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Contraceptive prevalence, attitude and choice of rural women of childbearing age in Jammu, India

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  • Save Public Health Research 2013, 3(4): 92-97 DOI: 10.5923/j.phr.20130304.02 Contraceptive Prevalence, Attitude and Choice among Women of Reproductive Age Group in a Rural Area of Jammu, India Rajiv Kumar Gupta*, Aruna Kumari Verma, Tajali N Shora PG Department of Community M edicine, GM C, Jammu, India Abstract Study Question: To find the prevalence of contraceptive use, unmet need and choice of contraceptive methods among reproductive age women in a rural area of Jammu d istrict. Materials and Methods: A descriptive cross-sectional study was conducted in a rando mly selected village in Miran Sahib zone of RS Pura block of Jammu d istrict .House to house survey was conducted and in each house currently married females of reproductive age group were interv iewed. A pre tested, pre-structured questionnaire was applied. The total population of village was 785. Overall 157 females were interviewed. Results: Majority of females (77/157) had t wo children while 42/157(26.75%) females had > 2children. 63.05% females opted for the two child norm. 83.43% o f females opined that the ideal gap between two ch ild ren should be >2yrs. 86% (129/ 157) wanted to adopt some method of contraception of which 70% (106/157) were using one or the other method of contraception hence unmet need of contraception came out to be16%. Tubectomy was the most preferred choice of family planning(36.79% ). Keywords Contraception, Couple Protection Rate, Un met Need 1. Introduction India has undergone fertility transition and important feature of this transition is the fact that contraceptive use has spread to even uneducated women[1] NFHS-III reports the prevalence of contraception as 56.3%[2]. The extent of acceptance of contraceptive methods and choice of contraceptive varies within societies .The factors for such varied picture operate at individual, family and co mmunity level with their roots in the socio-economic and cultural milieu of the Indian society[3]. It was envisaged in RCH-II to achieve a couple protection rate (CPR) of 53% as a short term strategic framewo rk, while CPR of 65% should be achieved by 2012 to reach all India total fert ility rate of 2.2[4]. It h as also been o bserved t hat add it io n o f one n ew contraceptive method would increase CPR by 12%[2] and availability of contraceptives at the hour of need is the major issue in addressing the unmet need in contraception. This co n cep t po in ts g ap b et ween wo men ’s rep ro d u ct iv e intentions and their contraceptive behavior[5]. Un met need rises as more wo men want to control their fertility but are not practicing any contraceptive method for one reason or the * Corresponding author: rajivguptagmc@redi (Rajiv Kumar Gupt) Published online at Copyright © 2013 Scientific & Academic Publishing. All Rights Reserved other and unmet need falls as more and more females use co n tracep tiv es [6]. Despite launching Nat ional Family Planning Program in 1952 and with exponential growth o f contraceptives in the last four decades, India still continues to face population explosion with last census reporting 1.21 billion population in the country[7]. About 68.8%of this population resides in rural areas of the country where pregnancies continue to be unplanned and unmet need for contraception remains high. It remains a major challenge for health wo rkers to meet the contraceptive needs of the rural wo men where most of the wo men live and give birth. So a study in the currently married females was undertaken in a rural area of Jammu and Kashmir, India. 2. Aims and Objectives To find the prevalence of contraceptive use, unmet need and choice of contraceptive method among currently ma rried wo men (15-49 years) in a rural area of Jammu d istrict (J&K), India. 3. Methodology Jammu province is the winter capital of Jammu & Kashmir state of India and has 10 districts. Jammu d istrict has a population of 1526406 as per 2011 census with 10 Public Health Research 2013, 3(4): 92-97 93 blocks for health delivery purposes. The study was conducted in RS Pura b lock of Jammu district, India which is a field practice area of Govt. Medical Co llege, Jammu as shown in Figure 1. R.S Pura is a tehsil headquater bordering Pakistan with majority of people engaged in cu ltivation and following Hindu relig ion. Figure 2 shows various states and union territories of India. Using a simple random sampling technique, Miran Sahib Zone was selected out of eight zones in RS Pura block .In the next step, one village out of eight villages in the Miran Sahib zone was chosen to conduct the study