Awareness and practice of contraception among women of child bearing age in Chennai
Sulekha Naresh 1, Tharaka Senathirajah 2
1 IV MBBS, Saveetha Medical College, Thandalam, Chennai, India.
Email: [email protected]
2 Department of Obstetrics and Gynaecology, Saveetha Medical College, Thandalam, Chennai, India.
Email: [email protected]
ABSTRACT
Aim: To assess the level of awareness and practice of contraception among women of child bearing age (15-49 years).
Introduction: India being the second most populous country in the world, family planning is an important tool in controlling various complications of health. It helps to avoid complications to both mother and child. It is only achieved through proper awareness and practice.
Material and methods: Cross-sectional study done at Chennai using structured questionnaire. It consisted 169 women of child bearing age. Data was analysed statistically and evaluated.
Result: 81.7% of the total women were aware of the term contraception and 43.2% only practiced different methods of contraception. Awareness was low among adolescents and overall awareness on emergency contraception was only about 27.5%. Most of the women accepted that health education is needed.
Conclusion: Though majority are aware of contraception, more awareness is needed among adolescents and also knowledge on emergency contraception is important. Improving literacy and expanding health education for women is must. Eventually, good practice will be obtained among women.
Keywords: contraception, awareness, practice, women
Introduction:
India is facing a steady population growth and continues to be the second most populous country in the world with a population of 1,359 million in the year mid 2018 (Park K., 2019). Family planning is an important tool in controlling various complications in the aspect of health, both in mother and child. Family planning allows people to attain their desired number of children, if any, and to determine the spacing of their pregnancies (WHO). Thus unwanted pregnancies, maternal deaths, morbidity, unsafe abortions can be reduced and birth spacing can be increased.
It is only achieved through proper awareness and practice of contraceptive methods. As per 2017 estimates, 214 million women of reproductive age in developing regions have an unmet need for contraception and use of contraceptives prevented 308 million unintended pregnancies (WHO).
According to NFHS 4 survey, use of family planning method in married women of reproductive age in total was 53.5% and 12.9% had unmet need for contraception (NFHS4). Couple protection rate is an important indicator which determines the prevalence of contraceptive practice in community. To achieve net reproduction rate of 1, CPR should exceed 60%. India is the first country in the world to implement National programme for family planning in 1952. Its goal is to reduce overall fertility rate to 2.1 by the year 2025 by promoting reproductive health and reducing maternal, child and infant mortality and morbidity (nhp.gov.in). Thus contraception is a need for every family. This study aims at assessing the awareness on contraception and its practice in reproductive age women along with various factors associated.
Material and methods:
This cross-sectional study was done at Chennai, India from Jan 2021 to May 2021. Sample size was about 169 women wherein the population was calculated from a study done by Lamba J (Lamba J et al., 2019). Women of child bearing age (15- 49 years) were included. Infertile women and women with medical disorders were excluded. Also those who were not willing to participate were excluded from the study. Participants were selected using convenient sampling except those who met the exclusion criteria. Structured questionnaire on awareness and practice of contraception was used. Informed consent was taken from participants. Questionnaire consisted demographic details such as age, education, marital status, family type and socio- economic class calculated according to Modified BG Prasad socio-economic classification- 2019. Awareness was assessed on contraception along with source of knowledge on it. Women were also asked about contraceptive practice, type of method used, reason if not used and whether visited health professionals for contraception counseling. Approval from ethical committee was taken before study. Data was evaluated using SPSS software version 16 and analysed using excel spreadsheet. Statistical analysis for significance was done using chi-square test. Ethical clearance was obtained using institutional ethical clearance board.
Result:
Socio-demography:
This study included 169 participants of age 15-49 years and was conducted in Chennai. Among the participants 32% belonged to the age group 20-29 years. 75.1% belonged to nuclear type of family whereas the remaining came from joint family. Nearly 56.2% were married women and 40.8% were unmarried. Majority of them were graduate/post-graduate whereas 11% were illiterate. According to socioeconomic class, most of them belonged to lower middle class (29%) followed by middle class (26.6%) and then by upper class, upper middle class and lower class.
