The Effects of Temperament and Character on the Choice of Contraceptive Methods

Jan 24, 03:55 AM

ABSTRACT Objectives To identify the effects of temperament and character on the selection of contraceptive methods.

Methods Cross-sectional study carried out in June 2005 at the Ondokuz Mayis University Samsun Health College with the participation of 102 young women. The participants were asked to complete the Contraception Choice Questionnaire devised by the researchers, and the Cloninger Temperament and Character Inventory.

Results The mean age of the participants was 22.30 +- 1.27 years; 39 participants (38.2%) mentioned Norplant(R), 30 (29.4%) condoms, 17 (16.6%) intrauterine devices (IUDs) and 16 (15.7%) oral contraceptives (OCs) as the method they would consider using in the future. The mean scores of self-directedness and self-transcendence of the groups differed significantly (p < 0.05). Students who indicated they would choose OCs had higher average scores for self- directedness than those choosing IUDs; the mean self-transcendence scores of students choosing IUDs were significantly higher than the scores of those selecting condoms (p < 0.01). Subjects choosing Norplant(R) cited ease of use; those choosing condoms cited their eliciting fewer side effects; those choosing IUDs cited their high levels of safety; and those choosing OCs cited ease of use and high reliability as the reasons for their choices.

Conclusions We think that identifying the roles of temperament and character in the selection process of a contraceptive method will help in achieving a wider application of contraception.

KEY WORDS Contraception, Choice of contraceptive method, Temperament, Character, Temperament and character inventory

INTRODUCTION

More than 100 million acts of sexual intercourse are estimated to take place daily throughout the world; of these, 910,000 result in pregnancy and 365,000 in sexually transmitted infections (STIs). One out of four pregnancies is certainly unwanted. Some 150,000 pregnancies are terminated every day through abortions. One-third of these abortions are performed in unhygienic conditions, resulting in 500 deaths per day. During pregnancy and delivery, which are physiological processes, 1370 women lose their lives daily, while the number of those emerging from this process with physical and psychological disabilities is several times that figure1.

The control that one should be able to exert over one's own fertility by selecting a safe, effective, affordable and acceptable contraceptive method is a basic human right . Correct information should be provided to this end.

Several factors influence the selection of contraceptive methods, such as the efficacy, reliability and cost of the technique, its relationship to sexual intercourse, non-contraceptive benefits, attendant side effects and complications, dependence on and accessibility of family planning services for implementation, and return to fertility2,3.

It has been proposed that personality is composed of temperament, character and intelligence . Temperament is the tendency of the person to react to certain emotional stimuli in an automatic fashion and is determined structurally at birth; character is defined as the objectively experienced behavioural patterns of the individual, which are relatively stable and subjectively reported internal experiences '6. In other words, temperament relates to biological contributions to personality, while character relates to social and cultural contributions4.

The aim of this study was to identify the effects of temperament and character on the choice of contraceptive methods.

MATERIALS AND METHODS

This cross-sectional study was carried out at the Ondokuz Mayis University Samsun Health College in June 2005. It was planned that the study group would consist of young persons who had received education in contraceptive techniques, who were single, not using any contraceptive technique at the time, and who expressed the desire to apply contraceptive measures once married or having a regular partner. A course on 'Contraceptive Methods' is taught in the 3rd year in the nursing school and in the 4th year in the midwifery school; for this reason 3rd and 4th year nursing school students and 4th year midwifery school students constituted the study group. Approval of the local ethics committee was obtained. Of the 128 young women in the study group, 26 (21.3%) were excluded because they were married (2), already using contraceptive methods (8), failed to complete the questionnaire (6) or were unwilling to participate without giving any specific reason (10), leaving a total of 102 students in the study. All the participants were young women, since only women are admitted to nursing and midwifery schools in Turkey. The participants were presented the Contraceptive Choice Questionnaire devised by the authors and the Cloninger Temperament and Character Inventory (CTCI).

The Temperament and Character Inventory developed by Cloninger et al. was translated into Turkish by Kose and Arkar, and its relevance and reliability were tested7,8.

