Post on 13-Jan-2016
transcript
How Husbands Influence Women in the Use of Contraceptives – Spousal Factors
9/7/12
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Mak Wei LanMedical Social WorkerMedical Social Work Department
Medical Social Work Department (MSW)
KK Women’s and Children’s Hospital
Introduction
Unintended pregnancy – social, psychological and financial costs (Klima, 1998)
Consisting of mistimed and unwanted pregnancies (Moos, 2003)
A burden to a nation’s healthcare and resources, associated with late
bookings for prenatal care, lower birth weight and even child abuse (Moos,
2003; Schwartz, 2010)
The use of family planning is thus pivotal in giving individuals and couples
the freedom “to anticipate and attain their desired number of children and
the spacing and timing of their births.” (WHO, 2011)
Introduction
Lack of contraceptive use is one of the causes of unintended pregnancy
Contraception: ‘intentional prevention of pregnancy’ (Moos, 2003)
Barrier methods, steroid hormonal, intrauterine devices, male and female
sterilization and emergency contraception
Introduction
Patients seen in MSW Department for Abortion Counseling
Marital Status June’11-May’12 June’10-May’11
Married 165 140
Single 153 199
Divorced 27 23
Introduction
Personal Factors
Partner Relationship
Factors
Societal and Cultural Factors
Age
Income
Religion
Education & Working Status
Unreliable Use of Contraceptives
Lack of Information, Misinformation &
Fear of Side Effects
Pregnancy Motivations
Quality & Stage of Relationship
Domestic Violence
Partner Involvement & Communication
Self-Efficacy & Partner Involvement
Social Status of Men & Women
Accessibility
Determinants of Contraceptive Use
Introduction
Partner Influence is one of the determinants of contraceptives use (Kern et
al, 2003; Soler et al, 2000)
The study aimed to explore women’s experiences of how husbands
influence their decisions in the use of contraceptives within a Singapore
context, using a sample from KK Women’s and Children’s Hospital
Methods: Criteria
Female patients from KK Women’s and Children’s Hospital, Singapore
Married
21-30 years old
English speaking
Have experienced an unintended pregnancy
Methods
5 participants recruited from the Specialist Outpatient Clinic and Medical
Social Work (MSW) Department
Open-ended interviews with an interview guide
Interviews conducted over the phone or face-to-face
Methods: Interview Guide
24 questions
Themes: Relationship, decision-making, conflict resolution, communication,
influence, contraceptives and pregnancy
Methods: Interview Guide
Interview Guide
Methods: Participants and Procedures
Characteristics of Participants
Participant
Age/Occupation Husband’s Age/Occupation
Ethnicity Educational Level
Number of Children
A 31/Marketing Coordinator
38/Logistics Chinese Secondary School
N.A.
B 31/Childcare Teacher 37/Property Agent
Chinese Secondary School
3
C 30/Homemaker 29/Pest Controller
Malay Primary School 2
D 21/Nursing Student 25/Delivery Driver
Malay Secondary School
1
E 23/Homemaker 28/Lifting Supervisor
Indian Secondary School
4
Methods: Data Collection and Analysis
Interviews were taped with permission from participants and then transcribed
Transcripts were read several times to familiarize and gain an overall impression of
the data before a deeper analysis was carried out
Primary codes: Contraceptives, family planning, relationship with husband and
decision making
Subcategories and categories identified
Results (i)
Women’s Experiences of Husbands’ Influence in the Use of Contraceptives
Opinions on Using Contraceptives
Concerns about Family Planning and Pregnancy
Relationship with Husband
Decision Making
Purpose of Using Contraceptives
Concerns towards Use of
Contraceptives
Obtaining Information about Contraceptives
Regrets
Future Plans
Spousal Factors
Financial Considerations
Children’s Well-Being
Display of Concern
Communication
Relationship Satisfaction
Satisfaction
Compromise with Husband
Display of Support
Results (ii)
Spousal Factors
Consensus with Husband on which Contraceptive to
Use
Husband’s Limited Role in Decision
Making
Husband’s Fair Understanding of Contraceptives
“..so I asked [my husband], do you agree. Then he asked, are you
comfortable with the injection, the pain?”
“because for [my husband], he doesn’t actually do research first. For me I’m someone who will do research for this kind of thing. So I actually went to research on the different side effects of each and every one of them.. So that’s why after that, I was telling him. This will happen, this and this will happen. Cause pregnancy how many percent”
“I’m the one who gives [my husband] ideas you know. Then he says ok, its
up to you. So boring”
“for [my husband] I would say he has a fair understanding of it. We do have the mutual respect in the sense that he does understand the consequences if we do not use contraceptives and other things”
Results (iii)Relationship with Husband
Display of Concern Relationship Satisfaction
Communication
Husband shows concern
Mutual consultation
Discussion about contraceptive options
Discussion about family size
Frequent communication
B: “..[my husband] is quite, I would say, easy going. So long as [the contraceptive] doesn’t cause me any harm I would say he is still alright about it”
C: “.. he will call me about small things. He understands women’s emotions are hard to control”
B: “.. Usually if I decide to do something, I will talk to him.”
Satisfaction with relationship
Perceive husband’s satisfaction
C: “..so far so good. No problems.”
E: “..we are good, we are happy. There is trust between us.”
