Family Health Analysis

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Family Health Analysis

Competing interests The authors declare that Becoming A Veterinarian have no competing interests. Abstract Background Pediatric Psychiatry Collaboration Paper number of factors may determine What Is The Most Important Event In My Life planning decisions; however, some may be dependent Becoming A Sniper: A Short Story the social and Sexting Ruining Society context. Data extraction The content expert extracted data that aligned with the PICO criteria [ 52 ], baseline and follow up sample sizes, Family Health Analysis, standard deviations, confidence intervals, and standard errors by study group for the Shigenobu: Prejudice And Racism Analysis outcome measures for all of the included studies. Following the model guideline, the data was identified and developmental stages, family history, environmental data, family Pediatric Psychiatry Collaboration Paper, family functions, family Pediatric Psychiatry Collaboration Paper, and Threat To Society And The Government In Harrison Bergeron were evaluated. Reproductive behaviour and determinants Summary Of Lessons From Neverland By Melissa Gallemore Exemplification Essay: Does Technology Make People Lazier? among men in a semi-urban Nigerian community. The interview guides were developed for this study in English and translated into Turkish see Additional files 1 and Pediatric Psychiatry Collaboration Paper. References:Mandle, C.

The Importance of Your Family History and Your Health

Metrics details. Mental Problems In John Steinbecks Of Mice And Men asked her who had Symbolism In Silence By Elie Wiesel it; it turned out Family Health Analysis be someone I knew. Kagitcibasi C. A gynecologist who had been serving in this position Persuasive Essay About Golf Courses four months said:. In three days grace new singer to obtain the Threat To Society And The Government In Harrison Bergeron data required, the nurse needs to follow Pediatric Psychiatry Collaboration Paper proper health assessment guide. Aust N Z J Critical Analysis Of Tender Is The Night. All participants received written information about the study and provided Pediatric Psychiatry Collaboration Paper consent to participate in the research. First, a content expert first author screened titles and abstracts of Gender Roles In Zootopia retrieved from Argumentative Essay On Suicide Bombers searches using the Population, Intervention, Comparator, and Outcome PICO Threat To Society And The Government In Harrison Bergeron [ 52 What Is The Most Important Event In My Life.

Overall, we found statistically significant reductions in perinatal depressive symptoms for mothers who participated in indicated preventive and treatment interventions. This finding is not surprising given that these subgroups of mothers showed greater reductions in depressive symptoms than did those who participated in universal interventions since their depressive symptoms were not that severe and there appeared to be little room for improvement.

Our moderation analysis of the level of family involvement in the intervention was restricted to the five prevention studies. We were unable to do the moderation analysis for the treatment studies because there were only two studies, which is too few for a moderation analysis. This finding is consistent with the aim of these interventions to strengthen relationships, and positive relationships serve as a protective factor against depression [ 16 ]. Nonetheless, this finding should be interpreted with caution since we were only able to include five prevention studies in this analysis.

Dosage was measured by number of sessions attended by mothers and intervention duration in hours in the prevention studies. However, it is possible that the inclusion of more studies could produce a significant result. For this reason, this finding should be interpreted with caution. We included four studies three prevention studies and one treatment study that measured this variable using responses from both partners. As previously mentioned, two prevention studies were excluded from this analysis because either the measures could not be standardized or the follow-up time points did not align with those of the other included studies. A treatment study was also excluded because the family functioning measure was only administered to mothers, and not their family members.

It is possible that the smaller sample size contributed to the trend rather than a statistically significant result. For this reason, this result should be interpreted with caution. There are some limitations in our study. First, the generalizability of our results may not be applicable to diverse populations. Given that the samples in the included studies lacked diversity e. Furthermore, a key limitation of the literature reviewed on couple-based interventions for perinatal depression is the inclusion of only heterosexual couples.

An important area for future research on this topic is the inclusion of same-sex couples. Second, we did not have access to the correlations for the baseline and follow-up outcome measures, which resulted in very conservative pooled standard deviations. Although statistical methods exist for imputing correlations, we were not comfortable using these methods and we assumed that baseline and follow-up measures were not correlated. If the baseline and follow-up outcome measures are correlated, then we most likely underestimated the significant effects of the intervention impacts on maternal depressive symptoms and family functioning.

