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Erfani A, Shojaei J. Shifts in Contraceptive Use in the City of Tehran, Iran: 2000-2014. Avicenna J Nurs Midwifery Care 2020; 28 (1) :57-66
URL: http://nmj.umsha.ac.ir/article-1-2022-en.html
Shifts in Contraceptive Use in the City of Tehran, Iran: 2000-2014
Amir Erfani *1, Javad Shojaei2
1- Department of Sociology & Anthropology, Nipissing University,North Bay, Canada , amire@nipissingu.ca
2- Senior Expert (PhD.), Population Policy Studies and Monitoring Committee, Supreme Council for Cultural Revolution, Tehran, Iran
Keywords: Contraception, Family planning, Reproductive health
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✅ The increasing prevalence of withdrawal and condom signifies a need for provision of effective family planning education and counseling to prevent unintended pregnancy.
Extended Abstract:   (560 Views)
Introduction

Pregnancy prevention with modern or traditional methods is one of the main determinants of fertility rate [1], which plays an important role in moderating high fertility rates and population growth [2], improving the health of children and mothers, with appropriate spacing between births, [5-3] and promotes mental health in couples. For example, the effective use of contraceptives in 172 countries, including Iran, has reduced the mortality rate of infants and mothers [7]. It is estimated that 61% reduction in fertility from the normal high level of about 9 children per woman in the observed rate of 2 children in 2000 in Iran has been related to the use of various methods of contraception [8].
Although the aim of the birth control policy rotation is to promote the birth rate, the new research shows that sterilization of men and women and the use of IUD have played a very small role (7%) in reducing fertility [10]. Therefore, the successful implementation of any population policy encouraging births requires awareness of new developments in the use of birth control methods.
For this purpose, the aim of this study was to investigate the rate, pattern and process of using contraceptive methods using data from three fertility surveys in a 14-year period (2000-2014) in Tehran. Where there is little scientific information about changes in patterns of contraceptive use in the country, the results of this study make it possible for decision makers and population policy makers to consider changes in contraceptive behaviors. The lack of long-term scientific data in this field in the country shows the need for this research.

 

Materials and Methods

This study mainly uses data from the 2014 fertility survey in Tehran [11]. In order to investigate the trend of changes in the use of contraceptive methods, in addition to the Tehran fertility survey in 2014, data from the 2009 Tehran fertility survey [12] and the population and health survey of Iran in 2000 [13] have been used.
The Tehran Infertility Survey Questionnaire was designed in five sections to gather information about household members and the socio-economic characteristics of women and their spouses, fertility and lactation, fertility and family planning, and intentional abortion. The survey questionnaire is in accordance with the methodological principles used in the design of standard questionnaires for well-known population and health surveys. Also, some questions of the Iranian Population and Health Survey of 2000 and many of the 2009 Tehran fertility survey questions have been used in the 2014 survey questionnaire to compare the trend of changes in demographic and health indicators, including contraception.
Based on the cluster analysis of the average monthly cost of households and the years of education of women living in the 22nd district of Tehran, the variable was classified into three clusters of areas with high socio-economic base, medium and low classification, which is used in this article.


 

Results

In 2014, 82% of women used contraceptive methods (48% modern methods, and 34% traditional methods). Withdrawal (33%) and condoms (21%) had the highest prevalence, compared with female sterilization (9%), IUD (7%) and Pills (7%). Over 2000-2014, the use of withdrawal and condoms increased by 69% and 20%, respectively. In contrast, the prevalence of female sterilization, pills, male sterilization, and IUD  decreased respectively by 20%, 42%, 45% and 51% over the same period. The use of withdrawal method increased with women’s age. Withdrawal and condom were used by 67% of contraceptive users, who mostly hold higher education levels, were employed, and lived in upper residential districts. In contrast, users of modern methods, namely sterilizations, IUD and pills, mostly hold lower levels of education and income, were unemployed, lived in the lower residential districts, and had two or more children. Results are shown in Tables 1, 2 and 3. 

