Qualitative analysis of factors associated with the experience of contraception in rural setting

Introduction: The phenomenon of contraception, its prevalence and its implication for women's emancipation is influenced by a number of social factors, including the environment. The purpose of this study was to examine the phenomenon of contraception through the eyes, knowledge, experience and perception of women living in rural areas. Methods: The phenomenological approach was used within the framework of qualitative methodology. The purposive sample included eight women aged 20 to 50 years, living in the rural areas of western Slovenia. The research was conducted in April and May 2015. The data obtained through semi-structured interviews were analysed using the method of phenomenological text analysis. Results: The analysis yielded four thematic groups which conceptualize the studied phenomenon: (1) the factors affecting the choice and use of a contraceptive method and its acceptance, (2) the importance of contraception for women, (3) the education and acquisition of adequate contraceptive knowledge, (4) the women's social status. Discussion and conclusion: Results of the research indicate that contraception is an important dimension of women's quality of life and their social status. The acceptance of contraception and the selection of a contraceptive method are influenced by a number of social factors and guided by various support systems. The knowledge of these factors enables nurses to systematically plan and deliver health education. Further research of the phenomenon could be conducted also among urban female population.


Introduction
Throughout history, mankind has tried to limit family size (Glasier, 2002).The idea of contraception has been around for thousands of years and has been documented through various forms of art and written word (Evans, 2009).Birth control methods throughout history have ranged from ritualistic and mythical to practical and effective.Until the last century, this was largely achieved by behavioural modifications, including abstinence, infrequent coitus, the avoidance of intercourse during the fertile period of the cycle and coitus interruptus (the withdrawal method).Breastfeeding, which inhibits normal ovarian activity, has been, for instance, one of the most important means of limiting fertility, whereas for individual couples, coitus interruptus, first mentioned in the book of Genesis, has had a major role to play (Glasier, 2002;Cook, 2004).Many of the contraceptive techniques used in the past are not so different from the methods popular today (Evans, 2009).Contraceptives have been used in one form or another for thousands of years -throughout human history and even prehistory.In fact, family planning has always been widely practiced, even in societies dominated by social, political, or religious codes (Gordon, 2002;Stankuniene & Maslauskaite, 2008;Planned Parenthood Federation of America, 2012), that required people to "be fruitful and multiply" -from the era of Pericles in ancient Athens to that of pope, today (Planned Parenthood Federation of America, 2012).
Today, several methods of contraception are available which the medical science divides into traditional or natural, and modern.The modern methods include male and female sterilisation, contraceptive pills, intrauterine devices, contraceptive injections, implants, rings, condoms, sponges, spermicides, and diaphragm.The traditional contraceptive methods encompass breast-feeding, withdrawal and natural family planning (Cook, 2004;Evans, 2009;Oliveira da Silva, et al., 2011).Scott (2013) states that women's contraceptive needs change throughout their lives.Sexually active women can choose the most effective contraceptive method that will best suit them in particular life circumstances and psychosocial needs (Tone, 2012).
In 2011, worldwide an estimated 63 per cent of women were using a contraceptive method, though contraceptive prevalence levels varied widely across major areas and sub-regions (United Nations, 2013).According to the most recent data available, contraceptive prevalence among women of reproductive age who are married or in a union varies between 4 percent in South Sudan and 88 percent in Norway.Contraceptive prevalence was lowest in Africa (31 percent), and 70 percent or higher in Europe, Latin America and the Caribbean, and Northern America.In developed countries shortterm and reversible methods (e.g.pill, injectable and male condom) were more commonly used, while in the developing countries female sterilization and the Intra Uterine Device (IUD), the longer-term or permanent methods, were the two most common methods used by married or in-union women worldwide (United Nations, 2013).
According to the National Institute of Public Health, nearly a million packages of birth control pills were dispensed in Slovenia in 2012, which indicates that more than 77, 000 women of reproductive age (15-47 years), that is 162 out of 1000 women use hormone contraception.The use of the latter has increased in adolescents and young women between 20 and 24 years of age.On the other hand, the use of hormone contraception in women aged over 30 years is in decline.Hormonal contraceptives are used by one out of three women aged 20-24 years and one out of five women aged 15-19 and 25-29 years.The IUD was commonly used in the 1980s and in the early 1990s, but later its use decreased.In the last decade its use has been on the rise again.Condoms remain the most common contraceptive method among the young beginning their sexual life (Nacionalni inštitut za javno zdravje, 2014).

