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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 48-54

The prevalence and factors affecting the use of contraceptive methods among Saudi women in Sabya, Jazan, Saudi Arabia


1 Department of Nursing, University College in Sabya, Jazan University, Jazan, Saudi Arabia
2 Department of Nursing, University College in Sabya, Jazan University, Jazan, Saudi Arabia; Department of Biotechnology, Shendi University, Shendi, Sudan

Date of Submission14-Sep-2021
Date of Decision15-Nov-2021
Date of Acceptance30-Nov-2021
Date of Web Publication2-May-2022

Correspondence Address:
Hind Abdallah Modawi Elamin
Department of Nursing, University College in Sabya, Jazan University, Jazan
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_135_21

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  Abstract 


Context: The socioeconomic changes in the Saudi community with an increase in women's education and employment resulted in changes in the concept of birth spacing and contraceptives use. Aims: The goal of this study was to evaluate the prevalence of contraception usage among Saudi women in Sabya City in Jazan, as well as the socioeconomic, demographic, and reproductive variables that impact contraception use. Settings and Design: This was a cross-sectional descriptive study, conducted between January and October 2020. Subjects and Methods: Data were collected by direct interview of 220 Saudi married women at reproductive age, during their routine visit to primary care centers in Sabya City_Jazan, Saudi Arabia. Statistical Analysis Used: A Chi-squared test was performed to evaluate the factors associated with contraceptive use. P < 0.05 was considered statistically significant. Results: The prevalence of contraceptive use was 75%. Pills were the most used method, most of the users obtain their contraceptives from the Pharmacy. The majority of participants (84%) had poor knowledge regarding contraceptive methods, however, the acceptance rate for using contraception was high (82.3%). History of having an abnormal child and experience of unintended pregnancy were the only factors significantly associated with the use of contraceptives, all the investigated sociodemographic factors were not significantly associated with contraceptive use. The most important reason for not using contraception was the husband's disagreement. Conclusions: This study revealed that a high percentage of Saudi women in the Jazan region are using contraceptives, though their knowledge is poor. This indicates the need for greater efforts to improve the quality of family planning services in the region.

Keywords: Attitude, contraceptive, knowledge, prevalence, Saudi Arabia, use


How to cite this article:
Elamin HA, Gadir IK, Alhazmi MH, Owisi NH. The prevalence and factors affecting the use of contraceptive methods among Saudi women in Sabya, Jazan, Saudi Arabia. Saudi J Health Sci 2022;11:48-54

How to cite this URL:
Elamin HA, Gadir IK, Alhazmi MH, Owisi NH. The prevalence and factors affecting the use of contraceptive methods among Saudi women in Sabya, Jazan, Saudi Arabia. Saudi J Health Sci [serial online] 2022 [cited 2022 Aug 19];11:48-54. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/1/48/344481




  Introduction Top


Family planning describes the desire of a couple to use contraceptive methods to limit or space the number of children they have.[1] Contraception is important for reducing the rate of unplanned pregnancy in all ages, allowing spacing of families, and improving both maternal and child health.[2] Contraception use has many health benefits beyond contraception, these benefits may influence the method used and the continuation of use, barrier method prevents sexually transmitted diseases, the combined pill offers protection from certain types of cancer such as ovarian and endometrial as well as colorectal cancer, this public health benefit overweigh the risk of ovarian cancer,[3] moreover, they reduce heavy menstrual bleeding, regulate menstrual cycles, and alleviate dysmenorrhea,[4] also combined pills help in reducing asthma symptoms, pelvic inflammatory disease, rheumatoid arthritis, and preserve bone density.[5] Despite these benefits, contraceptives have side effects, pills are known to cause a mild increase in blood pressure in long-term use, infections of urinary tract are more frequent in pill users by 25%–50%, glucose tolerance is slightly decreased, they also increase the risk of thrombosis.[6] The pill is contraindicated with symptoms of thrombophlebitis and thromboembolism, sickle cell anemia, proposed surgery, long-term immobilization, latent diabetes, and lipid metabolism disorders.[6]

Many countries in the Middle East have witnessed increased contraceptive prevalence rates. The growing acceptance of contraception among Arab populations could be attributed to the increase in girls' education and participation in wider society.[7] The Saudi community has seen a recent change in the sociodemographic pattern related to women's education and career, these changes have played a role in tendencies to birth spacing and, consequently, the use of the contraceptives.[8] In 2018, according to Saudi Household Health Survey, the prevalence of contraceptive use in Saudi Arabia was 30.4%.[9] Contraception has a fundamental role in reproductive health improvement and women's empowerment,[10] thus, Saudi Arabia with the current vision of 2030 needs to focus more efforts on contraception.

