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RUSIAN LAW JOURNAL Volume XI (2023) Issue 4
THEMATIC ANALYSIS OF LIVED PSYCHOSOCIAL EXPERIENCES WITH ORAL CONTRACEPTIVE USERS IN FAISALABAD (PAKISTAN)
1DR SHAMMEM AKHTAR, 2ALI AKBAR SULTAN, 3ROBIN GHOSH
1Assistant Professor Psychology Riphah International University Faisalabad
Phone # 00923027367921 Email: shammem.akhtar@gmail.com 2M. Phil. Scholar Riphah International University Faisalabad
3M. Phil. Scholar Riphah International University Faisalabad
ABSTRACT
Background; the Current study was conducted to assess the lived psychosocial experiences of women with using contraceptive. Contraceptive means adopting measure for birth control, although contraceptive implants are very effective in their functions but they have certain side effects. There are fears and side effects that bear some women from uptake and continued contraceptive use.1
METHOD; in depth twenty interview were conducted in Faisalabad at different places with females using contraceptives approved from government and private center by trained psychologist, interview recorded and transcribed, and thematic analysis carried out through initial Coding subthemes and main themes generated.
Results three major themes were identified, physiological issues, psychological issues and social issues.
Conclusion; it has been concluded that contraceptive although having useful effects yet they have
side effects also which disturbed female physical, psychological and as well as social life.
Key words: Contraceptives, implants, physiological issues, psychological issues and social issues
INTRODUCTION
Family planning is a fundamental right of every human being. It is an important that Pakistan is having very high Total Fertility Rate (TFR) and subsequently highest maternal (MMR) and infant mortality rate (IMR). Many of developing nations are fighting the battle against burden of increasing population among which, one is Pakistan, and is the sixth most populous country in the world, fourth in Asia and 2nd Muslim nation with a population 177 million.2
There is a wide range of contraceptives which used widely and some are traditional others are modern. Among modern, long term and safe contraceptives the sub-dermal birth control implant is one of them. Norplant was the first implantable contraceptive for women and is currently the most widely used. First tested in 1966, clinical studies have involved more than 55,000 women, and Norplant is registered in at least 60 countries.3
Contraceptives have many side effects which are the most commonly reported reason why females stop using the contraceptives. It has been reported in a cross-sectional survey of 6676 European females, participants identified side effects that's the most common reason for terminating the contraceptives. Women in that survey who reported past side effects were about twice as likely to have discontinued the oral contraceptive as women who reported not experiencing side effects. The value of this comparison is limited.4
However, by the cross-sectional and retrospective nature of the data collection study, In a prospective cohort study of 1657 U.S. women enrolled at family planning clinics and private practices, 37% of oral contraceptives users who discontinued cited side effects as the reason for discontinuation; however, this study had no information regarding the prevalence of side effects among the women who continued oral contraceptive use.5
In one research study comparison was done on four specific symptoms among women who discontinue the contraceptive during the first six months of use to those among women who continue the contraceptive and examine only symptoms that many clinicians and patients view as contraceptive side effects: weight change, headaches, mood changes, and sexual satisfaction. study clearly shows that women who report increased headache and moodiness during early months of contraceptives use are more likely to discontinue. Subjects who gained weight or reported a "bad" weight change were also more likely to discontinue the contraceptives by six months.6
METHODS
The aim of present study was to identify the side effects of contraceptive implant in women at different family planning centers. Thematic analysis technique of qualitative research methods approach was used and initially informed consent was taken for recording of interviews and in-depth interview were conducted from twenty women's who came in first six months of using contraceptives. Their body language, emotional state and pauses were also noted as field notes of clients. Duration of interview was one hour. Sami structured interview-based questions were asked from participants to take their in-depth experiences, feelings and attitude about contraceptive implant.
After interview taking thematic analysis process was started. Thematic analysis is very unique approach in qualitative research methods that used to systematically organize and analyses complex data sets. The goal of thematic analysis is to identify themes and patterns in the data and used these themes to address the issue7- More researchers explained that it involves the identification of themes through careful reading and re-reading of the transcribed data7. A rigorous thematic analysis approach can produce insightful and trustworthy findings 8 for thematic analysis technique following steps carried out for data analysis.