The impact of contraception of women's emancipation
Birth control plays an important role in controlling family size and population growth.It is also central to the welfare of population, especially women (Gordon, 2002;Cook, 2004;Benagiano, et al., 2007).Gordon (2002) argues that women's status cannot be linked to a specific system of sexual or reproductive regulation.The changes of the latter go hand in hand with the change in women's status.They influence and reflect each other.There is a strong correlation between women's subordination and birth control prohibition.Birth control has played an important role in society's attitudes toward gender inequality and has always been central to women's status.On the other hand, women's emancipation and equity between sexes may open new paths to family planning and women's reproductive rights.Lupton (2003) claims that contraception and abortion are focal points in societal ambivalence about the feminine role, the right of women to take control over their bodies and their reproductive destinies, and the subsequent impact upon their potential for emancipation.
By the end of the 19 th century the conventional medicine abandoned the idea of further development of oral contraceptives.Half a century later, Margaret Sanger and Katherine Dexter McCormick, the American birth control activists and ardent supports of women's rights, spurred its development.McCormick financed the then controversial research conducted by Gregory Pincus, Min Chueh Chang and John Rock.They tried to produce an oral contraceptive based on synthetic progesterone, the distribution of which was approved in 1960 (Lupton, 2003;Prescott, 2011;Planned Parenthood Federation of America, 2012;Wigginton, et al., 2015).Although the first pill was far from perfect, it was the first time in history that women gained an unheard-of effective and simple control over reproduction.Subsequently, the pill made the sexual liberation movement of the 1960s a lot less risky than the one which occurred after World War I (Planned Parenthood Federation of America, 2012).
The second sexual revolution spread the idea of free love and free sexuality.The double standard of evaluations of sexual behaviour existing among the two genders gradually faded away and women were granted the right to their own sexuality and sexual pleasure.The non-reproductive sexual relationships and non-conceptive copulations began to be separated from the sexual reproductive function, which gave way to openness of sexuality and commercialisation of sexual sphere (Anurin, 2002).Giddens (2000) argues that the sexual revolutionary changes are closely related to women's emancipation which contributed to their sexual and emotional equality and freedom.Although the sexual freedom is only partial, there is a huge difference with what it was decades ago.Contraception caused drastic changes which freed women from constant fear of repetitive pregnancies and therefore of maternal or infant death, given the substantial proportion of women who perished in childbirth.Not only did contraception allow women to plan and space pregnancies, it also brought about deep changes in women's lives.According to Giddens (2000), sexuality became malleable and "a potential property" of women in a manner that allowed them to escape men's dominance' (te Velde, 2011).
The ethnographic research on sexuality in Slovene rural communities from the beginning of the 20 th century to 1960 (Miklavčič, 2014), describes the harsh and unenviable position of women who were denied equal rights.Their sole responsibility was to be a good housewife, bear children and meet their husbands' needs.Boh (1975) discussed an important effect of contraceptive pill and other modern contraceptive methods on women's freedom which started in 1970s.Women no longer needed their husbands' cooperation in family planning, they could regulate and control their fertility without men's consent or control.Ule and Kuhar (2003) stated that with the introduction of safe and reliable contraceptive methods it became possible to separate sexuality from its reproductive consequences.Women, especially young ones, suddenly had full control over their bodies and reproduction.The availability of simple and effective methods of contraception fundamentaly changed partner relationships within and outside the family.Women joined the workforce and became equal to men in this respect.Having children became an issue of women's personal choice who tend to delay motherhood due to training for jobs and careers (Ule & Kuhar, 2003;te Velde, 2011).Speaking of the Central and Eastern European countries, the described changes are, however, not equally and universally present.In the post-communist European countries of the 'new' Europe, including Slovenia, the enormous changes started in the family formation and fertility patterns which followed the second demographic transition, namely, individualism, secularism and female emancipation.The family changes have been taking place in the region only since 1990s (Stankuniene & Maslauskaite, 2008).The measures that would help curb the population explosion are also frequently blocked by political regimes and by those professing conservative religious beliefs, but the world's religions are not uniformly conservative on issues of family planning (Maguire, 2003).The Roman Catholic Church does not approve of intrinsically evil 'artificial' contraceptive methods, claiming that it enhances promiscuity and acts against nature (Tone, 2002).

