A cross sectional study on knowledge, attitude and practice of family planning method usage among urban women of Dr. B. R. Ambedkar Medical College field practice area

INTRODUCTION

Since 1952, national health program of India has been emphasizing on family planning to reduce birth rates, stabilize population, reducing maternal, infant and child mortality and morbidity.¹

One of the method by WHO expert committee to evaluate success of family planning programme, is evaluation of knowledge, attitude and behavior among people towards family planning methods as they can determine adoption of family planning methods.²Karnataka is 8^th largest and 9^th most populated state in India with population of 66.1 million (2016).³

In some studies it was observed that Indian women are dependent and constrained from using the family planning methods due to cultural practices.⁴ Studies have also shown that acceptance of family planning method is associated with increasing age, family type and literacy level.⁵

According to some studies, usage of family planning method was influenced by age of women at time of marriage and first child, spacing between births, literacy level, religious attitude, and embarrassment to discuss about birth control methods.⁴

More than 100 million women in developing countries or about 17% of all married women would prefer to avoid a pregnancy but are not using any form of family planning.²

With an objective to understand the various factors influencing usage of family planning methods this study was conducted in urban field practice area of Dr. B. R. Ambedkar Medical College and Hospital.

METHODS

It was a community based cross-sectional study, conducted in Kacharakanahalli, which is urban practice area of Dr. B.R. Ambedkar Medical College, Kadugondanahalli, Bengaluru-45. It comprises of about 14,646 population out of which there were 7168 females under reproductive age group. Married women in the reproductive age group of 18-45 years, who are residing in study area for minimum of 6 months duration were included in the study. But women who had already attained menopause were not included in the study.

This study was conducted in total duration of 3 months (April 2018 to July 2018). Ethical clearance for conducting the study was obtained from Institution ethics committee, Dr. B. R. Ambedkar Medical College and Hospital.

Systematic Random Sampling of the study population was done to select the participants who were interviewed after obtaining their consent. The objectives of the study were explained and the questionnaire was explained briefly before initiating face to face interview. The questionnaire comprised of totally 29 questions regarding socio demographic information of interviewee, 8 knowledge based questions, 3 attitudinal questions and 7 practice based questions.

At the end of interview session recommendations were made regarding various contraceptive methods and encourage its utilization. Knowledge regarding importance of contraception to regulate child birth and also to reduce maternal and neonatal morbidity and mortality was imparted. Myths regarding contraceptive usage and side effects related to it were also cleared.

The questionnaire was prepared in EpiInfo7 application, data entry was done to obtain the spreadsheet in MS-Excel software and further statistical analysis was done.

RESULTS

This study was conducted in 416 married women of urban field practice area of Dr. B. R. Ambedkar Medical College and Hospital, which is located approximately 2 KM away from the main center at K.G Halli.

Demographic information of the study population is described in Table 1.

In this study it was found that 88.7% (369 women) of women knew that limitation of birth and spacing could be done using various family planning methods.

Various contraceptive methods known to study population are described in Figure 1. Though contraceptives like vaginal condom, implants, emergency contraceptive are old but just 4.3%(18 women), 2.6%(11 women) and 13.6%(56 women) respectively knew about it. Injectable contraceptive is the recently released and well-advertised type of contraceptive method and 13.9%(58 women) women in study were aware of it.

In this study population it was also observed that majority 213(51.2%) of the women considered family planning as a method for limitation of birth only. Whereas just 103(24.8%) of the women knew that it could be used for limitation of birth and spacing between pregnancies.

It was noticed that 397(95.4%) of the women were aware that a family should have less than 2 children and 245(58.9%) women preferred spacing of 3 to 4 years.

Source of information for the awareness regarding various contraceptive methods, family size and duration for spacing between two pregnancies among most of the mothers was health centers 288(69.2%) followed by media 269(64.7%). They also gained information from other means 83(20%) like by discussion among family members and peers, as a part of training sessions.

Table 2 shows total number of women being aware of types of contraceptives (family planning method) and number of women practicing the specific method.

In this study it was found that there were 22.1%(92) women who had heard about complications due to using of contraceptive from family and friends, out of whom 61% believed that using IUCD like Copper T could cause perforation in uterus, irregularities in menstruation (excess bleeding), white discharge per vagina, hypertrophy of uterine muscles, etc. nearly 35% women heard problems due to OCP like- obesity, mastalgia, abdominal pain, irregular menstruation, etc.

Some common complications occurring due to usage of various contraceptive methods are- backache, menstrual irregularities, abdominal pain, obesity, lethargy. But, 67.5% of the women had never heard regarding complications arising due to usage of contraceptive methods. Details are described in Table 3.

Out of 22.1% women aware of complications due to contraceptives, 60.9% women believed that Intrauterine devices caused complications and 34.8% believed that oral contraceptive pills could cause complication after their usage.

On enquiring from where these services can be availed, very few (5 women) knew that these services could be availed from Anganwadi too, other responses are shown in Table 4.

In this study it was observed that 142(34.1%) of women were willing to change the contraceptive method which they were currently using. After briefly describing each contraceptive with its duration to provide safety, further 178(47.5%) of women expressed desire to change family planning method or start using one in future.

Various reasons for not willing to change or utilize contraceptive methods are described in Table 5.

Most common reason for not utilizing contraceptives at all or not continuing to use was that its usage was uncomfortable [76.6% (95 of the women)] and other reasons are described in Table 6.

Among the women under study, 131(44.8%) women have used permanent method that is tubectomy. There are 136 (46.6%) of women using condom as family planning method which is most common method and oral pills were used by 118(40.4%) women. Other details of Contraceptives utilized is depicted in Table 2.