Knowledge about different contraceptive methods is poor among Saudi women, about half of women involved in a study conducted in Hail region, Saudi Arabia, in 2017 concluded that their knowledge about different contraceptive methods was not enough.[11] The knowledge gap in the use of different contraceptive methods was also reported in a study conducted in 2018 in Jeddah, Saudi Arabia.[12]

The acceptance of Saudi community to contraception is increased, Mubashar et al. reported that most of their participants have a positive attitude toward contraception,[8] although a small percentage of women have negative attitudes, due to fear of side effects.[13],[14] Men also showed a positive attitude and approved contraceptive use.[15]

Maternal age, educational level, working conditions, parity, family size, and gender of the last child are reported factors that affect the decision of contraceptive use by women in Saudi Arabia.[16],[17] The most popular contraceptive methods used in Saudi Arabia are oral contraceptive pills (OCPs) and intrauterine contraceptive devices (IUCDs).[18],[19]

Many studies regarding this vital issue were conducted in different regions of Saudi Arabia (Abha, Riyadh, Jeddah, Taif),[2],[12],[17],[20] but no similar studies were reported from Jazan region, though it is one of the growing regions in the country and witnessed a lot of improvements in education and health care.

The current study aimed to measure the prevalence and identify the factors affecting the use of contraceptive among Saudi women in Sabya, Jazan, Saudi Arabia.


  Subjects and Methods Top


Study design, setting and population

This was a cross-sectional study conducted in four governmental primary health-care centers in Sabya City, Jazan, Saudi Arabia, from January to March 2020. All Saudi women who were married, aged from 18 to 49 years and who had at least one child were recruited.

Exclusion criteria

Non-Saudi women.

Women in the age group (18–49 years) who are not married.

Married women in the age group (18–49 years) who have no children.

Women fulfilling the inclusion criteria but refused to participate in the study.

Variables

The dependent variable is the utilization of contraceptive methods.

The predisposing variables are age, education level, current work status, average monthly income, family size, and knowledge and attitudes toward contraceptives.

Sampling design

There are four primary care centers in Sabya City; all of them were used to achieve the sample size. The participants were randomly selected from the centers.

Sample size

The sample size was distributed with proportional allocation between the four primary health-care centers. The total number was 220 participants.

Data collection

A structured questionnaire was developed to fulfill the research objectives. The questionnaire was originally developed in English and then translated into Arabic; its validity was reviewed by selected health-care experts and professionals and was tested on a sample of the target population.

Trained female nursing students interviewed selected women. Women were approached while waiting for services at the primary care centers and given a brief description of the study. Written consent was taken from those who were willing to participate, and the questionnaire was administered verbally.

Data analysis

Data were analyzed using IBM© SPSS© Statistics version 20 (IBM© Corp., Armonk, NY, USA). The prevalence of contraceptive use was measured as the percentage of users from the total number of participants. In addition to descriptive statistics, the Chi-squared test was used to determine the association of independent variables with the variable of interest (use of contraceptives) with a P < 0.05 was considered statistically significant.

Ethical approval

This research was approved by the Scientific Research Ethics Committee of Jazan University (HAPO-10-Z-001), research code: FS10-036.


  Results Top


This study was conducted from January to March 2020, among 220 married reproductive age, Saudi women attending primary health-care centers in Sabya, Jazan.