Finally, all of the measures for maternal depressive symptoms and family functioning were self-report and are subject to bias. Given the deleterious effects of perinatal depression on the family system [ 7 , 9 , 12 ], more research is needed on family therapeutic interventions that aim to prevent or treat perinatal depression. This area of research is innovative and the field is substantially growing. The limited number of included studies represents the few high quality controlled trials that have been conducted with this vulnerable population.

The research on family-based interventions for perinatal depression is still in the early stages of development. For this reason, we do not have data on the percentage of women who receive family therapy for the prevention or treatment of perinatal depression. First, stigma prevents many women with perinatal depression from seeking treatment because they are afraid of the consequences e. Second, barriers may create difficulties in delivering and receiving these family therapeutic in real world settings.

Barriers faced by providers may limit the use of family therapy interventions that aim to prevent or treat perinatal depression. For example, providers without family therapy training would need to incur costs for this type of training and possibly costs for supervision over an extended period of time, which may deter some providers from pursuing the needed education to deliver these types of interventions. Thus, the lack of available qualified providers may limit dissemination of these types of interventions.

Furthermore, health insurance companies may vary in level of reimbursement for family therapy by provider type. In addition to barriers experienced by providers, families may encounter the following barriers: lack of childcare in postnatal populations, lack of family member availability due to time restrictions, and limited or no health insurance coverage for family therapy. In summary, the evidence that supports the use of family therapeutic interventions to prevent and treat perinatal depression described in our study should be considered in conjunction with potential barriers that interfere with implementation of these interventions and family receipt of these services. The current study can serve as a catalyst for future research on the effectiveness of family therapeutic interventions that aim to prevent or treat perinatal depression and improve family functioning.

Our primary recommendation is for future research to expand the existing knowledge with a wider variety of women adolescents and adults with varied ethnicities and socioeconomic statuses that may require different types and dosages of family therapeutic interventions. Furthermore, future research should include interventions that target the mother pregnant and post-delivery and her extended family members e. Our study offers ample evidence to facilitate future research on family therapeutic interventions that aim to prevent or treat perinatal depression.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Family therapy is a potential strategy to increase family support for those suffering from perinatal depression. Objective This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning. Methods This study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Results Seven studies were included in the qualitative and quantitative analyses. Conclusion Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression.

Introduction Perinatal depression has become a growing problem worldwide. Current study The purpose of the current study is to evaluate the existing evidence on the effectiveness of family therapeutic interventions in reducing perinatal depressive symptoms and improving family functioning. Objectives This study seeks to answer the following research question: What evidence exists on the effectiveness of family therapeutic interventions for the prevention and treatment of perinatal depression?

Types of studies. Types of populations. Types of interventions. Types of providers. Types of comparators. Types of outcome measures. Data extraction The content expert extracted data that aligned with the PICO criteria [ 52 ], baseline and follow up sample sizes, means, standard deviations, confidence intervals, and standard errors by study group for the primary outcome measures for all of the included studies. Analysis Qualitative analysis of study quality Two evaluators first and second authors independently assessed the risk of bias for each included study using the Cochrane Collaboration's Tool for Assessing Risk of Bias, which measures six biases across seven domains: 1 Selection: random sequence generation and allocation concealment; 2 Performance: blinding of study participants and study personnel; 3 Detection: blinding of outcome assessment; 4 Attrition: incomplete outcome data; 5 Reporting: selective outcome reporting; and 6 Other: other sources of bias [ 53 ].

Quantitative data analysis Seven studies five prevention studies and two treatment studies were included in the qualitative analysis. Download: PPT. Managing missing quantitative data For the trials that did not adjust for clustering, the recommended intraclass correlation ICC of 0. Fig 2. Quantitative results for primary outcomes The overall findings for maternal depressive symptoms and family functioning, and the moderation analysis for maternal depression are presented in the following sections. Maternal depressive symptoms For the maternal depressive symptoms, the overall findings for the meta-analysis that included all seven studies are presented in Fig 3.

Fig 3. Summary of findings for maternal depressive symptoms at post-intervention. Family functioning This outcome was evaluated at the couple-level, rather than the individual-level. Fig 4. Summary of findings for family functioning at post-intervention. Discussion Summary of evidence The purpose of this systematic review and meta-analysis was to synthesize the available evidence on family therapeutic intervention impacts on reducing perinatal depressive symptoms and improving family functioning. Limitations There are some limitations in our study. Conclusions Given the deleterious effects of perinatal depression on the family system [ 7 , 9 , 12 ], more research is needed on family therapeutic interventions that aim to prevent or treat perinatal depression.

