Unmet family planning needs and associated factors among women with rheumatologic diseases

Nezaket Sabır, Oğulcan Çöme, Tolga Günvar

Abstract

Women of reproductive age with rheumatologic diseases face increased risks during pregnancy, yet evidence on their family planning (FP) needs is limited. This study aimed to determine the prevalence of unmet family planning needs and to identify associated factors among women with rheumatologic diseases.This cross-sectional study included 378 women aged 18–49 attending the Dokuz Eylul University Rheumatology Outpatient Clinic (March–June 2024). Unmet FP need, defined using an expanded Bradley/Westoff framework, was 34.1%, nearly three times higher than national estimates. Independent predictors included older age, absence of teratogenic medication use, and reliance on social media or relatives for FP information, while longer disease duration and higher parity were protective. ROC analysis identified number of pregnancies as the strongest discriminator, with nulliparous women showing the highest risk. These findings highlight the need to integrate provider-led contraceptive and preconception counseling into rheumatology care.

Full Text:

PDF

References

.1. Koo M, Lu MC. Rheumatic diseases: new progress in clinical research and pathogenesis. Medicina (Kaunas). 2023;59(9):1581.

Rees F, Doherty M, Grainge MJ, et al. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017;56(11):1945-1961.

Zhang, Z. et al. (2025). Global, regional, and national epidemiology of rheumatoid arthritis: incidence trends from 1990 to 2021. Scientific Reports.

Andreoli L, La Corte R, Ramonda R, Doria A, Zen M. Management of pregnancy in autoimmune rheumatic diseases. RMD Open 2024;10(2):e004091.

Apraş Bilgen Ş, Kılıç L, Erden A, Aşlar Z, Bes C, Karabulut G, Tufan A, Ertenli İ ,Kiraz S. The recommendations of Turkish Society for Rheumatology for pregnancy management in rheumatic diseases and the use of antirheumatic drugs during pregnancy. Ulus Romatol Derg. 2019 Dec 1;11(2):91–104.

Coşkun BN, Pehlivan Y. Gebelerde romatizmal ilaçların yönetimi. Turk Klin J Intern Med Spec Top 2022;2(3):78–83.

Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022;400(10348):295–327.

Inter-Agency Working Group on Reproductive Health. Family planning: inter-agency field manual on reproductive health in humanitarian settings. Geneva: World Health Organization; 2010.

Hacettepe University Institute of Population Studies. 2018 Turkey Demographic and Health Survey. Ankara, Turkey: Hacettepe University; 2019.

Romer SE, Blum J, Borrero S, Crowley JM, Hart J, Magee MM, Nichols J, Parsons S, Robbins C , Thomas J. Providing quality family planning services in the United States: recommendations of the U.S. Office of Population Affairs (Revised 2024). Am J Prev Med. 2024 Dec 1;67(6):S41–S86.

Oyinlola FF, Kupoluyi JA, Adetutu OM. Changes in unmet need for family planning among married women of reproductive age in Nigeria: a multilevel analysis of ten‑year DHS waves. PLoS One 2024;19(8):e0306768.

Ergöçmen BA, Bozbeyoğlu AÇ. Türkiye’de aile planlamasında karşılanmamış ihtiyacın ölçümüne farklı bir yaklaşım. Nüfusbilim Derg 2016;27:3–16.

Ökem ZG, Pekkurnaz D. Determinants of unmet need for family planning: evidence from the 2018 Turkey Demographic and Health Survey. J Biosoc Sci 2024;56(1):90–103.

Skinner‑Taylor CM, Perez‑Barbosa L, Barriga‑Maldonado ES, et al. Sexual and reproductive health counseling and contraceptive use in Mexican women with rheumatic diseases: a cross‑sectional study. Rheumatol Int 2021;41(3):409–414.

Wulifan JK, Brenner S, Jahn A , De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2016 Jan 15;16(1):2.

Manaf RA, Ismail IZ, Latiff LA. Contraceptive use among women with chronic medical conditions and factors associated with its non-use in Malaysia. Glob J Health Sci 2012;4(5):91–99.

Wani RT, Rashid I, Nabi SS, Dar H. Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir: a cross-sectional study. J Family Med Prim Care 2019;8(4):1319–1325.

O Stens, et al. Navigating risk: Effect of counseling on contraception practice and teratogenic medication use in women of child-bearing age. International Journal of Gynecology & Obstetrics. 2025; [Epub ahead of print]. DOI:10.1002/ijgo.70414

Karadon D, Esmer Y, Okcuoglu BA, Kurutas S, Baykal SS, Huber-Krum S, Sahin Y, Ozturk Y. Understanding family planning decision-making: perspectives of providers and community stakeholders from Istanbul, Turkey. BMC Womens Health 2021;21(1):439.

Nansseu JRN, Nchinda EC, Katte JC, Nchagnouot FM, Nguetsa GD. Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon. Reprod Health 2015;12(1):71.

Refbacks

  • There are currently no refbacks.