222945 Role of fear and misinformation about contraceptives in unmet need: Are we measuring it correctly? A case study in attitudes from Uttar Pradesh, India

Monday, November 8, 2010

Laura Swift , Maternal and Child Health Dept., UC Berkeley School of Public Health, Berkeley, CA
Nuriye Sahin-Hodoglugil, MD PhD , Venture Strategies Innovations, Berkeley, CA
Martha Campbell, PhD , University of California, Berkeley, Berkeley, CA
Ramakrishnan Ganesan , Venture Strategies Innovations, PRISM, Berkeley, CA
Gopi Gopalakrishnan , World Health Partners, New Delhi, India
Karen Pak Oppenheimer, MS, MPH , Venture Strategies Innovations, Berkeley, CA
Preeti Tiwari , Venture Strategies Innovations, PRISM, Berkeley, CA
Julia Walsh, MD DrPH , UC Berkeley School of Public Health, Berkeley, CA
BACKGROUND: The Demographic and Health Survey (DHS) has become the standard instrument to quantify unmet need for contraception. However, the usefulness of the DHS as a tool to identify reasons for unmet need remains questionable. In regions with high unmet need, such as Uttar Pradesh (21% among married women), it is imperative to be able to quantify and empirically analyze how attitudes about contraceptive methods (e.g. fear of side effects and misinformed health concerns) may become barriers to contraceptive adoption or reasons for method discontinuation. METHODS: Qualitative data from six focus group discussions and 48 in-depth interviews were analyzed for couples' experiences with contraception in two rural villages in Uttar Pradesh, between April-June 2008. In addition, quantitative data from India DHS 2005-6 was explored to identify contraceptive attitudes and empirical testing of qualitative results. RESULTS: Qualitative analysis revealed a high degree of negative attitudes about reversible contraceptive methods among users and non-users alike. These included beliefs that these methods were harmful to health; ineffective; cause weakness of the body; or cause permanent sterility. Quantitatively, data were very limited, and showed a discrepancy in results; health concerns and fear of side effects were indicated in only 17% of respondents with identified unmet need. CONCLUSIONS: Without attitudinal measures, the DHS is rendered insufficient to fully understand the reasons for unmet need, and limited data may be misleading. We are recommending an algorithm to improve the measurement of attitudes towards contraceptive methods to fill the gap in understanding the reasons for unmet need.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related public policy
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Explain how fear and misinformation about contraceptives contribute to unmet need. 2. Identify a limitation to the Demographic and Health Survey in the measurement of attitudes about contraceptives. 3. Describe an algorithm to improve measurement of contraceptive attitudes.

Keywords: Contraceptives, Methodology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author on the content I am responsible for because I am a graduate student studying reproductive health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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