Medicalization of contraception
Controversies regarding the provision of contraception and safe methods of contraception of women have revolved around notions of the ideal motherhood and the desire of medicine to preserve the control over women's reproduction (Lupton, 2003).Lowe (2005) claims that medicalization of contraception attracted attention of several feminist researchers.They emphasise that one of the significant differences between the historical and current use of contraception lies in the involvement of medical profession and its control over women's body, especially their reproductive role.Riessman (1983) argued that medicalization of women's health became a reality of contemporary society.Women themselves allowed biomedicine enter into their lives in their desire to free themselves of the burden of natural, biological processes.According to te Velde (2011), women will never give up their newly gained independence and freedom in the 1960s.Before the 1960s only a small minority of women discussed a medically controlled family planning.At that time, most of the couples relied on the diaphragm as medicalized birth control method.For several reasons couples prefered condoms and other natural contraceptive methods, and it fell out of favour.The introduction of contraceptive pill caused a large medicalization of contraception, used against unintended pregnancy by millions of women worldwide (Tone, 2012).Lowe (2005) claims that contraception has an extraordinary status in medicine.As it is prescribed to a vast number of healthy women, often for a long period of time, and therefore these women can not be treated as patients in the classical sense.On the other hand, Tone (2012) believes that the introduction of the pill and its popularity normalized the prevailing influence of medicalization on contraception and women's reproductive health, and opened the path to other hormonal contraceptives and medicines of the modern lifestyle.

Aim and objectives
The aim of the research was to examine the phenomenon of contraception through the perception, knowledge and experiences of women in rural areas.Several social factors, including environment, affect the contraceptive use and its impact on women's emancipation.Due to the multifaceted nature of the phenomenon, the research was primarily focused on women's perception of contraception.The following qualitative issues were researched: The contraceptive knowledge, attitude and practice among rural women.The influence of micro-level living environment on the use of female contraception.
The impact of women's contraceptive knowledge and motivation on the selection and consistent use of contraception.

Methods
A qualitative research method and a non-probability purposive sampling were used in a phenomenological study to obtain in-depth information pertaining to participants' understanding, viewpoints and perception of contraception.

Description of the research instrument
The data were gathered through a semi-structured interview.According to Kvale (2007), the purpose of a qualitative research interview is to gather descriptions of the life-world of the interviewee with the intention of interpreting the meaning of the described phenomena.The interviews were organised around a set of predetermined open-ended questions, with other questions emerging from the dialogue between interviewer and interviewees (DiCicco-Bloom & Crabtree, 2006).The questionnaire consisted of 12 general open-ended questions which later developed into a more individual in-depth interview, delving deeply into personal matters regarding contraception and its consequential effects on quality of life.Following are some examples of research questions: What are your views on the status of women in modern society?; Was sex education and contraception part of your early health education at home?; When did you first consider the use of birth control?; What is your personal opinion about birth control?; How does birth control effect your sexual life and the quality of your life?; Did you let your gynaecologist choose the contraceptive method you are currently using?; Did you decide upon a contraceptive method prior to your visit to a gynaecologist?

Description of a sample
A purposive sample was used because it enables the collection of opinions and understanding of social phenomena through the eyes of the target population whose experience is invaluable for research (Robinson, 2006).The sample consisted of eight women living in rural western Slovenia.The respondents' age ranged from 20 to 49 years, the average age of the sample was 34.6 years.According to Mason (2010), a number of issues can affect sample size in qualitative research; but the guiding principle should be the concept of saturation.
Detailed information about the respondents is given in Table 1.

