Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115107

Andrzej Kulczycki, PhD and Sarah Nabukera, MPH. Maternal and Child Health, University of Alabama at Birmingham, 1665 University Blvd., 320 Ryals Public Health Bldg., Birmingham, AL 35294-0022, 205-934-9875, andrzej@uab.edu

Oral contraceptives and intrauterine devices (IUDs) account for over one-third of all contraceptive use worldwide. In the Middle East, this fraction rises to about half. However, pill prevalence rates are no longer rising as before and despite steady gains in most populations, IUD use remains low elsewhere. This situation is poorly understood. In Lebanon, pills and IUDs are the most widely adopted modern methods, yet they account for only 44% of all contraceptive use, despite a relatively advanced stage of fertility transition. We describe patterns of pill and IUD use, and the preference rationale for users, husbands, and service providers in southern Lebanon, where accessibility and economic barriers to method adoption are minimal. This permits detailed analysis of why these methods are often viewed poorly and continuation rates are lower than would be expected. Findings derive from a small-scale household survey, interviews with service providers, and 25 focus-groups conducted separately with married women and men. Women and men recognize the convenience of these methods, but pill use especially is plagued by adverse rumors and myths, poor compliance, and inadequate attention to method follow-up (also due to limited program resources). Many women are unclear about the pill's advantages and are much more likely to question its efficacy than the IUD. Although past work has suggested the IUD's suitability for Muslim populations, most women fear side-effects from both these methods, particularly regarding future fertility and menstrual disruption. The role of client-provider interactions in explaining this situation, and in ameliorating it, is emphasized.

Learning Objectives: At the conclusion of the session, participants will be able to

• Describe the contraceptive profile of Middle Eastern countries and how this compares to other major regions.
• Articulate the major challenges facing reproductive health service providers in rural Arab populations.
• Identify reasons why compliance rates for both pill and IUD use are relatively low in the study region, and the major barriers to more effective use of these methods.
• Recognize similarities and differences in the perspectives of wives, husbands, and service providers concerning use of these methods.
• Discuss the importance of client-provider relations in determining contraceptive use practice.

Keywords: Contraception, Reproductive Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.