**2. Family planning**

Family planning is defined as having the freedom and responsibility of all the couples and the individuals to decide the number of children they desire and having the knowledge, education and tools for this purpose. In other words, family planning is a preventive service that allows married couples achieving their desired number of children and deciding the spacing of pregnancies according to their economic opportunities and personal wishes, and to ensure that the births are at appropriate intervals for the mother and child health.

Family planning does not mean limiting the number of people in a family. The goal of family planning is preventing pregnancy-related health risks in women and reducing the need for unsafe abortion and infant mortality (see **Table 1**). Maternal health, risk of pregnancy and even maternal death significantly increase when births made at intervals of less than 2 years. In addition, babies born at frequent intervals are not fully developed (babies with low birth weight), disability rate increases, care becomes difficult and infant mortality increases in the mother's womb.

Family planning can result in higher levels of education, better employment opportunities, higher socioeconomic status and empowerment. Another aim of family planning services is to prevent unwanted pregnancies and related maternal and infant mortalities, to provide help and counseling to every family whenever they want and to have as many children as they want. Family planning services improve the abilities of family members in decision-making and recognize the freedom to make free decision about having a child. Family planning services have an important role within the scope of "Primary Health Care", which must be presented to the public [9–11].

In studies on family planning in the world, differentiation in attitudes, behaviors and the use of contraceptive methods largely lead to change in fertility [4]. Biological, psychosocial,


47,000 maternal deaths in the short or long term, mostly in developing countries [3]. It is estimated that up to one-third of maternal deaths can be prevented by using contraception in

Across the world, it is estimated that 222 million women have unmet need for family planning [5]. This unmet need prevalent in particular populations, especially those who are sexually active, those with low socioeconomic status, those living in rural communities and those

Increasing usage of contraceptives in some developing countries has reduced the annual number of maternal deaths by 40% in the last 20 years and has reduced the maternal mortality rate (the number of maternal deaths in 100,000 live births) by 26% in recent years. If the need for uncontrolled birth is met, it is estimated that maternal mortality still occurring in these countries can be avoided by more than 30% [7]. The 'Family Planning 2020' initiative was started at the London Family Planning Summit in July 2012. The main objective of this initiative is to provide contraceptive information, services and supplies for 120 million women and girls until 2020 [8].

Family planning is defined as having the freedom and responsibility of all the couples and the individuals to decide the number of children they desire and having the knowledge, education and tools for this purpose. In other words, family planning is a preventive service that allows married couples achieving their desired number of children and deciding the spacing of pregnancies according to their economic opportunities and personal wishes, and to ensure

Family planning does not mean limiting the number of people in a family. The goal of family planning is preventing pregnancy-related health risks in women and reducing the need for unsafe abortion and infant mortality (see **Table 1**). Maternal health, risk of pregnancy and even maternal death significantly increase when births made at intervals of less than 2 years. In addition, babies born at frequent intervals are not fully developed (babies with low birth weight), disability rate increases, care becomes difficult and infant mortality increases in the

Family planning can result in higher levels of education, better employment opportunities, higher socioeconomic status and empowerment. Another aim of family planning services is to prevent unwanted pregnancies and related maternal and infant mortalities, to provide help and counseling to every family whenever they want and to have as many children as they want. Family planning services improve the abilities of family members in decision-making and recognize the freedom to make free decision about having a child. Family planning services have an important role within the scope of "Primary Health Care", which must be pre-

In studies on family planning in the world, differentiation in attitudes, behaviors and the use of contraceptive methods largely lead to change in fertility [4]. Biological, psychosocial,

that the births are at appropriate intervals for the mother and child health.

women who are seeking to postpone or delay postpartum [4].

coping with conflicts and disasters [6].

**2. Family planning**

34 Family Planning

mother's womb.

sented to the public [9–11].


**Table 1.** The purposes of family planning.

cultural factors determining fertility and factors affecting choice and use with birth control instrument are evaluated together in the regulation of fertility [12].

#### **3. Unmet need for family planning**

Unmet need for family planning is a concept that has come to the agenda in recent years. Unmet need for family planning refers to women who have the ability to give birth before they have another child (want to increase the interval of births) or who do not want to have any other children (want to terminate their fertility) but do not use any contraceptive methods.

In developing countries, there is a significant gap between women's reproductive preferences and the use of contraception. This inconsistency is called an 'unmet need' for family planning [13]. At least 1 in 10 married or in-union women in most regions of the world has an unmet need for family planning. Worldwide, approximately 12% of married or in-union women are estimated to have an unmet need for family planning; that is, they wanted to stop or delay childbearing but were not using any method of contraception.

In general, unmet need is high where contraceptive prevalence is low. The lowest level of contraceptive prevalence in Asia were in Afghanistan and Timor-Leste at 29%. In 59 countries, at least 1 in 5 women on average had an unmet need for family planning in 2015, and 34 of these 59 countries are in Eastern Africa, Middle Africa or Western Africa [14]. In Turkey, the unmet family planning requirement is 6% [15].