Description of the research procedure and data analysis
The potential participants were personally invited to take part in the research, using the snowball sampling technique.They were informed about the  , 2002;World Health Organization, 2016), the respondents freely signed the so-called informed consent, which included information in appropriate detail, and in terms meaningful to participants, about its goals and aims, how research is to be disseminated and used, the risks and benefits, the confidentiality of personal information, anonymity, the duration of interview, the right to refuse participation whenever and for whatever reason they wish, and the feedback on findings.At the beginning of the interview each participant was asked to provide some basic demographic data.The interviews were soundrecorded.Each interview lasted approximately 25 minutes.
The data gathered were analysed by means of thematic content analysis technique used in phenomenological research, as described by Robinson (2006).The interviews were sound-recorded and listened to several times.Recordings were then transcribed into written form, using the so-called unfocused transcription, which does not include the details of conversation and characteristics of interaction (Gibson & Brown, 2009).The respondents' real names were changed.The entire transcripts were re-read several times and studied, searching for the key phrases, statements and commonalities referring to the phenomenon investigated, which led to identification, organisation and integration of phrases into cluster groups.The phenomenon was conceptually defined.In order to ensure credibility and reliability of data, the final conceptual definition was confirmed by the co-author.On the basis of frequency of similar phrases, the cluster groups were organised hierarchically.

Results
Four main themes emerged from the studies of contraception as perceived by the study participants.The cluster groups are hierarchically presented in Table 2.For better clarity and transparency each individual phrase is presented within a larger context of interview transcription.Religious attitudes and beliefs are still reflected in the contraceptive method selection (it should be remembered that according to religious teachings artificial contraception is considered a mortal sin).Nevertheless, even women with a Catholic upbringing increasingly use artificial contraception.The choice of contraceptive methods among younger women is significantly influenced by their peers or other women.Most women discuss the choice of contraceptive method with their partner, although they believe that it is primarily their choice, and expect their partners' support.
Opinions concerning the importance of gynaecological expert counselling in their choice of contraceptive methods vary across women.It is believed that side effects of some contraceptive methods (especially oral contraceptives) may have a negative impact on a woman's body, which also determines the choice of contraceptive method.Women change their contraceptive method mainly because of their health problems or because they want to deepen their relationship bonds.
As the sensation during sexual contact is an important factor in contraceptive selection, the condom use may sometimes be problematic.The problem may also be the correct and consistent use of contraceptive pills and their side effects.
Making the best choice of birth control will take some time and a lot of thought.Women find support in the use of birth control methods in different mass media.They are especially supported by their gynaecologists who recommend the use of contraception.

Importance of contraception for women
Using contraception increases women's quality of life as it allows them to practice safe and relaxed sex irrespective of the fertile phase of their menstrual cycle.It also allows planning of pregnancies so that children are born when they are wanted and when they can be provided the best care possible.The use of contraception has influence on couples' relationships, which are becoming increasingly liberated and less committed.The majority of women claim that the use of contraceptives influences women's social status in modern society.It allows them to choose between a family and a career.As men and women in contemporary society prefer to live in comfort and feel secure, a decision to start a family or even to have several children is conditioned by the economic situation of the couple.

