Objects of temporary contraception: an exploratory study of women's perspectives in Karachi, Pakistan

OBJECTIVES To explore perspectives of three modern contraceptive objects, using an emic approach, among women in a low-income community in Karachi, Pakistan. DESIGN A qualitative interview study design was employed, using qualitative content analysis with an inductive approach and manual thematic coding. SETTING Shah Faisal Colony, Karachi. PARTICIPANTS 20 women, potential contraceptive users of reproductive age and living within a health centre catchment, were purposively selected to provide a similar number of non-users (n=5), contraceptive injection users (n=7), pill users (n=4), and intrauterine device users (n=4). One interview was excluded because it was not recorded. No other exclusion criteria were used. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was interpretation of potency and effects of selected family planning objects. Secondary outcome measures were knowledge of family planning and description of therapeutic approaches used and preferred. RESULTS Awareness of family planning was high. Women described different therapeutic approaches, stating they generally preferred modern medicine for contraception as it was fastest and most powerful. They reported that fear of some contraceptive objects, particularly injections and intrauterine contraceptive devices, influenced their choices. Women explained their perceptions of how the heating effects of contraceptives could cause unwanted side effects including menstrual irregularities, weight gain and weakness, leading to disease. CONCLUSIONS Most women wanted family planning, but remained dissatisfied with the available contraceptives and their effects. While women reported that they relied on modern medicine for contraception, their descriptions of how contraceptives affected their health relied on the hot-cold explanatory idiom of traditional medicine.