A study on assessment of unmet need and contraceptives practices adopted among currently married females residing at urban slums of Ahmedabad

INTRODUCTION

Globally; family planning is promoted as a mechanism to address the reproductive health needs of men and women, as well as the crucial challenge of rapid population increase.¹ Family planning is a practice by which a couple space the number of years between each child they want to give birth, through the use of contraceptive methods.² India, with one of the world’s fastest growing populations, is a nation very much in need of contraceptive counseling.³ Each year, more than 208 million pregnancies occur worldwide; 185 million occur in the developing world alone. More than 40% of pregnancies worldwide are unintended. There are approximately 40 million women in India who would prefer to avoid becoming pregnant but are not practicing any form of contraception.⁴ In spite of increased use of contraceptive, almost 50% pregnancies are unplanned and almost 60% pregnancies result in abortion.⁵ Lack of awareness, knowledge and education, religious beliefs and fear of side effects are the main causes why women do not use family planning methods.⁶ Further, the levels of unwanted pregnancy have been quite high in India among married young women.⁷

Present study was aimed at focusing contraceptive practices of females in early reproductive age and females who are in late reproductive age group for better understanding of unmet need of contraception in both these groups. Females in early reproductive age are most of the time unaware about availability of various contraceptive methods and have unplanned pregnancies. In late reproductive age group, females are attaining menopause and having irregular cycle which may lead to unwanted pregnancy if they are not using any contraceptive methods.

Present study was carried out with objectives of assessing unmet need, knowledge and attitude towards family planning as well as contraceptive practice among early and late reproductive age group females.

METHODS

A cross- sectional type of study was carried out during September to December 2019.Study participants were females residing under the urban field practice area of one of the medical Colleges of Ahmedabad. Females of 18 to 25 years of age were considered as early reproductive age group (Group 1) and 35 to 49 years of females were selected as late reproductive age group (Group 2).⁸

Sample size

In Gujarat prevalence of contraception usage among reproductive age group is 66.6%.⁹ Considering P=66.6%, q=33.4% and 10% allowable error, sample size of 200 was calculated using formula 4pq/l2.¹⁰

Inclusion criteria

Currently married females from early (18 - 25 years) and late (35 - 49 years) reproductive age groups and those who gave verbal informed consent for participation in the study were included in the study.

Exclusion criteria

Widow and living separate from her husband, females who had attained menopause, currently married women not in active married life in last 6 months due to any reason, female with history of hysterectomy were excluded from the study.

Operational definitions

Family planning

A way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decisions by individuals and couples, in order to promote the health and welfare of family group and thus contribute effectively to the social development of a country.¹¹

Study method

After obtained essential permission from Institutional Ethics Committee, a house to house survey was conducted in the field practice area till the required sample size of 200 was achieved. Data was collected by interview method using pre-designed and pretested questionnaires. Proforma includes questions regarding socio-demographic and obstetric profile of study participants. Knowledge about family planning objectives and various methods, attitude and practice of contraception as well as unmet need related questions were included in the proforma.

Knowledge about various aspects of listed objectives of family planning was assessed to avoid unwanted births, to bring out wanted births, to regulate the intervals between pregnancies, to control the time at which births occur in relation to the ages of the parent and to determine the number of children in the family.¹¹

It was consider as no knowledge if study participants don’t know or knows only one objectives of family planning, those who knows 2 or 3 objectives then it was taken as partially correct. Knowledge of more than 3 objectives was considered as correct. Females who are willing to use any kind of family planning method was considered as having positive attitude towards family planning.

Data entry and analysis

Data was entered in M S Excel and analyzed using IBM SPSS statistics for windows, version 20.0. Armonk, NY: IBM Corp. (Statistical Package for the Social Sciences). Frequency and percentages was used for descriptive analysis and Chi square (χ2) test was used as statistical test for finding out significance level.

RESULTS

Mean age of participants was 23.6±1.6 years and 39±4.05 years among early and late reproductive age group, respectively. Out of 200, 84.5% females were unemployed. Most of them were living in joint family. Around 51% females were belongs to lower middle socioeconomic class according to modified B G Prasad classification (Table 1).

On assessing the obstetric history of study participants, it was revealed that, around 93% of early reproductive age group women had no history of abortion. Among late reproductive age group women 4% had history of abortion. In late reproductive age group, 44% were having 2 living children, and 40% of early reproductive age group was having 1 living child. Around 75% women from both age groups desired to have at least 2 children.

*As per modified BG Prasad classification Consumer Price Index for August 2019= 320.¹²

Among both age groups, percentage of females having partially correct knowledge was almost similar. Numbers of female having correct knowledge were more in late reproductive age group (45%) (Figure 1).

There was significant difference among both groups in context to knowledge about side effects of various contraceptive methods and incentives given for permanent contraceptive method was concerned (Table 2).