1. Familiarization with data
Authors' descriptions in papers convey the impression that transcribing is a straightforward technical task, summed up using terms such as 'verbatim transcription.9 However, representing audible talk as written words requires reduction, interpretation and representation to make the written text readable and meaningful.10 Literature unpicks some of the theoretical and practical decisions involved in transcribing for researchers for the qualitative data analysis.11 After conducting interview, transcribed and red by researcher again and again to make it specify and summarized.
2. Generating initial codes (Data reduction)
Generating Initial Codes in phase two was, to assign codes to the all data. A code is a brief description of what is being said in the interview; so, each time you note something interesting in your data, you write down a code. A code is a description, not an interpretation. After data reduction initial coding was done by the thoroughly reading of trained scripted data and initial codes related to research question were identified.12
Table 1 : Searching for themes from initial codes
Initial codes Sub Themes Main Themes
1. Hopelessness 2. Cry 3. Loneliness 4. Sleep disturbance 5. Aggression 6. Lack of energy 7. Lack of interest 8. Worry about contraceptives Depression Psychological Issues
1. Tingling sensations 2. Worry every time Anxiety Psychological Issues
3. Vertigo 4. restlessness
1. Heavy Bleedings 2. Mensural Irregularity 3. Weakness 4. Nausea 5. Shivering Menstrual symptoms P hysiological Issues
1. Eye pain 2. Headache 3. Hand numbness 4. Legs pain Body aches Physiological Issues
1. Disturb marital relations 2. Disturb relations with family 3. Disturb social relations 4. Lack of interest in social activities 5. Aggression on others 6. Irritable mood 7. Low response Lack of Social Contacts Social Issues
RESULTS
A rigorous thematic analysis approach can produce insightful and trustworthy findings 13 argued that thematic analysis is theoretically flexible for identifying, exploring and interpreting patterns (themes) within a data set in great detail lived psychosocial experiences of female using contraceptive were included in study aimed to explore the side effects that cause problems in their lives. Each participant in depth interview (conducted in native language of the participants) and recordings were comprehended in great detail through a thematic analysis approach. The focus of carrying out the detailed analysis was to explore Lived psychosocial experiences of female using contraceptive were included in study aimed to explore the side effects three superordinate themes arose from the data analysis: (1) physiological issues, (2) psychological issues and (3) social issues. 1. Theme one; psychological issues
In 1974, a longitudinal study of nearly 46,000 women, conducted by Kay et al. reported a 30% increase in depressive symptoms and decreased libido in women taking oral contraceptive pills (OCPs). Psychological symptoms improved after discontinuing OCPs in this sample.14 Contraceptive use were found high rate of physiological, psychological and social issues in female that strongly effects their wellbeing and disturb all Ares of life, in reference to side effects of contraceptive, is an important construct to explore because side effects of contraceptive demonstrates complex behaviors that require an individual's knowledge and motivation to initiate and maintain necessary measures for management of these effects. Under this theme sub-themes related to; psycho logical issues participants' views were discussed.
1.1 Sub themes one; Depression
Depression is most common psychological mental health issue that facing even normal population. In current study participants complain symptoms that were indicated of depression.15 Participants mentioned the following symptoms they are facing continuously and the most common psychological issue is depression that represent feelings of Hopelessness, Cry, Loneliness, Sleep disturbance, Aggression, Lack of energy, Lack of interest, and low mood.
" I feel very much aggression on children's and on my husband, I want to leave alone that no body talk to me, I feel lack of interest in any activity it's very difficult for me to concentrate on any task''(Almas)
In that way all clients gave the same comments regarding using of contraceptives from six months.
1.2 Sub themes two; Anxiety
Anxiety was another sub theme generated from the participants statements and views regarding using of contraceptives as, irritability, tingling sensations, worry all time, vertigo, restlessness and darken in front of eyes. As one client statement;
''I feel dizziness, darken in front of eyes and when anybody talk to me, I feel agitated, restlessness, and I feel that all things happening with me due to the injection''(Lubna)
2. Themes two; physiological issues
Almost all participants Contraceptive use were found high rate of physiological issues that cause disturbance in daily routine life. Under this theme sub-themes related to; physiological issues participants views were discussed.
