Ethnic Chinese women's perceptions about condoms, withdrawal and rhythm methods of birth control

Abstract

Objective

To gain a better understanding of ethnic Chinese women's perceptions and experiences of using barrier and rhythm methods of contraception in order to improve contraceptive counseling at abortion clinics.

Design

Qualitative descriptive study.

Setting

Urban abortion clinic.

Participants

Forty ethnic Chinese women presenting for abortion.

Method

Data were collected in semi-structured interviews by one interviewer who is fluent in English, Mandarin and Cantonese. Transcribed interviews were systematically analyzed to identify salient themes.

Main findings

All of the women interviewed had used condoms (none with spermicide), 20 had used rhythm and 17 withdrawal, usually a combination of two or three of these methods. Many women noted that these methods are under male control and talked about the difficulty negotiating their use with partners. The majority of women using rhythm were unable to correctly identify “safe periods.”

Introduction

A previous study in Vancouver reporting on the barriers to use of oral contraception in ethnic Chinese women found that they prefer to use a combination of condoms, withdrawal and rhythm as their methods of contraception [1]. It has been common practice for doctors and other healthcare workers to tell patients that those methods are not useful and to try to persuade them to use hormonal methods or IUDs. It is important that healthcare workers counseling women about contraception understand more about how these methods are used and how women feel about them. Currently, about 10% of people in Vancouver speak Chinese at home [2]. In our clinic, about 25% are ethnic Chinese. We undertook this study to understand these women's experiences with contraception as a prelude to understanding how best to offer them information and advice about contraception after abortions.

The 1998 Canadian Contraception Study surveyed 1599 women and found that in the previous 6 months, 44% had used condoms, 43% oral contraceptives, 9% withdrawal and 2% rhythm [3]. Data from the 1995 National Survey of Family Growth were used to compute actual contraceptive failure rates and found that within 1 year of starting to use a reversible method of contraception, 9% of women experience contraceptive failure; 8% of those using the pill, 14% using the male condom, 21% using periodic abstinence and 24% using withdrawal [4], [5]. These rates are much higher than those quoted in clinical trials sponsored by pharmaceutical companies and reflect the imperfect use of these methods. There was a discontinuation rate of 44% within 12 months. An interview study of 6630 European women indicated that periodic abstinence and withdrawal were more common in older women and those from Southern Europe. For example, 33.4% of the women from Southern Italy reported using withdrawal compared to 10.2% of the women from Northern Italy [6]. A study of US high school students showed that 13% used withdrawal as their method of contraception for the last episode of intercourse [7]. A study of 1338 Israeli women showed that for older women and those in more traditional marriages, withdrawal was more likely to be used than in less traditional marriages [8]. A study of 2031 women in the United Kingdom and Germany showed that a general dislike of medical methods was related to greater reliance on condoms, withdrawal and rhythm [9]. There was no study found on attitudes and use of these methods in ethnic Chinese.

We have limited understandings of the reasons behind the choices individuals in this population of women make about contraception or indeed how they are able to implement the choices once chosen. In order to be most helpful to women, we need to understand this issue from their perspective. Qualitative research designs are most appropriate when the perception of the participants is the focus of the research. In this case, the insights of the women themselves was the focus of our study, therefore, we chose a qualitative methodological approach [10], [11], [12], [13].