INTRODUCTION:
Awareness, attitude and understanding of the
responsibilities of the residents of a nation towards their land constitute the
heart of its feasible growth and development. Out of all the issues, which
India is fighting in the current scenario, uncontrolled population growth is
the most important limiting factor, which halts the progressive development of
the nation. Family planning is the key
to slowing unsustainable population growth that has multiple negative impacts
on the economy, environment and maternal as well as infant health. Family planning refers to a conscious effort
by a couple to limit or space the number of children; they have through the use
of contraceptive methods [1]. WHO has defined family planning as
giving a chance to society to determine the number of children and pregnancy
spacing through contraceptive methods [2]. According to Tsehaye et al. [3]
maternal and infant mortality can be reduced by a minimum of 25% through
appropriate family planning programs and birth spacing in developing countries. India was
the first country in the world to implement a national population control
programme in year 1952 but is still struggling to contain the baby boom [4].
India ranks 2nd amongst the
world’s most populous countries with a birth rate of 19 births/1,000 population
and is projected to be the world's most populous country by 2024, surpassing
the population of China [5]. Many efficacious
methods of contraception, such as condoms,
pills, diaphragms, IUDs, implant, male sterilization (vasectomy), female sterilization
(tubectomy) are easily available.
Despite these many alternatives, the incidence of unwanted pregnancies still remains high in many
countries. According to Singh et al.
[6] 15·6 million abortions
(range 14·1 million–17·3 million) took place in India in 2015, giving an
abortion rate of 47·0 (42·2–52·1) per 1000 women aged 15–49 years. These findings give an impression that the majority of women are unaware of the need for contraception and many
have still not identified an ideal method of contraception, which fits their
lifestyle and meets their personal requirements [7]. Increased
usage of contraceptives during the postpartum period and spacing a new
pregnancy to at least 3 years after the previous birth substantially reduces
the rates of maternal and infant mortality by preventing unwanted pregnancies [8].
According
to Conde et al. [9], there
is an increased risk of maternal morbidity and complications in pregnancies
with women with short birth intervals (<24 months). Acceptance and adoption of contraceptive
practices can control unwanted pregnancies, thus reducing the potential
complications related to them, as well as have a significant positive impact
on women’s general health and quality of life due to their physical and psychological growth [10]. The
perception of family planning by women is also dependent on good knowledge and
has a great impact on their attitudes and practices [11]. Women
could potentially be benefiting from increased awareness and guidance on
contraceptive practices and can be assured that their chosen method is the best
suitable method according to their individual needs. Most of the reproductive
age women have little or incorrect information about family planning methods.
Even, when they are aware of some names of contraceptives, they don’t know
where to avail them or how to use them. In order to follow old traditions and
misleading information that is being passed in their family for generations,
women tend to have negative attitudes about their health problems, newer
techniques and the importance of family planning [12]. This study
was conducted with an objective to assess the knowledge, attitude and practices
(KAP) of family planning methods and various socio-demographic parameters and
enhance the contraceptive practices among the women in an urban area of
Haryana, so as to have a positive impact on
their beliefs regarding the use of
contraceptive methods.
MATERIAL
AND METHODS
Study
design and participants- It was a cross-sectional study conducted
in the area of Rohtak district, Haryana by the
Department of Pharmacology, Pt. B.D. Sharma, PGIMS, Rohtak, India from July 2019 to September 2019. The study participants were enrolled by conducting a
survey of both married and unmarried women
attending the Outpatient Departments (OPD) in PGIMS Rohtak, Haryana. Prior consent was obtained from the
participants before the interview.
Inclusion
Criteria- Women in the reproductive age group residing in that
area.
Exclusion
Criteria- Women, who refused to
participate in the study.
Study design-
A pre-tested; pre-designed questionnaire was used by the investigator to
interview the selected participants. A total of 260 women of reproductive age
group (16–50 years) were enrolled in the study and asked about the questions
included in the study. The
questionnaire had two domains, the first domain consisted of 7 demographic
questions and second domain consisted of 12 questions that assessed their
knowledge, attitude and practices of contraception.
