Background:

Women awareness and full knowledge about using contraception methods and their side effects given by health care providers are important for satisfaction and compliance. Dissatisfaction with contraceptive methods may lead to unplanned pregnancies.

Objectives:

To evaluate using contraception, and methods, satisfaction about current used contraceptive methods, women satisfaction with their knowledge about contraception's and feedback of women regarding suggestions to improve health care education for women using contraception.

Design:

Cross sectional population based survey study.

Settings:

Kingdom of Saudi Arabia.

Contraception provides control over pregnancy timing and prevention of unintended pregnancy.  As stated by the American College of Obstetricians and Gynecologists (ACOG), a reproductive life plan is "a set of personal goals regarding whether, when, and how to have children based on individual priorities, resources, and values. Contraception is a major component of preventive health care for women. There are indications that women are not satisfied with the methods of birth control currently available. Women awareness and full knowledge about using contraception methods and their side effects given by health care providers are important for satisfaction and compliance. Dissatisfaction with contraceptive methods may lead to unplanned pregnancies. Unintended pregnancies account for most of the 1.1 million abortions performed annually in the United States. Studies on contraceptive methods satisfaction both international and national either outdated or limited in participants numbers. In Germany 1999, a population-based survey of 1466 women regarding their satisfaction with birth control methods, concluded that oral contraceptive and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the public often believes.  In 2008, a Cross-sectional survey of women in Al-Qassem region (Saudi Arabia) about Awareness, Prevalence, and Determinants of Birth Control Methods Use among Women in Saudi Arabia, 287 woman were surveyed, the study showed there is deficiency in the awareness of contraceptive methods in Al- Qassim region, as well as the knowledge, attitude, and practice of family planning. Also another survey study about Contraception: attitudes and experiences of Saudi Arabian women, was conducted in Al-Dammam university 2008, were including 215 women, the study found that a majority of Saudi women are using contraception methods but without medical advice. In era of social media and patient easy access to internet and access to knowledge women, demand more information about contraception methods.In our study, we conducted a cross sectional population based survey study for all residents in Saudi Arabia to evaluate:

1. Using contraception, and methods
2. Satisfaction about current used contraceptive methods.
3. Feedback of women regarding suggestions to improve health care education for women using contraception.

Research Significance:

At present, there is no large scale national cross sectional study to evaluate contraception satisfaction for women in different demographic area in Saudi Arabia.

It will help us to:

understand women’s concerns about contraception methods 

understand their perception of adequate contraception education by health care provider

Study period and population:

The ethical board review approval obtained. We did a Cross-sectional online population based survey in Arabic language and randomly distributed by different social media applications. We include women (Saudi or non-Saudi) who are living in Saudi Arabia; the survey conducted from October until December 2017.

Exclusion criteria: Were those who had incomplete information and who has used contraception not for birth control.

The survey included information about age, major region of the kingdom, Education level, current work status, number of children, the outcome of last pregnancy (miscarriage, vaginal delivery, cesarean section, & how many previous cesarean sections), current method of contraception, satisfaction about current used contraception method, prescribing source, the suggestions that may improve their satisfaction about contraception.

2179 women completed the survey. A1740 women reported using contraception (79.85% of sample), while 438 women are not using any contraception (20.14%) (Figure 1)

Figure 1: Using contraception among women in Saudi Arabia

Most of contraception users were aged from 20-39 years (21.06%), and 14.22% were 40 years or above. A 17.54% of the women whose age between 20-39 years they are not using contraception, and 2.84% of non-user contraception in age 40years or above (Table 1). 

Table 1: The Age and Using contraception

A 66.64% of the participant they got bachelor degree, 52.92% of them they are using contraception, while 13.68% they are not 

(Figure 2) 

Figure 2: The level of education and using contraception.

The majority of the participant women are house wife, a 39.94% they are using contraception and a 9.60% they are not (Table 2). 

Table 2: the women job and using contraception.

We got response to answered our survey from all Saudi region, the most women surveyed are from the major regions (Riyadh, Madinah & Makkah) more than 50% they are using contraception (Table 3).

Table 3: using contraception in the different Saudi demographic regionsz                                         

 The most health care provide by private hospital around 58.15%, then ministry of health hospital and primary health care 21.20% (Table 4). 

Table 4: Antenatal care hospital and using contraception.

A 25.84% of participants have four children or more, a 22.63% they are using contraception (Table 5).

Table 5: Number of living children and using contraception.

 A 50.23% of the contraception users are post-vaginal delivery, while a 21.67% are post cesarean section (Table 6).

Table 6: using contraception and last pregnancy out come

We asked about the reason of not using contraception, 36% are not using because it may affect their future fertility, 18% their husband does not agree, 13% they are fearing of thrombosis and 11

The most of  the user contraception in productive age, those who are more than 40 years and are not satisfied at risk to get unplanned pregnancy with increased risk of advanced maternal age during pregnancy plus  the risk of trisomy fetus.The contraception using are more with women who have four children and more, those looks they complete their family and should be satisfied with using contraception with long acting to prevent future unplanned pregnancy.The private hospitals are the most health care provider for our surveyed women, then ministry of health came next.The previous cesarean section increased the risk to placenta previa in future pregnancy, and risk increased with repetitive cesarean scars, those women need long acting contraception with high level of satisfaction.We found the surveyed women are limited in type of using contraception in form of oral and cupper intrauterine device. Some of women prefer non-hormonal contraception like condom or withdrawal, but most of them are not satisfied becausethey have incomplete sexual intercourse and by the time they loss their interest and decreased libido. Almost 25% of contraception is non-prescription, it recommended by relative or friend or by women group in the social media without medical supervision. More than 50% of women, they need more time to discuss contraception with primary physician during hospital admission and clinic visit and educate them about proper using and possible side effect (Table 12)

Table 12: the method could increase satisfaction for using contraception

Results:

A 2179women completed the survey. A 1740 women reported using contraception (79.85% of sample), while 438 women are not using any contraception (20.14%). In total of 24.42% of contraception's are not prescribed by health care provider. Most of the user satisfied with combined oral contraception then cupper intra uterine device. 54.48% of surveyed women asked for enough time to discuss with physician about contraception.

Limitations:

No clear question for women satisfaction about contraception counseling by health care provider.

The women are Saudi Arabia needs more contraception counseling and education. It should include the husband during counseling and education regarding contraception. The health care providers should be well informed about updates in the medical practice and inform their patients accordingly regarding birth control methods. We suggest national program for women health care and family planning education