D: “[husband says that] I am the best wife”
Results (iv)
Decision Making
Satisfaction Compromise with Husband
Display of Support
C: “.. When it comes to decisions, we will discuss.. Whatever things, we will talk over.”
D: “..Sometimes I give in to some of the things that he really wants. We seldom fight about making decisions.”
A: “.. [when it comes to resolving] problems, he will give into me”
Advice Giving
Mutual communication
E: “..[husband will say] yeah its true, I need your advice before going into it.”
E: “.. Money problems.. He will ask me for advice..”
Discussion (i)
The study aimed to explore women’s subjective experience in contraceptive
use, including how husbands influence women in their decision to use
contraceptives.
There were significant issues that were raised from this qualitative study,
through a variety of experiences that these women shared during the
interview.
Findings are consistent with the general trend that birth control is often
regarded as the women’s responsibility, with men taking a limited degree of
ownership (Bongaarts & Bruce, 1995; Smith et al, 2011)
Discussion (ii)
Multi-level interventions & a combination of male and female
individual and couple interventions
There may be a need for programs to include support and training
for women when it comes to autonomous decision making in
contraceptive use.
Discussion (iii)
Highlights the need for contraceptive education to have an increased focus
on the personal responsibility of men when it comes to the use of
contraceptives, which would likely lead to increased involvement in decision-
making.
Gender-specific programmes such as through including male-female
negotiation concepts within schools, hospitals and family service centres
may be useful in achieving a more balanced role in contraceptive decision-
making. However, one needs to be cautious that efforts are made to
increase male involvement without male dominance (Bongaarts & Bruce,
1995).
Discussion (iv)
Most research may tend to focus on women and couples, few actually
focuses on healthcare providers.
Healthcare providers: advocates, gatekeepers and partners
Important for them to understand contraceptive users’ culture and social
context which they are from as it may affect how they relate to clients.
Explore healthcare providers’ views on contraceptives, the systems within
which they are from and work in as a means to meet the needs of
contraceptive users and improve service delivery.
Discussion (v)
However, with the creation of coitus-independent contraceptive
methods such as the pill, women gain more control of contraception
Hence, while more people are calling for increased involvement of
men in this area, methods such as the pill in fact allow women to
take more control over their reproductive decisions (Darroch, 2000).
To what extent then should men be involved in contraceptive
decision making?
Limitations
Small sample size
Female perspective
Timing of the interviews
Contributions
Exploratory study
However, findings contribute to the literature on gender imbalances
when it comes to contraceptive responsibility.
Increasing husbands’ involvement in the arena of family planning
seems to be essential in having more effective contraceptive use
and fewer unintended pregnancies, as studies have found (Kern et
al, 2003; Soler et al, 2000).
Conclusions
Limited male involvement in contraceptive decision making.
Male and female as well as couple interventions are recommended
On a macro level, information can be disseminated through various means
to educate and increase awareness in the area of contraceptive
responsibility and options.
However, given the availability of coitus-independent contraceptive
methods, is there really a need for men to play a greater role in this area?
And if so, what should the role be?
References
Berg, B.L. (1989) Qualitative Research Methods for the Social Sciences Allyn and Bacon Massachusetts, USA
Bongaart, J. & Bruce, J. (1995) The causes of unmet need for contraception and the social content of services Studies in Family Planning (26)(2)(57-75)
Darroch, J. (2000) The pill and men’s involvement in contraception Family Planning Perspectives (32)(2)(90-91)
Denzin, N.K. & Lincoln, Y.S. (2008) Strategies of Qualitative Inquiry Sage Publications Thousand Oaks, California
Fertility Regulation. In RHL The WHO Reproductive Health Library. Retrieved Feb 5 2011, from http://apps.who.int/rhl/fertility/en/
Kerns, J., Westhoff, C., Morroni, C., Murphy, P.A. (2003) Partner influence on early discontinuation of the pill in a predominantly Hispanic population Perspectives on Sexual and
Reproductive Health (35)(6)(256-260)
Klima, C.S. (1998). Unintended Pregnancy: Consequences and solutions for a worldwide problem Journal of Nurse-Midwifery (43)(6)(483-491)
Moos, Merry K. (2003) Unintended pregnancies: a call for nursing action The American Journal of Maternal/Child Nursing (28)(1)(24-30)
Rice, P.L. & Ezzy, D. (1999) Qualitative Research Methods: Health Focus Oxford University Press, Victoria, Australia
Rubin, A. & Babbie, E. (2005) Research Methods for Social Work (5th Ed) Thomson: Brooks/Cole, Belmont, Ca
Schwartz, A., Peacock, N., McRae, K., Seymour, R. & Gilliam, M. (2010) Defining new categories of pregnancy intention in African-American women Women’s Health Issues (20)
(6)371-379
Smith, J., Fenwick, J., Skinner, R., Merriman, G., & Hallett, J. (2011) Young males’ perspectives on pregnancy, fatherhood and condom use: Where does responsibility for birth control
lie? Sexual and Reproductive Healthcare (2)(1)(37-42)
Soler, H., Quadagno, D., Sly, D., Riehman, K. Eberstein, I. & Harrison, D. (2000) Relationship dynamics, ethnicity and condom use among low-income women Family Planning
Perspectives (32)(2)(82-88)