Attitude towards Contraceptives Use among Saudi Women

Abstract

Studies conducted in Saudi Arabia showed low levels of use of contraceptives. Low use of contraceptives among Saudi women might be due to religious issues. Aim of the study was to assess attitudes towards contraceptives use among Saudi women. Study design was descriptive cross sectional of ever married Saudi females living in Riyadh city. Study procedure was through self administered questionnaire uploaded via Google drive and was distributed via twitter and Facebook. Sample size was 305 ever married females (who responded to the online questionnaire). It was found that 86.6% of women have ever used contraception, and the most commonly used method were contraceptive pills (64.9%). Attitude of females towards contraception was affected by their working status. Also, husband approval was a significant factor improving female attitude towards contraceptives. It is worth mentioning that living in extended family, having chronic disease or education of either the women or her husband had no effect on women's attitude towards contraceptives. It is recommended to conduct health education programs regarding contraceptives; their side effects and safety in all primary care clinics in Saudi Arabia. Sustained efforts should be done to increase awareness and motivation for proper contraceptive use. Men should not be ignored in receiving education on birth control methods. Initiation of specialized family planning clinics that offers better counseling might raise the rate of contraceptive use based on good decision making and choice of suitable method.

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Attitude towards Contraceptives Use among
Saudi Women
1Samira M. Mahboub, 2Sabah M. Abdelkader
3Ahad Al-Muhanna, 4Fatima Al-Musallam, 5Jenan Al-Ghannam, 6Sitah Al-Munyif
1Lecturer of Tropical Health, High Institute of Public Health, Alexandria University, Egypt.
2,3,4,5,6 Assistant professor of Public Health, Community Health Sciences Department,
College of Applied medical sciences, King Saud University, Riyadh , Kingdom of Saudi Arabia
Abstract: Studies conducted in Saudi Arabia showed low levels of use of contraceptives. Low use of contraceptives
among Saudi women might be due to religious issues. Aim of the study was to assess attitudes towards
contraceptives use among Saudi women. Study design was descriptive cross sectional of ever married Saudi
females living in Riyadh city. Study procedure was through self administered questionnaire uploaded via Google
drive and was distributed via twitter and Facebook. Sample size was 305 ever married females (who responded to
the online questionnaire). It was found that 86.6% of women have ever used contraception, and the most
commonly used method were contraceptive pills (64.9%). Attitude of females towards contraception was affected
by their working status. Also, husband approval was a significant factor improving female attitude towards
contraceptives. It is worth mentioning that living in extended family, having chronic disease or education of either
the women or her husband had no effect on women’s attitude towards contraceptives. It is recommended to
conduct health education programs regarding contraceptives; their side effects and safety in all primary care
clinics in Saudi Arabia. Sustained efforts should be done to increase awareness and motivation for proper
contraceptive use. Men should not be ignored in receiving education on birth control methods. Initiation of
specialized family planning clinics that offers better counseling might raise the rate of contraceptive use based on
good decision making and choice of suitable method.
Keywords: Contraceptives Use, Saudi women.
I. INTRODUCTION
The World Health Organization (WHO) considers the prevalence of contraceptive use among a society as one of the
determinants of women’s health and empowerment in that society. Some societies, however, use contraceptives to
regulate pregnancies and in birth spacing. (1)
Many countries have budgets with millions of dollars in funding to support birth control related programs, including
family planning, distribution of condoms or various female contraceptives (in countries that support the use of
contraceptives), and the wide spread education in countries on the different methods of birth control. (2)
As for the use of contraceptives among Saudi females, it was found to be unrelated to fertility. This is probably because of
the low use of contraceptives and the tendency to use them for child spacing rather than limiting fertility, especially after
having a certain number of children.( 3)
Al-Ateeg. F Et al conducted a research about Natural Family Planning. The article focuses on the role of natural family
planning (NFP) as a component of reproductive health. It distinguishes NFP from the concept of fertility awareness
method. Educations on various methods of birth control, as well as the distribution of contraceptives are a major concern
for the international community. Research showed that many people in developing countries continue to have fears and
misconceptions on modern contraceptives. Religious issues may also play a large role in determining how couples view
such issues as contraception. Certain religions do not permit the use of contraception and children from religious families
may not even know the essentials on birth control methods. (2)