2.1 Sub themes one; menstrual symptoms
Menstrual symptoms were common issues for them that contributing factors for all others as reported clients they facing heavy bleedings, menstrual irregularity, weakness, Nausea and shivering as participants described;
''When I implant injection in my hand, there has been started heavy bleeding, some time I feel just spot and finished and after some days bleeding again stated that's why I don't feel neat and clean ''(Lubna)
2.2 Sub themes two; body aches
Body aches were also found most of the big problems for participants they complain multiple body pains as, Eye pain, Headache, Hand numbness, swellings and legs pain. As reported a client
"My fingers swelled and numbed whole arm pain and I suffer body pains, my feet also swelled I felt so much pain that's why I take some pain killer to sleep" (Sajda)
3. Themes three; social issues
A social issue is a problem that influences a considerable number of individuals within a society. Social issues may be individual personal or due to the environmental changes but in current study we found some social issues that facing females who using contraceptives from long time as Disturb marital relations, disturb relations with family, disturb social relations, lack of interest in social activities, aggression on others, irritable mood and low response towards others people. 3.1 Sub theme one; lack of social contacts
Human being is social animal and cannot live alone without the help of a society, for this purpose he needs to keep and maintain social relations in healthy ways, so they can help him or her in socialization, in current study client reported multiple social issues that effecting her life. As reported one participant
''I never quarreled any one, I never spoke harsh for any one, now I am very emotional and one day I quarreled in my street, I feel very aggressive and feel agitated that's all due to that injection" (Sajida)
DISCUSSION
The association between contraceptive and psychological issues observes in women and the role of contraceptive utilization is obvious.16 The ability of women to control their sexuality and fertility through proper use of contraceptives is the cornerstone to ensure other aspects of women's rights and human rights.17 Females reported psychological disturbances as depression, anxiety, or thought disorganization even when providing a safe and effective means of contraception. In current study participants explains many symptoms that comes in psychological issues as depression, anxiety, depression that represent feelings of hopelessness, cry, loneliness, sleep disturbance, aggressions, lack of energy, lack of interest, low mood and anxiety represent feelings of apprehension, irritability, tingling sensations, worry all time, vertigo, restlessness and darken in front of eyes. The purpose of present study was to explore the lived psychosocial experience of contraceptive user females by using thematic analysis. A study was conducted in which it has been explored that Depression is associated with using contraceptive from long time and could not be managed without medication, that's more common burden in developing countries.18
In a study total of 1,061,997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31 -1.42).19 Common side effects were irregularity in showed some contraceptive side effects, most common side effect was menstrual cycle disturbance. Patient was very disturbed and had concerned about her physical health and missed her menstrual periods for one year ago.
A 2016 Danish study of more than one million women supports our clinical findings. The researchers found that, compared to non-users, women aged 15-34 who took the combined oral contraceptive pill were 1.23 times more likely to be diagnosed with depression and prescribed antidepressant medication.20
In general, contraceptive users reported slightly longer bleeding episodes after initiating the method, whereas women using the injectable or implant experienced a wide variety of menstrual changes. Over time, injectable users increasingly tended to miss menstrual periods, whereas implant users became less likely to do so. Physiological issues mostly participants reported Heavy Bleedings, Mensural Irregularity, Weakness, Nausea and Shivering, Eye pain, Headache, Hand numbness and Legs pain.21
From the above data reveals some sorts of common physical side effects weight gain, eye sight problem, eye muscles pain, dizziness, numbness, acne problem and also body pain. For the shot, weight gain was also the most common side effect mentioned, followed by headaches and irregular periods. The side effects ranged from isolated, relatively minor reactions to severe and multiple health problems.22
A social issue is another problem that influences a considerable number of individuals within a society. Social issues may be individual personal or due to the environmental changes but in current study we found some social issues that facing females who using contraceptives from long time as Disturb marital relations, Disturb relations with family, Disturb social relations, Lack of interest in social activities, Aggression on others, Irritable mood and low response towards others people yet there has been not found literature that support our findings regarding social issues.23
CONCLUSION
As the use of contraceptive are very important for whole family and they provide benefits for family planning but, they have some side effects on women physical health like weight gain, eye sight problem, dizziness, numbness, and also body pains in the same way psychological and social issues were also identified as depression and anxiety. Limitation and suggestion
Women with contraceptive user, for more authenticity of result non user female should be studied to make comparison. More qualitative and mixed methods techniques may be used for more findings.
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