Characteristics of contributors
Table 1 reveals that the imply age of contributors and their husbands have been respectively 34.9 (SD = 6.2) and 39.3 (SD = 6.6) years. Participants’ age ranged from 21 to 47 years. About half (47%) of contributors have been married for lower than 10 years, with the imply length of 11.0 (SD = 6.3) years. Participants and their husbands accomplished 14.7 (SD = 3.8) and 14.6 (SD = 3.6) years of education, respectively. More than one-third (33%) of ladies have been employed, and 60% reported to have a Fars ethnic background. On common, girls had 1.8 (SD = 1.1) pregnancies and 1.4 (SD = 0.8) residing youngsters. Nearly three out of 5 girls (61%) reported that they didn’t intend to have (one other) youngsters. About three out of 4 (70%) girls reported that they “at all times” “simply speak to their husband about selecting a contraceptive methodology”. While 19% of contributors (girls) reported that “it was extra my desire than my husband’s” to make use of the withdrawal methodology, 14% reported that it was largely their husband’s desire, and the remainder of contributors (67%) said that they each (husband and spouse) most popular the withdrawal methodology. The imply length of withdrawal use was 8.1 (SD = 5.8) years, and solely 23% of contributors used a contemporary contraceptive methodology earlier than the present use of withdrawal. They switched both from condoms, capsules or IUD to withdrawal.
Source of contraceptive data
When contributors have been requested “When you will have an issue or query about contraceptive strategies, who do you normally speak to first and get data?”, they named “gynecologists” (42%) and “the web” (21%) as their first two major sources of contraceptive information. Other sources included “midwife within the well being facilities” (19%) and “Social networks”, together with kin, mates and colleagues (18%). Further bivariate analyses in Table 2 indicated that ladies who have been aged 35 or older (48%), employed (54%), and had some postsecondary education (45%), didn’t intend to have youngsters (46%), and sometimes or hardly ever talked to their husband about contraception (50%), have been extra prone to speak to a gynecologist about contraceptive strategies. Moreover, girls who meant to have youngsters and resided in wealthy residential districts of Tehran have been extra doubtless to make use of the web as their major supply of contraceptive information. While gynecologist was the principle supply of contraceptive information for older and extra educated girls, youthful and fewer educated girls, residing in average to poor communities have been extra prone to achieve their required contraceptive data from midwives within the public well being facilities. Finally, girls whose major supply of contraceptive information was their “social networks” have been largely younger, educated, and unemployed, meant to have youngsters, at all times talked to their husband simply about contraception and lived in average or poor residential districts.
Evaluation of contraceptive withdrawal
Participants have been requested to call as much as two most vital “benefits and downsides” of the withdrawal methodology. As Table 3 reveals, essentially the most steadily cited benefits of withdrawal have been “has no unwanted side effects” (39%), “simple to make use of” (38%), “will increase sexual pleasure and intimacy” (37%), and “has no value and is accessible” (18%). A lady quoted a abstract of benefits of withdrawal: “The pure methodology [withdrawal] does not enter additional or dangerous substances or objects into my physique. It is not like a condom that at all times worries me to not be torn. It does not have the unwanted side effects of the machine [IUD] and you do not must be continually cautious to not carry a heavy merchandise in order that the machine doesn’t come out of your physique, or you do not have to fret about recognizing. The pure methodology is totally at our personal hand, and we use it rigorously [before ejaculation or the release of a pre-ejaculate fluid].” (Aged 34, married for 13 years, 12 years of education, 2 youngsters). Other lady said, “I really feel good throughout intercourse, and I really feel extra intimacy with this methodology [withdrawal].” (Aged 32, married for six years, 16 years of education, 1 little one).