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Studies conducted in Saudi Arabia showed low levels of use of contraceptives with only (27%) of women in Abha and
(44%) of women in Qassim region. The national data of the Kingdom shows (31.8%) contraceptive use rate in 1996. This
percentage has fallen down in 2007 to be (23.8%) (1). In contrast, a study that was conducted in Al-Khobar showed high
use of contraceptives among the Saudi Arabian females with (74.8%). (4) In another study in Taif those who never used
any contraceptives represented about (34.1%) of the sample. While the national data shows contraceptive prevalence to be
only (31.8%) in 1996. This percentage has fallen down in 2007 to be (23.8%). (1)
According to the previous statistics, we might be able to say that low use of contraceptives among Saudi Arabian women
might be one of the factors that positively affect fertility in the country. Low use of contraceptives among Saudi women
might be affected by their faith of Islam, although no study proved that. (5)
In a study about the attitude of using contraceptive among Saudi women in AlKhobar conducted by Al-Turki, A, the study
showed that a woman’s decision whether to use contraceptives or not is affected by multiple factors including: education,
age of the woman, living in rural or urban area, health concerns, religious concerns and the desire to have large families.
(4) These factors can be generalized among the whole Kingdom, since another study conducted by Farheen, in 2013 in
Abha stated that women show a desire to have large families. (1)
Aim of the study: Assessment of attitudes towards contraceptives use among Saudi women.
Objectives:
1. Assessment of attitudes of Saudi females towards contraceptive use.
2. Studying factors affecting their attitudes towards contraceptive use.
II. METHODOLOGY
Study design: Descriptive cross sectional.
Study population: Ever married Saudi females living in Riyadh city.
Study procedure: Self administered questionnaire. The questionnaire was uploaded via Google drive and was distributed
via twitter and facebook.
Sample size: 305 ever married females (who responded to the online questionnaire).
Statistical analysis :
Data collected were coded, tabulated and analyzed using the statistical package of social science (SPSS) version 16.0. The
applied tests were chi-square, t test and ANOVA and 0.05 levels were used as a cutoff point of significance. Multiple
associations were evaluated in a multiple linear regression model based on forward stepwise selection. This procedure
allowed the estimation of the strength of the association between each independent variable and the dependent variable
taking into account the potential confounding effects of the other independent variables .
III. RESULTS
Table (1): Demographic characteristics of studied sample
No.
%
Age:
- 17-25 years old
- 26-35 years old
- 36-50 years old
- Above 50 years old
64
124
100
15
21.1
40.9
33.0
5.0
Educational level:
- Intermediate and below
- High school
- Bachelor and above
14
52
236
4.6
17.2
78.1
Marital status:
- Married
288
94.4