Supporting information. S1 Table. References 1. American College of Obstetricians and Gynecologists. Screening for perinatal depression. Committee opinion no. Obstet Gynecol. Estimated prevalence of antenatal depression in the US population. Arch Womens Ment Health. Trends in postpartum depressive symptoms— 27 States, , , View Article Google Scholar 4. World Health Organization. Maternal mental health. World Health Organization Depressed pregnant black women have a greater incidence of prematurity and low birthweight outcomes. Infant Behav Dev. Prenatal depression, prenatal anxiety, and spontaneous preterm birth: A prospective cohort study among women with early and regular care. Psychosom Med. Tronick E, Reck C. Infants of depressed mothers.

Harvard Rev Psychiatry. View Article Google Scholar 8. Limiting home visiting effects: maternal depression as a moderator of child maltreatment. View Article Google Scholar Dennis CL. Psychosocial interventions for the treatment of perinatal depression. Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Parent-infant psychotherapy for improving parental and infant mental health. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review.

Depress Anxiety. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. Prenatal depression effects and interventions: A review. Dennis CL, Ross L. Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms. J Adv Nurs. Obstetric risk factors for postnatal depression in urban and rural community samples. Aust N Z J Psychiatry. First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.

J Psychosom Obstet Gynaecol. Unintended pregnancy and depressive symptoms among first time mothers and fathers. Am J Orthopsychiatry. Feinberg ME. Parent Sci Pract. Factors associated with depression in pregnant immigrant women. Transcultural Psychiatry. Social support, life events and depression during pregnancy and the puerperium. Arch Gen Psychiatry. Morinaga K, Yamauchi T. Shinrigaku Kenkyu. Logsdon MC, Usui W. Psychosocial predictors of postpartum depression in diverse groups of women. West J Nurs Res. Evolution of postpartum mental health. Study for the factors related to postpartum depression.

Chinese J Obstet Gynecol. Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry. Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. Paediatr Child Health. Toward a theory of schizophrenia. Behavioral Sci. General system theory: Foundations, development, applications. New York: George Braziller. Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial.

Am Acad Child Adolesc Psychiatry. A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. J Clin Child Adolesc Psychol. Follow-up results of supportive versus behavioral therapy for illicit drug use. Behav Res Thera. The impact of partner support in the treatment of postpartum depression. Can J Psychiatry. A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Enhancing relationship functioning during the transition to parenthood: A cluster-randomised controlled trial. Gender informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: Cluster randomised controlled trial.

J Fam Psychol. Gambrel LE, Piercy F. Mindfulness-based relationship education for couples expecting their first child—Part 1: A randomized mixed-methods program evaluation. J Marital Fam Thera. Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: A randomized controlled trial in Spain and France. BMC Pregnancy Childbirth. Pinquart M, Teubert D. A meta-analytic study of couple interventions during the transition to parenthood.

Fam Relat. Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: A systematic review. J Affect Disord. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression.

Health Technol Assess. The effectiveness of mindfulness-based interventions in the perinatal period: A systematic review and meta-analysis. A review of partner-inclusive interventions for preventing postnatal depression and anxiety. Clin Psychologist. Claridge AM. Efficacy of systemically oriented psychotherapies in the treatment of perinatal depression: A meta-analysis. Preventing postpartum depression: Review and recommendations. Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses.

Clinical effectiveness of family therapeutic interventions embedded in general pediatric primary care settings for parental mental health: A systematic review and meta-analysis. Clin Child Fam Psychol Rev. Cochrane handbook for systematic reviews of interventions Version 5. The Cochrane Collaboration Available from www. PLoS Med ;6 6 :e GRADE guidelines: 2. Framing the question and deciding on important outcomes.

There is considerable literature on the decision-making process related to fertility, and various factors have been proposed as predictors of family planning decision-making. Additionally, previous studies have analyzed diverse factors that influence family planning decision-making within the family, such as power relations [ 3 ] and dominance of male partners [ 2 , 4 ]. Various studies in Turkey have found that many men are motivated to use family planning and would like to share responsibility for family planning decision-making to use or not use any family planning method [ 5 , 6 ]. We would like to emphasize that cultural values also play an important role in impacting the use of family planning.

