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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Acceptability and Use of the Diaphragm and Replens® Lubricant Gel for HIV Prevention in Southern Africa

The acceptability and use of the diaphragm and lubricant gel were assessed as part of a large randomized controlled trial to determine the effectiveness of the methods in women’s HIV acquisition. 2,452 intervention-arm women were enrolled at five Southern African clinics and followed quarterly for 12–24 months. Acceptability and use data were collected by face-to-face interviews at Month 3 and Exit. Participants were “very comfortable” with the physical mechanics of diaphragm use throughout the trial, and approval of the gel consistency, quantity and the applicator was high. At Exit, consistent disclosure of use (AOR 1.97, 95% CI: 1.10–3.55); an overall high diaphragm rating (AOR 1.84, 95% CI: 1.45–2.34) and perception of partner approval (AOR 1.75, 95% CI: 1.35–2.26) were the most significant acceptability factors independently associated with consistent use. Despite being female-initiated, disclosure of use to male partners and his perceived approval of the products were factors significantly associated with their consistent use

Female health workers: An obstetric risk group

Objective: The aim of the study was to gather information about the pregnancies of female health workers and to compare them with those of another group of working women with different working conditions, namely bank workers. Methods: Using a cross-sectional comparative design, physicians (184), nurses (197) and bank-workers (192) were interviewed about their previous pregnancies and working conditions during those pregnancies. Results: The majority of physicians (70.6%) and nurses (81.2%) had night work during their pregnancies and two-thirds of them continued this work until the last month of pregnancy, even though they have a legal right not to work during the night after the 7th month of pregnancy. Health workers had shorter maternity leaves than bank workers (P < 0.001) and complained more about the negative attitudes of managers and colleagues during their pregnancy (P < 0.001). Health workers had more preterm deliveries (P < 0.05) compared with bank workers, and nurses had more low birth weight babies compared with bank workers (P < 0.05). Conclusion: There is a need for a change in the climate in hospitals in terms of the working conditions of pregnant health staff and the attitudes towards them

Why withdrawal? Why not withdrawal? Men's perspectives

Withdrawal is an ancient and prevalent form of male contraception which has largely been ignored by family planning programme managers all over the world. The objective of this study was to understand men's perspectives on withdrawal use, both users and non-users. In-depth interviews with 62 mole factory workers in western Turkey are reported, on use of withdrawal, attitudes to family planning, information on contraception, marital and sexual experience, and gender values and attitudes. Advantages reported both by users and non-users of withdrawal were being free from side effects, ease of access and having no cost. While current users said withdrawal was easy to use and practical, non-users complained about the difficulties of using withdrawal, that it was coitus-dependent, caused anxiety and decreased pleasure during sexual intercourse. Current users emphasised taking responsibility as husbands for family planning and protecting their wives from possible adverse effects of contraceptives. Withdrawal should be seen as a valuable choice in a world where increasing method choice, male participation and responsibility taking in reproductive health are all desirable. With its cited advantages withdrawal is likely to fill an important niche among current contraceptive practices and deserves more attention and support. (c) 2005 Reproductive Health Matters. All rights reserved

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other:study participants. In the initial 2-6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier,and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of I year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked. (C) 2001 Elsevier Science Inc. All rights reserved

Curable sexually transmitted infections among the clientele of a family planning clinic in Istanbul, Turkey

Background: Integrating screening and treatment of sexually transmitted infections into existing family planning programs can be a good way to fight this problem. Also, the number of studies on the prevalence of certain sexually transmitted infections in this population in Turkey is limited

Challenges for the adoption of evidence-based maternity care in Turkey

Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs. (c) 2005 Elsevier Ltd. All rights reserved