, and 16% (n: 128) were not using
contraception. The most preferred method among
women using modern methods was IUD 20%, (n: 163).
Condoms (15%, n: 123), tube ligation (9%, n: 73), and
oral contraceptives (4%, n: 33) followed it (table-1). .
The reasons of using traditional methods were easy
use (35%, n: 98), effectiveness (34%, n: 95), and
partner's/husband's choice (31%, n: 87) (figure-2). The
reasons for not using contraception were desire to
have children (35%, n: 45), partner's/husband's choice
to not prefer contraception (35%, n: 45), association
with infertility (16%, n: 20), partner's/husband's
discomfort during intercourse (7%, n: 9), concerns of
cancer (4%, n: 5), considering it as a sin (2%, n: 3), and
other reason (1%, n: 1) (figure-3).
The reasons of not using oral contraceptives were
weight gain (35% ), association with infertility (25%),
association with embolization (20%), association with
cancer (10%), inconvenience of using pills on a daily
basis (9%), and other reason (1% ) (figure-4).
Discussion
Figure-5: The reasons of not using intrauterine device
The reason for using the given modern method was
considering it more effective (32%, n: 125),
Acta Med Anatol 2014;2(1):9-13
Results of the present study show that 84% of women
of reproductive age in the city of Hatay use a family
planning method; and modern methods are more
commonly preferred compared to traditional methods
(49% vs. 35%). One of the other important finding of
the present study is the fact that women with previous
unintended pregnancies had conceived while using
traditional
methods.
However,
during
the
questionnaire it was seen that use of modern methods
was more common among with previous unintended
pregnancies compared to no such history. In terms of
contraception preference, only 5% reported following
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Original Article
the recommendations of healthcare professionals.
Furthermore, it was observed that partners had an
important role in choice of contraception methods
and the use of modern methods. Additionally, it was
seen that an important portion of the patients chose
not to use modern methods due to misinformation
about the methods and their side effects.
Contraception is the most important medical
intervention with positive outcomes. The right to
reproduce is one of the fundamental human rights and
contraception allowed equality between genders. In
addition, the most important benefit of contraception
is the decrease in maternal and neonatal mortality. In
developed countries, maternal mortality has been
reported to decrease by 40% during the last 20 years
with the use of contraception (2). In developing
countries, family planning is the most affordable and
convenient way of decreasing maternal mortality as it
does not require complex technologies as other
alternative methods (8). As the association between
the interval during pregnancies and neonatal death is
well-established, family planning is apparently
expected to influence this aspect (3). Rutstein et al.
reviewed 52 studies and showed that allowing an
interval of 24 months between two pregnancies would
decrease neonatal mortality by seven percent (3).
Modern contraceptive methods provide protection
from sexually transmitted diseases and cancer.
Furthermore, family planning is an affordable
approach which decreases the cost of outcomes
(ectopic pregnancy, intended or spontaneous
abortion, birth) associated with unintended
pregnancies (9).
Figure-6: Educational levels and ratios of using
modern contraception methods.
For majority of women, the health related benefits of
modern contraception outweigh the associated risks,
and there is a lower risk with the use of these methods
compared to not using contraception (10). While
serious health problems are rare, side effects are
commonly seen with modern contraceptive methods.
Irregular menstrual bleeding is a side effect often seen
Acta Med Anatol 2014;2(1):9-13
Kekin Kurt R et al.
with the use of OC and IUD. Although these side
effects are minor, women in some regions may
consider them unacceptable and discontinue
contraception (8). In the present study, most of the
participants reported not using modern contraception
due to concerns of side effects. Although most women
are informed on family planning, the rate of accepting
contraceptive methods is significantly lower compared
to knowing them. Individual and social beliefs
regarding health influence the decisions to an
important extent; such beliefs may not be scientific;
however, they have considerable effect on individuals.
The use of family planning methods and
discontinuation rates depend on women's perception
of benefits and risks, the effect of side effects on daily
life activities as well as their relationship with their
partners (11). Majority of the studies have shown that
partners greatly influence the decision regarding
contraceptive methods (12). Misinformation and
rumours about contraceptive methods affect the
prevalence of contraception use (13). Michieli et al.
studied patients' perspective on IUDs during the
termination of pregnancy and 23.6% of the patients
reported that they were concerned about the device
shifting to another part of the body
(14).
Exaggeration of the side effects associated with
contraceptive methods influence the use of
contraception (15). The present study shows that
advice of friends and the partner regarding the choice
of contraception outweigh the recommendation of the
physician. Additionally, misinformation about the side
effects of contraception has been observed as well as
exaggeration of the rare side effects. It is crucial to
inform women about the importance of contraception
as well as the ways to access safe and effective
methods (16).
In our country, the prevalence of modern
contraception use has increased in recent years;
however, it remains below the desired level. During
the last 20 years, no significant difference has been
observed regarding the prevalence of the widely used
withdrawal method, and 1 in 4 married couples in
Turkey continue to use this method (6). Women must
be interrogated regarding contraceptive methods
during polyclinic visits, the appropriate contraception
alternatives should be explained, and objective
information should be used to overcome the
misleading information and beliefs.
Although 800 patients were included in the present
study, the limited number of participants may be
considered as a limitation. The single-center design of
the study may also be regarded as another limitation.
Because 15% of the participants were illiterate, they
12
Original Article
may have been guided by the physician who filled out
the questionnaire.
Conclusion
In conclusion, 84% of the women in reproductive age
in the city of Hatay use a family planning method, and
modern methods are widely preferred. Another
Kekin Kurt R et al.
important finding of the present study is the fact that
women with unintended pregnancies had conceived
while using traditional methods. We believe that this
rate can be further improved by improving awareness
about
modern
contraception,
increasing
socioeconomic level, and providing convenient access
to these methods.
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