The questionnaire included information regarding age, education, occupation,
religion, knowledge, attitude, practices towards various family planning
methods etc. The questionnaire was first validated by conducting a pilot study
on 30 women and the required changes were made in the proforma.
Statistical
Analysis: The collected data was entered into an excel sheet
and it was analyzed using percentage and test of proportions. The responses to
the schedule by each participant were entered into an
excel sheet. The data was tabulated and
statistical analysis done by using SPSS
(Statistical Package for the Social Sciences) software, version 23.0. This study was conducted to assess current levels
of usage and awareness of different forms of contraception, reasons for
choosing or changing methods and sources of information.
RESULTS: As
depicted in Table 1, mean age of the study participants was 26.3 years. The
most frequent age group was 25 to 29 years (44.61%). The
majority of the participants were literate (88.85%) and the rest of them (11.15%) were illiterate. Total 81.53% of the women belonged to the Hindu
religion. Among these women, 81.15% of the women were married and 18.84% of
them were unmarried. Most of the participants were housewives (45.76%) and
working (40%) and around 14.23% of the women were students.
Table 1: Demographic
characteristics of the study population
|
Characteristics |
n(%) |
|
Age (years) |
|
|
<20 |
14(5.38) |
|
20-24 |
83(31.92) |
|
25-29 |
116(44.61) |
|
30-34 |
34(13.07) |
|
35-39 |
4(1.53) |
|
≥40 |
9(3.46) |
|
Education status |
|
|
Literate |
231(88.85) |
|
Illiterate |
29(11.15) |
|
Religion |
|
|
Hindu |
212(81.53) |
|
Muslim |
31(11.92) |
|
Sikh |
11(4.23) |
|
Christian |
6(2.30) |
|
Marital status |
|
|
Married |
211(81.15) |
|
Unmarried |
49(18.84) |
|
Occupation |
|
|
Housewife |
119(45.76) |
|
Working |
104(40) |
|
Student |
37(14.23) |
Table
2 shows that the awareness of participants regarding contraceptive methods. Total
97.69% of women were aware of contraceptive practices and family planning and
2.30% women were unawareness about contraceptive practices.
Table
2: Awareness
of contraceptive methods
|
Awareness about contraception |
n(%) |
|
Yes |
254
(97.69) |
|
No |
6
(2.30) |
Table 3 shows the knowledge and
practices of various contraceptive methods. Most of the women were aware of
male condoms (94.23%) and 66.92%, 64.23%, 51.15% of the women knew about the
pills, tubectomy and intrauterine devices respectively. 50%, 44.23% and 30% of
the women were aware of calendar method, lactation amenorrhea and coitus interruptus respectively. Women were less aware of
the implants, diaphragms and female condoms. Also, 71.53% of women had gained
knowledge regarding contraception through TV, radio or newspapers, 58.07% of
women had gained knowledge through health workers and 53.07% of women knew
about contraceptive methods through family or friends.
Total 80.76% of the women availed the
contraceptives in pharmacies, 67.30% through hospitals and around 23.46%
through health workers.
Table 3: Awareness
regarding various contraceptive methods
|
Methods |
Awareness n(%) |
|
Lactation
amenorrhoea |
115(44.23) |
|
Calendar
method |
130(50) |
|
Coitus
interruptus |
78(30) |
|
Male
condoms |
245(94.23) |
|
Female
condoms |
51(19.61) |
|
Pills |
174(66.92) |
|
Diaphragms |
30(11.53) |
|
Intrauterine
devices (Cu–T) |
133(51.15) |
|
Implants |
40(15.38) |
|
Vasectomy |
93(35.67) |
|
Tubectomy |
167(64.23) |
|
Source |
|
|
TV/
Radio/Newspaper |
186(71.53) |
|
Health
worker |
151(58.07) |
|
Family/Friends |
138(53.07) |
|
Access |
|
|
Hospitals |
175(67.30) |
|
Health-workers |
61(23.46) |
|
Pharmacies |
210(80.76) |
As depicted in Table 4, 92.30% of women believed
that using contraception was beneficial, 73.07% of women encouraged their
family members to support contraception, 33.07% of women were embarrassed,
while buying or asking about contraception, 17.69% of women had difficulty in
availing contraceptives.