using simp le random sampling. A descriptive cross-sectional study was conducted in this randomly selected village. A team of undergraduate students was trained for data collection and collation .They conducted survey under the guidance of the authors. A house to house survey was done and in each house the currently married females of reproductive age group were interviewed after taking the informed consent from the interviewer. The total population of village was 785. Overall 157 females were interviewed. A pre tested, pre-structured questionnaire was prepared in the local language. Initially a pilot study was conducted which helped in testing and restructuring the instrument for actual study. Figure 1. Map of Jammu District showing the Study area (R.S Pura) Figure 2. Map of India showing states and union territories 94 Rajiv Kumar Gupta et al.: Contraceptive Prevalence, Attitude and Choice among Women of Reproductive Age Group in a Rural Area of Jammu, India Some defini tions 1. Couple protection rate – defined as percent of eligible couples effectively protected against child birth by one or other approved methods of Family p lanning viz. Sterilization, condom, IUD or Oral p ills. 2. Un met need of contraception – it is the discrepancy between reproductive intentions and birth control practices. 3. Illiterate - a person who cannot read or write with understanding in any language. to meet the unmet need of contraception. 65.33% (98/ 150) of the females in the study population were satisfied by the family planning services provided by the health worker in their area. Permanent female sterilizat ion was most preferred method of contraception as 39/150 wo men had already undergone tubectomy followed by oral contraceptive pill usage by 24/ 150 females. 18/150 wo men also reported condom use as a method of contraception. Table 1. Socio-demographic characteristic of studied females 4. Results In the study population, it was found that 39.49% (62/157) of females were in age group of 25-30 yrs. Regarding literacy status of the studied females , only 11/157 (7%) were illiterate and 33.75% (53/ 157) had studied up to secondary school certificate (10th standard) . Majority of females (77/157) had two children while 42/ 157 (26.75%) females had ≥ 2 children. An overwhelming 90.45% (142/ 157) were > 18 years of age at the time of marriage. (Table 1). 63.05% females agreed that two child ren norm would complete their family and only47/ 157 (29.93%) opined that they should have ≥3 children. A majority of the respondents i.e. 147/ 157 (93.63%) opined that the status of male and female child is equal. Sizeable nu mber of females 76/157 (48.40%) thought that the sex of the child after first and second delivery had a bearing on the decision about the total number of children in the family. 131/ 157 (83.43%) of females were of opinion that the ideal gap between two children should be >2yrs.There was history of abortion in 46/ 157 (29.29%) of females of whom 43.47% had induced abortion. 150 out of 157 females had heard of any contraceptive method, so further participation regarding choice of contraceptive and knowledge, attitude and practices was limited to them only. 86% (129/ 150) wanted to adopt some method of contraception of which 70% (106/150) were using one or the other method of contraception. 85.33% were of opinion that contraceptive choice should be jointly decided by couple.14.66% were of the opinion that the method of contraceptive should be decided only by husband or by wife, (Table 2). 18% of participants viewed that the spacing method of contraceptives would have an adverse effect on their future fertility. Accessibility to the family p lanning services is an important factor for acceptance of contraceptives as well as S.No Ch aract erist ics Number 1. Age in Years <20 8 20-24 38 25-30 62 31-49 49 Tot al 157 2. Literacy Le vel Illit erat e 11 Primary 12 Middle 43 Secondary 53 HSC 21 ≥Graduat e 17 Tot al 157 3. Age at Marriage <18yrs 15 >18yrs 142 4. No.of Children 0 11 1 27 2 77 >2 42 Tot al 157 5. History of abortion Yes 46 No 111 Tot al 157 6. Type of abortion Sp o nt an eo us 26 Induced 20 Tot al 46 Percent % 5 24.2 39.49 31.21 100 7 7.64 27.38 33.75 13.37 10.82 100 09.55 90.45 7.00 17.19 49.04 26.75 100 29.29 70.70 100 56.52 43.47 100 Public Health Research 2013, 3(4): 92-97 95 Table 2. Attitude, Prevalence andChoice of contraceptive among reproductive age females S.No Quest io n 1. How many children you think you should have 1 2 3 >3 Tot al 2. How much should be ideal gap between two children ≤2yrs >2yrs Tot al 3. Do you think you should have children immediately after marriage Yes No Tot al 4. Do you think male and female are equal as children Yes No Tot al 5. Do you think sex of child should/will change