¹College of Medicine, University of Ha’il, Kingdom of Saudi Arabia,

²College of Sciences, University of Ha’il, Kingdom of Saudi Arabia

Corresponding author email: jahooralam@gmail.com

Article Publishing History

INTRODUCTION

The dynamics of decision-making between a husband and wife also create barriers to access. Several studies have examined the influence of social and cultural factors on contraceptive use. These studies have emphasized the influence of the mother-in-law and the husband on family planning decision-making and have highlighted the importance of communication between spouses regarding the use of contraception (Pasha et al., 2001; Kadir et. al., 2003  Al-Mousa et al., 2019 ). Despite the huge benefits, family planning is one of the most difficult and least discussed topics, particularly amongst males in a conservative and patriarchal society where men have the final decision-making power regarding most issues, including reproductive health. Nevertheless, there have been some efforts to target men through either advocacy or behavioral change interventions, but very little have been achieved (Omolase et. al., 2009).

Healthy timing and spacing of pregnancy (HTSP) is a family planning intervention to help women and couples delay, time, space, or limit their pregnancies to achieve the healthiest outcomes for women, newborns, infants, and children regardless of the total number of children (Marston, 2005). It has been documented that perinatal outcomes and child survival can be improved mainly by lengthening inter-pregnancy intervals. Over one million maternal deaths were averted between 1990 and 2005 because the fertility rate in developing countries has declined and by reducing high parity births family planning contributed to reducing the maternal mortality ratio. On the contrary, birth to pregnancy intervals of less than 18 months are associated with risk of low birth weight, preterm birth, small size for gestational age, and stillbirth (Celand et. al., 2012; Stover and Ross, 2010 Alhusain, 2018).

Use of family planning (FP) methods can contribute to a substantial reduction in fertility and reduce the proportion of unwanted pregnancies as well as maternal deaths that would otherwise occur in the absence of contraception. In 2008, contraceptive use averted over 250,000 maternal deaths worldwide by reducing unintended pregnancies, which is equivalent to 40% of the 355,000 maternal deaths that occurred in that year (Alege, et.al., 2016).Fear of contraceptive side effects and associated treatment costs, cultural barriers and low male involvement continue to hamper effective use of FP services in most countries. Lack of knowledge of where to obtain FP methods and lack of information on what women consider to be trusted sources of FP information and services, are key barriers that affect access to and utilization of FP methods (Celand et. al., 2012, Abdulreshid and Dadi, 2020).

The presented study was designed to study the knowledge and practices of family planning methods   adopted in Hail Region of Kingdom of Saudi Arabia.

MATERIAL AND METHODS

This study was a cross-sectional study conducted in Hail province and its villages. The consent was taken from each subject before the interview.  Married men and women were the study subjects.  A detailed questionnaire was prepared containing demographic profiles and questions related to knowledge about family planning (FP) methods. A multistage sampling was used for the selection of subjects.  Firstly, a list of villages were made and selected randomly. After the selection of villages, subjects were selected starting from a pin-point made in the village till the final subject selected from the village.

Statistical analysis: The results are presented in frequencies and percentages. Chi-square test was used to assess the associations. The p-value<0.05 was considered significant. All the analysis was carried out on SPSS 16.0 version.

RESULTS AND DISCUSSION

More than one third of the subjects were ≤25 and 26-35 years each constituted 36.3%. Most of the subjects were females (55.6%).  More than one third of the subjects had college level of education (44.4%) and majority of the subjects were employed (73.4%). Marriage duration was 16-20 years among more than one third of subjects (37.1%). More than one third of subjects had 1-3 kids (45.2%) (Table-1).

Table 1. Demographic profile of study subjects

Demographic profile	No. (n=124)	%
Age in years
≤25	45	36.3
26-35	45	36.3
36-45	13	10.5
46-55	10	8.1
>55	11	8.9
Gender
Male	55	44.4
Female	69	55.6
Level of education
Collage	55	44.4
High school	12	9.7
Elementary school	21	16.9
Pre-primary school	14	11.3
None	22	17.7
Occupation
Employed	91	73.4
Farmer	1	0.8
Business	11	8.9
Housewife	10	8.1
Retired	11	8.9
Marriage duration in years
1-5	14	11.3
6-10	19	15.3
11-15	33	26.6
16-20	46	37.1
>20	12	9.7
No. of kids
1-3	56	45.2
4-7	46	37.1
>7	22	17.7

Overall, the knowledge about family planning methods was among 95.2% (95%CI=89.8-97.7%) of the subjects (Fig. 1).

