How do contraception preferences change over time? Eight years of experience in a tertiary hospital

Discussion

A family’s decision to have a child depends on many factors. Some couples plan to have children and take the necessary measures to achieve this, while others may have children unintentionally. However, in the modern world, family planning allows couples to have children whenever they want to or to determine the desired number of children and birth intervals according to their economic conditions and personal preferences.⁶ In a study by Alsaleem et al,⁷ the most important factors associated with contraceptive use were found to be age, education of women, gravida, number of living children, gender, and age of the last child. There are families in our country who do not have enough knowledge regarding birth control methods. The best example of this can be given as the most common contraception method used in every age group in this study which is coitus interruptus. In addition, factors such as ethnic factors, socioeconomic and sociocultural factors, and education level can also affect the choice of birth control methods.⁸ However, family planning centers can help in this situation and advise patients regarding which contraceptive methods can be used.⁹ As seen in the study data, different contraception methods were recommended to 84.4% of the patients. Type 2 DM, hypothyroidism, and generalized anxiety disorder, which are the most common comorbid diseases in the patient population in the study, were considered for the recommended contraception preferences.

Many factors, such as age, fertility, gender, and more, can influence a person’s choice of contraception. Young women often prefer oral contraceptives or condoms. These methods are low-cost, easily accessible, and less invasive.¹⁰ Older women, on the other hand, may prefer long-term birth control methods. Long-term methods of contraception ensure that birth control is continuous and effective. Older women may not use contraception due to the end of their fertile period. Therefore, it should be considered that people of different age groups may choose other methods of contraception.¹¹ In our study, when examining the 3 different age groups, the number of patients with condom use decreased as the age increased. On the other hand, IUD use rates were higher in the group aged 18-40 years than in the older age group. In addition, hormone-containing methods were not preferred by women over the age of 40 years.

The use of contraception methods has increased worldwide in recent years, but financial concerns remain an obstacle for many people. In many countries, especially in low- and middle-income countries, the increasing use of contraception is due to women’s increased education levels and easier access to sexual health services. However, in many countries, high costs and limited access to contraceptive products are still barriers for many women.¹² The withdrawal method is widely used as an alternative to high-cost contraceptive methods. However, the effectiveness of the withdrawal method is lower than that of other methods and may lead to unwanted pregnancies. The use of condoms and oral contraceptives has decreased in recent years. This may be because alternative methods are becoming more common. In addition, the inadequacy of campaigns promoting sexual education, the COVID-19 pandemic, and contraceptive use in some countries may also contribute to this decrease.¹³ Similarly, our study showed that in the last 4 years, the number of people who wanted to use contraception increased significantly compared to the first 4 years. In contrast, the use of condoms and oral contraceptive pill (OCP) decreased significantly. The use of the coitus interruptus method increased. The financial crises experienced in our country and even worldwide in recent years may be the reason for this.

Although the opposite is seen in some countries, the breastfeeding rates increased as maternal age decreased in Turkey.¹⁴ These data reveal that the breastfeeding behaviors of mothers in different age groups vary and that young mothers prefer to breastfeed. At the same time, studies have shown that as the number of cesarean sections and age increases, the probability of undergoing bilateral tubal ligation (BTL) also increases. Regret rates seem to be high in women with BTL carried out at a young age. The BTL, which is among the methods recommended to patients in our study, has been recommended for women with advancing age, supporting the literature.

The choice and use of birth control methods depend on many factors and cannot be based solely on education level. Factors such as sexual education, cultural norms, economic status, religion, partner attitudes, and access to health services can also have an impact on birth control method preferences. Demir et al¹⁵ showed that there was an inverse relationship between education status and coitus interruptus in their study. In our study, it is clear that there was a similar relationship.

Future research should focus on identifying the factors that affect the acceptability of each method. If these factors can be identified, we can develop strategies to increase the acceptability of contraceptive methods or help women find a suitable method based on their preferences.