Sociodemographic and reproductive characteristics

[Table 1] most of the respondents (41%) were in the middle age category (25–34 years), had secondary school or higher education (60%), were housewives (47%), and live in urban areas (67%). The majority of them (49%) had their first child when they were younger than 20 years, had more than 4 children (39%), had no history of an abnormal child (70%), but nearly half (53%) experienced an unintended pregnancy.
Table 1: Sociodemographic, reproductive characteristics, and correlation with contraceptive use

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Knowledge about contraceptives

[Table 2] shows the knowledge status of participants. Most of the participants (95%) heard about contraceptives, but only 16% of them had good knowledge (recognized more than two methods of contraception). The media were the least important source of knowledge (7%), while the parents and family were the most important source (39%).
Table 2: Participants' knowledge about contraceptive

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The pills were the most popular methods, known by 36% of the participants, followed by the loop (18%), injections (15%), and implants (13%), with vasectomy as the least recognized method (2%). Seventy-four percent of the participants knew the benefits of contraception. Family planning was the most known benefit (selected by 30% of the respondents), followed by preventing unwanted pregnancy and improving the health of the mother and her baby, 6% of respondents thought that contraceptives could prevent sexually transmitted diseases. No association was found between the knowledge and the use of contraceptives (P = 0.200).

Attitude toward fertility and contraception

As shown in [Table 3], most of the participants (82.3%) accepted the use of contraception, while their husbands showed a lesser acceptance rate (64.1%). Nearly half of the participants (48.6%) desired to have <5 children, while 11.8% preferred to have more than ten children. Most (46.4%) of the participants preferred 2–3 years birth interval, the other two intervals had almost equal proportion as 25.9% preferred more than 3 years and 27.3% preferred <2 years. There was no correlation between the use of contraception and the desired number of children (P = 0.337) nor the birth interval (P = 0.168).
Table 3: Respondents attitude toward contraception

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The most important reason for accepting the use of contraceptives was preserving the mother and child health (52.5%), the next was work or study of the mother (47%), and birth spacing was the least important cause (only 1.7%). Most of the respondents (67.6%) refused contraception because they fear its side effects, 22.1% thought that it is against religious beliefs, only 8.6% refused it because they want to have more children.

Use and prevalence of contraception

[Table 4] shows the participant's use of contraception. Almost 95% of the participants knew one or more methods of contraception, but 75% were practicing it. Of those, who used contraceptives, there was a variation in the duration of use as 74% used contraception for more than a year, however, only 26% reported the use of contraceptives for <1 year. Among current users, the majority (54%) used OCPs, 15% used injection, and 15% used IUCD. More than one method can be used by the same participant.
Table 4: The use of contraceptive among respondents

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The least number of users (26) got their contraceptive from governmental health-care centers. However, most 57% (n = 96) of the participants got their contraceptive from the pharmacy.

[Figure 1] spells out the different reasons of using and not using contraceptive methods by our respondents, most of the women (37%) were using contraceptives for birth spacing and 33% for health improvement while 7% for financial problems. Out of 53 women who are not practicing contraception, 47% were not using them due to husband's disagreement, 26% did not have adequate knowledge about contraception, and 26% desired more children.
Figure 1: Reason of using and reasons of not using contraceptive

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The prevalence of contraceptive use related to sociodemographic and reproductive characteristics

[Table 1] represents the relation between the prevalence of contraceptive use and the sociodemographic and reproductive characteristics. Although a greater prevalence was found among participants in the middle age group (80%), students and working women (80%), those with secondary or higher education (78%), and participants with high income (81%), none of these factors had a significant effect on the use of contraceptives (P > 0.05). There is a negative association between the use of contraceptives and husband's education (P = 0.290), breastfeeding (P = 0.560), history of chronic disease (P = 0.900), and the number (P = 0.900) or gender (P = 0.500) of living children. Only two of the studied factors had a significant influence on contraceptive use: A history of an abnormal baby (P = 0.022) and experience with unintended pregnancy (P = 0.045).


  Discussion Top


The issue of contraception has received a lot of attention in recent years, especially in developing countries. Many studies described the prevalence, knowledge, and practice of contraception in Saudi Arabia, however, no similar studies have been recorded from Jazan region.

In this study, the prevalence of contraceptive use among Saudi women who were married and aged between 18 – 49 years was 75% at the time of the survey. This is in contrast to a study done in Al-Qassim region, Saudi Arabia which showed 44.8% prevalence.[16] Although a low level of contraceptive use was reported in Saudi Arabia compared to some countries in the middle east,[21] the rate of contraceptive use has increased remarkably in Saudi Arabia during the recent few years. A study in Taif showed 67.7% use rate,[20] and in Abha, the prevalence was 58.8%,[17] this is related to the socioeconomic development in the community, with resultant increases in women's education and employment and changes in the concept of contraception and family planning.[8] These levels are approaching the high levels reported in countries such as Iran (77.40%), Turkey (73.50%), and Egypt (58.90%).[21]