Table 4: Attitude
regarding contraceptives
|
Attitude regarding contraceptives |
n(%) |
|
Contraception
is beneficial |
240
(92.30%) |
|
Feel
embarrassment in asking about contraceptive |
86(33.07) |
|
Difficulty
in availing contraceptives |
46(17.69) |
|
Encourage
family members to use contraception |
190(73.07) |
As
depicted in Fig. 1, male condoms were the most common method of contraception
practiced by almost 38.07% of women, followed by pills used by 24.61% of women
and IUDs by 13.84%. Implants, diaphragms, female condoms were the least
practiced methods of contraception.
Fig.
1: Practice
of contraceptives
As
depicted in Table 5, most common side effect due
to contraceptive methods was weight gain observed in 13.07% of women followed
by bleeding (9.23%), acne (8.84%) and nausea (8.46%).
Table
5: Adverse
effects of contraceptives
|
Side effects experienced due to
contraception |
n(%) |
|
Weight
gain |
34(13.07) |
|
Bleeding |
24(9.23) |
|
Nausea |
22(8.46) |
|
Infection |
4(1.53) |
|
Acne |
23(8.84) |
As depicted in Table 6, 16.15% of women are not using
any contraception. Out of them, 3.84% of participants did not use any contraception
because they have no proper information or they want to conceive (4.61%) and
7.69% were opposed by family.
Table
6: Reasons
for not using any contraception
|
|
n(%) |
|
Women
not using any contraception |
42(16.15) |
|
Reasons |
n(%) |
|
Want
to get pregnant |
12(4.61) |
|
No
proper information |
10(3.84) |
|
Family
opposes |
20(7.69) |
As
depicted in Table 7, the majority of the working women and students have heard
of at least one family planning method and almost 90% thought that using contraception
is beneficial. Students and housewives were almost embarrassed at the same
level, whereas working women were least embarrassed (18.26%) regarding the
discussion of contraception. More than 70% of working women and students
believed in encouraging their family members regarding contraception, followed
by housewives.
Table
7: Knowledge,
attitude and practices of women according to their occupation
|
|
Housewives (n =119) |
Working (n =104) |
Students (n=37) |
|
Heard
of contraception |
113(94.95%) |
104(100%) |
37(100%) |
|
Contraception
is beneficial |
108(90.75%) |
99(95.19%) |
33(89.18%) |
|
Feel
embarrassment in asking about contraceptive |
51(42.85%) |
19(18.26%) |
16(43.24%) |
|
Encourage
family members to use contraception |
82(68.90%) |
81(77.88%) |
27(72.97%) |
DISCUSSION-
This
study evaluated the data of 260 participants, most of them (44.61%) were in the
age group of 25-29 years. 88.84% of the
participants were literate, 81.15% of the women were married and 81.53% of the women
belonged to the Hindu religion. Most of the participants were housewives
(45.61%) and working (40%) and around 14.23% of the women were students.
According to NFHS-4 around 99% of women in Haryana had knowledge regarding any
one of the contraceptive methods [13]. According
to this study, around 97.69% of women had heard of contraception. In the present study, the most common contraceptive used was
condom (38.07%), followed by pills (24.61%) and IUDs (13.64%). Implants, diaphragms, female condoms are the least
practiced methods of contraception which was also similar to the
study by Kashyap and Prasad [14] according to which most of the women were using male
condoms (55%) followed by oral contraceptive pills (OCPs) (26%), intrauterine
contraceptive device (13%). According
to the study of Nigar [15] barrier method (condoms) was in practice
by 26.8%, pills in 5.6%, Cu T users were 3.2% and 1.2% were using DMPA
(Depo-Medroxyprogesterone Acetate) for contraception.