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- Divorced
- widowed
11
6
3.6
2.0
Occupational status:
- Working
- Not working
159
146
52.1
47.9
Family Income:
- Less than 3000
- 3000-7000
- 8000-13000
- More than 13000
12
50
108
134
3.9
16.4
35.5
44.1
Residence Location:
- Middle
- North
- South
- East
- West
23
118
31
84
49
7.5
38.7
10.2
27.5
16.1
Family Type:
- Extended
- Nuclear
103
200
33.9
65.8
Table (1) demonstrates socio-demographic characteristics of study participants, most of them aged 26-35 (40.9%) and the
lowest percentage were above 50 years old (5%). As regard the levels of education, the majority of participants had
bachelor degree or higher (78.1%) and only (4.6%) had Intermediate school education or less. The majority of the sample
were married (94.4%). More than half were working (52.1%) and only 3.9% of participants had income less than 3000
riyals/month, while 44.1% had income higher than 13000 riyals/month. As for residence, (38.7%) of the participants are
living in North of Riyadh City, and only (7.5%) are in Middle of Riyadh. Two-thirds of the sample were living in nuclear
family (65.8%) and the other one third were within extended families (33.9%).
Table (2): Frequency and pattern of contraceptive use
%
No. (305)
Variable
87.1
12.9
264
39
Yes
No
Ever use of contraception
2.9
47.1
32.4
17.6
1
16
11
6
Religious concerns
Medical Reasons
Husband's Approval
Other
Cause of not using
contraception
78.3
20.2
0.4
1.2
5.6
198
51
1
3
17
Pills
IUD
Injection
Vaginal ring
Others
Type of contraceptive
47.8
20.4
10.2
21.6
117
50
25
53
Less than 12 months
13-24 months
25-36 months
More than 36 months
Duration of use

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26.7
73.3
80
220
Yes
No
Fixed space between
children
32.5
54.5
12.9
25
42
10
Less than 2 years
2-4 years
more than 4 years
Length of space
70.4
29.6
197
83
Yes
No
Did you use contraception
by prescription
97.4
2.6
266
7
Yes
No
Does your husband know
94.9
5.1
262
14
Yes
No
Does your husband approve
Frequency and pattern of contraceptive use were demonstrated in table (2), it shows that 87.1% of the samples have used
contraception, and 50% of those who did not use it reported the cause to be medical reasons. The preferable type of
contraception was pills (78.3%) then IUD (20.2%), and injection was least preferable (0.4%). The duration of
contraception use was mostly less than 12 months (47.8%), with only (21.6%) used it for more than 36 months.
73.3% of the Participant didn't have a fixed space between their children and among those who have fixed space between
children, about 55% preferred 2-4 years in-between. About two third of women used contraception had it by doctors
prescription.
Regarding husband approval of contraceptive use, 5% did not approve use of contraception. It was also found that about
3% of participants using contraception did not tell their husbands about their use.
Use of different types of contraception according to age was illustrated in figure (1) that revealed that young females
preferred use of vaginal rings and old ones preferred either IUD or pills.
Figure (1): Use of contraceptives according to age
0
5
10
15
20
25
30
35
40
Pills IUD Injections vaginal
rings
Mean
age

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Figure (2): Attitude of studied sample towards contraception
Table (3) demonstrates attitude of the studied sample towards contraception. Only one fifth of them had a positive
attitude and figure (2) demonstrates their attitude in details, more than half of them agreed that contraceptives have health
risks and about 60% thinks that contraceptives can affect their fertility.
Table (3): Attitude of studied sample towards contraception
0
10
20
30
40
50
60
70
80
90
100
do you think
that
contraceptives
can affect
fertility
do you think
that the benfite
of using
contraceptives
overcome their
harms
when you get
adviced to use
it,will you use it
without
prescribtion
do you advise
your freinds to
use
contraceptives
do you think
there is a risk of
using
contraception
Disagree
Neutral
Agree
Frequency
Percent
Attitude
Negative
28
9.2
Neutral
211
69.4
Positive
65
21.4
Total
304
100.0

