الفهرس 
INTRODUCTION
Family Planning in EgyptOnly 14 pages are availabe for public view
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Abstract
Family planning is critical for the health of women and their families, and it can accelerate a country’s progress toward reducing poverty and achieving development goals(Fahimi et al., 2012). It was found that the information that women receive from their providers about contraceptive methods was an important contributing factor to the underuse of contraceptive methods by women (Moos et al., 2003).
Poor communication between providers and patients about contraceptive methods may be due to the providers’ incomplete knowledge of evidence-based information about contraceptive methods (Rowlands, 2009). Several studies have suggested that provider knowledge is in fact deficient in some aspects of contraception (Harper et al., 2008; Ibrahim et al., 2013).
This study aimed to identify the level of knowledge of the family planning physicians about different contraceptive methodsand to identify their attitude towards offering different contraceptive methods to family planning clients.
Research design:
A descriptive cross-sectional study.
Setting:
Public sectorFPphysicians offering family planning services at 261 primary health care units of Assiut Governorate were recruited during attending the monthly meetings of family planning sector in Assiut 13 different directorates. At least one physician from each site offering family planning services is invited to attend the meeting.
Participants were also recruited from maternal and child health centers (MCH) of Assiut city, to compensate for their absenteeism from the family planning sector monthly meetings.
Tools for data collection:
The tools used for data collection consisted of semi-structured self-administered questionnairedetailing:
a. Participant demographics (age, sex, marital status, residence, qualification and years of experience).
b. Knowledge of family planning physicians about the eligibility of women to use different contraceptive methods and the correct use and side effects of different contraceptive methods.
c. Attitude of family planning physicians towards recommending different contraceptive methods to family planning clients, contraceptive methods use, effectiveness and safety and comfort in discussing contraceptive use with the clients.
Main results:
Sociodemographic characteristics
A total of 250 physicians were included in the study. Most of the studied physicians were females (60.4%). The majority were general practitioners and only (12.4 %) were specialists. Two thirds of them (67.6%) were working in rural health units.
Knowledge about contraceptive methods
Large percentages of the studied physicians had some misconceptions about COCs, such as the contraindication to use COCs for women with hypertension, even if controlled, and for women with varicose veins. Also, the majority (80 %) had the misconception that COCs increases the body weight of the users.
Moreover, despite that most physicians rejected the possibility of POPs to cause abortion, congenital anomalies, osteoporosis, ectopic pregnancy, infertility or cancer, still some physicians had these misconceptions or didn’t know whether POPs could cause such complications.
The most frequent misconception physicians had about Implanon is its association with increasing body weight as 59.6 %of them agreed that it shouldn’t be used by obese women and 17.2 % of them didn’t know.
The majority of respondents(93.2 %) had heard about emergency contraceptives, the most common source of information was the university education and 79.8% knew that EC is legal in Egypt.
Only (4.7 %) knew that EC works by preventing both ovulation and implantation and only 39.9% knew the correct effectiveness rate of EC.
from the physicians who had ever heard about EC,39.1% of them did not know the common side effects of EC, and the most frequently mentioned side effect was nausea/ vomiting, despite being mentioned by only (29.2%), 63.5% correctly mentioned that there is no contraindication to use, only 28.8% knew that there is a recommended medication with EC use, and only 41.8 % of them knew that antiemetic should be recommended for concurrent use with EC.
Most physicians knew correctly that IUD don’t increase the possibility of infertility (74.4 %). However, less than half of the physicians (40 %) knew that IUD don’t increase the possibility of PID.
Only 16.8 % of FP physicians knew the correct effectiveness rate of natural FP methods.
It was found that physicians had high knowledge scores about IUD and causing infertility, contraindication of using COCs in case of migraine and the use of progesterone only injectable by lactating women.
It was also found that physicians had least knowledge scoresaboutthe use of COCs by hypertensive women (even if controlled), the use ofCOCs in case of varicose veins and the duration of effectiveness of EC after unprotected intercourse.
Attitude towards contraceptive methods
The majority of participants(86.8%) believed in safety of IUD, effectiveness (86 %), and (82.2 %) agreed they don’t feel embarrassed to recommend IUD for women. However, most physicians restrict IUD insertion to menstruating women.
There are many misconceptions about recommending IUD insertion among women of reproductive age considering different eligibility criteria, women less than 20 years of age(49.2 %), women with history of ectopic pregnancy (34%), women with history of PID(40%), women with history of STDs(18.4 %) and women with no history of previous pregnancy(22.8 %).
Only 31.2 % of physicians considered that EC is a safe contraceptive method, 59.2% agreed that EC are less effective than other contraceptive methods and only 21.6% considered that EC is a suitable contraceptive method for Egyptian women.
Only 68 % neither agreed nor disagreed that the use of EC would decrease the use of other more effective contraceptive methods, 82.4 % neither agreed nor disagreed thatits use would increase the risky sexual behaviours, 82.2 % disagreed that it should be available without prescriptionand 71.6% were neutral about not recommending EC for moral or religious reasons.
When clients asked FP physician about the natural FP methods, 64.8 % of them gave the clients information about all methods. Mid-cycle intercourse is the most frequently recommended natural method by physicians for getting pregnant.
Training needs
Half of physicians who had previously received FP training received only one training. IUD was the most frequent method included in the last training (87%), followed by COCs (79.3%) and the injectable (74.1%).Most physicians (81.3 %) mentioned that they benefited from the trainings in practice.
Most of physicians (71.2 %)mentioned that they need further training. The most frequently required methods in the trainings were Implanon (70.8 %), EC (58.4 %) and IUD (57.9 %).
Factors affecting knowledge about contraceptive methods
In bivariate analysis, female physicians, physicians who worked in district or general hospitals, physicians who worked in urban areas, previously receiving FP training and receiving the training within the last year were significant factors with higher knowledge scores.
The results of regression analysis of the predictors of the higher FP physicians’ knowledge scores about different contraceptive methods found that training within the last year before data collection and working in urban areas were the only significant predictors.
In conclusion, a considerable proportion of family planning physicians working in the public sector of Assiut Governorate were found to have insufficient, out of dates information and negative attitudes towards different contraceptive methods.
This study recommends continuous education and in- service training about the up-to-date eligibility criteria of using different contraceptive methods and dissemination of evidence-based guidelines, such as the WHO medical eligibility criteria.