Family planning

Understanding Family Planning Decision-Making: Perspectives from Providers and Community Actors in Istanbul, Turkey | BMC Women’s Health

The results of this study highlight the main factors that influence family planning decision-making. According to Turkey’s 2018 Demographic and Health Survey, 99.5% of married women of reproductive age know at least one method of contraception [8]. Our results are consistent with existing literature which shows that contraceptive methods (whether modern or traditional) are widely known in the community. Thus, one of the main conclusions of the study is that women, and in particular married women, know at least one method of contraception. Therefore, high levels of knowledge about contraceptives offer programs the opportunity to overcome barriers that might impede the translation of this knowledge into practice.

We found that, according to the perceptions of key informants, traditional methods were preferred over modern methods, and most respondents explained that women prefer traditional methods mainly because of the lack of side effects and the ease of use. There is a widespread perception that modern methods might have unwanted side effects. Additionally, there are religious reasons such as the consideration by couples of the natural and easy use of the method with more minor side effects for traditional methods being the most preferred methods. According to Cebeci et al., however, even religious beliefs should not be identified as the main obstacle to contraceptives; rather, they affect the choice of particular methods such as withdrawal [7]. The effect of religious beliefs on contraceptive choice may be the reason couples continue to use traditional methods. However, studies are needed to better understand the motivations for preference for traditional methods in the study and how women could be supported to ensure that these methods meet their reproductive needs.

Participants indicated that family planning is a “women’s domain” although sometimes other family members, such as mothers-in-law and fathers-in-law, can influence decision-making. A study of married people in Umraniye, another district of Istanbul, also found that family planning decision-making was seen as a “women’s issue” by male partners. [7]. Yet decision-making is not limited to women and women’s partners; family members are also involved in their contraceptive choices. These patterns underscore the need for a better understanding of intrafamilial relationships and the opportunities these relationships provide to help the women in the study achieve their reproductive goals.

Our results show that although women trust family planning providers on matters of contraception, they have more confidence in the previous family planning experiences of other people such as their friends, neighbors or relatives. This highlights the importance of women’s social networks as a source of information as well as a determinant of behavior. As Yee and Simon found, women identified their social networks as one of the most influential factors in the family planning decision-making process, particularly regarding side effects, safety and effectiveness, and most of them considered this information to be more reliable than other sources. of information [15]. Husbands, however, do not tend to share contraceptive information with each other. Thus, husbands can turn to their wives for accurate and reliable information on contraception. [16]. Understanding how women’s and men’s social networks influence contraceptive use in this context may be key to increasing contraceptive use among women who do not want pregnancy. Intervention studies could also consider leveraging women’s social networks to provide contraceptive education (eg, peer educators or women’s groups).

Regarding the accessibility and quality of services that influence decision-making, our results show that women prefer female doctors and consultants to men when it comes to contraception. In addition, some community actors reported prejudices in the accessibility of contraceptive methods against single women. Pharmacies provide male condoms, pills and emergency contraceptives without a written prescription in Turkey. The pharmacy sector supplies more than 45% of male condoms and pills [8]. Many single women find it more convenient to obtain contraceptives from pharmacies, although contraception is not free from pharmacies. This is likely due to the fact that many single women prefer to avoid social pressure in health care settings and fear being ostracized for having sex that is considered illegitimate. The finding that many women in the study prefer to obtain contraceptives from pharmacies suggests that there is a need to improve pharmacists’ ability to provide contraceptive information and advice to customers.

Various studies in Turkey have shown that a variety of perspectives need to be considered to fully understand family planning decision-making processes. On the one hand, men say family planning is a shared responsibility [6]and that pregnancy planning should be done jointly between the partners [17] which is consistent with existing evidence showing that male participation and shared decision-making is a key component of reproductive decisions [5, 18]. On the other hand, several studies show that both men and women are not resistant to contraception, although women are seen as the decision makers in family planning. [7, 19]. Our results show that men are little involved in family planning decision-making and that it is often women who decide whether or not to avoid pregnancy. While some respondents suggested men might be opposed to contraception, the majority said men were simply indifferent. Moreover, the lack of male involvement probably stems from pro-natalist views. The results suggest that there is a need to better understand contraceptive decision-making at the couple level and how best to involve men in supporting women’s reproductive needs.

Studies show that a variety of factors influence fertility decisions, including the number of living children [20, 21]level of education of parents and especially of female partners [22]and socio-cultural norms and religious attitudes [17]. However, men in almost all settings want more children than women. [17, 23]. In general, family planning service providers and community actors in our study reported that men want more children than women. However, the burden of raising children falls on women, which reflects gender roles in the family. Men’s desire to have children could be associated with a need to perpetuate the family line and increase their social value [24]making sense in terms of the social value of having a child primarily for men [25]. This is a further indication of the need to understand the perspectives of men in the study and how best to engage them in supporting women’s reproductive needs.

Our results showed that women placed greater importance on religious beliefs, although in practice these beliefs did not directly influence family planning decisions. Although the women believed that contraception could be against God’s will, this did not stop them from using the methods. This is consistent with the results of another qualitative study which showed that religious beliefs were not barriers to contraception, but that these beliefs influenced method choice. [7]. Religion often does not deter women and men from wanting small families, but instead of using the most effective methods, they instead rely on methods they perceive to be in line with religious beliefs or methods which are not as bad as others. Although most respondents in our study said contraception was seen as a sin, women still used methods. It is possible that religious values ​​encourage the use of traditional methods, such as withdrawal, which have a long historical tradition of use in this context. Cebeci and his colleagues have found that in addition to people seeing weaning as a natural, easy-to-use method with fewer side effects compared to modern methods, some see it as the method encouraged by the Prophet Muhammad, indicating that modern methods are perceived as harmful. [7]. Findings underscore the need for family programs in the study to integrate empowerment principles into client counseling to address misconceptions about modern contraceptives influenced by religious beliefs.

Our results may be influenced by how participants were selected. In particular, community stakeholders and service providers were deliberately selected based on their knowledge of women’s reproductive health topics, including family planning, and the sample included only one male participant. All interviews were conducted in Turkish and translated into English for analysis. Although some meanings may be lost in the process, a small sample of the transcripts was back-translated to determine the extent of this loss. There was no loss of meaning due to translation from one language to another. Additionally, all interviews were conducted in a private space to reduce the risk of social desirability bias. By its very nature, our sample has limited external validity that prevents us from making inferences about trends within the study or about the country as a whole. Although our findings, based on a limited targeted sample with key informants, are consistent with findings from other studies using larger samples with more diverse groups of women, other qualitative research with representative samples of women of age childbearing are necessary to determine how well our findings are consistent with prevailing trends across the country.