your decision about having more children Yes No Tot al 6. Have you ever heard of contraception Yes No Tot al 7. Do you think you should practice some method of contraception to prevent unwanted pregnancy Yes No Tot al 8. Who do youthink should decide about which type of contraceptive to be used Only Husband Only Wife Bot h Tot al 9. Do you think spacing contraceptive has an adverse effect on fert ility Yes No Tot al 10. Do you think you are getting adequate family planning services from your health worker Yes No Tot al 11. Are you practicing some method of contraception Yes No Tot al 12. Method of Contraceptives T ubectomy Only OCP Only Condom Nat ural Barrier + OCP IUD Vasectomy Number 11 99 32 15 157 26 131 157 53 104 157 147 10 157 76 81 157 150 7 157 129 21 150 11 11 128 150 27 123 150 98 52 150 106 44 150 39 24 18 10 9 5 1 P ercent 7 63.05 20.38 9.55 100 16.56 83.43 100 33.75 66.24 100 93.63 6.36 100 48.40 51.59 100 95.55 04.45 100 86 14 100 7.33 7.33 85.33 100 18 82 100 65.33 34.66 100 70.66 29.34 100 36.79 22.64 16.98 9.43 8.49 4.71 0.94 96 Rajiv Kumar Gupta et al.: Contraceptive Prevalence, Attitude and Choice among Women of Reproductive Age Group in a Rural Area of Jammu, India 5. Discussion The contraceptive prevalence in the present study was found to be 70.66%wh ich was 14% higher than NFHS-3 data which reported a contraceptive prevalence rate of 56.3%. Worldwide contraceptive prevalence increased fro m 54.8% in 1990 to 63.6% in 2010[8]. The un met need of contraception in the current study came out to be 16% wh ile DLHS-3 showed it to be 21.3%[9]. Similarly, un met need for contraception was reported to be 30.6% , 41.67% and 49.80% by Khokar A[10], SK Bhattacharya[11] and Puri A[12] respectively. The find ings in the current study correspond to the global trend which shows that unmet need for family planning declined to 12.3% in 2010fro m 15.4% in 1990[8]. 62/ 157[39.49%]of the respondents in the current study belonged to 25-30 year age group which was contrary to the findings of Kansal A et al[13] who reported 24.42% fe males in the same age group in his study. The currently married females in 25-29 year age group co mprises 21.78% in Jammu and Kashmir whereas this figure is 21.97% at the national level[14]. The mean age at effective ma rriage is the age at which consummat ion of marriage occurs, is almost stagnant and is hovering around 20 years between 2005 and 2009[14]. However in the rural areas substantial proportion of marriages continue to take place when the girl is around 16 years of age[2]. 93% (146/ 157) females in the current study were literate contrary to 54% at the national level[2]. It may be the reason for h igh contraceptive prevalence and low unmet need of contraception in our study. SK Bhattacharya[11] reported literacy rate of 56.70% in his study and a lowe r contraceptive prevalence of 45.83%. It was also supported by S. Bisoi et al[15] who reported that acceptance of contraception significantly higher among the literates (65.52%) than illiterates (55.8%).In another study, Harsha M Solanki et al[16] reported contraception prevalence of 59.2% in the met group who were mainly fro m 20-29year age group (46.6%), 46.8% were literate and 30.9% were fro m h igh socio – economic group as compared to the unmet need group in the study population. Another finding in the current study was that 73.23% of females had <2 living ch ildren and only 26.7% had ≥ 2 living children. The most probable reason for this was the high female literacy rate in the current study. NFHS – 3 data shows that total fertility rate declines from 3.55 amongst illiterate wo men to 1.8 in wo men who have co mpleted ten years of school education[2]. In our study, 36.79%o f females had chosen tubectomy as a contraceptive method followed by other methods of contraception like oral contraceptive pill and Condom. Bhasin SK[17], Kansal A[13],Ganai AM et al[18] and Puri A[12] also reported tubectomy as the most preferred choice in their studies. According to DLHS -3, the current use of contraceptive method was 47.1% using any modern method, out of which 34% used tubectony which almost conforms to the current study while only 5.9% used condoms whereas condom usage was 16.98% in our study. However, Oral Contraceptive Pills were more preferred than condom as a spacing method in our study. This may be because of more number o f younger wo man with h igher awareness level due to their high literacy and easy accessibility to the family planning services in the study area. Another important feature of the current study was that 85.33%(128/150) o f the wo men opined that contraceptive choice is a joint decision of the couple and hence contraceptive preference involves ma le’s equal partic ipation. 