Factors influencing the choice, use and acceptance of contraceptive methods
The first thematic group is defined by the influence of social environment (e.g.religion) and support systems (e.g.family, partner, peers, gynaecologist).
At the time the study was conducted, all interviewees lived in rural areas where Christian beliefs about contraception still have a strong impact on the choice of contraceptive methods.It is therefore not surprising that some respondents claim that contraception is a mortal sin, which is in accordance with Christian teachings on contraception and birth control -passed on to them by their parents.Nevertheless, religious adherents vary in their views and some find it acceptable to use contraception and birth control.
"Those, who have received religious upbringing, disapprove of the use of contraception.In my home, the children were taught that contraception is a mortal sin.As a consequence, I never used contraception in my youth until after a serious consideration hereof."(Katja,49 years) All interviewees agree that contemporary society is open to different contraceptive methods despite Christian teachings on contraception and birth control.They observed that the use of contraception is largely approved of in mass media and promoted by their gynaecologists.
"Today contraception is more widely used and the society is more open towards it.My mother's and my former attitudes towards contraception and our occasional discussions about contraception and sexuality cannot be compared to the conversations I have with my daughters.Today I explain my daughters to do what is good for them.I feel much more spontaneous talking about these topics and I want my daughters to know that I am here to listen to and discuss their problems."(Jana,46 years) Maja, a mother of seven and expecting another child, told the interviewer that her gynaecologist encouraged her to use contraception and even suggested abortion at the beginning of her last pregnancy.
"My gynaecologist persistently offered me contraceptives following every childbirth.In this way she wanted to tell me that I had enough children and it was probably for this reason that she suggested abortion at the beginning of my eighth pregnancy.She gave me a referral for abortion, or, as she said 'curettage'.In such a situation you have to use your own head and follow your wishes".(Maja,38 years) Younger interviewees reported that their choice of contraceptive methods was largely influenced by their peers.It could be inferred that the latter influenced also the interviewees' choice of and trust in a given gynaecologist.Most of the respondents cited that they discussed the selection of contraceptive methods with their partners, although they believed that it was primarily their choice, and expected their partners' support in this respect.

"After our second daughter was born, we (my husband and I) mutually decided that I would use oral contraception. To be honest, even if my husband had disagreed, I would not have bothered. I would have used this type of protection irrespective of my husband' opinion, because I take decision about my body". (Janja, 27 years)
The participants' opinions varied as to the importance of gynaecology counselling in contraceptive method selection.One of the participants expressed concern about her gynaecologist's professionalism and claimed that her doctor did not give her adequate information on birth control methods.
"I asked my gynaecologist how it was possible that I got pregnant in spite of correct and consistent use of oral contraceptives.She answered: "Yes, these birth control pills are not 100% reliable".But if she was aware of this unreliability, why did she not prescribe me some other, stronger ones, with a higher dose of hormones?I was using this contraceptive to avoid unintended pregnancy.I was really disturbed by her answer.She could have told me before that there are other options available, that some pills are more effective than others and that I was using the brand of contraceptive pill which may not work for me".(Eva,38 years) 3.
Early parental education and the acquisition of adequate knowledge about contraception The respondents reported of different experiences regarding sexual education and contraception provided by their parents who frequently experienced sexuality as a taboo.
Thinking about contraception is triggered by teenage conversations, the first relations with opposite sex and eventually the first sexual relation as secondary school students.
The health and school systems do not provide adequate education to make informed decisions, so women search for the necessary (albeit erroneous) information about contraception by themselves.
Women are generally satisfied with their knowledge about contraceptive methods and are not overly concerned with this issue.43 4.

