The survey of effective factors on different practical failure methods of family planning in women referred to health centers

Authors:
Dr. Seyed Hbibolah Kavari. Health management (Ph.D.),
Dr. Ali Keshtkaran

Principal lecturers of the school of management & medical Information science Shiraz medical university, Shiraz, Iran

Correspondence:
Tel: 98-711-2296031-32
Fax: 98-711-2288607
Email: kavarih@sums.ac.ir, kavari2000@yahoo.com

Editors Note: The original survey and article were conducted in the local language and we apologise for any detail that may have been lost in the translation. The results of the survey showed the need for public education on family planning.

In spite of the proportional access to means of family planning in Iran, the rate of unwanted pregnancy is very high. This is due to the failure of family planning methods and/or the failure to follow these methods carefully. In this research 938 cases of unwanted pregnancy from the view point of prevention methods employed; and the reason for not using family planning methods, were investigated. On the whole 88.6 percent of women used one of the methods of family planning in the month of pregnancy. 37.2 percent used prevention tablets and, 5.9 percent of pregnancy cases were because of careless use of tablets. Anther important reason for failure was using these irregularly.

The use of methods in which the patients were not confident, and having wrong beliefs about different prevention methods were the most important practical reasons for their failure and this relates directly and indirectly with the need for family planning education. Correct education regarding family planning is one of the important prevention factors in unwanted pregnancy.

Keywords: Family planning methods, unwanted pregnancy.

About half a million mothers die annually in developing countries due to pregnancy and its complications. Unwanted pregnancy can lead to many problems in the population, including a decrease in maternal health and up to a thousand mothers each year encounter problems due to illegal abortion and infections from such abortions (293). Illegal abortion is one of the major factors in maternal death. (2)

In the USA almost 60 percent of pregnancies are unwanted (3, 4). And in our country, Iran, about 4000 to 5000 unwanted pregnancies occur annually with .8/thousand of them (16%) leading to abortion (5). Unwanted pregnancy is a widespread problem in a world (6)and can lead to social, economical and health problems.(7) In some research the relationship between unwanted pregnancy and the rate of death in infants, schizophrenia in children, abuse and neglect of children has been shown. (1, 9, 8). Worldwide there is a dilemma between a mother's willingness to control fertility, and the family planning methods used result in the high prevalence of unwanted pregnancy and the risks and dangers caused by it. Currently failure of family planning methods is high and each year millions of Tomans (Iranian monetary unit) are spent on this issue. This has resulted in this research to evaluate various family planning methods and the reasons for their failure, particularly the failure of the most commonly used methods.

MATERIALS AND METHODS

This research was undertaken between July 2002 and February 2004, and involved unwanted pregnancy cases referred to health centers, public and private hospitals and private clinics of gynecologists and obstetricians in Shiraz, and was evaluated with simple random sampling.

All cases of unplanned pregnancy were considered as an unwanted pregnancy.

The data collection method included interview and completion of questionnaires by a trained researcher. The number of the sampling on the basis of the prevalence of unwanted pregnancy was 310 cases. But because the research extended to all of the city of Shiraz the final number of 938 unwanted pregnancies were collected from all of the health centers.

The sampling method included all presentations to these health centers that via interview were classified as wanted pregnancy or unwanted pregnancy. If the pregnancy was deemed unwanted the questionnaire was to be completed irrespective of how long the pregnancy was underway. Data on the mother's literacy, the husband's literacy, age of marriage, husband's job, and type of family planning methods was sought. How to use the family planning method, the reason for its failure and when the family planning method was used was evaluated.

The KAY Skuare examination was used for evaluating (the relationship) between different variables with type of family planning method and how to use it.