86%(129/150) of the females in the study group had a positive attitude towards contraceptive usage and wanted to space their children, though current usage of contraceptive methods was 70.66% (106/150). 14.66% (28/150) opined that method of contraception should be decided by either of the spouse. 34.66% in the study were not receiving adequate family planning services. 18% o f the total females in the study thought that spacing methods used by them would affect their future fertility and similar findings were reported by Sandra GG et al[19] in their study. This may be the obvious reason for non – acceptance of any contraceptive method in the rest of 29.34% (44/`150) of the fe ma les who reported non – utilizat ion of any of the contraceptive methods. The study was limited to one village because of paucity of funds. The authors recommend to empower wo men for removal of sex bias, enhancing their educational status to graduation or more and improving the health services to local populace to imp rove contraceptive acceptance. 6. Conclusions In the current study, there is high contraceptive prevalence and low unmet need of contraception. The study shows that acceptance and contraceptive choice depends on joint decision of the couple and the female literacy has a positive impact on contraceptive practices .The need of the hour is continuous awareness regarding contraceptive methods, their usage and availability to the beneficiaries by our health workers in order to improve contraceptive prevalence rate. REFERENCES [1] M cNay K, Arokiasamy P, Cassen R. Why are uneducated women in India using contraception? A multilevel analysis. Population studies. 2003;57(1):21-40. [2] National Family Health Survey-3 (2005-06) India. International Institute of Population Sciences, New M umbai. [3] Rao AP, Somayajules VV. Factors responsible for Family Planningacceptance with single child findings from a study in Kolkata. Demography India 1999; 28(1)65-73. [4] Reproductive and Child Health – II (2005-06), Web Edition. M inistry of Health and Family Welfare, New Delhi. [5] Conception M .B, Family formation and contraception in Public Health Research 2013, 3(4): 92-97 97 selected developing countries; Policy implications of WFS findings. World fertility survey conference , London, July 7-11,1980,Plenary session No. 3 Voorburg, Netherlands, International Statistical Institute,1989;62. [6] Westoff CF, Bankola A. Unmet need, 1990-94. Converton, M aryland, M acro International, June 1995. [7] Govt. of India (2011). Census of India 2011. Provisional Population Totals, Paper 1 of 2011. [8] Leontine A , Vladimir K ,Clar M , Ann B: National , regional and global rates and trends in contraceptive prevalence and unmet need for Family Planning between 1990 and 2015 : a systematic and comprehensive analysis ; The Lancet , vol. 381 , Issue 9878 , P 1642 – 1652 , M ay 2013. [9] District level household and facility survey – 3 (2007-8). M inistry of Health and Family welfare, Govt. of India [10] A Khokar, M M ehra. Contraceptive use in women from a resettlement area in Delhi. Indian J Community M ed. Vol. 30, No.1, Jan-M arch, 2005. [11] S.K Bhattacharya et al. Study of Unmet Need for Family Planning among women of r eproductive age group attending immunization clinic in a medical college of Kolkata. Indian J Community M ed. Vol.31, No.2, Apr-June, 2006. [12] A Puri, S. Garg, M M ehra. Assessment of Unmet need for contraception in an Urban Slum of Delhi. Indian J Community M ed. Vol. XXIX, No. 3, July- Sept, 2004. [13] A Kansal, R Chandra, S.D Kandpal, K.S Negi. Epidemiology Correlates of Contraceptive Prevalence in Rural Population of Dehradun District. Indian Journal of Community M ed Vol.30, no.2, Apr-June 2005. [14] Family welfare statistics, 2011. M inistry of HhhHHealth and Family welfare , Govt. of India. [15] S. Bisoi et al. Contraceptive practice: an experience from rural West Bengal, India. International Journal of Basic and Applied M edical Sciences, Jan- April 2012; vol.2 (1): 174-178. [16] Harsha M Solanki et al. A comparative study between met and unmet need groups of contraception in rural areas of M aharashtra, India. Global Journal of M edicine and Public Health, vol. 2, No. 1, 2013. [17] S.K Bhasin, M Pant,M M etha, S. Kumar. Prevalence of usage of different contraceptive methods in East- Delhi-A Cross-sectional Study. Indian J Community M ed. Vol. 30, No. 2, Apr-June 2005. [18] Ganai AM et al. Study of Contraceptive Knowledge and Practice in Cohort of Kashmiri women. Jr of M edical Sciences, Vol.13, No.1 (Jan 2010). [19] Sandra GG, Rachel S, Jain A. Preferences for contraceptive attributes: Voices of Women in Ciudad Juarez, M exico. International Family Planning Perspectives. Vol. 23, No.2. June 1997.

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