Due
to their low cost, availability and convenience, oral pills and condoms are the
most preferred contraceptive methods [16]. In this study, it was
observed that the majority of women (71.53%) had gained knowledge regarding
contraception through TV, radio or newspapers, followed by health workers and
family or friends. This observation was also consistent with the study of
Kashyap and Prasad [14] according to which a major source of knowledge about family
planning methods was mass media (54%), health facility (42%), followed by
personal relations i.e. spouse, friends, and relatives (34%), and magazines
(21%).
In another study, most patients came to know about contraception from television,
doctors and other healthcare giver [17]. According to Sharma
and Valente [18] women, who was exposed to Radio programmes had
significantly discussed family planning with their spouse. In around 8% of women,
it was observed that the reason for not using contraception was an opposition
to the family or husband. In a study, it
was observed that wives are more likely to use contraception if their husband
approve of it, or couples discuss this topic which each other and plan
accordingly Lasee and Becker [19]. According to Hemavarneshwari et al. [20] around 7.2% of
women were opposed by family members. In this study, it was observed that
weight gain followed by bleeding (9.23%), acne (8.84%) and nausea (8.46%) were
the most common side effect associated with contraceptive methods. According to Thapa et al. [21], commonest side effects were weight gain and
menstrual irregularities followed by heavy bleeding (20.5%) and amenorrhea
(18.2%). According to this study, most working women and students believed in
encouraging their family members regarding contraception and were less embarrassed
in asking about contraceptive practices, followed by housewives. It has been
observed in various studies that more empowerment and education of women can
change their attitude and beliefs regarding their safety, health promotion and
could improve the use of contraceptives [21,22]. The adoption of
Family planning is not just related to control the birth rate, it is also
associated with programmes, policies, interventions, awareness, information and
practices which provide all the individuals with the ability to understand and
promote measures for better health outcomes [23]. Konkane et al. [24] mentioned that encouragement and a good knowledge of
healthcare workers, thus decreasing the fear of side effects and myths, and
counseling of husbands are very important to improve the perspectives regarding
contraceptive use among the population. The government needs to improve the
education provided by family planning healthcare workers [25].
CONCLUSIONS-
Occupation
and literacy are the utmost important factors for understanding of the concept
of family planning in the population. Family members play an important role in
supporting women for the adoption of family planning therefore the involvement
of family members during the counseling sessions should be increased, thus
limiting the myths and misbelieve regarding contraceptive practices.
Mass media and health workers played an
important role in educating women, the internet can be used or social media can
be utilized in this era to grab the attention of people regarding these
practices.
ACKNOWLEDGEMENTS- I
gratefully acknowledge Dr. M.C. Gupta and Dr Sarita Goyal. Their ever available
guidance, ability to pinpoint minor details, inexhaustible encouragement and
efforts on suggesting, designing, advising and improving the study has enabled
me to complete the study. I also acknowledge the participants for their support
and patience.
CONTRIBUTION OF AUTHORS
Research concept- Dr. MC Gupta, Dr. Sarita Goyal,
Dr. Sanjana Dawra
Research design- Dr. MC Gupta, Dr. Sarita
Goyal, Dr. Sanjana Dawra
Supervision- Dr. MC Gupta, Dr. Sarita
Goyal
Data collection- Dr. Sanjana Dawra
Data analysis and Interpretation- Dr. MC Gupta, Dr.
Sarita Goyal, Dr. Sanjana Dawra
Literature search- Dr. MC Gupta, Dr. Sarita
Goyal, Dr. Sanjana Dawra
Writing article- Dr. MC Gupta, Dr. Sarita
Goyal, Dr. Sanjana Dawra
Critical review- Dr. MC Gupta, Dr. Sarita
Goyal
Article editing- Dr. MC Gupta, Dr. Sarita
Goyal
Final approval- Dr. MC Gupta, Dr. Sarita
Goyal
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