In present study, 78% of group-1 and 85% of group-2 females had positive attitude toward family planning practices. Total 71% and 79% women of group one and two respectively desired to have at least 2 children. Around 70% and 64% females of early and late age group respectively, were willing to attend family planning counseling session. In group one 22% and group two 23% women believed that they had adequate knowledge of family planning.

Total 45% and 55% of early and late reproductive age group respectively, females were currently using contraception. Most common method used by early group 1 women was Intra Uterine Devices (35.5%), followed by Oral Contraceptive pills (31.2%) and in other group was permanent sterilization (74.5%) followed by barrier (9.1%) and Intra Uterine Devices (9.1%). None were using any injectable contraceptives in both age groups.

‘No contraceptive is required’ was the commonest reason among current non users of both groups. Higher number of females in early reproductive age (30.9%) mentioned that, they were unable to decide suitable contraceptive method for them (Figure 2). Among the past users, most common reasons behind discontinuation of family planning methods were occurrence of side effects and desire for child. Common side effect felt among OC pills users was weight gain (23%) and among IUD users was Heavy bleeding (31.2%). Among both groups none had given history of failure of contraception in the past.

Unmet need of family planning was 29% and 18% among early and late reproductive age groups, respectively. No statistical significant difference was found for unmet need of family planning among early and late reproductive age group women (Table 3).

Among early and late reproductive age group women common reason of unmet need of family planning were lack of clarity (69%) and fear of adverse effects (67%), respectively.

DISCUSSION

In present study 44.5% women were in 22-25 years of age group, similar results was seen in studies conducted by Brahmbhatt et al, Srivastava et al, Querishi et al and Thapap et al studies.^13-16 It was observed that 47.5% women were educated up to secondary level in this study. Similar result was found in study of Brahmbhatt et al, Qazi et al while in Gupta et al, 43.4% women were study up to primary school.^13,17,18 In the study carried out by Pegu et al, 26.5% were illiterate. In present study 84.5% women were housewives and same result obtained in Thapa et al.^16,19 Around half of study participants belonged to lower middle class in present study. Similar finding was there in the study carried out by Qazi et al (56.58%).¹⁷ In the Gupta et al, 37.2% belonged to lower middle class.¹⁸

Among study participants, 54% had partially correct knowledge about family planning objectives. Similar result was noticed by Qazi et al.¹⁷ In present study 96.5% of females had knowledge about various methods of family planning, similar findings were found by Qazi et al (94%), Shukla et al (91%), Thapa et al (92.3%).^16,17,20 Reason behind uniformly higher level of knowledge about various family planning methods can be easy availability of information through mass media and education.

In this study, 81.5% females from both age groups had positive attitude toward family planning practices, similar results were found by Gupta et al.¹⁸ Percentage of females having positive attitude were quite high (91%) in the study conducted by Thapa et al.¹⁶ In study of Pegu et al, 48.5% of women and and 51.5% of men showed positive attitude towards family planning.¹⁹ Dissimilarities in the attitude towards family planning as compared to other studies can be because of difference in socio cultural practices.

Most common method practiced by late reproductive age group was permanent sterilization followed by Intra uterine devices. In early reproductive age group most practiced method was Intra uterine devices followed by Oral contraceptive pills. In other studies most common methods used was condom.^16-20 In present study, main reasons found among non-users from early age group women was unable to decide what to use. Among early and late age group females, 38.1% and 46% felt no requirement for contraception, respectively. In this study 25% of study participants felt side effects, similar findings was found by Thapa et al, while 50% participants felt side effects in the study of Qazi et al.^16,17

Unmet need of family planning was 29% and 18% among early and late reproductive age group, respectively in this study. Commonest reason behind unmet need of family planning was lack of clarity and fear of adverse effect, respectively among early and late reproductive age group women. As per NFHS - 4 survey, 17% of unmet need is found for Gujarat state.⁹ Vohra et al who conducted their study at Rajasthan, 35% unmet need of family planning was found.²¹

CONCLUSION

Correct knowledge about objectives as well as practice of family planning methods was high among late reproductive age group as compared to early age group. However, over all knowledge was not satisfactory in both the groups. Only half of the females from study area were currently using any kind of contraception. IUCD and OC pills were most common methods used by majority of early reproductive age group, whereas permanent sterilization was found to be more common among late reproductive age group. Most common reasons behind not using contraception were lack of awareness and fear of side effect.

Recommendations

Unmet need of family planning was higher among early reproductive age group. Findings suggest that, there is a need to focus on family planning aspects among the study group. Females of early reproductive age group need to be given more attention while addressing the issue of family planning. There should be emphasis on awareness programs regarding family-planning, based on bridging the knowledge gaps among the women in reproductive age group which can leads to decrease in unmet need of family planning.

Funding: No funding sources

Conflict of interest: None declared

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

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