Knowledge , Attitude and Practice of Contraceptives among Saudi Women in Aseer Region , Saudi Arabia

Objective: The study was carried out to assess the knowledge, attitude towards, and practice of contraception and the factors that could affect its use among Saudi women in Aseer region of Saudi Arabia. Methods: This cross-sectional and hospital-based study was conducted in Aseer Region, Saudi Arabia, during one year (January, 2014 – December, 2014). Five-hundred women of reproductive age (18–45 year) were interviewed regarding their knowledge, attitude and practices of contraception. The inquiries were recorded by a predesigned questionnaire. Questions on methods of contraception known and source of knowledge and their practices were recorded. Results: The mean ± SD of age was 32.7 + 7.2 years. (99.2%) of women heard and had knowledge of contraception, while (0.8%) said they did not know anything about contraception. (377 subjects, 75.4%) used contraception, while 123 subjects (24.6%) did not. Oral pill method of contraception was the most popular method known and practiced (87.0%, 32.2% respectively). The media seemed to be the major source of information (40.8%). In response to the reason for non-use, the majority said they wanted more children (10.2%). The major reason for the use of contraception was to limit family size (32.0%). The majority (79.6%) of women had good attitude towards contraception. Conclusion: The present study concludes that a significant proportion of respondents have good knowledge about contraception. But practice of contraception and compliance is low. Desire of more children is one of the major factors among reasons of the non-use of contraception.


Introduction
For any country's productive capability, the size and assessment of its population is important 1 .The pace of the population growth in Saudi Arabia is one of the highest in the world, and a distinguishing feature of the Saudi Arabian population is their desire for large families 2 .The birth rate is as high 28.55 births per 1,000 people, one of the highest in the world.Recently, with improved health care facilities and health care education, women in Saudi Arabia have been practicing the newer methods of contraception.Birth control has long been accepted among Saudi women, but traditional contraceptives incorrect practices result in unplanned pregnancies 3,4 ,jeopardizing the health of the women and their families and putting a burden on society as a whole.In countries where the use of contraceptives is lower and the fertility is higher, women are at risk of dying due to pregnancy and childbirth 5 .The published data addressing the issue of the knowledge, attitudes and practices among women of reproductive age towards contraception particularly in Abha, a city in the Aseer Region, Saudi Arabia, are very scarce as most of the available studies are conducted in the main cities like Riyadh, the capital.The aim of this study is to assess knowledge, attitudes, and practices towards contraception and the factors that could affect their use among Saudi women in the Aseer region of Saudi Arabia Materials and methods This is a descriptive, cross-sectional and hospitalbased study conducted in Abha Maternity and Pediatric Hospital (AMPH) and two private health centers in Saudi Arabia over a period of one year from January 2014 to December 2014.Five-hundred women of reproductive age (18-45 year) were interviewed regarding their knowledge, attitudes and practices of contraception.Questions on methods of contraception known and source of knowledge and their practices were recorded.The source of knowledge and the women's attitudes towards the contraception in the form of motivation, involvement of spouse and/or self and acceptability of contraception were recorded.An Arabic version was used to collect data.Sample size was calculated on the assumption that the rate of women aged 18-45 years to the total population was 22.3 % 6 , considering a degree of precision 0.05, a design effect 1.8 and nonresponse rate 10 %.A sample size of 500 married women was decided upon 7 .Statistical analysis was performed via SPSS software (Chicago, IL, USA).Percentages, frequencies and means were used to present the data.Ethical clearance and approval for conducting this research was granted by the Ethics Committee of King Khalid University and the AMPD director.An informed written consent was obtained from every respondent who agreed to participate in the study.