Table 1. Frequency distribution and percentage of married women aged 15 to 49 years in terms of background characteristics in 2014 in Tehran

Total No methods  
Traditional methods		 Traditional methods Modern methods Modern methods All of the methodsا Age
N % No method Pregnant
 		 A safe period Intermittent sex condom Pills Injection* IUD Male sterilization Female sterilization
22
154
456
759
600
532
489		 100
100
100
100
100
100
100		 13.7
12.4
10.1
9.4
6.0
11.3
32.3		 13.6
14.9
11.0
7.3
3.8
0.4
0.2		 0.0
0.6
0.4
0.5
0.2
0.0
0.2		 27.2
31.2
32.0
32.7
35.8
39.2
27.2		 27.2
31.8
32.4
33.2
36.0
39.2
27.4		 27.4
20.2
28.2
30.8
24.1
10.2
4.7		 13.6
11.7
10.1
6.3
7.5
5.8
2.2		 0.0
1.9
0.4
1.1
1.1
0.8
0.2		 4.5
7.1
7.2
7.5
10.0
8.6
3.1		 0.0
0.0
0.4
1.4
3.2
6.8
7.8		 0.0
0.0
0.2
3.0
8.3
16.9
22.1		 45.5
40.9
46.5
50.1
54.2
49.1
40.1		 72.7
72.7
78.9
83.3
90.2
88.3
67.5		 19-15
24-20
29-25
34-30
39-35
44-40
49-45
3012 100 13.1 5.2 0.3 33.4 33.7 20.6 6.7 0.8 7.4 3.5 9.0 48.0 81.7 Total
Note: * Includes 7 cases of neuroplants.

Table 2. Distribution of the percentage of married women aged 15 to 49 years according to the method of prevention used during the interview with individual characteristics in 2014 in Tehran

Total No methods  
Traditional methods		 Traditional methods Modern methods Modern methods All of the methodsا  
Attributes
N % No method Pregnant
 		 A safe period Intermittent sex condom Pills Injection* IUD Male sterilization Female sterilization
 
494
1000
1075
443		  
100
100
100
100		  
20.2
11.4
10.1
15.8		  
16.2
6.1
1.3
0.7		  
0.2
0.2
0.4
0.7		  
24.7
38.7
39.4
16.2		  
24.9
38.9
39.8
16.9		  
29.8
27.2
16.0
6.2		  
7.5
7.1
7.4
3.2		  
0.6
0.8
1.0
0.9		  
0.4
6.7
10.9
8.4		  
0.4
0.3
6.1
7.9		  
0.0
1.5
7.4
40.0		  
38.7
43.6
48.8
66.6		  
63.6
82.5
88.6
83.5		 N. of Children
None
One
Two
Three or more
 
298
203
316
1121
1074		  
100
100
100
100
100		  
21.1
14.3
13.6
12.4
11.1		  
2.1
2.0
4.4
6.0
6.2		  
0.7
0.5
0.3
0.4
0.0		  
24.5
24.6
32.0
36.7
34.5		  
25.2
25.1
32.3
37.1
34.5		  
8.3
10.3
10.9
18.6
30.8		  
6.4
7.9
6.6
6.3
7.0		  
0.3
2.0
1.9
0.7
0.6		  
4.7
11.8
11.7
7.9
5.5		  
5.4
5.9
4.7
4.4
1.3		  
26.5
20.7
13.9
6.6
3.1		  
51.6
58.6
49.7
44.5
48.2		  
76.8
83.7
82.0
81.6
82.7		 Education
Elementary
Guidance Sch
High school
Diploma
College dgree
 
2474
538		  
100
100		  
13.3
11.9		  
5.5
4.3		  
0.4
0.0		  
31.7
40.7		  
32.1
40.7		  
19.4
25.8		  
7.0
5.6		  
0.9
0.4		  
7.6
6.3		  
4.1
0.9		  
10.1
4.1		  
49.1
43.1		  
81.2
83.8		 Employment
Unemployed
Employed
 
 
701
752
554
1005		  
 
100
100
100
100		  
 
14.7
13.6
11.7
12.2		  
 
7.3
5.9
5.4
3.3		  
 
0.6
0.3
0.2
0.2		  
 
32.2
31.2
34.1
35.3		  
 
32.8
31.5
34.3
35.5		  
 
17.0
17.7
21.6
24.5		  
 
7.2
8.1
6.9
5.2		  
 
1.0
1.1
0.0
1.1		  
 
8.3
8.0
7.2
6.5		  
 
2.4
4.0
3.2
4.1		  
 
9.3
10.2
9.7
7.6		  
 
45.2
49.1
48.6
49.0		  
 
78.0
80.6
82.9
84.5		 Household cost (1000 Tomans)
Less than 1000
1499-1000
1999-1500
2000 and more
 
1063
1107
842		  
100
100
100		  
12.8
11.7
15.2		  
3.3
6.4
6.2		  
0.1
0.5
0.2		  
35.2
34.8
29.2		  
35.3
35.3
29.4		  
28.6
15.6
16.6		  
5.6
6.4
8.6		  
0.7
0.7
1.3		  
5.7
8.5
8.1		  
2.4
5.0
3.1		  
5.6
10.4
11.5		  
48.6
46.6
49.2		  
83.9
81.9
78.6		 Residential area
North
Central
South
 
