"Skilled Enough to Pull Out": factors influencing contraceptive use in urban Albanian youth. Open Access

Langdon, Fraser Daniel (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/wd375w385?locale=en



"Skilled Enough to Pull Out": factors influencing contraceptive use in urban Albanian
By Fraser Daniel Langdon

Background: Rates of contraceptive use in Albania are among the lowest in Europe.
Modern contraceptives, such as long-acting reversible methods, are less popular than
traditional contraceptive methods such as withdrawal. Identifying factors associated with
contraceptive practice, and increasing understanding of the reasons individuals choose one
method can help governments and organizations design appropriate interventions. One
intervention designed to increase contraceptive prevalence is C-Change/Albania's Maternal
Newborn Health Family Planning (MNCH FP) program, which uses peer educators to
increase knowledge and motivate positive behaviors among young urban Albanians.
Objective: This study aims to increase understanding of how the social environment in
Albania affects contraceptive use. By exploring the behaviors and perceptions of trained
reproductive health peer educators, the study can provide insight into behaviors that
influence contraceptive acceptance and practice, thus helping to identify why young
Albanians may not utilize modern contraceptives.
Methods: Data col ection emphasized qualitative methods. Four Focus Group Discussions
were carried out to provide the framework for an interview guide for In-Depth Interviews.
Twenty-one In-Depth Interviews were carried out among university-aged Albanian peer
educators. Key themes that emerged in the interviews were analyzed according to grounded
Results: Factors influencing contraceptive use included: norms around masculinity and
male-dominance, trust in long-term partners, the normativity of withdrawal, misinformation,
and gender norms governing desired levels of sexual experience for men and women
respectively. These factors influenced whether a couple would use contraceptives and which
contraceptives they might choose. Among sexual y active respondents, condoms and pills
were some of the most popular methods. Participants discussed how, prior to the C-
Change/Albania intervention, they or their friends used withdrawal as a primary method of
contraception and provided insights into their motivations.
Discussion: Increased understanding of the context in which young Albanians' reproductive
health decisions are made can inform the design and implementation of more appropriate
and efficient interventions. We propose more research on underlying determinants of
withdrawal and that intervention development should focus on social norms and sexual
divisions of labor and power in Albania.

"Skil ed Enough to Pull Out": factors influencing contraceptive use in urban Albanian
Fraser Daniel Langdon
B.S., Northern Arizona University, 2003
Kate Winskell, PhD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfil ment of the requirements for the degree of
Master of Public Health
in the Hubert Department of Global Health

Table of Contents

Distribution Agreement i
Abstract iv
Chapter 1: Introduction 1
Chapter 2: Comprehensive Review of the Literature 4
Historical Background 5
Contraceptives 6
Conceptual Framework 7
Religion 10
Gender and Power 10
Knowledge, Attitudes and Practices 11
Peer Education and C-Change 12
Contribution of Student 14
Manuscript 15
Abstract 16
Introduction 17
Methods 21
Results 23
Abortion 23
Male Roles 23
Female Roles 29
Initiating Relationships and Contraceptives 31
Contraceptives 34
Trust 35
Specific Methods 36
Household Influence 39
Peer Education 40
Discussion 42
Limitations 46
Acknowledgements 47
Appendix 51

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