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Table (4): Factors that affect attitude towards contraceptive use
Table (4) demonstrates that attitude of females towards contraception was affected by their working status, it was better
among housewives (p=0.042). Also, husband approval was a significant factor improving female attitude towards
contraceptives (p=0.024). It is worth mentioning that living in extended family, having chronic disease or education of
either the women or her husband had no effect on women’s attitude towards contraceptives.
Attitude
Chronic diseases
- Yes
- No
1.82 ± 0.48
1.84 ± 0.41
ANOVA
.655
Family type
- Extended
- Nuclear
1.86 ± 0.42
1.83 ± 0.43
ANOVA
.802
Income
- Less than 3000
- 3000-7000
- 8000-12000
- 13000 or more
1.63 ± 0.50
1.94 ± 0.42
1.82 ± 0.40
1.85 ± 0.43
ANOVA
.146
Work
- Yes
- No
1.79 ± 0.46
1.89 ± 0.38
ANOVA
.042 **
Participant education
- Intermediate or less
- High school
- Bachelor and above
1.76 ± 0.43
1.90 ± 0.40
1.84 ± 0.42
ANOVA
.508
Husband education
- Intermediate or less
- High school
- Bachelor and above
1.77 ± 0.44
1.78 ± 0.41
1.86 ± 0.43
ANOVA
.339
Age
- 17-25 y.o.
- 26-35 y.o.
- 36-50 y.o.
- 50 years and above
1.84 ± 0.44
1.87 ± 0.39
1.82 ± 0.43
1.73 ± 0.59
ANOVA
.559
Husband’s approval
- Yes
- No
1.89 ± 0.38
1.64 ± 0.63
ANOVA
.024 **

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Table (5): Time interval between stopping different types of contraception and getting pregnant again
N
Mean
(in month)
Std. Deviation
Sig
pills
159
7.2642
13.19448
p>0.05
IUD
37
5.5676
5.71324
virginal ring
3
1.6667
1.52753
On studying the time interval between stopping of contraception and getting pregnant again it was less than 12 months
among 90.2% of females, and those who took more than 36 months were only 1.7%. Analyzing these findings according
to type of contraception in table (5), it was found that the longest mean time was for pills (7.3 months) followed by IUD
(5.6 months) and the least was for vaginal rings (1.7 months).
IV. DISCUSSION
Given the large numbers of contraceptive users, reports in public and scientific media of life and health threatening effects
of pharmacological or mechanical contraceptives have the potential to alarm many people. Concern on possible side
effects of pharmacological contraceptives is the most common reason given for not using a method by women who are at
risk of unintended pregnancy. The majority of contraceptive methods available must be practiced by women. (2) About
two thirds of women in the current study used contraception provided by doctor's prescription. The study in Abha 2013
showed that women with obstetric/medical history preferred pills. The study recomended that different methods of
contraception and their benefits on both mother and children must be emphasized. (1)
The current study shows that the preferable type of contraception was pills (78.3%) then IUD (20.2%), and injection was
least preferable (0.4%). In a study conducted among Jordanian women in 2001 revealed that 43% of Jordanian women
were using Intra Uterine Device (IUD), and 12% were using pills in 1997. (10=6) A similar study in Egypt in 2012 showed
that IUD and pills were common among urban women. A study in Abha in 2013 showed that 62.9% of women used pills
and 37.1% used Intra Uterine Device (IUD). (1) Another study in Al-Khobar said that 36.6% of women preferred pills and
19.9% used IUD. The other 43.5% used other methods including condoms, calendar, external ejaculation and breast
feeding. (4)
Use of different types of contraception according to age in the current study revealed that young females preferred use of
vaginal rings and old ones preferred either IUD or pills. In a study conducted among Jordanian women in 2001 revealed
that the percentage of use was increasing with increasing age in women aged less than 40 years. (6)
The current study illustrates that attitude of females towards contraception was affected by their working status, it was
better among housewives. The study in Abha, showed that women who preferred IUD were mostly working women. As
for women with obstetric/medical history preferred pills. The study concluded that different methods of contraception and
their benefits on both mother and children must be emphasized. (1) Alsheeha. M conducted a research in 2010, there was a
significant increase in contraceptives use among workingwomen, 30 years and older, with a higher level of education, and
those having large number of children. Multiple regression models revealed that the significant determinants of the use of
contraceptives were women’s working and education.(7)
Alsheeha. M in 2010 about the awareness and use of contraceptives among Saudi women. The overall rapid change in the
socio-demographic pattern of the Saudi Arabian community, especially the change concerned with women’s education
and work will be an important factor in changing fertility beliefs and behaviors with more tendencies to birth spacing and,
consequently the use of contraceptives. The study aimed to identify the perception of Saudi women regarding the use of
contraceptives. A cross-sectional study was conducted among Saudi women attending primary care centers of Al-Qassim
region. A structured questionnaire was developed to cover the research objectives. The dependent variable was the
utilization of contraceptives methods and the socioeconomic variables were independent variables. The results identified