Results
The socio-demographic characteristics are shown in Table I.A total of 500 women of reproductive age were included in the study.Most of the women were from the age group 26-35 years which comprised 235 (47.0%)and the mean age was 32.2+1.2years.The majority of respondents (93.8%) are welleducated, 67% of them were housewives in regard to occupation, and over a half of the respondents' husbands are university graduates or with postgraduate degrees (61.0%).79% of the respondents are in social Class II and their income is between 5 and 15 thousands Riyals per month.The high percent in parity was for those who had a number of children from 2-4, 230 (46.0%) with a mean of 1.94 + 0.758 child.As for the husbands, their age ranged between 15 to 45 years of age, 201 of which were aged between 25 to 35 years of age (40.2%).Results showed that the majority of participants (99.2%) of women in the study heard and had knowledge of contraception.Concerning methods known, all the women interviewed known at least more than 2 methods of contraception The best known methods was the oral pill (435, 87.0%) followed by the IUCD (337, 67.4%).Whereas, the least method known was spermicidal (23, 4.6%).Other methods such as vasectomy and implant were least commonly known by most respondents

Variables
Frequency Percent Age in years 15  III).
Multiple responses to the reason for non-use were given by the interviewed women.They were primarily the desire for more children (10.2%), the fear of side effects (6.0%), followed by husband's disapproval (3.4%), and medical reasons (1.6%).The most common reason attributed to the use of contraceptives was to prevent pregnancies(32%).Followed by spacing (28.4%), then husbands' orders (8.2%), and medical disorders (3.4%) (Table IV).Discussion Socio-demographic determinants, such as age, rural/urban residence, women's education or family income and cultural influences are variables indirectly associated with contraception through their effects on the behavior of women and their health status.The effect of these factors is well documented in other similar studies 8,9 .
The results of the current study revealed that the knowledge for contraception was (99.2%), which is comparable to a study done by Farrag OA were the main sources of knowledge regarding contraception in the community 4,13 .
In contrast to our findings, other studies reported relatives and friends being the major source of information 14,15 .Overall, the media seems to play a major role in providing information regarding contraception and could do more by spreading practical information.Also, health personnel (30.8%) and social circles (husband, friends and relatives) (28.7%) have contributed to impart knowledge for contraception in our study.This is different from the Indian study, which showed that the social circle (70%) and the media (39%) were the main sources of information 11 .
It is interesting to find that 79.6% of the women approve of and have a positive attitude towards contraception.This shows that women are in favor of contraception, which is almost the same and comparable to studies done by Al-Sekait MA 8 , among Saudi Arabian women; an India study has already described similar findings 11 .
The contraceptive usage in our study was (75.4%), compared to the KAP survey conducted in 1999 by Al-Sekait, M.A and Ogbeide, DA, and the prevalence of contraceptives among married women has increased by 35%, but is nearly equal to that found by Al-Turky HA 2011 in Saudi Arabia (74%) 3 .To the contrary, in Baghdad, the contraceptive prevalence rate was (28.40%) 16 , in Qatar (47.8%) 17 and in India 45%, 18 which is a very low prevalence rate compared with our study.The present study reveals that, OCP is the most commonly used method, followed by IUCD, injectables, safe period and other methods, which is similar to that in other studies.Their preference is based on the belief that they are safe and easy methods 9 .

Attitude towards contraception Frequency Percent
Not The study shows that, the desire for more children, fear of side effects, and husband' opposition are the main reasons for not using contraceptives among the respondents, a finding that has been similar to and comparable with other studies [12][13][14] , the reasons given for non-use are fear of side effects and personal or husbands' attitudes towards contraception and women's desire for more children.

Conclusion
The study concludes that a significant proportion of respondents have good knowledge and favorable attitude towards contraception.But the practice of using contraception is low.The main reason for not using contraception is the desire for more children.Socio-demographic factors like the education level and husbands' support of contraception are found to influence the use of contraceptive methods among our respondents.

Conflict of interest: None
References:

Table II :
12n Knowledge, methods known, and source of knowledge of contraception among respondents the Eastern Province of Saudi Arabia.Also in a Lahore study (Pakistan)10, contraceptive knowledge rate was 99%, which supports our study.Oe other hand, our findings are somewhat high, compared with those reported by an Indian study which revealed a knowledge rate of 82.2%11.Fikree et al. stated that women were more likely to use contraceptives when messages of family planning were delivered through the media12.The media, like television, the internet, and newspapers, played a major role in raising awareness: 40.8% responded in the present study as getting information through such media.Other studies by Jabbar FAet al and Khawaja et al, have also noticed similar findings in which multimedia and family planning workers

Table III :
Distribution of the respondents according to their attitudes towards contraception and methods of practice of contraception

Table IV :
Reasons of the use and rejection of contraception among respondents