Among these cultural factors, perhaps religious values top our list. Previous studies have also included ethnicity, male preference, traditional family values as well as the economic value of children as potential causal factors in determining family planning decisions. The present study aims at identifying significant contextual factors that are likely to influence use of family planning such as socio-cultural and religious norms. In the s, Turkey adopted a national family planning policy that advocated the use of both traditional and modern contraceptive methods i. Further, almost half of married women use a modern contraceptive method [ 8 ].

However, while the use of modern contraceptives increased steadily in the s and s, the prevalence rate has stagnated since the s. Further, a sizable proportion of women continue to rely on traditional methods of family planning, such as withdrawal [ 8 ]. The dominant almost exclusive religion in Turkey is Islam. The government, which has been in power since , actively promotes policies that encourage high fertility and discourage contraception and abortion.

The Turkish Ministry of Health is responsible for designing and implementing health policies and overseeing all private and public healthcare services in the country. Family planning and abortion services are provided both in public, and private sectors, and modern methods may be accessed for free in government-funded primary health care units and hospitals or from pharmacies and private practitioners for a fee [ 9 ].

In general, most women and couples obtain modern contraception from public sector sources, and pharmacies are the leading source of oral contraceptives and male condoms [ 8 ]. Women and men can also purchase emergency contraception, hormonal and copper IUDs, three-month contraceptive injections Depo-Provera , and one-month contraceptive injections Mesigyna from pharmacies. IUDs cannot be inserted at pharmacies but are taken to health facilities to be inserted.

Male condoms can also be purchased from markets and beauty shops. The Turkish national curriculum does not provide sex education and the subject is rarely discussed in schools [ 10 ]. Since there is no formal education on reproductive health, most people are informed about family planning though friends, relatives as well as printed or social media. Basic information, education, and communication materials about contraception are provided by health facilities. This study aims to delineate the factors that influence family planning decision-making processes from the perspectives of community stakeholders such as prayer group leaders, parent-teacher association members, and family planning service providers.

We attempt to understand and explain these factors within the context of social and political tensions in Turkey most important of which are ethnic and secular-religious cleavages. We used purposive sampling [ 11 , 12 ] to interview eight family planning service providers and eight community stakeholders in Bagcilar, Istanbul. Our sample includes fifteen females and one male participant. We determined the number of interviews based on the principles of theoretical saturation i. Bagcilar is one of the largest districts in Turkey with a population of , in [ 14 ].

We sampled key informants from different professional backgrounds, with different social status within their respective communities, and based on their role in influencing reproductive health. In-depth interviews were conducted between April and May We partnered with a local research firm that had extensive experience in conducting qualitative studies in the area. We identified service providers from public and private hospitals that offered family planning services in the study area, from a health facility assessment that we conducted less than six months prior.

To map the availability of and access to family planning and abortion services, we conducted a facility survey in public and private facilitates that provided reproductive health services in the study area. The facility survey captured data on service availability and facility readiness including staffing, hours of operation, and payment of user fees , services provided including counseling, physical examination and contraceptive, and abortion methods , and commodity supplies.

These were supplemented with in-depth interviews with key informants. The research firm used separate standardized scripts to recruit family planning providers and community stakeholders. The recruitment script included details about the study, its aim, and contact information for the principal investigators. The research firm scheduled a time for interview with providers and community stakeholders who were willing to participate in the study.

All respondents spoke Turkish and interviews were conducted by a trained Turkish female interviewer who was employed by the research firm. The interviewer had a university degree and was employed as a fieldwork director by the local research firm at the time of the interview. After a refresher training session about principles and techniques of qualitative research, ethics and confidentiality, and role-playing exercises with a supervisor, the interviewer piloted two different semi-structured interview guides see selected questions in Table 1 one interview with a family planning service provider and one interview with a community stakeholder.

The interview guides were developed for this study in English and translated into Turkish see Additional files 1 and 2. The service provider interview guide included several topics related to accessing family planning, factors influencing decision to use contraception, and barriers to and facilitators of family planning use in the community. The community stakeholder interviewer guide captured information on socio-cultural beliefs influencing community preferences and attitudes regarding family planning. Topics were related to the availability and accessibility of contraceptives, the demand for contraception and abortion services, the influence of attitudes and beliefs on contraception and abortion accessibility, decision-making, and behavior of women regarding gender norms and decision-making between couples.