Social status of women
Women hold differing views on gender equality and social status of women, especially in the field of decision-making.
In patriarchal society women are forced to assume 'male' behavioural patterns.
Along with employment, motherhood is recognised as the central role of women even in contemporary society.
Some interviewees changed their contraceptive method mainly because of their health problems or because they wanted to "deepen their relationship bonds".Others are satisfied with the contraceptive methods currently used and do not consider switching their birth control method.The interviewees' statements indicate that side effects of contraceptive methods (especially contraceptive pills), endangering women's health, largely impact the selection of birth control method.According to the respondents, the use of condoms may be problematic because they reduce or interfere with sexual pleasure and sensation.The problem identified was also regular and correct use of birth control pills and the possible side effects.
"I never wanted to use contraceptive pills because I do not support the idea of hormonal contraception.I find condoms most acceptable because they have no side or ill effects on health.This is most important.Therefore I never favoured hormonal birth control methods which affect the system, the body and interfere with hormonal functioning".(Dajana,28 years) "I could say that there is an awkward moment when a partner rolls the condom on [laugh].I am sure it could be even better if we did not use a condom".(Dajana,28 years) Two of the study participants pointed out that today's society offers too much sexual freedom to the younger population and that the use of contraception should for that reason be well thought out.
"Freedom leads to contraception, which is not bad by itself.But we should be aware that too much freedom is not good, one should be aware of its limits.The contemporary society lacks the proper judgement that assists in distinguishing right from wrong.I see this also in the youngsters who indiscriminately accept everything that is offered to them.It is the responsibility of adults to properly explain and present the young the dimensions and significance of contraception and abortion".(Dajana,28 years) The importance of contraception for women The three cluster groups define "the importance of contraception for women" revealing the interviewees' perceptions of contraception and its impact on women's quality of life, partnership relations and their social status.The use of contraception helps women plan their life events and pursue their goals.All the participants using birth control admit that with contraception they may enjoy safer and more relaxed sexuality.Two of them also emphasised sexual freedom during their fertile period when sexual desire is most pronounced.Contrary to these views were the statements of one participant who does not use any birth control and who perceives contraception as acting against herself and against nature (life).All contraceptive users agree that reliable contraception allows planning of pregnancies so that children are born when they are wanted and when they can be provided the best care possible.Three of the respondents highlight the importance of family spacing and size so that a child can receive the necessary care and attention during the tender years of their development and that mothers are not overburdened with obligations and responsibility.The two older participants accentuate the benefits of contraception for perimenopausal women who can still conceive but feel too old for another pregnancy.
"Since I was sterilised, my sexual life has gained in quality as I am 100% protected.I no longer fear my visits to the toilet to check if my period has come […].Now we (my husband and I) both feel more relaxed and enjoy making love whenever we feel like it, we no longer need to worry".(Eva,38 years) "Yes, we are not yet too old to make love and I can still get pregnant until I reach the time of menopause.But I feel that my time to give birth is over.I am anxious to have grandchildren, but I would not go through all that again: give birth to a child, upbringing, school -I would not be psychologically strong enough, at least not the way I used to when I was younger".(Katja,49 years) Most respondents believe that the use of contraception may deepen the couple's relationship, which is nowadays becoming more liberated and less committed.Most of the respondents are also convinced that women's ability to use reliable contraception has a significant impact on their social and economic status and allows them to choose between a family and a career.Three participants claim that a decision to start a family or even to have several children is nowadays conditioned by the couple's economic situation.In modern society people want to live in comfort and feel secure.
"In the past people used to have one, maybe two partners, and then they got married and had children [...], unlike today when girls and boys have several relationships, they have premarital sexual experiences and only then commit to a marital relationship".(Meta,20 years)

Upbringing and education about contraception
The interviewees were also asked if sexuality education and education about contraception was part of their upbringing within a family and where they searched for information about contraceptive protection when needed.The analysis of the data yielded a conclusion that the respondents received different sexual and contraceptive education which was to a large extent conditioned by their parents' attitudes towards sex.As a consequence, some women experienced sexuality education within sex-negative taboos.
"My mother and I never had an open, face-to-face discussion about these things.It seems that she was also brought up in a family where discussions about sexual perceptions and behaviours were considered as taboo.
This issue was not to be spoken about.I think that the Church and religion had an important influence on the fact that we never openly discussed this matter.Even today, the Church opposes the use of contraception".(Jana,46 years) Some respondents observe that the health and school education do not provide adequate information about contraceptive methods.Women learn about this topic on the internet and in popular magazines when they need contraception.The users of contraception report that the idea of using protection was first discussed among peers, and that they searched for more information when they became engaged in their first love relationships and sexual activity, usually as secondary school students.
"The only intimate, confidential discussion I had on contraception was with my peers.Now one can discuss contraception with a medical staff, though neither I nor my friends had such a conversation experience.Maybe, it is different now.At school we were taught something about sexuality and very little about contraception during biology classes, but that was far from comprehensive information.We were provided with little information, at least, that was my experience".(Dajana,28 years) The participants report that they have no problem using the selected contraceptive method.They are generally satisfied with their knowledge about contraceptive methods and are not overly concerned with this issue.
"To be honest, I do not really care if I am adequately informed about contraception.I have no pains, I have no problems, it does not bother me and I stopped thinking about it."(Katja,49 years)

