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 childbearing age know at least one method of contraception. . Our results are consistent with the existing literature which shows that contraceptive methods (modern or traditional method) are widely known in the community. Thus, a key finding of the study is that women, and especially married women, are familiar with at least one method of contraception. Therefore, high levels of contraceptive knowledge provide an opportunity for programs to overcome barriers that may hinder the application of this knowledge.
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 absence of side effects and ease of use. of use. There is a widespread perception that modern methods could have unwanted side effects. In addition, there are religious reasons such as the consideration by couples of a natural and easy to use 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 dominant barrier to contraceptives; rather they affect the choice of particular methods such as withdrawal . The effect of religious beliefs on the choice of contraception may be the reason why couples continue to rely on traditional methods. There is, however, a need for studies to better understand the motivations for the preference for traditional methods in the study and how women could be supported to ensure that these methods meet their reproductive needs.
Participants noted 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 perceived as a “women’s problem” by male partners. . Yet decision-making is not limited to women and women’s partners; family members are also involved in their contraceptive choices. These models highlight the need for a better understanding of intra-family relationships and the opportunities that these relationships offer to help the women in the study achieve their reproductive goals.
Our results show that although women trust family planning providers on contraceptive issues, they are more confident in the previous family planning experiences of other people such as their friends, neighbors, or relatives. This underlines the importance of women’s social networks as a source of information as well as a determinant of behavior. As Yee and Simon discovered, women have identified their social networks as one of the most influential factors in the family planning decision-making process, especially when it comes to side effects, safety. and effectiveness, and most of them considered this information to be more reliable than other sources. of information . 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. . Understanding how the social networks of women and men influence contraceptive use in this context can be essential for increasing contraceptive use in women who do not want to become pregnant. Intervention studies might 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 women to men doctors and contraceptive consultants. In addition, some community actors have reported prejudices regarding access to contraceptive methods against unmarried women. Pharmacies provide male condoms, pills, and emergency contraception without a written prescription in Turkey. The pharmacy sector supplies more than 45% of the male condom and pills . Many single women find it more convenient to obtain contraceptives from pharmacies, although contraception is not free at pharmacies. This is probably due to the fact that many single women prefer to avoid social pressure in health facilities and fear being ostracized for having sex considered illegitimate. The finding that many women in the study prefer to obtain contraceptives from pharmacies suggests a need to improve the ability of pharmacists to provide contraceptive information and advice to clients.
Various studies in Turkey have shown that a variety of perspectives must be taken into account to fully understand family planning decision-making processes. On the one hand, men say family planning is a shared responsibility , and that pregnancy planning should be done jointly between partners  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 those who make decisions about family planning. [7, 19]. Our results show that men are not very 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 against contraception, the majority said men were just indifferent. In addition, the lack of male involvement probably stems from pro-natalist views. The results suggest the need for a better understanding of contraceptive decision-making at the couple level and how best to involve men in addressing women’s reproductive needs.
Studies show that various factors influence fertility decisions, including the number of children alive [20, 21], educational level of parents and especially female partners , and socio-cultural norms and religious attitudes . 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 the gender roles in the family. Men’s desire to have children may be associated with a need to continue the family line and improve their social worth , making sense in terms of the social value of having a child mainly for men . This is yet another indication of the need to understand men’s perspectives in the study and how best to involve them in addressing women’s reproductive needs.
Our results showed that women attached greater importance to religious beliefs even though in practice these beliefs did not directly influence decisions about family planning. Although the women believed that contraception could be against God’s will, that 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 these beliefs influenced the choice of methods. . Religion does not often dissuade 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 accordance with religious beliefs or methods that are not as bad as the others. Although most of those interviewed in our study reported that contraception is viewed as a sin, women still used methods. Religious values may encourage the use of traditional methods, such as withdrawal, which have a long and historical tradition of being used in this setting. Cebeci and his colleagues found that in addition to viewing withdrawal as a natural and easy-to-use method with fewer side effects compared to modern methods, some viewed it as the method promoted by the Prophet Muhammad, indicating that modern methods are seen as harmful. . The findings underscore the need for family programs in the study to incorporate empowerment principles into client counseling in order to dispel misconceptions about modern contraceptives influenced by religious beliefs.
Our results can be influenced by how the participants were selected. In particular, community actors and service providers were purposely selected on the basis of their knowledge of topics related to women’s reproductive health, 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 the translation from one language to another. In addition, all interviews were conducted in a private space in order to reduce the risk of social desirability bias. By its very nature, our sample has limited external validity, which prevents us from making inferences about trends within the study setting or the country as a whole. While our results, based on a small intentional sample with key informants, are consistent with the results of other studies using larger samples with more diverse groups of women, other qualitative research with representative samples of women in childbearing age are needed to determine how well our findings align with prevailing trends across the country.