Family Practice Vol. 18, No. 2, 204-208
© Oxford University Press 2001
Factors influencing contraceptive use in Tehran
National Research Centre for Reproductive Health (NRCRH), Deputy Ministry for Research Affairs, Ministry of Health and Medical Education, Tehran, Iran.
Tehrani FR, Farahani FKA and Hashemi MS. Factors influencing contraceptive use in Tehran. Family Practice 2001; 18: 204–208.
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Abstract |
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Background. Despite reluctance to conceive, ~30% of couples do not use any method of contraception. Health concerns, side effects, failure of the method and some demographic issues such as education, age, residential region and number of living children have a major effect on contraceptive use.
Objective. The aim of the present study was to determine those factors which influence contraceptive use in Tehran.
Methods. Data from the project ‘The Study of the Effectiveness of Postpartum Consultation about Family Planning on Contraceptive Practice during 2 years after Parturition in University Hospitals of Tehran in 1996’ were applied for the analysis of those factors which influence contraceptive use by Iranian couples. A total of 4177 women of reproductive age who gave birth in one of the 12 hospitals in Tehran during the 24 hours following the interview of the initial study and had at least one living child were enrolled in the present study. The questionnaire used included some questions about socio-demographic status, fertility history, knowledge of contraceptives and the source of this knowledge, and previous contraception practice and its effectiveness.
Results. Using a logistic regression model, it was found that age, women's level of education, their husbands' level of education and previous familiarity with contraceptive methods were the most significant factors influencing contraceptive use.
Conclusions. It is suggested that health policy makers strengthen the family planning services through providing appropriate counselling in family planning clinics.
Keywords. Contraceptive prevalence rate, contraceptive use, discontinuation rate, education..
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Introduction |
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Asia, where >60% of the world's 900 million couples of reproductive age live, shows a large variety in patterns of contraceptive use and use of different methods. The prevalence of contraceptive use ranges from a low of 12% in Pakistan to >80% in China and Hong Kong.1 According to the latest census, which was conducted in 1996, Iran has a population of 60 055 488.The country's average annual population growth rate in two consecutive censuses of 1976 and 1986 was reported to be 2.7 and 3.2%, respectively, showing an increase of 0.5%.2 Due to the increasing rate of population growth, the government decided to take effective steps to reduce the rapid growth rate. One of the most important steps was to make contraceptives available free of charge throughout the whole country.
However, despite government efforts, the prevalence rate of contraceptive use was estimated to be ~55.4% in 1999.2 Side effects, health concerns and failure of the method are some of the reasons given for discontinuation of contraception.
In a study conducted in China, it has been shown that reasons for discontinuation differ from one method to another. The quality of services in general has relatively little impact on contraception practice based on this study, and individual characteristics and levels of motivation were the major determinants of continuation of use.3 Education, residential region, age, sex of children and number of living children have a major effect on the use of contraception.4
Due to a lack of information regarding factors which influence contraceptive status in Tehran, we conducted this study to determine these factors.
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Methods |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Data from the project ‘The Study of the Effectiveness of Postpartum Consultation about Family Planning on Contraceptive Practice during 2 years after Parturition in University Hospitals of Tehran in 1996’ were applied for the analysis of the factors which influence contraceptive use by Iranian couples. A total of 4177 women of reproductive age, who had given birth in one of the 12 studied hospitals in Tehran in the 24 hours following an interview for that study and who had at least one living child, were enrolled in this study.
The questionnaire administered included some questions about socio-demographic status, fertility history, methods of contraception used before the latest pregnancy, whether this pregnancy was planned, knowledge of contraceptives and the source of this knowledge. The interviewer also asked women some questions about their mode of contraceptive use and then compared this with the standard protocol in order to determine if they had used their contraceptive method correctly or not.
Data were input into a computer and the SPSS package was used for the analysis by a logistic regression model.
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Results |
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A total of 4177 subjects were enrolled in this study. Their mean age was 23.7 ± 4.3 years, with a maximum of 40 and a minimum of 18 years; 72% of subjects were aged 21–35, 26.5% were
20 and 1.5% were >35 years old. Of the women, 3.8% were illiterate, 30.4% had primary level and 40.2% had intermediate level education (Table 1
). With regard to the level of education of their husbands, 71.8% had education up to diploma grade, 25.3% had university degrees and ~3% were illiterate (Table 1). Fifty percent of the women had one living child, 36.4% had two children and 11.7% had three children (Table 1).
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The use of contraception in women who attended these hospitals during the study was 60.9%. Natural methods (withdrawal and rhythm) were the most common, accounting for 61.0% of contraceptive use. The percentage use of oral contraceptives, intra-uterine devices and condoms was 22.9, 10.1 and 6.0%, respectively (Fig. 1
).
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Of the women surveyed, 74.4% were familiar with contraceptive methods previously and 25.6% were not (Fig. 2
). Among those with prior knowledge, the most common source of information was a family planning clinic (46.3%); friends, publications, husbands, radio and TV, and physicians were the other sources of obtaining information, at 33.1, 24.1, 13.3, 13 and 9.2%, respectively.