All the investigated sociodemographic factors in this study revealed no significant effect on contraceptive use, this may be because of the general adoption of contraceptive methods by all groups. However, many studies revealed the effect of some sociodemographic factors on contraceptive use. Egede et al. reported that contraceptive practice was significantly affected by the educational level of their participants.[22] Our results agree with a study conducted in Bangladesh which reported that women's education showed no significant association with contraceptive use.[23] However, contrary to our results, they found significant effect regarding the age, husbands' education, breastfeeding, and the desired number of children. Our findings revealed that the history of abnormal baby and experience of unintended pregnancy were the only reproductive factors that were significantly associated with the use of contraceptive, however, a study done in Uganda among women living with HIV found no association between contraceptive use and unintended pregnancy.[24]

Regarding the awareness of contraception, 95% of the respondents heard about contraceptive methods, similar to a study done in Abha with 80.3% of their participants heard about contraception.[13] Our study revealed that the most common source of information about contraceptive methods is parents and family, this may explain the high percentage (83.7%) of the respondents who had poor knowledge about contraception.

The present study revealed that the pills are the most known type of contraceptive methods (recognized by 36% of participants), followed by the loop (recognized by 18%), pills were reported as the most known contraception method among females in Saudi Arabia[25] as well as among university students in Uganda.[26]

Seventy-four percent of our participants believed that the use of contraception is beneficial, however, 6% reported that contraception could prevent transmission of sexual disease.

Poor knowledge was reported in this study (15.7% of participants identified more than two methods of contraception), however, a study in Al-Qassim, Saudi Arabia, reported that 79.4% of their participants had good knowledge.[19]

A large percentage of our participants (82.3%) accept the use of contraception while only 64.1% of their husbands approved contraceptive use. Improving mother and child health is the most important reason or acceptance. The refusal of contraception was mainly due to the fear of its side effects (67.6%), some think that it can affect marital life (22.2%), others say it is against religious belief (21.1%), only 8.3% refuse contraception because they desire more children. Alpana Singh et al. reported that 46% of their respondents did not prefer to use contraception, the main reasons were religious belief followed by the desire for more children.[27]

In the present study, the most commonly used contraceptive method is OCPs, this is the most used method in Saudi Arabia as reported by other local studies.[17],[12] The popularity of OCP is may be due to their effectiveness, availability, and easy use. Although IUCD and injections came in the second place in this study, their use remains low when compared to OCPs, this reflects the poverty of knowledge about these methods and addresses the role of physicians and health-care workers to discuss these methods with women and explain their use and possible side effects. Male condoms and female sterilization were not preferred by our participants, this finding is documented not only in Saudi Arabia[17] but also in other countries in the Middle East[28] probably due to cultural and religious reasons, however, these two methods are the most commonly used worldwide.[29]

More than half of our participants get their contraceptives from the pharmacy, this is similar to a finding documented from Riyadh, Saudi Arabia.[30] This over the counter purchase may be un-supervised by physicians which may result in increased risks of improper use (such as side effects and failure of contraception). On the other hand, only 16% get contraception from governmental health-care centers, this proves the need for more family planning services sponsored by the government.

Spacing of births and improvement of mother and child health were the most important reasons to use contraceptives buy our respondents, this is similar to findings reported by Al-sheeha[16] and Alsaleem et al.[17] stating that Saudi women prefer to use contraceptives for birth spacing rather than to limit the number of children.

Most of the nonusers in this study claimed that husband's disagreement was the most important cause for not using contraception. Although the fear of side effects was reported as the main cause of nonuse in developing countries[31] and also in a study performed in Jeddah, Saudi Arabia.[12]


  Conclusion Top


It can be concluded that despite the high prevalence of contraceptive use, the knowledge among women who are practicing different contraceptive methods was poor, and there was limited use to methods other than the pills. Moreover, the most important reason for not using contraception was the partner's refusal. Family planning programs should be sponsored by governmental agencies with providing health education programs to increase the awareness about the safe and effective contraceptive methods, plus facilitating the access to methods that do not contradict the customs of society to ensure compliance.

Financial support and sponsorship

Jazan University.

Conflicts of interest

There are no conflicts of interest.



 
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