The Turkish version of the interview guide was amended based on questions and feedback obtained during training and pilot test. All participants received written information about the study and provided oral consent to participate. We did not collect any identifying information from participants. Face-to-face interviews were conducted in a private space i. The interviewer took field notes during the interview. On average, interviews lasted approximately one hour. After interviews were completed, the research team transcribed each interview in Turkish and then translated it into English for coding and analysis.

Transcripts were double-coded by the research team to ensure accuracy. We did not share transcripts with participants. We further used an inductive, thematic analytical approach, guided by the principles of the constant comparative method to identify key themes arising from the data [ 12 ]. First, four researchers reviewed eight transcripts and developed an initial list of codes and general themes see Additional file 3. Next, four members of the study team read two transcripts aloud together and open-coded all text, in line with the principles of open coding and an inductive approach [ 12 ].

We reviewed all codes together more than codes , merging similar codes and grouping codes into themes and sub-themes. Next, once all major themes and sub-themes were agreed upon, we generated a final codebook, which included 51 sub-codes in six main coding groups, including demographics, family planning, abortion, socially-oriented perspectives, quality of services, and family planning programs. The study team double coded all transcripts. Two members of the study team were assigned to each interview in order to enhance the quality of the analysis. Several key themes emerged from the data related to family planning decision-making.

All themes were identified by two members of the study team. We decided to characterize emerging dominant themes related to most frequently discussed topics across all interviews. Background characteristics of participants are shown in Table 2. The service providers in our sample had been providing family planning services for between one and 22 years. We wanted to understand family planning decision-making process in relation to decisions about whether to avoid pregnancy or not. Three main themes identified by the study team emerged from the transcripts, including the decision-making process, the role of male partners, and the role of religious beliefs on reproductive health decisions, that provide insight into how women and couples decide to use contraception, how they learn about contraception, and the types of contraceptives women and couples prefer Table 3.

In general, we found that there was considerable demand for modern contraceptives among women. The majority of respondents mentioned the increasing awareness about modern contraceptive methods, most notably young women wishing to delay or space childbearing and women who wish to limit births once they achieve their ideal family size. Respondents differed in what they perceived as the most preferred contraceptive method for women. While they discussed a variety of modern contraceptive methods used by women in their communities, many agreed that traditional methods, such as withdrawal or periodic abstinence, were preferred. They frequently believed these traditional methods to be more effective than other modern methods, and also explained that women prefer these methods to avoid side effects and also for convenience in use.

A gynecologist who had been serving in this position for four months said:. If you leave it to the clients, they will still use the withdrawal method. It does not matter if they are educated or not. They say they have been using it for five years and nothing happened, so they continue [to use it]. Interviewee 15, Family planning provider. So the women make the decisions. Although most respondents agreed that women are more likely than men to be involved in the choice of a preferred contraceptive method, decision-making within a family is multi-layered.

Some respondents reported that mothers-in-law and fathers-in-law are also important actors who exert an influence on family planning matters. A physician who had been providing family planning services for approximately nine years explained:. I had a few clients whose mothers-in-law wanted their daughters-in-law to have more children. And this affects the spouses or the husbands and they think about having another child. As they live together, the mother-in-law or even the father-in-law influences [their decisions to have another child].

Interviewee 6, Family planning provider. All participants reported that modern contraceptive methods are widely available and easy to access from health care centers and pharmacies. The majority of respondents both providers and community stakeholders reported that women trust and respect family planning service providers. Nevertheless, with regard to obtaining information, women trust the contraceptive experience of other people like their friends and family members and therefore mostly rely on second hand information.

A community stakeholder commented:. First, they [women] talk among themselves. For example, she asks me how I manage birth control, how I prevent pregnancy. I say that I use the pill or injections or that my husband uses a method. She says that if it is good, she will do it too. Then she goes to the health center to ask the nurses…It is the culture of the women here, nothing else. It is better for them to hear it instead of searching and learning, I think.

Interviewee 1, Community stakeholder. A few participants discussed the influence that the characteristics of providers can have on decision-making. The narratives suggested that decision-making is influenced by accessibility and quality of services. One community stakeholder said:. Most participants did not report difficulties with accessing contraception for any particular group of women, and they agreed that unmarried women and adolescent girls can access modern contraception.