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the low knowledge level of the participant women regarding the variety of the contraceptives methods. They intended to
have from 5 to 10 children. (7)
Religious issues may also play a large role in determining how couples view such issues as contraception. Certain
religions do not permit the use of contraception and children from religious families may not even know the essentials on
birth control methods. (2)
On studying the time interval between stopping of contraception and getting pregnant again it was less than 12 months
among 90.2% of females, and those who took more than 36 months were only 1.7%. Analyzing these findings according
to type of contraception, it was found that the longest mean time was for pills (7.3 months) followed by IUD (5.6 months)
and the least was for vaginal rings (1.7 months). 73.3% of the Participant didn't have a fixed space between their children
and among those who have fixed space between children, about 55% preferred 2-4 years in-between. The duration of
contraception use was mostly less than 12 months (47.8%), with only (21.6%) used it for more than 36 months. Alsheeha.
M in 2010 about the awareness and use of contraceptives among Saudi women found that most participants and their
husbands showed acceptance to the use of contraceptives for birth spacing. They preferred birth interval of 2-3 years. (7)
Khraif (2001) found that use of contraceptive was not wide spread in Saudi Arabia and its use was mainly for spacing
rather than desire to limit family size. (3)
Regarding husband approval of contraceptive use, 5% did not approve use of contraception. It was also found that about
3% of participants using contraception did not tell their husbands about their use. Husband approval was a significant
factor improving female attitude towards contraceptives. Statistics have shown that men are often less willing to wear a
condom than females are to take the pill. Therefore, women often make the decisions on which contraceptive methods to
use. (2)
The current study showed that living in extended family, having chronic disease or education of either the women or her
husband had no effect on women’s attitude towards contraceptives. However, 50% of those who did not use it reported
the cause to be medical reasons. Al Ateeg et al mentioned that women in Malaysian study reported fear of side effects
which was the most important reason for not using contraceptives. A study in Turkey found that many women believed
that intrauterine devices (IUDs) involved a procedure to “tie up” fallopian tubes, a belief which could be affecting IUD
acceptance in Turkey. Another study found that Chinese couples believed that male sterilizations were less effective than
female sterilization and that male sterilization has negative effects on physical activity. (2)
The current study shows no association between type of contraception used with time to get pregnant. So we might say
contraception method has no effect on fertility. Al-Riyami, A et al conducted a study in 2003 about the determinants of
women’s fertility in Oman to study the association of women education, and empowerment with some of the fertility
determinants in a community based survey. Results say that about 31% of the sample was considered highly empowered
in decision-making. Women of higher score of decision-making index were more likely to have longer closed birth
interval. Those scored low in the decision-making index were more likely to get a child at an earlier age. (8)
V. CONCLUSION
It was found that 86.6% of women have ever used contraception, and the most commonly used method were contraceptive
pills (64.9%).
Attitude of females towards contraception was affected by their working status. Also, husband approval was a significant
factor improving female attitude towards contraceptives. It is worth mentioning that living in extended family, having
chronic disease or education of either the women or her husband had no effect on women’s attitude towards
contraceptives.
VI. RECOMMENDATIONS
 It could be helpful to conduct health education programs regarding contraceptives; their side effects and safety in all
primary care clinics in Saudi Arabia .
 Sustained efforts to increase awareness and motivation for proper contraceptive use.
 Men should not be ignored in receiving education on birth control methods.
 Initiation of specialized family planning clinics that offers better counseling might raise the rate of contraceptive use
based on good decision making and choice of suitable method.

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