[Refer Table 1]
Table 1- Socio-demographic variables
Variables Total [n=169(100%)]
Age (in years)
15-19 27(16%)
20-29 54(32%)
30-39 49(29%)
40-49 39(23%)
Type of family Nuclear 127(75.1%)
Joint 42(24.9%)
Marital status Married 95(56.2%)
Unmarried 69(40.8%)
Divorced 2(1.2%)
Widowed 3(1.8%)
Education Graduate/Post graduate 75(44.4%) Post high school diploma 32(18.9%)
High school 37(21.9%)
Middle school 9(5.3%)
Primary school 5(3%)
Illiterate 11(6.5%)
Socio-economic class
Upper class 32(19%)
Upper middle class 25(14.8%)
Middle class 45(26.6%)
Lower middle class 49(29%)
Lower class 18(10.6%)
Awareness on contraception:
138 participants (81.7%) were aware about contraception or family planning and remaining 18.3% were unaware about it.
Figure-1 Awareness on contraception
Among 138 participants, 79% of participants were aware of condoms followed by OCP (60.1%) , sterilization surgery (58.7%) and copper-T (53.6%). 18.3% did not know about contraceptive methods. Most of them also agreed that sterilization is permanent method of contraception (73.2%). Knowledge on emergency contraception was absent among100 people which covered 72.5%. 51.5% were unaware and 48.5% were aware of benefits and drawbacks of different methods of contraception. STD’s can be prevented by condom was agreed by majority consisting 66.7%. Their source of knowledge was majorly from, health professionals, friends and family and books. Most of the women (87%) among 169 women opted that health education on contraception is needed. [Refer Table 2]
Table 2- Awareness on contraception
Awareness on, Total [(n=138(100%)]
Different contraceptive methods
Withdrawal 53(38.4%)
Calendar method 67(48.5%)
Condom 109(79%)
Copper-T 74(53.6%)
Oral contraceptive pills 83(60.1%) Injectables/implants 30(21.7%) Sterilization surgery 81(58.7%)
Sterilization is permanent Agree 101(73.2%)
Disagree 37(26.8%)
Aware of Emergency contraception
Yes 38(27.5%)
No 100(72.5%)
Benefits and drawbacks of Present 67(48.5%)
81.7%
18.3%
Awareness on contraception
Present Absent
different methods known Absent 71(51.5%)
Condoms prevent STD Agree 92(66.7%)
Disagree 46(33.3%)
Source of knowledge Books 29(21%)
Friends and family 41(29.7%) Health professionals 42(30.4%)
Media 10(7.2%)
Social network 11(8%)
Nil 5(3.6%)
Total [n=169(100%)]
Health education needed for women on contraception
Yes 147(87%)
No 22(13%)
Practice of contraception:
Out of 169 participants, 73 (43.2%) practiced contraception, and 96 (56.8%) did not practice.
[Refer Figure 2]
Figure 2- Practice of contraception
Most of the participants used condom (19%) and have done sterilization surgery (10%).
Among the population who have not practiced, it was recorded that, not married was the major reason (39.6%) followed by lack of information (24%). Minimum accepted that inconvenient to buy, fear for side effects, partner opposition and wanting for children as reason for not using.
25% of them had no specific reason. 123 of the total participants have not visited health professionals for counselling on contraception whereas 46 have undergone counselling for the same. [Refer Table 3]
Table 3- Practice of contraception
Total
[n=169(100%)]
Method used recently Withdrawal 6(3.6%)
Calendar method 5(3%)
Condom 32(19%)
Copper T 11(6.5%)
43.20%
56.80%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Yes No
Practice of contraception
Practice of contraception
Oral contraceptive pills 2(1.2%) Injectables/implants 0(0%) Sterilization surgery 17(10%)
Not used 96(56.8%)
Visited heath professional for counselling on contraception
Yes 46(27.2%)
No 123(72.8%)
Total
[n=96(100%)]
Reason if not used Not married 38(39.6%)
Lack of information 23(24%) Inconvenient to buy 2(2.1%)
Side effects 3(3.1%)
Partner opposition 2(2.1%) Wanted children 4(4.2%) No specific reason 24(25%) Association and significance:
It is noted that age group, education and socio-economic status of women is associated with their awareness on contraception and it is significant by chi-square test (<0.05). Mostly adolescent age group, women with poor education and lower socioeconomic status need more awareness on family planning/ contraception. Practice of contraceptive methods is significant with age group of women but not related to their education and socio-economic status. [Refer Table 4]
Table 4- Association and significance Socio-
demographic variables
Awareness on contraception [n=138(100%)]
p value Practice of contraception [n=73(100%)]
p value
Age (in years) 15-19 4(2.9%) <0.000 01
1(1.4%) <0.000
20-29 51(37%) 20(27.4%) 01
30-39 45(32.6%) 25(34.2%)
40-49 38(27.5%) 27(37%)
Education Graduate/Post graduate
75(54.3%) <0.01 33(45.2%) 0.377 Post high school
diploma
32(23.2%) 17(23.3%)
High school 17(12.3%) 15(20.5%)
Middle school 6(4.3%) 4(5.5%)
Primary school 3(2.2%) 2(2.7%)
Illiterate 5(3.6%) 2(2.7%)
Socio-
economic class
Upper class 31(22.4%) <0.000 01
19(26%) 0.059
Upper middle class
24(17.4%) 14(19.2%)
Middle class 39(28.2%) 19(26%)
Lower middle class
38(27.5%) 16(22%)
Lower class 6(4.3%) 5(6.8%)
Discussion:
Increasing population growth is now a global burden. There is a need for more awareness about family planning and its importance for both social life and economy. In the present study, approximately 81.7% women have heard and aware of the term contraception / family planning.
