Academic journal article Journal of Comparative Family Studies

Factors Associated with the Use of Withdrawal in Iran: Do Fertility Intentions Matter?

Academic journal article Journal of Comparative Family Studies

Factors Associated with the Use of Withdrawal in Iran: Do Fertility Intentions Matter?

Article excerpt

(ProQuest: Text missing in the original.)

INTRODUCTION

Withdrawal, as a main traditional method, is one of the most widely used temporary contraceptive methods in the world. Before the introduction of modem contraceptives, it played an important role in the control of high fertility in the currently developed countries (Santow, 1993, 1995). It is also speculated that withdrawal has played a similar fertilityinhibiting role in the recent fertility transition in the Islamic Republic of Iran (AbbassiShavazi et al., 2009:96; Aghajanian et al., 2007). Nevertheless, the high prevalence of withdrawal in certain Eastern European and Asian countries, including Iran, remains a concern for stakeholders in the field of public health, reproductive health, and population policy as the high failure rates of withdrawal lead to a large number of unwanted pregnancies and induced abortions (Erfani, 2010a). This concern is particularly important for countries like Iran, where even though there is little unmet need for contraception (5 percent) (Abbasi-Shavazi et al., 2009: 110), a large number of reported pregnancies remains unwanted (16 percent) (IDHS, 2002). Furthermore, annually about 73,000 clandestine, unsafe abortions occur outside the legal system, often carried out by unskilled practitioners or under unhygienic conditions (Erfani and McQuillan, 2008). Recent evidence shows that almost half of abortions and more than two-thirds of unwanted pregnancies in Iran occurred while women were using withdrawal. Moreover, the desire to limit births, followed by spacing births, is the most frequently reported reason for abortion among women in Iran and other Asian countries (Bankole, 1998; Erfani, 2009; Erfani and McQuillan, 2008). These facts indicate that the majority of unwanted (not mistimed) pregnancies and induced abortions occur among women who do not want any more children and who use withdrawal. This study refers to these women as "birth limiters." Looking at contraceptive behavior of women based on their fertility intentions allows an assessment of the need for contraception. Thus, to better understand the contraceptive behavior of married women in Iran, this study examines the effect of fertility intention and other factors which influence the likelihood of using withdrawal rather than modern contraceptive methods.

The study aims to improve our knowledge about the mix of contraceptive methods used by Iranian married women based on their intention to limit or space the next birth and to identify subgroups of women who are more likely to use withdrawal rather than modem methods to prevent or delay additional births. Furthermore, we will investigate the net effect of women's intention to space or limit births and its interaction with other theoretically and empirically relevant socio-economic and demographic factors on the likelihood of using withdrawal. Using nationally representative data from the 2000 Iran Demographic and Health Surveys, this study intends to address these objectives by applying multivariate logistic regression methods. We hope that this study will provide further insights into the contraceptive behavior of married women by looking at their fertility intention.

FAMILY PLANNING PROGRAM IN IRAN

In Iran, before the enactment of the first official Population and Family Planning Program in 1967, some contraceptives, including the pill, foam, and jell, were delivered to women living in certain urban areas in clinics or had been obtained from pharmacies since 1951 (MOHME, 2004). After the Iran's Islamic Revolution of 1979, which brought with it a dramatic change in population policy (Aghajanian, 1995), the previous family planning program was terminated and the new government enacted a strongly pro-natalist policy. The growth of religious fervor, promoted by the new government, encouraged early marriage and childbearing. The government also put in place policies designed to support larger families financially, which provided an incentive to childbearing. …

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