As the commonest disadvantages of withdrawal, respondents reported, “its excessive threat of undesirable pregnancies” and “worry and anxiousness of undesirable pregnancies” 37% and 34% of the time, respectively. For instance, a lady cited, “There is being pregnant stress in utilizing the pure methodology [withdrawal]. We made a mistake with this methodology as soon as, so I acquired pregnant and needed to abort it.” (Aged 32, married for 7 years, 18 years of education, 0 little one). Another lady quoted, “You could out of the blue change into pregnant like my second little one.” (Aged 26, married for 7 years, 12 years of education, 2 youngsters). Only 8% of contributors reported that withdrawal “decreases sexual pleasure” and has “threat of an infection”. For occasion, some girls quoted: “The most vital disadvantage is that it’s a must to pull out on the peak of enjoyment.” (Aged 36, married for 3 years, 14 years of education, 1 little one); “It is extra of a flaw for a person, and it reduces his pleasure, and for me it additionally reduces the pleasure as a result of I just like the liquid to spill inside my physique.” (Aged 34, married for 12 years, 14 years of education, 3 youngsters); “It causes infections on either side.” (Aged 44, married for twenty-four years, 16 years of education, 1 little one). One-fourth of contributors believed that withdrawal “has no disadvantages”.
Attitudes towards withdrawal methodology
This examine measured contributors’ attitudes towards completely different points associated to contraceptive withdrawal, together with anxiousness of unintended pregnancies, defending girls from antagonistic results of recent contraceptive strategies, effectiveness of withdrawal, decreased sexual satisfaction, and males’s function in contraception and contraceptive decision-making. The outcomes are offered in Fig. 1 and Table 4. The majority (77%) of withdrawal customers agreed, “Women who’re utilizing withdrawal are at all times underneath the stress of getting unintentionally pregnant.” The approval of this merchandise was considerably larger amongst girls aged underneath 35 versus 35 or older (86% vs. 69%), those that ‘at all times’ relatively than ‘typically or hardly ever’ simply speak to their husband about contraception (84% vs. 63%), and amongst girls who reported that withdrawal use was largely their husband’s desire relatively than their very own desire (100% vs. 60%).
Percent destribution of withdrawal customers (married girls aged 15–49) by attitudes towards Withdrawal: Tehran, Iran 2021 (n = 79).
Most (75%) agreed that “Men use withdrawal to guard their spouse from the unwanted side effects of recent strategies”. Women who “at all times” simply talked to their husband about contraceptive points (84%) have been considerably extra prone to assist this perspective. Regarding the effectiveness of withdrawal, solely 56% agreed that it was an efficient contraceptive methodology. This merchandise was largely authorized by those that have been youthful (62%), lived within the wealthy residential areas (62%), and along with their husband most popular to make use of withdrawal (60%). Moreover, about two-thirds of ladies disagreed that withdrawal would forestall males or girls from reaching a “full sexual satisfaction.” This mentality was considerably larger amongst girls who have been residing in moderate-poorer versus wealthy residential areas (71% vs. 41% for males; 77% vs. 33% for ladies). Similarly, most respondents (68%) disagreed with the view that “since males don’t want youngsters, they management fertility themselves by withdrawal to ensure to forestall unintended pregnancies.” Employed versus unemployed (85% vs. 60%), these residing in moderate-poor versus wealthy residential areas (75% vs. 56%), and girls who both themselves alone or along with their husband relatively than their husband alone most popular to make use of withdrawal (73%, 72% vs. 46%), have been considerably extra prone to disagree this view. Finally, 72% of contributors disagreed with the view that “males are the final word decision-makers for choosing contraceptive methodology”. The proportion of ladies who considerably disagreed with this merchandise was larger amongst those that both themselves alone or along with their husband relatively than their husband alone most popular to make use of withdrawal (87%, 79% vs. 18%).
Reasons for utilizing contraceptive withdrawal
Table 5 reveals the explanations given by contributors for not utilizing any fashionable strategies as a substitute of withdrawal, and particularly the explanations for not utilizing male condoms as a substitute of withdrawal. The most typical cause given by 70% of ladies was “antagonistic results of recent strategies”. For instance, a lady reported, “I’m utilizing withdrawal due to the unwanted side effects of different strategies that all of us tried. I’m allergic to condoms. I used to be bleeding with IUDs. I had abdomen bleeding with the tablet. I used to be paralyzed within the physique with the injection” (aged 33, married for 12 years, 14 years of education, 1 little one). Another participant quoted: “I took the tablet, however it gave me a hypertension. I took IUD twice, however it was expelled” (aged 40, married for 20 years, 12 years of education, 2 youngsters). Other cause cited was “worry of the unwanted side effects” (24%), which was largely based mostly on what they heard from the expertise of individuals round them. For occasion, a lady quoted: “They [other people] say that condoms trigger fibroids, and the tablet make folks nervous. They additionally say if you wish to use IUDs, you shouldn’t do heavy work” (aged 29, married for five years, 16 years of education, 1 little one).
