The world population is estimated to increase to 9.2 billion by 2050 from 7.9 billion in 2022 [1
]. Unregulated fertility results in rapid population growth and causes a burden on resources, which affects the economic development and political stability of many developing countries [1
Family planning helps families regulate fertility by limiting the number of children and widening the interval between their gravidities by using diverse contraceptive methods [3
]. By precluding unintended gravidity, maternal mortality and morbidities decrease. Contraception also helps reduce unsafe abortions, fetal infections, and fetal deaths [3
In 2019, it was estimated that there were 1.9 billion women within the reproductive age group worldwide and approximately a billion of these women needed family planning. Of these, 842 million are utilizing contraceptive approaches, and the other 270 million had no access to contraception despite their willingness to use it [5
]. However, misconceptions regarding both health benefits and health risks of oral contraceptive utilization remain a significant challenge to contraception use [8
The oral contraceptive pill (OCP) is one contraceptive method, and it is the most used method of contraception [9
]. OCP effectiveness is user-dependent and relies upon the individual woman to comprehend how it works and how to take it correctly [10
]. OCP abuse and withdrawal result in more than 750 million unattended pregnancies amongst young women in the U.S. every year [11
]. However, in Saudi Arabia, data regarding misuse of OCP and unintended pregnancies are not available.
There are multiple health benefits of OCP use, including protection against dysmenorrhea, menorrhagia, iron insufficiency anemia, ectopic gestation, pelvic inflammatory condition, ovarian cysts, benign bone disease, endometrial cancer, and ovarian cancer [12
]. However, there are also health risks related to OCP usage, which can differ depending on the type of OCP used, either progestin-only pills or pills that are combined with estrogen. These risks can include but are not limited to increased risks of thromboembolism, cervical cancer, breast cancer, stroke, and cardiovascular events among smokers who use the OCP. In addition, OCP use may cause adverse effects, such as body weight change, nausea, breast tenderness, abdominal bloating, skin problems, and menstrual period disturbance [10
In Saudi Arabia, a large family is a cultural preference of the Saudi population. Consequently, Saudi Arabia still has higher birth rates and fertility rates compared to developed countries, though, over recent years, there has been a significant decrease in both rates [16
]. According to the Mundi Index, there were 18.78 births/1000 population in Saudi Arabia in 2014, and the figure dropped to 14.56 births/1000 population in 2021, which remains higher than reports from industrialized countries [16
Numerous factors impact women’s decisions concerning contraceptive methods [19
]. Knowledge of contraceptive methods’ efficiency and proper usage is an important aspect of the woman’s decision-making process. General knowledge and awareness of contraceptives differ widely across populaces, with notable inequalities among minority and younger populations who have limited awareness and understanding of different contraceptive methods.
This study was conducted to study the knowledge, attitude, and practice regarding contraceptive pills and their side effects among women in the general population in the Jazan region.
In this study, 570 questionnaires were distributed, and the response rate was 98.3%. The majority (30.5%) of the women were aged 18–25 years, followed by those aged more than 40 years. Most participants had undergraduate and graduate levels of education, accounting for 28.9% and 49.1%, respectively. The majority (46.3%) were employed, while 3% were retirees. Most of the participants earned more than 5000 riyals per month.
The majority (58.8%) of the participants had been married for more than five years, and about one-third had not been pregnant. Around a third of the participants did not have any children, while 24.3% had more than four children (Table 1
3.1. Knowledge about OCP
The majority (94.8%) declared that they knew how to use the pills and that their family was the source of information on the OCP for most women (52.1%) (Figure 1
Social media ranked the highest in providing knowledge about OCP’s mechanism of action, followed by physicians and instruction sheets available in the OCP package. Overall, 57.1% of the participants knew that other medications could counteract the pill efficacy, and 47.1% reported that antibiotics might counteract OCP efficacy.
3.2. Attitude toward OCP
The most popular reason was the OCP availability, 84.4%, followed by ease of use, 83.7% (Figure 2
The majority (94.3%) of all participants were concerned about OCP side effects, and 36.1% thought that the OCPs were safe. Most (73%) women believed that the pills effectively prevented pregnancy.
Of participants, 38.9% believed that the pills could cause breast cancer, 46.8% believed it could cause uterine cancer, 59.3% infertility, and 91.3% believed it could cause hormonal imbalance.
The majority of the OCP users had at some point stopped using the pills due to various reasons. For example, the difficulty of use and the side effects experienced, and their ineffectiveness. However, about 93% of OCP users stated that the pills were effective. In comparison, 80.2% of OCP users experienced some side effects.