Figure 1: Knowledge about family planning methods

The knowledge about family planning methods was higher among female subjects (97.1%) than males (92.7%), however, the association was statistically insignificant (p>0.05) (Table-2)More than one third of subjects had good knowledge about FP methods (42.4%) and 32.2% had excellent knowledge.  The percentage of good and excellent knowledge was found to be higher among females than males (Table-3).Drug use was in majority of subjects as the method of family planning (70.3%). However, 26.3% used condom as the method of family planning. Majority of males used drugs (70.6%) and condom (60.8%) as the method of family planning. However, 70.1% females used drugs for family planning (Table-4).About half of the subjects got knowledge about FP methods from doctors (51.7%) and one third got from family & friends (30.5%).  Males (54.9%) and females (49.3%) also got knowledge from doctors (Table-5).

Table 2. Knowledge about family planning methods among study subjects

Gender	No. of subjects	Knowledge about family planning methods				p-value1
		Yes		No
		No.	%	No.	%
Male	55	51	92.7	4	7.3	0.25
Female	69	67	97.1	2	2.9

¹Chi-square test

Table 3. Level of knowledge about family planning methods among study subjects

Level of knowledge about family planning methods	Male (n=51)		Female (n=67)		Total (n=118)
	No.	%	No.	%	No.	%
Little	14	27.5	4	6.0	18	15.3
Moderate	4	7.8	8	11.9	12	10.2
Good	18	35.3	32	47.8	50	42.4
Excellent	15	29.4	23	34.3	38	32.2

Table 4. Attitudes towards use of family planning methods among study subjects

Contraceptive methods used*	Gender				Total (n=118)
	Male (n=51)		Female (n=67)
	No.	%	No.	%	No.	%
Drugs	36	70.6	47	70.1	83	70.3
IUD	0	0.0	22	32.8	22	18.6
Condom	31	60.8	0	0	31	26.3
Uterine barrier	0	0.0	3	4.5	3	2.5
Withdrawal	6	11.8	9	13.4	15	12.7
Injections	0	0.0	6	9.0	6	5.1

*Multiple response

Table 5. Source of knowledge about family planning methods among study subjects

Source of knowledge*	Gender				Total (n=118)
	Male (n=51)		Female (n=67)
	No.	%	No.	%	No.	%
Family and friends	8	15.7	28	41.8	36	30.5
TV	5	9.8	9	13.4	14	11.9
Internet	5	9.8	6	9.0	11	9.3
Doctors	28	54.9	33	49.3	61	51.7

DISCUSSION

In the present study, more than one third of the subjects were ≤25 and 26-35 years each constituted 36.3%. Most of the subjects were females (55.6%). (Gupta et. al., 2012) showed that 32 (32% of the married women belonged to 20-24 years of age group.In this study, the knowledge about family planning methods was among 95.2% (95%CI=89.8-97.7%) of the subjects. This finding is in agreement with the study by (Gupta et. al., 2012) in which 94 (94%) of participants have knowledge about contraception.

In the present study, drug use was in majority of subjects as the method of family planning (70.3%). However, 26.3% used condom as the method of family planning. However, in a study (Gupta et. al., 2012), 64 (68%) were using modern contraception methods. They also showed that injectables hormonal contraceptives were most commonly practiced by 34 (54%) women.  However, in the present study, Majority of males used drugs (70.6%) and condom (60.8%) as the method of family planning. However, 70.1% females used drugs for family planning. This study showed that about half of the subjects got knowledge about FP methods from doctors (51.7%) and one third got from family & friends (30.5%).  It is reported that clinic providers, friends and the media were the most trusted sources of contraceptive information while government and private health facilities were the main sources of FP methods (Celand et. al., 2012; Al-Turki, 2010, Abdulreshid and Dadi, 2020, Kantorova et. al., 2020)

There are some of the limitations of this study. One them is fewer sample size. Studies on larger sample size are recommended to have robust findings.

CONCLUSION

The study showed almost universal knowledge about family planning methods with higher knowledge among women. The family planning and birth spacing interventions need to focus on alleviating fears about side-effects among men and women through effective counseling and providing adequate information to both men and women about method-related side-effects and how to manage them. In addition, involving community leaders, religious clerics, and health workers in awareness raising campaigns can help address sociocultural and religious concerns.

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