Women additionally cited “discount of sexual pleasure” and “difficulties in utilizing fashionable strategies correctly” 30% and 15% of the time, respectively. Most quotations relating to discount in sexual pleasure was associated to condoms or IUDs. For instance, a participant quoted: “My husband disagrees with the machine [IUD] and the condom as a result of he says he feels that an exterior issue prevents the sexual relationship” (aged 36, married for 12 years, 10 years of education, 2 youngsters). Contrary to the overall expectation, solely 6% and 4% of ladies reported “entry” to and “value” have been respectively the explanations for not utilizing fashionable strategies. The causes given for difficulties in entry to fashionable strategies have been largely “the disgrace of buying condoms” and “strategies should not being available”. Moreover, 15% of contributors reported, “they’re comfy with withdrawal and it’s a dependable methodology”.
As two male contraceptive strategies, contributors have been requested to offer causes for not utilizing male condoms relatively than withdrawal. The ends in Table 5 present that discount within the sexual pleasure of husband or each husband and spouse have been the commonest causes cited 60% and 15% of the time. Most girls quoted that “my husband doesn’t wish to exist a hindrance throughout intercourse and he needs the skin-to-skin relationship to be excellent.” One-sixth (17%) of contributors gave a well being cause associated to having pores and skin allergic reactions to condoms or vaginal dryness. Only 8% of respondents didn’t use condoms due to socioeconomic difficulties in accessing condoms. They primarily cited “due to the embarrassment of buying a condom” (6%), and partly quoted “it’s costly” (2%). Moreover, 7% of respondents most popular withdrawal in relative to condoms as a result of they discovered it “more practical” and different respondents (6%) use withdrawal as a result of their husband is “not ready to make use of condoms correctly”.
Bivariate evaluation in Table 6 reveals that reported causes for utilizing contraceptive withdrawal considerably differ by the function of spouse and husband in selecting withdrawal. The outcomes present that 37% of all causes reported are about “unwanted side effects of recent strategies” adopted by “worry of unwanted side effects of recent strategies (16%), and “discount in sexual satisfaction” (14%). The cause “unwanted side effects of recent strategies” was given largely by girls who themselves alone versus their husband alone most popular to make use of withdrawal (52% vs. 19%). In addition, girls whose husband alone most popular withdrawal to fashionable strategies versus those that collectively with their husband selected withdrawal have been extra prone to cite “discount in sexual pleasure” and “worry of unwanted side effects” (28% vs. 10%; 25% vs. 15%).
Other bivariate outcomes, although not statistically important, present that “unwanted side effects of recent strategies” got largely by girls who refer primarily to their social networks for contraceptive data (42%), “at all times” simply speak to their husband about contraceptive points (41%), used fashionable strategies earlier than withdrawal (40%), had some postsecondary schooling (40%) and aged lower than 35 (41%). Furthermore, girls who ‘typically or hardly ever’ simply talked to their husband about contraceptive points, and primarily referred to healthcare suppliers for contraceptive data (19%), largely gave the explanations “discount in sexual pleasure”). The cause “worry of unwanted side effects” was given largely by girls aged underneath 35 (18%), had some secondary or much less schooling (21%), used fashionable strategies previous to withdrawal use (23%), and utilized “the web” as their fundamental supply of contraceptive data (23%).
Willingness to change to fashionable strategies
Table 7 reveals that 75% of withdrawal customers wouldn’t be prepared to change to a contemporary contraceptive methodology, even when the trendy strategies have been freely accessible, whereas the remaining (25%) have been prepared to do that swap. The bivariate outcomes point out that ladies and their husbands with postsecondary schooling, those that didn’t use fashionable strategies previous to withdrawal, and people who collectively with their husband or husband alone determined to make use of withdrawal are extra doubtless to not be prepared to change to fashionable strategies. Specifically, the chances of willingness to change to fashionable strategies have been respectively 72% and 80% decrease amongst girls with postsecondary schooling and people whose husbands had postsecondary schooling than some secondary schooling. Participants who have been utilizing fashionable strategies earlier than present withdrawal use and girls who themselves alone most popular to make use of withdrawal, have been respectively 6.4 and three.4 instances extra prone to be prepared to change to fashionable strategies, if they’d be offered freely and simply.