The CTCI is a self-administered test consisting of 240 true or false items. It contains a four-dimensional temperament component consisting of novelty seeking (40 items), harm avoidance (35 items), reward dependence (24 items) and persistence (eight items), and a three-dimensional character component assessing self-directedness (44 items), cooperativeness (42 items) and self-transcendence (33 items)4,5,9.

The first temperament component in the CTCI is novelty seeking (NS). This latter is an inborn tendency towards any action in a search for novelty; instinctive decisions are taken, and excess and exuberance emerge when there is a possibility of obtaining a reward. It also includes easy and rapid bursts of anger, and active avoidance of prevention. People with low NS scores are not easily angered; they are unenthusiastic, calm, incurious, thrifty and discreet; they can tolerate monotony and are systematic. People with high NS scores grow angry very quickly; they are inquisitive, curious, hard working, enthusiastic, prone to boredom, instinctive and tend to be untidy4"6'9,10.

The second temperament component in CTCI is harm avoidance (HA). In responses given to prohibitive, non-rewarding and punishment signals it consists of an inborn tendency to the prevention of the behaviour. Persons with low HA scores tend to be untroubled, relaxed, courageous, audacious, calm and optimistic, even in environments that would make most people anxious. In social circles these individuals are described as sympathetic, courageous and self- confident. They tend to have high energy levels and give others the impression that they are dynamic, lively and strong individuals. People with high HA scores are cautious, attentive, anxious, tense, apprehensive, shy, sceptical, unenthusiastic, insecure, passive and pessimistic in environments where other persons normally would not be anxious. In most social environments these individuals tend to be restrained and timid. They feel the need for approval and encouragement more often than most other people, and are very sensitive to criticism and punishment4-6,9,10.

The third temperament component in CTCI is reward dependence (R- D). It reflects the genetic tendency to a behavioural response as activated by a reward and to the continuation of this behaviour. It manifests itself as excessive emotionality, social sensitivity, bonding and a dependency on others' approval. Subjects with low RD scores are practical and frequently raise objections; they are described as rigid, cold and socially insensitive. They are happy to be alone and rarely initiate open communication with others. Individuals with high RD scores are caring, good-hearted, sensitive, socially dependent and easily influenced. They are open to social communication with others and wherever they go they will find someone to get along with4-6,9,10.

The last temperament component of CTCI is persistence (P). It reflects the inborn tendency to the continuation of the behavioural pattern despite being impeded or fatigued and infrequent encouragement. This characteristic manifests itself in the form of industriousness, determination, ambition and perfectionism. Individuals with low P scores are lazy, immobile, indecisive and untidy. They rarely work towards greater success and give up very easily. Individuals with high P scores are hardworking and determined, work very hard for anticipated reward responses and are more successful than anticipated4-6,9,10.

The first character component of the CTCI is self-directedness (SD); this is the basic determinant for the presence or absence of a personality disorder. The main idea behind SD is that in accordance with their chosen ideals and the values individuals have to work on regulate and control their behavioural patterns to maintain their current condition. SD reflects the adequacy and willpower involved in achieving this. People with high SD scores are mature, strong, self-sufficient, trustworthy and constructive. They have self- respect and self-confidence. In contrast, persons with low SD scores are weak, immature, fragile, accusatory, ineffectual, irresponsible and insecure, and have limited self-respect. These individuals are described by physicians as not having matured sufficiently and as people with personality disorders4-6,9,10. The second character component of the CTCI is co-operativeness (C); it describes individual variations in description and the acceptance levels of others towards that individual. Persons who are able to cooperate possess social tolerance and are compassionate and empathic. They like to help others, are fair and abide by their principles. Individuals with a low capacity for cooperation lack social tolerance, enjoy criticizing and are indifferent to others. They are not ready to lend others a helping hand, but enjoy taking revenge; they are resentful and opportunistic4-6,9,10.