They gained information regarding these methods from doctors, either at the time of ANC checkup or at post-partum duration of stay in hospital.

In present study it was also noticed that some contraceptives had failed their purpose (10 women) and few women faced complications (30 women) due to its usage.

Majority (8 to 9 women) complained of weight gain, excess bleeding during menstrual cycles and feeling, drowsy after using contraceptive like OCP or IUCD. Other complications faced are described in Table 7.

DISCUSSION

Though fertility rates have reduced due to the efforts of activities under national family planning programme but, the fertility rates are still higher than the developed nations. With the recent advances in family planning methods and the widespread advertisements, the level of acceptance is expected to be improved, but studies show that there exists a wide gap between knowledge and acceptance of the contraceptives.

In a study conducted on socio economic determinant by Valecha SM et al, the awareness level and use of family planning method was compared, it was seen that even in the high level awareness group only 54.3% actually used contraception. Study also shows that awareness as well as use of family planning methods are affected by various factors such as age, education level, economic status and religion.⁷

In a study conducted by Nansseu et al, Ninety-six percent of these women had already heard about family planning. Almost all respondents (98%) were aware of at least one contraceptive method, the most cited being the male condom (96%), the safe period (86.1%), injectables (76.2%) and oral pills (75.2%).⁸

In the current study, it was observed that despite of 369(88.7%) of women being aware about contraceptive methods just 292(70.2%) had ever used contraceptive. In this study most popular family planning method known to participants was female sterilization (89.9%) followed by usage of condoms (83.2%), oral contraceptive pills (81.5%), and IUCDs (78.1%).

In another study conducted by Prateek et al it was observed that, 89.66% of the study subjects used temporary methods and 10.34% used permanent methods. Cu-T (41.37%) was most preferred method. Religion, education status and age at marriage were significantly associated with contraceptive usage.⁹

In current study it is observed that the percentage of women who ever used contraceptive is high among age group of 20 to 40 years (91.4%). And majority of women use contraceptives in their early 15 years of marriage (88.4%). According to a study conducted by Rajinder SB et al, it was observed that among 260 eligible couples, 71.79% of the couples aged between 30 -34 years and 65% contraceptive coverage was observed using at least one of the method of contraception.¹⁰

Religion is said to be one of the important determinant influencing acceptance and us of contraceptive methods in India. In this study majority of women who utilized family planning methods belong to Hindu religion (90.8%). Also in a study conducted in Uttar Pradesh in the year 2015, it was found that usage of contraception is 46% lower among Muslims compared with Hindus.¹¹

In another study conducted in 2016 by Rao BS et al, only 46% of study population had knowledge regarding family planning methods. Among whom 31% of women who had awareness were literate, and 69% were illiterate. But the literate couples would understand better and show willingness for contraception after counseling. This implies that apart from literacy status separate education regarding family planning is needed. A 43% of mothers opted to limit family size as 71% had already 2 children, 23.9% had 3 children and 5% had 1 child. In most of the families, final decision regarding family planning method was taken by husband alone or by elders. The main reason for non-usage of contraception was lack of awareness, followed by socioeconomic issues and gender issues.¹²

Educational status of women was found to be significant factor for knowledge regarding contraceptive. Women belonging to nuclear family had more knowledge and also had ever used contraceptive method compared to others. In this study it was also seen that, though majority of the women had unplanned pregnancy but most of them had restricted number of births to two or less than two children. In another study of Uttar Pradesh conducted by Singh A et al, it was observed that, highest percentages of respondents (women) were in the age group 35-49(40-45%) in all the districts considered for the study. and there was a highly significant association (p<0.01) of age group, educational status of respondents, the number of living children, the wealth of the respondent, media exposure and husband’s education with the variable KAP GAP for all six cities under study.¹³

The findings observed in other studies were similar to current study, except that in this study it was seen that women with greater parity had low usage of contraceptive as well as knowledge regarding the same. Some of the factors influencing usage of family planning methods in this study are: age of mother, occupation, religion, educational level of women under study, parity of women, number of living children, type of family, socio economic group, not comfortable to use, no family support, cultural factors, myths pertaining to contraceptive methods, previous painful experience.

Limitations

• • Study participants were reluctant to answer certain questions.
• • Details from husband regarding his view about contraception was not enquired.
• • Some of the questions were given multiple answers.

CONCLUSION

In this study it was observed that though women are well aware of various methods for family planning but most of them are comfortable using older methods like barrier methods. Since the number of women with knowledge regarding contraceptives is exceeding those actually using one of the contraceptive, despite of knowing the consequences of not using contraceptives, it shows poor attitude of study population towards family planning method.

In this study, some of the factors influencing usage of family planning methods were age of the mother, occupational status, religion, their marital duration and parity, elder’s opinion, socioeconomic status.

With the current cafeteria approach for encouraging usage of contraceptives further motivation is required through advertisement regarding newer methods and their advantages.

It was also seen that myths regarding complications are more than the actual women who have faced problem due to contraception usage. In this study none of the women had faced any serious complication. Most of the women were also hesitant to discuss regarding contraceptives, thus basic knowledge of contraceptives should be imparted in education system.

Male should also be aware of various family planning methods available for them and its advantages. Contribution of both men and women towards planning for family size would bring prosper and health to family and nation.

ACKNOWLEDGEMENTS

Authors would like to thank the participants for their co-operation during the sessions, supporting staffs who accompanied during the interview. The study was analyzed with the help of expert in biostatics, Mr. Puttaswamy M. and reviewed and furnished to current status by Dr. Jagadish S. Devaru.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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