Participants opinions about the effectiveness of contraceptives

The majority of participants in the focus groups had the opinion that if a woman used a contraceptive in the right way, it was 100% effective against pregnancy. Therefore, they thought that if someone got pregnant while taking contraceptives, it was likely due to user failure or the failure of health workers. Participants cited common mistakes: for example, if they forgot to take the birth control pill every day or exceeded the prescribed dosage, or if they did not receive an injection on the exact day the health workers

recommended. The failure of providers seemed to be related to distrust of private clinics. Some participants complained that health workers in private clinics injected women with only half dosage or water instead of medicine.

They claimed that health workers in private clinics are more concerned with making money, and the participants told that they had never heard of this kind of accident happening to women who went to public medical facilities.

There were also participants who thought that contraceptives could not prevent pregnancy or that pregnancy prevention depended on certain conditions. Some participants mentioned that women had different blood types, and some blood types reject contraceptive medicines. Therefore these women could not be protected from pregnancy by contraceptives, even if they took it properly. Others said that birth control pills cannot prevent

pregnancy when women feel a strong sexual desire. Some believed that pills cannot prevent pregnancy at all because of the belief that pills accumulated in the body. Regarding condoms, some male participants mentioned that condoms were breakable during sex, and thus the method was not

trustworthy.

Two more methods of contraception, breast feeding and the calendar rhythm method, were also discussed. There were different opinions about

breastfeeding as a natural form of contraception, opinions which drew on personal experience or from hearing about other’s experiences. Some people believed that breastfeeding is effective against pregnancy, while others thought that breastfeeding did not prevent pregnancy at all because they

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themselves had become pregnant, or knew other women that got pregnant during breastfeeding. One group of participants said that getting pregnant during breastfeeding depended on the condition of the women and/or the babies. They believed that pregnancies in this period occurred due to a woman’s predisposition, or depended on how much breast milk women produced. However, the majority of participants considered breastfeeding as an ineffective form of contraception. In general few participants thought breastfeeding was an alternative method to modern contraceptives.

The calendar rhythm method was also mentioned as one of the methods for natural birth control. While some participants had knowledge and opinions about this method, others did not know about this method at all. The health personnel at the health centre in the town told that this type of contraception method was effective if the people used it correctly. One of the interviewed health personnel in the health centre explains how she presented this method:

“(We explain) there are two types of periods decided by the menstrual cycle.

One is the fertile period where women get pregnant easily and the other is the infertile period where women do not get pregnant easily. If a woman has a 28 days stable menstrual cycle, first divide 28 by 2. It is 14 days. Then subtract 5 days from the first 14 days and 5 days plus the latter 14 days. So, from the 9th day to the 14th day is identified as a fertile period. Other days are safe. So, we advise people to use condom or to be abstinent from having sex during the fertile period. Additionally we also explain that the method cannot prevent pregnancy perfectly because the menstrual cycle can be irregular sometimes. Then the method does not work”.

The health personnel emphasized that they taught the method to the

“educated” people who seemed to understand the method, but did not teach the method to those they considered uneducated. However, we found that there were various opinions about fertile and infertile periods among the participants. For what was considered the fertile period, methods of counting varied drastically: for example, within 10 days after menstruation, within 15

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days from starting menstruation, immediately after menstruation, three days before and after menstruation, within nine days from starting

menstruation, after 18th days from starting menstruation, and within one week after finishing menstruation.

The effectiveness of the calendar rhythm method was disputed in the focus groups. Some suspected that this method was not reliable, and did not believe it prevented pregnancy. Others said it was not applicable to all women because of husband’s lack of tolerance of sexual abstinence. Some were confident that the method prevented pregnancy as long as one did not have sex in the unsafe periods. One male participant from one of the focus groups told about his wife’s unexpected pregnancy due to the calendar rhythm method:

“I asked health care workers and they told me that if a woman has sex

within nine days after menstruation starts, she will become pregnant, Then I separated my bed from my wife’s for nine days and I added two days more myself. So we had sex after 11 days from her menstruation came. But she got pregnant. I don’t believe that calendar method works”. (FGD4)

The staffs who worked with reproductive health in an NGO were asked about their opinion on the calendar rhythm method. One staff member said:

“The method is not a preferable contraception because it has a high failure rate. We recommend using other contraceptive methods because there are many uneducated people in our community. The method is not proper for uneducated people. Therefore we provide contraceptive medicines and

education programmes for them. But, we do not prohibit health personnel to teach the people the method. We do not recommend it. We encourage people to use other methods, especially long term methods.”

The health personnel considered the method to be useful if used by educated people considered to have ability to understand the method. Uneducated

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people were not considered to be capable of understanding the method. The health personnel did not seem to consider the communication going on among people, and which included communication between both educated and uneducated people. Limited access to information from the health personnel seemed to produce misinformation among people and allowed for fewer chances to receive accurate information. As a result, the level of

knowledge about different contraceptive methods varied greatly from person to person. Although the NGO staff thought the method was not fully reliable as contraception, the health personnel in the health centre did not seem to emphasize the fact that the method was not preferable when they taught people. Even if practicing the method may be better than doing nothing, the data indicate that this approach may serve as an obstacle to use modern contraceptives, which would be more effective if they were used properly.