Social status of women
The respondents showed great interest also in the place of women in the social order.Their discussions about the status of women in a larger social context show that they hold different views on gender equality.Some of them argue that in contemporary society men and women have equal opportunities and are equally involved in decision-making processes, while others claim the opposite.The latter concede that social status of women is better than in the past, but insist that gender equality is still not a reality.Although progress has been made, there is still a gender pay gap and women are not equally represented in decisionmaking processes.According to one older respondent, the unequal opportunities result also from different models of gender not-neutral parenting and education in the past.
"I think that women's social status is much better than it used to be, but gender inequalities still exist in all fields of work.Women do have equal educational opportunities, but the problem arises in the professional career.We are fully aware that women are paid less than men for doing similar work.But the situation is definitely better than it was some 50 years ago".(Dajana,28 years) "It may be that my generation and, of course, earlier generations were brought up with a belief that men were more important and powerful than women and enjoyed a higher status.But when I grew older and started my family, I realised that in fact women hold up three corners of a house".(Katja,49 years) Three participants are convinced that patriarchal society forces women, who wish to make a career and be successful in their profession, to assume 'male' behavioural patterns.Other participants, however, feel that besides employment, women's mothering is a central and defining feature of the social organization of gender even in contemporary society.
"Women are more loving, maternal, emotional, and as such, they should be primarily mothers, responsible for raising children".(Ana,31 years) "It is interesting that I felt happier with each consecutive child -not that I was not happy when I gave birth to my first baby girl, but each new child intensified my feelings of happiness, fulfilment and differentness, which can be experienced only by having children".(Maja,38 years)