Results from this research showed that most unwanted pregnancies were from a particular age group of 30-34 years old (28.8%), (1.5%). There were some cases in the age group 15-19 (6.9%). Levels of literacy equated with prevalence of unwanted pregnancy. (p<%.1). (15.80%) of the mothers were illiterate, 7% had education lower than high school, 24% had high school education and 4.6% had higher education than a diploma. 8.7% of unwanted pregnancies were from housekeepers, 65% were unwanted cases by both the woman and her husband, and in 26.8% of unwanted cases the woman alone did not want the pregnancy. 88.6% of pregnancy cases used at least one of the family planning methods for different reasons.
In the examined cases, 349 cases (37.2%) used oral prevention tablets as a family planning method, (17.6%) used natural method, and (15.2%) used injection ampoules.

169 cases did not use any prevention method at the time of pregnancy with the most important factor being lack of familiarity with the method. Careless using of oral tablets was an important reason for failure in those who used this method. (95.9%) tablet users pointed to careless use of them for different reasons (See Table 1 below)

TABLE 1

Method of using compound tablets	Every day	Before and after intercourse	Careless (cutting when illness or travel …)	Careless use	Total
Number	15	40	177	10	232
Percent	6.1%	16.4%	73%	4.1%	95.5%

153 cases related to failure when using condoms, an important reason for poor usage was (26.6%), no access to any (18.5%) and failure when using them (17.7%). 37 percent of cases resulted in unwanted pregnancy in spite of using condoms carefully.

The outcome of this research showed that lack of correct use of family planning methods were important factors in the failure of family planning methods.

Cheney-y et al in 2003 also reported the reason for unwanted pregnancies was failure in using family planning methods (71.9%)

Other research shows that in rural women in Ghazvin (86%) of unwanted pregnancy cases happened in those who use family planning method (89.6%) in tablet form because they were used carelessly. (13) Other results of this research showed that lacking confidence in these methods was another important reason of failure. The result of Malek Afzali's research about unwanted pregnancy showed that this was due to the lack of confidence in the method, especially natural methods (20%). (5)The data from the Ghazvin villages showed that (41.7%) of unwanted pregnancies was due to high failure rates of preventive methods(13).

Malek Afzali showed that an important reason for unwanted pregnancy in this country is lack of use family planning methods. (14) The reason for the difference between this result and our result is that this survey considered causes of failure of the method, such as careless use. Our research showed that careless use of oral tablets was one of the important reasons for failure. Rozberg estimated that more than one million cases of unwanted pregnancy related to incorrect use of oral tablets. (15)

The research showed that (63%) of condom users pointed to failure at the time of use and disorganized usage.

Sarinus et al in (2000) showed that (76.7) of condom users in unwanted pregnancy cases pointed to failure when using this method (16) because of complications. (21.4%) reported lack of attention to proper IUD usage (14.2%) due to using after expiry date, (7.1%) said there were the important reasons for failure in those who use I.U. D. 3 cases (10.7%) reported that they experienced unwanted pregnancy in spite of being careful.

Among those who used injections the most important reason for unwanted pregnancy was amenorrhea and menses disorder. No cases of pregnancy were reported in spite of using them carefully (24.7%) of samples experienced pregnancy when they were breastfeeding children. The belief in the inability to get pregnant, while breastfeeding (was 4%), lack of use of family planning methods in breastfeeding because of amenorrhoea (9.4%) and the belief that complications can happen in infants because of oral tablets (45%) were important reason of unwanted pregnancy in breastfeeding mothers.

70 cases of all of the cases became pregnant in spite of breastfeeding.

Careless use of tablets was reported by (42.8%), stopping their usage because of Amenorrhea (21.4%), and lack of assistance if they forgot to use tablets (20%).

The cases that reported lack of access to family planning are as follows: having no time to prepare for family planning (1.8%) distance from health centers (23.3%), and expense of family planning.

Careless use and lack of confidence in the method, the use of those methods that have high rates of failure, lack of any family planning method or diluting them for different reasons were the most important reason of practical failure in family planning method. This has a relationship both directly and indirectly therefore, with family planning training although complications of other means of family planning remains an unsolved health problem.

In accordance to the above findings, we suggest training be developed to show ways to use confidential methods of family planning correctly. Furthermore on active unit to educate on family planning should be established.