Tailoring online contraception education for culturally diverse women improves uptake and reduces unintended pregnancies

By Dr. Priyom Bose, Ph.D.May 15 2023

Unintended pregnancies are connected with a wide range of consequences that include adverse emotional, social, and medical sequelae. Women who are born overseas, have parents born overseas, or parents who can speak many languages are termed culturally and linguistically diverse (CALD) women. Previous studies have shown that women from a CALD background experience a higher rate of unintended pregnancies.

Study: What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds. Image Credit: New Africa / Shutterstock

Background

Women who underwent unintended pregnancies are at a higher risk of post-natal depression. In addition, these women experience disruption in educational attainment and also find it difficult to re-enter the workforce. Research showed that women from the CALD background practiced less effective contraceptive methods than those born in Australia.

One of the most effective forms of contraceptives is long-acting reversible contraceptives (LARC). These contraceptives are subdermal hormonal implants and intrauterine devices. An increase in the use of LARC by women from a CALD background could significantly reduce the rate of unintended pregnancy.

Interestingly, a previous study involving younger women watching online educational videos of LARC revealed an increase in LARC preference and use. Nevertheless, it is not clear whether a similar approach could increase LARC preference among women from CALD backgrounds. It is also important to understand the specific alterations needed in the online educational material suitable for CALD women in the Australian context.

About the Study

A recent Health Promotion Journal of Australia study focussed on identifying the components of an online educational intervention to enhance LARC preference and use among women from CALD backgrounds. 

This study included female, English-speaking participants between 18 and 44 years of age who were from an Indian, Chinese, or Middle Eastern cultural background. Qualitative data were obtained through semi-structured telephone interviews. The interviews were structured to gather data to identify personal and systemic enablers and barriers to improving online intervention. 

The social media platform Facebook was used to place advertisements in targeted demographic groups, such as the Lebanese community in Melbourne, Chinese in Melbourne, and Indians in Melbourne, and recruit participants. The audio interview recordings were transcribed and coded. This study used a thematic analysis methodology, where codes are developed into themes, and these themes comprise insightful answers to the research question.

Study Findings

A total of twenty-nine women completed the survey, which included twelve Indian, nine Chinese, and eight Middle Eastern women. The authors interviewed six representatives from each cultural group. The majority of women were below 30 years of age and resided in Victoria.

Women from CALD backgrounds addressed several issues and provided important suggestions that might positively influence online educational videos. The modified videos could, in turn, enhance LARC use in this group. The participants indicated the importance of addressing knowledge gaps and misconceptions regarding LARC use. In addition, they suggested that LARC availability must be widened and partners much be involved in reproductive decision-making.

Consistent with previous studies, the present study observed that women from the CALD background experience significant stigma regarding contraception and premarital intercourse. The use of LARC could empower women because of its covert nature, which should ensure that they are not subjected to social disapproval. 

The participants indicated the importance of information regarding the cost and availability of LARC. This information will benefit international students or young women from CALD backgrounds who are not eligible for the Pharmaceutical Benefits Scheme that provides subsidies for contraception.

LARC education should challenge cultural myths with scientific evidence. For instance, previous studies have revealed that Chinese women have an aversion to hormone-based contraception. Therefore, this group must be enlightened about how safe hormonal methods are. In addition, they must be provided with alternative non-hormonal LARC options, such as the copper IUD.

In India, menstruation has strong cultural significance. Menstruation is believed to remove bodily toxins, and women are discouraged from entering the kitchen and religious centers while menstruating. Hence, the video must include information about basic reproductive health, such as the menstrual cycle.

A strong aversion towards abortion was noted amongst some Middle Eastern women. Hence, the video must explain the mechanism of action of LARC and rectify the myth that this method is associated with abortion. It was found that Middle Eastern women prefer natural contraceptive methods, such as withdrawal, over artificial contraceptives. Therefore, the video must contain information about how ineffective natural contraceptive methods are compared to LARC. The current study also emphasized the importance of delivering video content by a female doctor, which could address cultural sensitivity. 

Conclusions

The current study revealed the importance of highlighting the covertness of LARC contraceptive methods for women from CALD backgrounds. Educational videos must have information regarding the cost and how to access these contraceptives. It is important to promote online education regarding reproductive health through social media platforms and government websites. It is important for male partners of varied age groups to be aware of these interventions.