Discussion
The use of contraception allows couples and especially women planning their first and all consecutive pregnancies.In choosing the timing of the next pregnancy, individuals and couples should consider health risks and benefits along with other circumstances such as their age, fecundity, fertility aspirations, access to health-care services, childrearing support, social and economic circumstances, and personal preferences.Contraception thus exerts an important impact on the couples' life and the quality of women's life (Benagiano, et al., 2007).The complexity of the issue requires further extensive and comprehensive qualitative research of contraception in everyday life of women, within their specific environment, which shapes their beliefs and guides their actions.Such a research aims to explore into a variety of subjective perspectives of women conditioned by their social environment (Pahor, 2007).
The results of the qualitative text analysis are clustered around four themes, which define the significance of contraception for women.The hierarchy, which is based on the frequency of similar phrases, content and commonalities, reveals that the dominant theme concerns "the factors influencing the selection, use and acceptance of contraceptive methods".The interviewees are aware that a decision to use contraception should be well thought out.They are also aware that the choice of a contraceptive method is influenced by the users' religious beliefs, the opinion of their peers and partners and their gynaecologist, the side-effects and potential health risks, the desire to deepen their relationship bonds, and sexual contact and pleasure.The last but not least important is the press coverage of contraception as described by Garner and Mendez (2014), which excludes women from the debate and confirm the power of political, social, and religious groups to control the contraception narrative and women's lives.The research findings indicate that the religion's restrictive, conservative and pronatalist views still largely impact family planning.Nevertheless, it has been observed that despite the importance of religion in influencing decisions, practitioners of faith do not necessarily adhere to the prescribed doctrines of their faith and increasingly opt to use contraception.The role of religion in determining contraceptive usage should therefore be discussed within a context of a country, local community and family where women have to navigate between various messages about femininity, sexuality, contraception and motherhood.This study produced results which are in agreement with Lowe's (2005) findings which showed that a contraceptive decision is conditioned by the expectation of sexual activity, while the reasons for switching a contraceptive method are often related to health risks and side effects associated with different contraceptive methods or sensation of sexual contact.Another important finding of Lowe's research is that contraception impacts on the quality of women's lives and allows planned parenthood so that every child born is a wanted child.This is related to the second theme that emerged from the study, namely, "the significance of contraception for women".Most of the respondents agree that contraception improves their quality of life and allows them to practice safe and relaxed sex irrespective of the fertile phase of their menstrual cycle, and to plan their pregnancies.Thus the children are born when they are wanted and when they can be provided the best care possible.There is no doubt that contraception has a positive impact also on partnership relations.Sonfield and collegues (2013) report that planning, delaying and spacing births appears to help women to choose between a family and a career, to achieve their education and career goals.Further, there are other social and economic benefits of women's ability to use reliable contraception, including employment, socioeconomic stability, personal satisfaction and social status.
The third theme "early parental education and the acquisition of adequate knowledge about contraception" affirmed that the respondents received different sexuality, reproductive and contraception education within their families, often within sex-negative taboos.The respondents reported that they first thought about contraception when talking to their peers, and then during their first relations with the opposite sex and at the onset of sexual activity as secondary school students.They stated that the health and school systems did not provide enough information to make informed decisions about contraception, so they got informed about the necessary information elsewhere, mainly by their peers.The findings of the current study are consistent with those of Lowe (2005) who found that women obtain contraceptive knowledge by themselves and discuss the selected contraceptive method with women in their social surroundings and not their gynaecologist.According to Pinter and Grebenc (2010), adolescent girls develop sexuality at a much earlier age than was true in the past, which has resulted in a growing gap between their sexual and social maturity.In the absence of emotional and cognitive maturity, early pubertal timing predicts deleterious outcomes for young girls, including risky sexual behaviour and pregnancy.Timely and effective health education, tailored to the expectations and needs of the contemporary society, might significantly modify sexual behaviour among adolescents and reduce unintended consequences of early sexual experimentation.The participants of the current study report that after years of sexual experience and contraceptive use, or having children, they are generally satisfied with their knowledge about contraceptive methods and are not overly concerned with this issue.
The interpretative phenomenological analysis has shown that the cluster groups are closely related, which points to the complexity of the phenomenon studied.Although the topic of interest was primarily the respondents' views and use of contraception, the focus extended to the status of women in Slovenia and their emancipation stemming from contraception.The findings of the present research show that the respondents also disagree in their attitudes and views on the "the social status of women in contemporary society", which is the fourth theme identified in the study.Their opinions vary in the perception of gender equality, participation in decision-making and the adoption of male-specific behavioural patterns, helping them progress along their career ladder in a patriarchal society.Some respondents in the age group of 30 to 40 years believe that along with employment, motherhood remains the central role of women even in contemporary society.It is interesting to note that older respondents do not share these views.
This phenomenological research has some study design limitations and delimitations: (1) The study is geographically limited, which prevents or restricts generalisations to the larger population studied.If the study were based on a different theoretical framework, with additional questions, etc., the research might yield different results; (2) The phenomenological data analysis is, like in other qualitative studies, based on the researchers' interpretation, and therefore does not lend itself well to replicability; (3) The research did not examine the correlation between detailed demographic data of the respondents (e.g. economic status, religious beliefs, sexual practices, etc.), the provision of which was not even required.
There is abundant room for future research studies based on a larger sample size and expanded geographical scope to urban areas to ensure appropriate generalizations of the findings of the study.A further study is suggested which would include also the men's views on contraception, women's health, and prevention of sexual risk behaviours.However, such a research can be hindered by the extant cultural values and norms of specific environments.

Conclusion
With the event of contraception, especially hormonal contraceptives and their availability, women became able to have full control over their reproduction and separate sexuality from its reproductive consequences.Simple and effective contraception has provided opportunity also for female emancipation which led to different levels of gender equity across countries.The results of this study confirm that contraception is an important dimension of the quality of rural women's life, which is associated with their social status.The acceptance and selection of birth control methods are influenced by several social, political and environmental factors, and are determined by various support systems.
The nursing professionals should be well informed of these factors to be able to use a holistic and personcentred approach in planning and implementation of sexual health education and health promotion.

Table 2 :
Themes identified and cluster groups Tabela 2:

Table 1 :
Demographic data