The final character component of the CTCI is self-transcendence (ST). This is defined as going beyond one's self, identifying with others and spiritual acceptance. People who are transcendent are unpretentious, satisfied, patient and creative; they forget about themselves, possess strong beliefs and spiritual feelings, and are idealistic. Individuals with low ST scores are arrogant, impatient, lack creativity, and cannot tolerate ambiguities and surprises; they attempt to control everything and are materialistic4-6,9,10.

The analysis of the data obtained from the participants was performed using the SPSS for Windows 6.0 package programme. The data obtained as a result of the evaluation of the inventories was expressed as arithmetical mean +- standard deviation. In the statistical analysis, Kruskal-WaUis analysis of variance was used in the comparison of the numerical variables of more than two groups and the Bonferroni corrected Mann-Whitney U-test in the paired comparisons of groups identified as exhibiting differences.

RESULTS

Mean age of the participants was 22.30 +- 1.27 years; 39 (38.2%) cited Norplant(R), 30 (29.4%) condoms, 17 (16.6%) intrauterine devices (IUDs) and 16 (15.7%) oral contraceptives (OCs) as the methods they would consider using for contraception in the future.

Participants' mean CTCI scores compared with the choices they made are shown in Table 1.

The mean scores for self-directedness (chi^sup 2^^sub K-W^ = 9.12) and self-transcendence (chi^sup 2^^sub K-W^ = 9.99) differed statistically significantly between the groups (p < 0.05). Subjects who said they would choose OCs had higher mean scores for self- directedness than those choosing IUDs (U= 66.00), while the mean self-transcendence scores of those who would choose IUDs were significantly higher than those choosing condoms (Z=2.82, p < 0.01; Table 1).

Table 1 The distribution of mean scores obtained from the Temperament and Character Inventory subcomponents in relation to contraceptive choices

The distribution of the reasons for participants choosing a contraceptive method is presented in Table 2. Participants choosing Norplant(R) cited ease of use (87.2%); those choosing condoms cited their having fewer side effects (66.6%), those choosing IUDs cited their high level of safety (94.1%), while those choosing OCs gave the ease of use and high reliability of the method (68.7%) as the reasons for their choice.

DISCUSSION

The choice of a contraceptive method is a complex matter. Decisions regarding contraception are determined by a wide variety of psychological, social and cultural factors, related, for example, to perceptions of the advantages and disadvantages of available methods and perceived norms in the social environment11.

In Turkey, 74.5% of married women educated to high school level or above apply contraceptive measures; for 52.2% this is a modern method, while for 22.4% it is a traditional one. Among modern methods, the most commonly used are condoms (21.3%) and IUDs (19.4%); withdrawal (19.3%) is the most frequendy employed traditional method. Of those married women who do not employ any contraceptive methods, 47.4% would not consider using any method in the future, either. Of those who consider making use of a technique, 38% report IUDs as their method of choice12.

The frequency of contraceptive use among Turkish female health workers varies between 69.5 and 90.2% according to different studies. In 83.2-100% of the cases, these health workers resort to an effective method, the most common ones being IUDs and condoms13- 15. In the Ankara provincial centre, among female university graduates, the frequency of contraceptive use amounted to 83.5%, the frequency of using an effective technique was 75.3%, and the most popular choices were IUDs and condoms16.

The participants consisting of young adult health personnel in this study and their having an in-depth knowledge of the techniques seem to have been influential in the contraceptives they elected to use in the future, Norplant , condoms, IUDs and OCs, in that order. None of the participants chose a traditional technique. Although, on a worldwide basis, use of withdrawal is nowhere as frequent as in Turkey , no participants in this study selected that method. This may be because participants were all health workers. On the other hand, as withdrawal simplifies women's lives and husbands have an impact on the choice of contraceptive method, the participants in this study might still use this method in the future . It has also been reported that there may be a discrepancy between women's priorities and their choices18. However, consistency between priorities and the method employed is higher among women who have discussed contraception with a health care provider18. Further studies are needed to evaluate the consistency between current choices and the method that will be used in the future.