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Of the current pregnancies, 68.9% were wanted while 31.1% were not (either one or both parents did not want the pregnancy).
Contraceptive use varied based on the women's age; it was 41.1% among women aged 20 and increased to 68.1% for those aged 21–35 and to 68.8% for those over 35 (Table 1
). A total of 56.1% of illiterate women had used contraceptive methods before the latest pregnancy, while for those who had received primary, secondary, diploma and higher education this rate was 59.5, 60.8, 63.3 and 69.7%, respectively (see Fig. 3).
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Contraceptive use in women with more educated husbands was higher than for those with less educated husbands: 65.6% among women whose husbands had a university degree, 59.8% in those literate up to diploma and 52.9% in women with illiterate husbands (Fig. 4
).
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Among women who had one living child, 39.2% had used some form of of contraception, while this rate was 82.7 and 86.9% for women with two and three children, respectively.
Logistic regression modelling was also used to determine the factors which affect contraceptive use. Contraceptive use was considered as the dependent variable, and women's age, education, husband's education, awareness of contraceptive methods, number of living children and the children's sex were considered as independent variables.
The variable of women's education was classified into five groups (illiterate, primary, secondary, diploma and university). Husbands' education was classified into three groups (illiterate, literate up to diploma and university graduate). University education in women and in their husbands was considered as a reference level and other groups were compared with them. The woman's age was classified into three groups: 20 years old; 21–35 years old; and >35 years old. Women aged between 21 and 35 years old were considered as the reference group. Previous awareness of contraceptive methods was classified into two groups (aware and unaware), of which aware was considered as the reference group. The number of living children (daughters and sons) were entered into the model as a quantitative variable.
Using the logistic regression model, the odds ratios, their level of significance and standard deviation were calculated (Table 2). Backward logistic regression (Pe = 0.15 and Pr = 0.2) was used and the model is as follows:
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The sensitivity of this model is 61.6% and the specificity is 79.6%. The total power of this model for identification of the correct states is 72.6%.
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Discussion |
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In this study, the skewness of age distribution is due to a special method of information collection (hospital based), such that the sampling design is based on the attendance of women at hospitals; therefore, there was no control of age distribution in this study.
The estimated odds ratio of not using contraceptive methods was 1.3 and 1.9 among women aged 20 and >35, respectively, in comparison with women aged 21–35 years old.
The results show that the risk of not using contraception methods will decrease by increasing the woman's education level, so the odds ratio for non-use of contraception in illiterate women was ~3 which declined to 1.3 in women who had a diploma in comparison with those who had a university education. A husband's illiteracy increased the risk of not using contraception by 1.8 times; this result shows the important role of a husband's attitude towards and awareness of contraceptive use. Similar results have been shown in studies by Kijuan and Yue in 19945 and by Hardy in 1998.5
Despite the fact that family planning services are available free of charge in the whole country, it has been shown that 39.1% of women did not use any kind of contraception despite being unwilling to become pregnant. A total of 25.6% of women were unaware of contraceptive methods; this has led to an increase in the estimated odds ratio of not using contraceptive methods of 1.9 times (Table 2). Hardy's study confirmed the significant role of consultation in improving the prevalence rate of use of contraception.4
It is suggested that health policy makers strengthen the family planning services to provide appropriate methods of counselling in family planning clinics. According to this study, the ideal family is considered as one son and one daughter, and a greater number of children (i.e. more than one son or one daughter) reduces the estimated risk of not using contraception; for example, a couple who have two daughters had an estimated odds ratio of 0.432 and a couple who have two sons had a ratio of 0.508 (Table 3). The results of Kejuan's study5 were similar to ours but, in that study, preference for a particular sex had a significant role in non-use of contraception. Thus the results of our study show an upgraded conception about the desired number of children without any sex preference.
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It seems that unfamiliarity and unawareness about contraceptive methods in women aged 21–35 years old are the main reasons for an increased risk of not using contraception; however, it is possible that the number of women in this age group was not sufficient to reach such a conclusion.
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Acknowledgments |
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The authors would like to thank the research assistants and the members of NRCRH for their help during this work. The study was funded by United Nation Population Funds and the Deputy Ministry for Research Affairs, Ministry of Health and Medical Education.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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1 Shah IH. Contraceptive transition in Asia. Progress of Social Science Research on Reproductive Health. 1994: 139.
2 Country Report on the Population Reproductive Health and Family Planning Program in the Islamic Republic of Iran. 1998: 1–6.
3 Cleland J, Ali M. Contraceptive Transition in Asia. Quality of Care and Contraceptive Continuation. 1994: 124–125.
4 Hardy E et al. Contraceptive use and pregnancy before and after introducing lactational amenorrhea in a postpartum program. Adv Contracept 1998; 14: 59–68.[Web of Science][Medline]
5 Kejuan F, Yue L. The contraceptive prevalence, efficacy and influential factors among married minority women in China. Progress of Social Science Research on Reproductive Health. 1994: 170–177.
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