Influences on the decision to use contraception among Sarawakian women with diabetes: a qualitative exploration

Figures & data

Table 1. Interview topic guide

Preamble  Can you tell me about your diabetes?  When and how was it diagnosed?  What treatment did you receive?  Can you tell me about your diabetes control?  How do you space out your pregnancies? How do you feel about it?

General questions about contraceptive use  Could you share what you understand about family planning?  Please share your views about the various types of family planning methods that you know of.  Could you share your reasons for using your current family planning method?  Who decides the type of family planning method that you use?  How do you decide the type of family planning method to use?

Perceived seriousness/severity  Can you share what you know about the effects of diabetes on pregnancy?  What do you understand about the effects of pregnancy on your diabetes?  Can you share your opinion about the effects if you became pregnant, since you have diabetes?

Perceived susceptibility  What do you think are the chances of you getting pregnant with/without contraception?  What do you think is the likelihood of you developing the conditions that you mentioned if you got pregnant?

Perceived benefits of contraceptive use  How do you think using contraception will affect you and your family?

Perceived barriers to contraceptive use  What makes family planning less desirable or difficult for you?  What makes it easier for you to practise family planning? (Lack of barriers)  Could you share with us your reasons for choosing not to practise family planning?  Could you share with us your reasons for stopping family planning?

Cues to action  How does the doctor or nurses’ advice affect your decision to practise family planning?  How do others (friends and family, health care providers, mass media) affect your motivation to practise family planning?

Self-efficacy  How confident are you that you are able to practise family planning correctly?  What makes you more confident in practising family planning?

Table 2. Characteristics of participants

No.	Age (years)	Ethnicity	Employment status	Level of education	Current contraception use/method
1	51	Chinese	Employed	Tertiary	Condom
2	47	Malay	Homemaker (previously employed)	Secondary	IUCD
3	37	Iban	Homemaker	Secondary	BTL
4	42	Malay	Homemaker	Secondary	Coitus interruptus
5	31	Chinese	Homemaker (previously employed)	Secondary	Traditional medicine
6	36	Bidayuh	Homemaker (previously employed)	Secondary	POP
7	27	Bidayuh	Homemaker (previously employed)	Secondary	IM MPA
8	46	Iban	Homemaker	Primary	BTL
9	23	Malay	Student	University	None (Previously coitus interruptus)
10	36	Iban	Homemaker	Secondary	None (Recently stopped using IM MPA)
11	40	Malay	Homemaker	Secondary	None
12	41	Bidayuh	Homemaker	Secondary	None

Note: IUCD = intrauterine contraceptive device, BTL = bilateral tubal ligation, POP = progesterone-only pills, IM MPA = intramuscular medroxyprogesterone acetate

Table 3. Themes related to the decision to practise contraception, with examples of related quotes

Perceived likelihood of getting pregnant
“Well, I think at my age, I think the percentage (of getting pregnant) is very low. I just started having irregular (periods) you know. I am just starting my menopause, so I don’t want to take that risk”. (P1, a 51-year-old Chinese woman) “I have not used contraception for a long time. Since my last childbirth in 2009 until now, I have not used any contraception. No effect (getting pregnant) at all … . because my mother gave me some traditional medicine, to stop me from conceiving again, seeing that I am sick”. (P5, a 31-year-old Chinese woman)
Desired family size
“I asked the doctor, ‘Can I have my tubes tied? I don’t want to have children anymore; my children are older and have entered kindergarten’. The doctor said yes”. (P8, a 46-year-old Iban woman) “No. I don’t think my diabetes has anything to do with it [family planning]. Because when we got married, we had already discussed how many children we wanted … So it’s already fixed and just want to have two. So I don’t think [diabetes] has anything to do with family planning.” (P1, a 51-year-old Chinese woman)
Personal health risk of getting pregnant
a. Negative effects of diabetes on pregnancy “When I reflect on my own life, my first pregnancy ended in a miscarriage, my second passed away. So, after this, I have to plan properly so my pregnancy will be successful”. (P7, a 27-year-old Bidayuh woman) “Many things happened when I got pregnant, all sorts of things. Checking blood sugar for one week, a few times each month. Seven times (checking sugar) is a burden … need to buy … what’s that (glucose strips), buy it on my own”. (P10, a 34-year-old Iban woman) b. Anticipated difficulty during the delivery process “About pregnancy, I am afraid of going through the operation again. Oh, big baby, afraid of disabled or syndromic baby; I am afraid of that”. (P11, a 40-year-old Malay woman)
Social implications of getting pregnant
a. Financial burden of raising another child “That is why I don’t want to get pregnant again; my husband has difficulty earning a living”. (P11, a 40-year-old Malay woman) b. Personal freedom to focus on other priorities “I am doing my degree programme now; I want a good job, earn a salary after that, and my husband will also be working. If I have many children, who will take care of them? I do not want to trouble my mother-in-law, my own mother”. (P9, a 23-year-old Malay woman)
Opinion of significant others (including family members and friends, healthcare personnel, religious leaders)
“After I had my second child, my sister-in-law recommended that I start family planning because she said my pregnancies were too close”. (P2, a 47-year-old Malay woman) “Arr … because the doctor advised us to use (contraception) because he is afraid (of risks of getting pregnant again) … must wait for three years (after the caesarean section) before I conceive again”. (P3, a 37-year-old Iban woman) “Hmm … I tried … once I tried to ask my boyfriend to buy contraceptive pills for me … but my boyfriend just encouraged me and said I won’t get pregnant … he won’t ejaculate inside me … so I trusted him”. (P9, a 23-year-old Malay woman)