Table 2 The distribution of the reasons for participants choosing various contraceptive methods*

In the present study, the mean score of self-directedness was found to be higher in women who chose OCs than in those who chose IUDs or other methods, and this is understandable. Indeed, oral contraception necessitates taking responsibility; other people are not involved and it is a safe technique. Compared with other methods, the responsibility lies more on the shoulders of the women. An IUD requires the involvement of another person for its insertion. Apart from the (very questionable) need to control the presence of the strings, the woman wearing an IUD must not do anything.

High self-esteem has been reported to be significantly correlated to the effective use of contraceptives among young women . Kaemingk and Bootzin determined that self-efficacy influenced contraception in general and condom use in particular . Adler reported that a sense of control, self-competence and self-efficacy characterized young people who used contraceptive methods effectively . OCs are most efficiently used by women who are more responsible than their husbands, but who are also compatible with them . Successful use of the IUD appears to be hindered by emotional conflict . The finding of lower self-transcendence scores among participants who stated that they preferred IUDs supports this assertion.

In the present study, the mean score of self-transcendence was found to be higher in women who chose IUDs than in those who chose condoms. Use of condoms for contraception necessitates active participation on the part of the male, protects against STIs, is free of side effects and is not harmful to women's health. Individuals who self-transcend are absent-minded, insightful, unpretentious, believing individuals with spiritual feelings; those with low scores for self-transcendence are arrogant and not creative, they cannot tolerate ambiguities or surprises, they try to control everything, are materialistic and rarely inclined to make sacrifices . It is therefore not surprising that subjects who chose condoms had lower selftranscendence scores than those making other choices.

Two studies were performed in the Samsun provincial centre. In the first study, when married midwives working at health posts were asked why they had chosen the method they were using, they said that it had few side effects, that it provided effective contraception and that it was easy to use . In the other study, married women using OCs, IUDs and condoms reported ease of use as the reason behind their choices . In a study by Uner et at., ease of use, safety, efficacy and paucity of side effects were given as reasons for choosing the methods employed22. Efficacy, STI prevention and having few side effects were, in that order, the most considered points in the choice of contraceptive methods among young women. While efficacy was reported as the reason for OC use, IUDs were preferred for being easy to use and condoms for their health advantages, according to different studies23-25

In this study, reliability, ease of use and limited side effects were prioritized among the reasons behind the choices made. The confidence shown in the methods in our study group may be due to the participants all being health workers. It is interesting that the answers given to the question asked to identify the most important element in choosing a method were similar, although the choices made differed. It has been reported that users of a given contraceptive method users magnify its efficacy and believe it to be the most effective . Despite many similarities between women and men in their perceptions of contraceptives, various differences may have an important influence on the selection a method23. It is thought that as women have similar feelings about contraceptive methods, minor differences may affect the choice made. Kurtner reported that contraceptive choice is determined as a result of an interaction between the method and the personality of the user . Although women's feelings on the subject of contraceptive methods were similar, the differences in the choice of method may be due to differences in temperament and character.

The effects of family planning methods are not only related to how widely they are used, but also to how effective they are. The method individuals choose to use and the one they actually use may not overlap all the time for various reasons. Furthermore, people may cease to use their method of choice for a variety of reasons1 . The identification of the effects of temperament and character in the decision regarding contraceptive choice may be of help in making the use of the technique more widespread and in efforts to make its use effective and regular. REFERENCES

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Servet Aker, Omer Boke*, Cihad Dundar and Yildiz Peksen

Departments of Public Health and * Psychiatry, Ondokuz Mayis University School of Medicine, Samsun, Turkey

Correspondence: Dr Server Aker, Department of Public Health, Ondokuz Mayis University Medical School, Samsun, Turkey.

Tel: + 90-362-3121919/2728. Fax: + 90-362-4576041. E-mail: saker@omu.edu.tr

Copyright Taylor & Francis Ltd. Dec 2007

(c) 2007 European Journal of Contraception & Reproductive Health Care. Provided by ProQuest Information and Learning. All rights Reserved. The Effects of Temperament and Character on the Choice of Contraceptive Methods
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