Socioeconomic and cultural factors affecting family planning among families of thalassemic children in Southern Iran

Socioeconomic and cultural factors affecting family
planning among families of thalassemic children in
Southern Iran

Sheyda Johari MD , Mehran Karimi MD*
. Fasa School of Medical Sciences, Fasa, Iran.
. Thrombosis and Hemostasis Unit, Hematology Research Center, Dept. of
Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.







*Corresponding author:
Mehran Karimi, M.D.,
Associate Professor of Thrombosis and Hemostasis Unit,
Hematology Research Center, School of Medicine,
Shiraz University of Medical Sciences,
Shiraz, Iran.
Tel: #


Fax:

---

E-mail: Karimim@sums.ac.ir
ABSTRACT
Objective: Preventing of having thalassemic children depends on many factors. In
this study the effect of socioeconomic and cultural factors on family planning among
families with thalassemic children were discussed.
Methods:
parents having thalassemic children (
mothers and
fathers)
entered our study. A questionnaire was administered to determine the following:
demographic information, number of thalassemic children in family and their birth
order and use of family planning methods.
Results: Approximately
of parents were practicing contraception at the time of
research. Just
of families who the first child was thalassemic have no tendency
to have more children.
Conclusion: It seems that having a thalassemic child has no effect on family tendency
to have or not have further children.
Keywords: Socioeconomic and cultural factors, family planning, thalassemia,
Southern Iran

---

Introduction.
The thalassemias are a group of inherited recessive disorders in which defect in
synthesis of globins polypeptide chain of hemoglobin is present, that was not
recognized as a clinical entity until
. About
of the world's population (

million people) carries β-thalassemia gene.
The factors that affect on the kind of used methods in family planning are socio
economic and cultural factors, parents educational levels and their having occupation
or not, cultural ideas about number of children and even masculine or feminine state.
Having thalassemic children has no effect on this. In a research done by Han et al.,
% of participants used family planning methods.
This study was undertaken to investigate the role of having thalassemic children in
relation to socioeconomic and cultural factors affecting family planning.

---

Methods.
From March
to March
,
parents, who had thalassemic children
outpatient clinic, affiliated to Shiraz University of Medical Sciences were participated
in our cross-sectional study. A questionnaire was provided including information
about age, sex, degree of relationship to the index case thalassemic patients, birth
order, number of healthy and thalassemic children in family, socio economic and
cultural status of the family, residential area, use of family planning methods and
types of the methods.
The questionnaire was filled by a constant doctor and a written consent was provided.
Chi–Square was used for statistical analysis and a P value <
was considered
statistically significant.

---

Results.
Among the parents,
were mothers and
were fathers. In mothers group, most
were between
-
years old (reproductive age), that showed the importance of
information about family planning methods among this age group.
of the
parents used family planning methods at the time of research (
of fathers and
of mothers). Percentages of using of different methods of contraception were
shown in Table .
Making use of different methods of family planning had significant correlation with
educational level of parents. (P value=o.oo ). In the illiterate group, tubal legation
(TL) was the most frequent type of family planning (
) but in the educated
group, it was oral contraception pills (OCP) (
).
Making use of different methods of family planning also had significant correlation
with the number of children in families (P value= .oo ). In families who had less than
children, OCP was the greatest method of family planning (
%), but in families
with more than children, TL was the most frequent one (
). The frequency of
number of thalassemic children in families was shown in Table .
The number of thalassemic children in families had significant correlation with
educational status of mothers (that to be illiterate or educated and the level of their
education) (p value<
). But hadn't such correlation with educational level and
occupation of fathers (P value=
). This is true about number of children in
families.
of families in which the first child was thalassemic have no tendency
to have more children. In families that had the second thalassemic child despite of
having a healthy child, tendency of having further pregnancies was
.
of

---

families in which the rd child was thalassemic, had children. Having children
among families with the th child thalassemic, was
.
The less the economical status of the family, the higher the number of thalassemics
was in the family (p value=
). In families with incomes less than
-
$ per
month, the number of thalassemics was more than families who had more than
$
monthly income.
But the number of thalassemics in family hadn't significant relationship with
residential area (village, town, city,…).

---

Discussion.
Decision regarding child birth are often complex, even in the absence of thalassemia.
However issues in thalasemia, like those of the other genetic diseases, require
consideration of family experience with the disease and the ethnic and cultural issues
that affect reproductive choices. Psychosocial problems need to be handled carefully
because of the diversity in culture, religion or ethnic background, and the organization
and characteristics of the health care system, cultural and religious beliefs, knowledge
and previous experience with the disease and pressure from the partner and the family
influence on the perception and attitudes towards reproductive choice and child
bearing. In one research done by Gamberini et al., it was found that the couples
segregating for cooleys’ anemia, before knowledge of the risk, had a higher
reproductive rate than that of control couples. Knowledge of the genetic risk had a
different effect on reproductive behavior in the
s from that in later years.
The difference was attributed
th to the influence of cultural factors and to technical,
therapeutic and diagnostic advances.
Among most of the families, having thalassemic children regarding many problems
with a thalasemic child (psycho economico social problems, frequent transfusion…)
and with the risk of having thalassemic children in further pregnancies, there was
tendency to had further children. Result showed the role of mothers and their
educational level in decreasing the thalassemia in the society. Mothers' educational
level was correlated with making use of family planning methods.
This implies the role of cultural factors in Iran society .In Islamic culture of Iranians ,
having more children and especially "son" is very important, and factors like
belonging to low socio economical level and having psychiatric problems couldn't

---

prevent birth of more and more children in families (even thalassemic children in the
family).
This indicates the importance of training and increasing the socio cultural level of the
society such as Iran.
Acknowledgement. The authors would like to thank the Office of Vice
Chancellor for Research of Shiraz University of Medical Sciences for financial
support and Dr. Davood Mehrabani, the Center for Development of Clinical Studies
of Nemazee Hospital for editorial assistance.

---

References
. Lukens JN. The thalassemias and related disorders: Quantitative disorders of
hemoglobin synthesis. In: Wintrobe's Clinical Hematology.
th Edition.
Lippincott, Williams and Wilkins,
.
. Han E, Han AM, Myint T. Thalassemia in the Outpatient Department of the
Yangon Children's Hospital in Myanmar: Knowledge, attitudes and practice in relation to
thalassemia. Southest Asian J Trop Med Public Health
;
:
-
.
. Kadir RA, Sabin CA, Goldman E, Pollard D, Economides DL, Lee CA.
Reproductive choice of women in families with haemophilia. Hemophilia
; :
-
.
. Gamberini MR, Lucci M, Vullo C, et al. Reproductive behavior of familial
segregating for Cooley's anemia before and after the availability of prenatal diagnosis.
J Med Genet
;
:
- .

---

Table - Percentages of using of different methods of contraception in families who
have thalassemia patients
Methods of contraception
frequency
Percent
TL


Ocp


Vasectomy


Norplant


Age (post menopause)


Withdrawal


Total



. TL=Tubal ligation, . OCP= Oral contraceptive pills

---