1682
910
202
105
113		  
100
100
100
100
100		  
11.4
15.5
18.3
14.3
8.0		  
4.7
5.8
6.4
5.7
6.2		  
0.2
0.4
0.0
0.0
0.9		  
36.4
28.8
33.7
28.6
28.3		  
36.6
29.2
33.7
28.6
29.2		  
24.2
15.4
15.4
18.1
20.4		  
5.7
7.5
8.4
7.5
11.4		  
0.8
0.9
0.0
0.0
2.7		  
5.8
9.5
5.9
8.6
15.9		  
3.9
3.2
3.0
1.9
2.7		  
6.9
13.0
8.9
15.2
3.5		  
47.3
49.5
41.6
51.4
56.6		  
83.9
78.7
75.3
80.0
85.8		 nationality
Fars
Azeri
Gilak and Mazandarani
Lor
Kurdish / Other
 
2082
655
 
275		  
100
100
 
100		  
11.9
16.0
 
14.5		  
5.8
4.1
 
3.6		  
0.3
0.3
 
0.4		  
34.4
31.3
 
30.5		  
34.7
31.6
 
30.9		  
23.3
16.0
 
11.2		  
6.2
7.1
 
9.5		  
0.8
0.8
 
0.8		  
6.6
9.2
 
9.1		  
3.3
4.1
 
3.6		  
7.4
11.0
 
16.7		  
47.6
48.2
 
50.9		  
82.3
79.8
 
81.8		 Immigration status
Non-immigrant
Immigrants from the city
Immigrants from the village
3012 100 13.0 5.3 0.3 33.4 33.7 20.6 6.7 0.8 7.4 3.5 9.0 48.0 81.7 Total
Note: * Includes 7 cases of neuroplants


Table 3. Distribution of the percentage of married women according to the use of current methods of contraception in the years 2000 to 2014 in Tehran 

2014 2009 2000 Pregnancy prevention method
81.7 85.3 77.6 All methods
48.0 54.4 50.0 Modern methods
9.0
3.5
7.4
0.2
0.6
6.7
20.6		 10.5
6.4
12.5
0.6
0.0
8.9
15.5		 11.3
5.0
15.0
0.1
0.7
11.5
6.4		 Female sterilization
Male sterilization
IUD
Neuroplants
Injection
Pill
Condom
33.7 30.9 27.6 Traditional methods
33.4
0.3		 30.2
0.7		 26.9
0.7		 Intermittent sex
A safe period
18.3 14.7 22.4 No method
100.0 100.0 100.0 Total
Sources: Population and health survey conducted in 2000 in Iran and fertility survey conducted in 2009 in Tehran.

Conclusion

The increasing prevalence of withdrawal and condom signifies a need for provision of effective family planning, education and counseling to prevent unintended pregnancy.
 

