Herein, it was found that the withdrawal method is the most frequent way of contraception among the studied population regardless of socioeconomic status, age and education level. It is in line with this evidence that except of a few studies (6), withdrawal has been introduced as the most frequent traditional contraceptive method worldwide including Iranian population. Owing to the high rate of user error, it is considered as ineffective method associated with high rate of unwanted pregnancy (up to 27% in the first year) (7) (8). It was previously reported that easy to use, low expense and no need to medical care and advice are the most important factors behind selection of withdrawal as method of contraception (9). Given that last review on the role of education in selection of right contraception demonstrated positive effect, providing educational program by health care centers may decrease the frequency of traditional methods as well as withdrawal.
Economic factor including measurement of house, number of children and attitudes of women and their husbands were meaningfully associated with the choice of contraception. Frost JJ et al in the study on American population demonstrated that contraceptive choice was associated with socioeconomic factors which is in line with our finding regarding economic factors (10). Regarding number of offspring, Palamuleni ME et al. ,Kahraman K et al and Hossain MB et al have shown the same results as the present study among married women living in Malawi (South Africa), Turkey and Bangladesh, respectively (11–13). Women with higher number of children hopefully tend to have long lasting and more powerful method of contraception. Osmani Ak et al. have found that the contraception choice not only was associated with economic factor among Afghani women but also affected by the age range in order that the use of contraception was increased in higher ages (14). However, in the present study, it was shown that in spite of no meaningful association with age, using of contraception methods was lower among women less than 20 years old and higher than 40 years old. It is relying on the importance of education among lower aged women as the rate of induced criminal abortion has been reported to be higher in younger women considering their fertility potential (15).
Although it was not significantly associated with unwanted pregnancies and frequency of abortion, attitude of women and their husband beside economic status had shown meaningful effects on the type of contraception methods selected by women in the present study. It was notable that the attitude of husbands toward contraception methods especially among condom/spermicide and withdrawal users was meaningfully more than women. To the best of our knowledge, this is the first study which have investigated the role of both women and their husbands’ attitudes on contraception. Rahnama et al. have investigated the correlation between the attitudes of Iranian women who have selected the withdrawal on the contraception methods. They have shown that cheapness, easy to access and fewer drawbacks are the main reasons behind selecting of this method as contraception which is in line with our finding that being user-friendly and accessibility are the main factors affected the choice of contraception (9). Bani et al. have demonstrated that the attitude and awareness of Iranian men toward contraceptive methods had significant effect on the final choice which is consistent with our finding (16). However, Ehsanpour et al have shown that most of the their studied Iranian population had semi-desirable attitude toward withdrawal method which is in contradictory of our results (8). It is insisting on this fact that besides women, the Iranian men had critical need to be educated regarding the effectiveness of different contraception. Further studies, therefore, required to determine the attitudes of husbands toward contraception use following comprehensive education programs.