Original research articleEthnic Chinese women's perceptions about condoms, withdrawal and rhythm methods of birth control
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].
Section snippets
Methodological perspective
We used an open-ended interviewing approach in order to elicit the women's perspectives on their experiences in such a way as to allow us to derive implications to improve practice.
Sampling
Research participants were recruited from an abortion clinic with a high proportion of Chinese Canadians. The investigator (I.F.) approached every woman presenting to the abortion clinic during the study period who, by appearance or name, was thought to be of Chinese origin during the study period. Each woman had
Description
Fifty-nine women were eligible, 8 declined to be interviewed, 3 agreed but then withdrew and 8 agreed to be interviewed without being taped, so there were 40 taped interviews that were analyzed. The average age of study subjects was 25.4 years with a range from 17 to 39 years. Most of them were single, but 12 (30%) were married and 5 (12.5%) were living common-law. Only four (10%) had been born in Canada with most of the rest born in Hong Kong, China or Taiwan. Thirteen (32.5%) had lived in
Discussion
This group of women had quite different contraceptive experience than those in the Canadian Contraceptive Study (CCS) [4]. In the CCS, women were asked what contraceptives they had used in the previous 6 months while our patients were asked what they had used in the past (no time frame). In our study, 100% compared to 44% used condoms, 50% compared to 2% used rhythm, 43% compared to 9% used withdrawal. Only 35% had ever tried oral contraceptives, while 43% in the CCS had used them in the past 6
Summary
When counseling ethnic Chinese women about contraception, we need to focus on the reliability and safety of various methods and ensure that women understand how to use the rhythm method. It is important to discuss the communication needed between partners in order to use nonhormonal methods more successfully.
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Cited by (20)
Natural Family Planning: Physicians' Knowledge, Attitudes, and Practice
2010, Journal of Obstetrics and Gynaecology CanadaContraceptive failure related to estimated cycle day of conception relative to the start of the last bleeding episode
2009, ContraceptionCitation Excerpt :There are new hormonal contraceptives with 24 days of hormones and a 4-day break as well as a 3-month cycle [4,5] and a pill taken continuously with no break. The most common method of contraception in our abortion clinic patients is a mixture of calendar rhythm, withdrawal and condoms [6,7]. Since most women count the days after their periods as “safe”, early ovulation could cause contraceptive failure in these women as well.
Comparing continuation rates and side effects of hormonal contraceptives in East Asian and Caucasian women after abortion
2008, ContraceptionCitation Excerpt :About 40% of the patients at our clinics in Vancouver, Canada, are East Asian and our previous studies in this group have found that they perceive oral contraceptives to be dangerous and to have too many side effects [1–3].
Religious and Cultural Influences on Contraception
2008, Journal of Obstetrics and Gynaecology CanadaEthnic Korean women's perceptions about birth control
2006, Contraception
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Currently a Masters candidate at the University of Toronto, Toronto, Canada.