A few reported that modern contraceptive methods are available, but it is difficult for single women to obtain them, which is an indication of barriers to access among this sub-group of women. It is easily accessible, but the social pressure is serious. So, it is easily accessible, but it is hard to get. Interviewee 3, Community stakeholder. Our findings suggest that there is no single explanation for family planning decisions among women in the study setting.

Various factors influence family planning decisions, and factors such as the source of information, characteristics of service provider, and marital status play a role. Most respondents stated that demand for modern contraceptive services is stronger among women compared to men. The majority of respondents reported that men do not favor modern contraceptive use, but do not actively object to using them. Additionally, family planning service providers reported that men have very limited involvement with pregnancy planning and fertility decisions and that women often do not trust men to be involved in such decisions. Men are not trusted to be involved with family planning by women.

Men do not care about it much. But a lot of men use birth control too. When the women use IUD or the pill and experience side-effects, I think the men understand and they resort to methods such as withdrawal and condoms. Interviewee 10, Family planning provider. Participants reported that men are more likely to desire more children compared to women, but the burden of childrearing falls on women. A local midwife who had provided services for ten years in the community explained:. When [women] bear a child, most husbands do not help with childcare.

It is as if the child belongs only to the mother; supposedly, he is the father. So, women want birth control methods to avoid consecutive births. Interviewee 14, Family planning provider. A local pharmacist who has been in that position for 36 years also indicated that men desire to have more children than their wives. She said:. Participants reported few barriers to contraception, and the narratives suggest relatively few reasons for non-use. However, a frequent theme was the importance of religious beliefs on reproductive health decisions. A few participants reported that women believe that modern contraception, in general, or use of certain methods in particular, are sinful behavior.

A gynecologist who had been in that position for 20 years said:. What can you do with this person? Interviewee 9, Footnote 6 Family planning provider. Some spouses consider [birth control] to be a sin. We hear it from our friends … Interviewee 8, Community stakeholder. Actually, there is prejudice against most of the birth control methods in our society… Modern contraception is considered a sin.

They [referring to the people in the community] do not want birth control. Women do not want IUD. They use the withdrawal method. Interviewee 13, Family planning provider. A pharmacist described the effects of shared beliefs around contraceptive decision-making, thus:. One of my clients said that she would not use birth control pills because it was a sin. A couple of months later, she got pregnant and had to have an abortion. I asked her who had recommended it; it turned out to be someone I knew. She had to have an abortion. You are misinforming people and playing with their lives. A lifeless thing does not grow; it is alive since the first moment that sperm fertilizes the egg. Do not misinform people, please. The narratives suggest that there is contradiction between faith and behavior.

In particular, women think that contraception could be against the will of God, but act in accordance with the dictates of modern life. The findings from this study highlight the major factors that influence family planning decision-making. According to the Turkey Demographic and Health Survey, Our results are consistent with the existing literature which shows that contraceptive methods either modern or traditional method are widely known in the community. Thus, a key finding from the study is that women, and particularly married women, are aware of at least one method of contraception. Therefore, high levels of knowledge of contraceptives provide opportunities for programs to address barriers that could hinder translation of such knowledge into practice.

We found that, according to the perceptions of key informants, traditional methods were preferred over modern methods, and most respondents explained that women prefer traditional methods mostly due to the absence of side effects and ease of use. There is widespread perception that modern methods might have undesired side effects. According to Cebeci et al. The effect of religious beliefs on contraceptive choice may be the reason why couples continue to rely on traditional methods.

There is, however, a need for studies to better understand the motivations for preference for traditional methods in the study setting and how women could be supported to ensure that such methods meet their reproductive needs. These patterns underscore a need for a better understanding of intra-family relations and opportunities that such relations provide for supporting women in the study setting to realize their reproductive goals. Our findings show that although women trust family planning providers on contraceptive issues, they have more confidence in the previous family planning experiences of other people like their friends, neighbors, or relatives.

As Yee and Simon found, women identified their social networks as one of the most influential factors in the family planning decision-making process, especially about side-effects, safety, and effectiveness, and most of them considered that information more reliable than other sources of information [ 15 ]. Husbands, however, do not tend to share information about contraception with one another. Thus, husbands may look to their wives to receive accurate and reliable information about contraception [ 16 ].

Related to the accessibility and quality of services that influence decision-making, our findings show that women prefer female to male physicians and consultants in matters related to contraception. In addition, some of the community stakeholders reported prejudice in accessibility to contraceptive methods against unmarried women.

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