[Knowledge and attitudes among women in the Arab village regarding contraception and family planning and the reasons for having numerous children].
BACKGROUND
Families with numerous children (5 or more) are a common phenomenon in the Arab sector in Israel. Whereas the fertility rate of Jewish women is 2.6, Muslim women have a rate of 4.6. Research has found that approximately half of the children were the result of unplanned pregnancies. Among the risk factors for unplanned pregnancies are: low income, the woman's level of education and marriage at a young age. In Israel a number of studies have been conducted on the use of contraception, in general, and on the status of women in the Arab population. However, to the best of our knowledge, there has not yet been a study in which Arab women have been asked how they customarily act on the subjects of family planning and contraception and what their attitudes are vis-à-vis having numerous children.


OBJECTIVE
The aim of this study was to examine to what extent family planning and use of contraception exist in the Arab population and to determine the reasons for having so many children. The reasons examined included: the couple's wishes, religious faith, knowledge concerning contraception, socio-economic status and education.


METHODS
A detailed questionnaire was prepared, which included socio-demographic details and questions of knowledge and attitudes pertaining to family planning and contraception and the reasons for having numerous children. The questionnaire was completed by the clinic staff, who interviewed all the women, ages 20-45, who had 5 or more children.


RESULTS
Three hundred and three Arab women were interviewed, out of a total of 391 who had 5 children or more (compliance rate of 77.5%). Sixty percent of these women were married before the age of 18 and most of them are housewives (96.4%). A total of 18.8% of the women had an education of 0-4 years, 66.5% had an education of 5-8 years and 14.8% received 9 or more years of education. Most of them (92%) claimed that the decision regarding the number of children was jointly made with their husband; 24.8% thought that breastfeeding prevents pregnancy, about half of them became pregnant while breastfeeding. As to contraceptives--6.9% are currently taking contraceptive pills; 60.8% use IUD; and 11.2% had tubal ligation, most of them during a Caesarian section. In a single-variable analysis, a significant correlation was found between the women with a low level of education and more than 7 children. As the educational level rises there are fewer children in the family (P < 0.001). A significant correlation was also found between the low education of the husband and a number of children greater than 7 (P < 0.004). It was found that there is a significant high rate of women with 6 or more children that had tubal ligation. In a multi-variable analysis of the logistic regression, it was found that independent variables that predict a number of children higher than 7 are tubal ligation and the woman's level of education. The probability of uneducated women having 7 or more children is 15.2 times greater than for women with high education. Similarly, the probability that women who underwent tubal ligation have 7 or more children is 5.8 times greater than women who used no contraception.


CONCLUSIONS
This study reinforces findings from previous studies that indicate the connection between the parents' education, particularly the wife's education, and the number of children. Similarly, in the rural Arab sector in Israel, the woman's education is the most significant variable determining the number of children. Moreover, we have seen that only when the number of children is particularly high and the woman's age is high, she is persuaded to have tubal ligation, as opposed to other means of contraception. These results reinforce the approach, according to which there is great importance to the fact that women in the Arab sector should obtain a high school education and more, so as to be able to properly plan the size of their family.
Abu Ahmed
A
A
Department of Family Medicine, Ha'Emek Medical Center, Afula, Israel.
Tabenkin
H
H
Steinmetz
D
D
D000328:Adult; D018912:Arabs; D003267:Contraception / Q000379:methods; D004522:Educational Status; D005191:Family Characteristics; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D017533:Marital Status; D014930:Women