Similar study, showed about 87% awareness among married women (Pegu B et al., 2014).
Another study by Radha Ramaiah in 2017, also showed 81% awareness on family planning methods (Ramaiah R & Jayarama S, 2017)
Also, maximum percentage of women were aware about condom, among other methods of contraception, followed by OCP, sterilization surgery and others. According to a study by Tamira W, it was observed that, people were more aware about OCP (Tamira W &
Enqueselassie F, 2007). But condom was more known method according to another study similarly (Lamba J et al., 2019).
73.2% of women agreed that sterilization is permanent method of contraception and similar study concluded that 85% women had knowledge on sterilization (Quereishi M et al., 2017).
In this study awareness on emergency contraception was poor among women. Study by Tejaswini D., also showed that only 5.33% of women were aware of emergency contraception (Tejaswini D et al., 2018) and only 11.2% of educated working women had awareness about emergency contraception in another study (Takkar N et al., 2005).
Sexually transmitted diseases can be prevented by using condoms, was aware among 66.7% of women. Mostly the source of knowledge on contraception was from health professionals (30.4%) and friends & family (29.7%). A similar study also showed that, health worker as major source of knowledge (Pegu B et al., 2014). But according to another study, social circle was the major source (Tejaswini D et al., 2018). 87% of the women accepted that health education on contraception is needed. Education influences both awareness and usage of contraception ( Kaushal S.K et al., 2010).
It is also seen that, awareness was significantly low among adolescent age and age group affecting awareness about contraception was significant. Knowledge about sexual and reproductive health among adolescents leads to reduced access to contraception says a study (Munakampe M.N et al., 2018). Even education and socio-economic class influences low awareness and was significant. Similar study conducted in rural southern Nigeria concluded that, low literacy level is also a factor for less knowledge on contraception and its practice (Omo- Aghoja L.A et al., 2009). This study also reveals, practice is insignificant with education and low socio-economic class. But use of contraceptive is significant with education of women says a study ( Kaushal S.K et al., 2010). Study by Shumayla S, also found significance, that practice of contraceptive methods was associated with age group, socio-economic status and education (Shumayla S & Kapoor S et al., 2017).
56.8% of women were not practicing any method of contraception which was approximately similar to study done by Lamba J, wherein 62% didn’t use any method of contraception (Lamba
J et al., 2019). Thapa P study, says that 70.8% women used contraceptive methods with good awareness among them (Thapa P. et al., 2018).
Among the women who used different methods, majority used, condom followed by tubectomy.
Similarly study by Pegu B also showed condom was widely used method (Pegu B et al., 2014).
In contrast, study conducted by Musarrat Jabeen showed, most commonly used were traditional injectables and female sterilization (Jabeen M. et al., 2011).
When asked about the reason for not using contraceptive methods among the women who have not practiced contraception, the main reasons were due to, not married and lack of information.
25% also said that, there is no specific reason, in this study. In another study, wanted to have children, side effects were the major reason, which is contradicting with this study (Tejaswini D et al., 2018). Also Sunita Ghike mentioned in her study that main reason as partner from husband and in-laws (Ghike S. et al., 2010). Only 27.2% of the women have visited health professionals for counselling on contraception. Thus more women have to be encouraged to attain knowledge regarding contraception and its methods.
Conclusion:
Though majority are aware of the term contraception/ family planning, adolescents are in need for awareness. Also improvement in literacy of people plays vital role. Health education is a must on contraception and its benefits and drawbacks of different methods which has the power to enhance lifestyle of women and also limit the complications due to lack of contraception. As a step to avoid unwanted pregnancies, knowledge on emergency contraception is needed as there is a significant lack about it. Thus good practice will eventually get increased.
Acknowledgement:
The authors of the study would like to thank the institution and others who facilitated and helped us to carry out the study.
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