3.3. Patterns of OCP Usage
Contraceptive pills were the most used method among participants; 51.4% (288) confirmed using or have previously used oral contraceptives before. Of these, 87.5% used the contraceptive for birth control, while 12.5% used it for menstrual disorder control. Overall, 58.3% of OCP users consulted doctors, and 53.8% had a medical prescription for contraceptives (Table 2
3.4. Overall Knowledge, Attitude, Previous Experience, and Pattern of Usage
Our study found that overall knowledge, attitude, and previous experience did not significantly affect the pattern of usage (Table 3
). We found that 96.9% of the users were considered appropriate users, 93.1% had a positive attitude, and 77.8% were considered to have good knowledge of the OCP.
This cross-sectional study evaluated knowledge, attitude, and practice regarding contraceptives and the side effects among women in the Jazan region, Saudi Arabia. About 50% of the participants had used or were using OCPs (Table 2
) during this study period. This is slightly lower compared to other studies undertaken in Canada or even in Saudi Arabia, where OCP users were approximately 57% [8
]. The overall knowledge showed that the majority of the participants had good knowledge about the OCP, and about 95% of the women confirmed that they knew how to use them. This is much higher than another study conducted in Jordan, in which only 54% acknowledged knowing how to use the OCP [21
]. It is noteworthy that previous studies were conducted through face-to-face interviews, while our study was conducted via an online survey, which could explain differences in prevalence and knowledge of OCP usage.
We found out that the source of information about the OCP was mostly from family members, who had the most influence, followed by physicians and the media (Figure 1
). This is consistent with another study conducted in Saudi Arabia in which 33% of participants reported that families were the main source of information about OCP [17
]. When it comes to the mechanism of action of the OCP, our results are consistent with others, in which physicians and social media were the most popular sources of information [21
]. Our study showed that 57.1% of the participants knew that some medications, mainly antibiotics (47.1%), could counteract the pill. These findings are inconsistent with another report [8
], in which 80% of participants in a Canadian study conducted by Bryden and Fletcher believed that some medications could interact with OCP.
This study showed good knowledge with regard to oral contraception. This may be due to the higher levels of education among the majority of participants. However, knowledge did not significantly affect the pattern of use. The findings agree with previous studies carried out to assess the knowledge of oral contraception among women in various regions [8
]. For example, a study conducted in 2011 in Riyadh showed that a higher level of education and longer use were associated with better knowledge of OCP [24
]. Likewise, a study conducted in Australia in 2011 reported that having a university-level education was associated with better knowledge concerning the OCP [25
This study indicated that women had a positive attitude towards the OCP. This is similar to another study conducted in Alqassim, Saudi Arabia [17
]. The majority of the women preferred using OCPs compared to other contraception methods due to perceived wide availability, ease of use, and effectiveness (Figure 2
). These findings agree with reports from various studies conducted in different countries [17
]. The safety profile of OCPs was not a common reason why the users preferred the OCP. This was probably because the majority of the participants were not aware of OCP safety. However, the main reason why 94% of participants feared using OCPs was concerns about side effects. This finding is similar to another study where 74% of participants reported fearing side effects [21
]. Participants believed that some side effects could be associated with the OCP, such as hormonal imbalance, infertility, uterine cancer, and breast cancer. This concern about OCP side effects is shared by participants of other studies [21
], where women had a positive attitude towards OCP as an effective method of contraception but had concerns about its side effects.
We found that 38.9% of participants believed that the pills could cause breast cancer, and this is almost similar to what was reported in another study conducted at Wilfrid Laurier University, Canada [8
]. However, in a study conducted in 2012, the majority of women in Brazil believed that OCP has a minimal association with gynecological cancers [31
]. These differences in beliefs and concerns are primarily due to cultural and religious factors that shape the participants’ attitudes towards OCP use [29
About 91% of the participants had stopped using the OCP at some point in their lifetime. About 51% of them stated that they stopped using the pills because of the side effects they experienced and others due to other reasons such as its ineffectiveness. These results also agree with the study, which was conducted in Jordan, in which reported side effects are the main reason stopping the use of OCPs [21
In this study, the respondents showed a good pattern of OCP usage; almost 88% were using the OCP for birth control purposes, 58.5% sought medical consultation, and more than half reported that the pills were prescribed. These results are consistent with a study conducted in Jordan [21
As a limitation, this study was conducted in the Jazan region only, and the results may not accurately represent all regions of the Kingdom of Saudi Arabia. In addition, the online questionnaire was only distributed to those who had internet access and could read. Thus, a more extensive study that could be delivered in a face-to-face interview would reflect community knowledge and attitude toward OCP for a wider female population.
In conclusion, the study revealed that women in the Jazan region had a positive attitude towards OCP use. We found that the OCP is considered effective and preferred over all other methods of contraception. Side-effects were the most feared. However, the results of this study indicate that attitude, knowledge, and prior experience of OCP have no significant effect on the usage pattern of OCP among women in the Jazan region. Future studies may be conducted on a larger population to evaluate knowledge and attitude toward OCP use. Consequently, educational programs could be directed to women in need to raise awareness and further enhance the understanding of OCP usage and break the fear of OCP side effects.