Acknowledgments

This research is taken from the 2014 fertility survey plan of Tehran, which was carried out with the financial support of the Institute of Comprehensive and Specialized Population Studies and Management in Iran and Nipissing University in Canada. We hereby thank these two organizations for their support.
 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Midwifery
Received: 2019/04/7 | Accepted: 2019/11/12 | Published: 2020/01/3
References
1. Bongaarts J, Potter RG. Fertility, Biology, and Behaviour: An Analysis of the Proximate Determinants. New York: Academic Press. 1983.
2. Feeney G. Population Dynamics Based on Birth Intervals and Parity Progression. Population Studies. 1983 Mar 1;37(1):75-89. [DOI:10.1080/00324728.1983.10405925] [PMID]
3. World Health Organization (WHO). Technical Consultation on Birth Spacing Geneva, Switzerland 13-15 June 2005. Geneva, Switzerland. URL: https://www.who.int/maternal_child_adolescent/documents/birth_spacing05/en/ (accessed January 5, 2019).
4. Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-Analysis. Jama. 2006 Apr 19;295(15):1809-23. [DOI:10.1001/jama.295.15.1809] [PMID]
5. Haq A, Lallar M, Akhter S, Baba YZ, Ahmad J, Hamid MA. Interpregnancy Interval Raise Odds of Adverse Perinatal Outcome in High Fertility Region Mewat, Haryana. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2014;3(3):598-603. [DOI:10.5455/2320-1770.ijrcog20140934]
6. Hall KS, Steinberg JR, Cwiak CA, Allen RH, Marcus SM. Contraception and Mental Health: a Commentary on the evidence and principles for practice. American journal of obstetrics and gynecology. 2015 Jun 1;212(6):740-6. [DOI:10.1016/j.ajog.2014.12.010] [PMID] [PMCID]
7. Ahmed S, Li Q, Liu L, Tsui AO. Maternal Deaths Averted by Contraceptive Use: an Analysis of 172 Countries. The Lancet. 2012 Jul 14;380(9837):111-25. [DOI:10.1016/S0140-6736(12)60478-4]
8. Erfani A, McQuillan K. Rapid Fertility Decline in Iran: Analysis of Intermediate Variables. Journal of Biosocial Science. 2008 May;40(3):459-78. [DOI:10.1017/S002193200700243X] [PMID]
9. Erfani A. Curbing Publicly-Funded Family Planning Services in Iran: who Is Affected?. J Fam Plann Reprod Health Care. 2017 Jan 1;43(1):37-43. [DOI:10.1136/jfprhc-2015-101383] [PMID]
10. Erfani A. Curbing Family Planning in Iran: an Appraisal of Bill 446. BMJ Sexual & Reproductive Health. 2015 Oct 1;41(4):317. [DOI:10.1136/jfprhc-2015-101254] [PMID]
11. Erfani A. Tehran Survey of Fertility, 2014: Final Report. Tehran, Iran: National Population Studies and Comprehensive Management Institute, Ministry of Science. Research, and Technology. 2015.
12. Erfani A. Tehran Survey of Fertility, 2009: Final Report, Tehran, Iran: Population Studies and Research Center in Asia and Pacific, 2010. (Persian)
13. Ministry of Health and Medical Education (MOHME). Iran Demographic nd Health Survey 2000 (IDHS). Tehran: MOHME, Iran. 2000.
14. Erfani A. Induced Abortion in Tehran, Iran: estimated rates and correlates. International Perspectives on Sexual & Reproductive Health. 2011 Sep 1;37(3): 134-142 [DOI:10.1363/3713411] [PMID]
15. Erfani A, McQuillan K. The Changing Timing of Births in Iran: an Explanation of the Rise and Fall in Fertility after the 1979 Islamic Revolution. Biodemography and social biology. 2014 Jan 2;60(1):67-86. [DOI:10.1080/19485565.2014.899428] [PMID]
16. Bakht R, Omidi A. Study of Contraceptive Methods Use before the First Pregnancy. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2008 Nov 15;16(2):32-42.
17. Ahmad Shirvani M, Omidian A. Utilization Rate of Natural Family Planning and its Related Factors. Journal of hayat. 2007 Jun 15;13(3):37-47.
18. Rastak L. Correlation between socio-demographic characteristics and contraceptive methods. J Shahrekord Univ Med Sci. 2005; 7 (2) :21-28.(Persian)
19. Amiri P, Amouzegar A, Gharibzadeh S, Kazemian E, Ramezani Tehrani F, Azizi F. Socio-Behavioral and Reproductive Determinants Associated with Contraceptive Method Choice Among Tehranian Women: Tehran Lipid and Glucose Study. Research in Medicine. 2014 Aug 1;38(2):111-9.
20. Erfani A. Levels, Trends and Correlates of Abortion in Tehran, Iran: 2009-2014. International perspectives on sexual and reproductive health. 2016 Jun 1;42(2):93-101. [DOI:10.1363/42e1316] [PMID]
21. Erfani A, Shojaei J. New Evidence on Induced Abortion in Tehran, Iran: Rates, Causes, and Changes. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;21(3):64-77.
22. Erfani A. Levels, Trends, and Determinants of Unintended Pregnancy in Iran: the Role of Contraceptive Failures. Studies in Family Planning. 2013 Sep;44(3):299-317. [DOI:10.1111/j.1728-4465.2013.00359.x] [PMID]
23. Zaheri F, Ranaie F, Karimeh R, Shahoi R. Unwanted Pregnancy and Associated Factors Among Pregnant Women Who Referred to Sanandaj Health Centers in 2011. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2015;17(132):10-5.
24. Erfani A, Yuksel‐Kaptanoglu I. The Use of Withdrawal Among Birth Limiters in Iran and Turkey. Studies in Family Planning. 2012 Mar;43(1):21-32. [DOI:10.1111/j.1728-4465.2012.00299.x] [PMID]
25. Nazarpour S, Âzimi H. Study on the Rate of Using Different Family Planning Methods and Attitudes of Under 25 Years Married Females Towards Family Planning Referring to West Province Health Center of Mazandaran in 2001. Journal of Mazandaran University of Medical Sciences. 2002 Dec 15;12(37):46-55.
26. Pouransary Z, Sheikh Z, Eshrati B, Kamali P. Prevalence of Contraceptive Use and the Importance of the Husband's Cooperation in Married Women in Iranshahr, 2005. Iranian Journal of Epidemiology. 2008 Feb 15;3(3):55-60.
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