Unmet need for contraception and unwanted pregnancy is a major public health problem in most countries. However, the relationship between unmet need for contraception and unwanted pregnancy has not been studied adequately. Bishwajit et al. investigated that the prevalence of unmet need was 13.5%, and about 30% of these women expressed their unwanted birth of their last pregnancy in Bangladesh [16].

An important way to remove unmet needs for family planning is to increase the diversity of contraceptive methods. Individual choosing the contraceptive methods may change depending on their individual needs and family character differences [17]. Also, women refusing to use contraceptives and without desire to prevent pregnancy are responsible for about 38% of women with unmet needs.

The basis of most attitudes depends on childhood and is generally acquired through direct experience, reinforcement, imitation and social learning. The most important feature is that once they have developed, they are very resistant to change [29]. Studies conducted in different countries have found that most women know the methods of family planning but have a lack of practice. This is due to the fact that individuals are in a negative and prejudiced attitude toward modern methods. It is known that positive or negative attitude affects the use of family planning method. It is considered important to examine the current attitudes and

Factors Affecting the Attitudes of Women toward Family Planning

http://dx.doi.org/10.5772/intechopen.73255

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Individuals obtain information about family planning methods, emotionally empower them with information and ultimately turn their attitudes toward information into positive or negative behavior. Individuals also respond to the reactions they have through the process of

Individuals' attitudes for family planning methods are influenced by some characteristics, such as economic factors, sociocultural factors, environmental factors, location, age, educational, traditional beliefs, religion, family type and level of knowledge. It is known that these factors have effects on turning the attitudes into behaviors. Attitude is a notional concept and although it cannot be observed directly, the effects on behavior are well known [30, 31].

Individuals get the knowledge of family planning methods, then they transcribe it emotionally by themselves. After all they combine them with their attitudes and positive or negative

Many anthropologists have insisted that reproductive behavior or decisions made in relation to family planning is not only decided by economic factors, but also affected by sociocultural factors such as fertility preferences or values related to having children. Further, political issues such as national population policy or reproductive health programs, are also influential matters. Subsequently, anthropologists emphasize that it is very important to understand what social, cultural or structural factors may shape peoples thoughts and behaviors [33].

In early 1970s, two factors were found to affect the fertility behavior of women. Surveys on sex preferences have used deductions from attitude and behavior charts due to inadequate direct scales. In this regard it is possible to distinguish three groups of countries: countries where it is reasonable to choose male siblings; male siblings are preferred due to certain criteria; and countries with no sexual preference systematically. There is a period during which the transition from high fertility to low fertility requires couples to decrease the number of family members but yet not practitioners of contraception. Those who do not use any contraception methods, among those at any age, who want to limit their family size are far more numerous than those in developed societies compared to the developing societies. When education is considered as one of the variables of modernization, it is understood that inconsistent behavior tends to decrease with education [34]. By 1980s, comparable data for a large number of developing countries participating in the World Fertility Survey (WFS) have become available. Cross-national studies based on WFS data confirmed that education generally exerts a negative influence on fertility. But even at low levels of socioeconomic development, where education had a negligible, a negative association emerged after a critical level of schooling, was reached [35]. A pronounced preference of parents to have male children has been noted in a number of countries, although a desire

determinants in order to spread the choice of effective method [26–28].

behavior is ready for decision of which method is suitable for them [32].

of a balanced number of sons and daughters is also common [12].

transformation into behavior [2].

Giving expanded alternatives to different methods, if available, can help to meet some of their needs and increase their usage of contraceptives. Extension of accessibility for different method can reduce contraceptive discontinuation by 8%. Beside this, wider range of options may cause some of women (62%) who have unmet needs to become users [18]. For example, an increase in the availability of a new method may increase the contraceptive prevalence by 8 points [19]. Finally, some users will need contraception to protect against sexually transmitted infections such as human immunodeficiency virus [20].

There are very few studies comparing outcomes among women who have unmet need, depending on whether they are planning for future contraceptive use or not. Analysis of Cross-sectional Demographic and Health Sector (DHS) data reported that 26–83% of women who were unmet need in 48 countries thought to use any contraceptive [21]. Additionally, DHS data show that participants were considered to have unmet needs regardless of their attitudes toward their next pregnancy who indicated that they were pregnant or amenorrheic and wanted this pregnancy or had their last pregnancy. However, most of these women do not desire to get pregnant again in a short span of time, and say that they are willing to use contraceptives. Ross and Winfrey indicate that 40% of postpartum women in 27 countries are intend to use a method within the next year [22].

Between 2006 and 2009, 32% of 2853 women who were married during the survey period between the ages of 13 and 49, got pregnant at least once. Women with or without unmet need in these pregnancies were significantly more equally divided in terms of contraception (30 and 33%). All pregnancies among women who have unmet need are considered unwanted. However, 40% of unmet need pregnancies were among those who said they did not want more children; this result was interpreted as those women changed their childbearing intentions, stopped using the method or were exposed to contraceptive failure [23].
