Study of socio-demographic profile and contraceptive use among married women attending an Urban Health Centre, Berhampur

Padhy S 1, Nayak R 2, Tripathy R.M. 3

1Dr. Sarmistha Padhy, Assistant Professor, 2Dr. Ranjeeta Nayak, Post Graduate Student, 3Dr. R.M. Tripathy, Professor HOD, all authors are attached with Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India

Address for Correspondence: Dr Sarmistha Padhy, Department of Community Medicine, MKCG Medical College and Hospital, Berhampur, email- padhysarmistha95@gmail.com


Abstract

Introduction: The higher fertility in India is attributed to early marriage, low level of literacy, poor level of living, limited use of contraceptives and traditional ways of life. Family planning plays a key role in deciding the desired family size and effective limitation of fertility. Objectives: 1) To study the socio-demographic profile of married women of reproductive age group attending anganwadi centres 2) To assess knowledge and practice of contraception among them 3) To find out the unmet need of contraception. Materials and Methods: A cross sectional study was conducted from May to July 2014 among married females between 15-45 years attending any of the six Anganwadi centres under the Urban Health Centre, Ankuli, Berhampur. 224 participants were interviewed in local language using a predesigned and pretested questionnaire. Results: 58.58% of the women were between 20-30 years and lived in nuclear families (65.6%). 29% had history of induced abortion. Most common reason of induced abortion were cited as unintended pregnancy (48.45) followed by complete family size (37.8%). Awareness about OCPs and female sterilisation was 96.9% followed by Condom (90.3%). Major source of information on contraception were through friends and relatives (47.5%) followed by husband (41.4%). Contraception was practiced by 48% of the respondents. Majority of them (26.8%) were OCP users followed by condom (8%). Use of contraception was mutually decided by the couples (99%). The unmet need of contraception was found to be 34.3%. Conclusion: Awareness about contraceptives is not sufficient for its actual use in this community for which new ways of motivating people to adopt and sustain family planning methods should be considered.

Keywords: Family Planning, Knowledge, Practice, Unmet Need

Manuscript received: 8th December 2016, Reviewed: 15th December 2016
Author Corrected: 24th December 2016, Accepted for Publication: 31st December 2016

Introduction

With only 2.4% of the world’s land area, India is supporting about 17.5% of the world’s population [1]. India’s population is rapidly growing at the rate of 16 million each year [2]. Global total fertility rate is 2.5 ranging from 1.7 for industrialised countries and 2.9 for developing countries to 4.1 for least developed countries. Fertility rates depend on numerous factors. The higher fertility in India is attributed to universality of marriage, early age at marriage, low level of literacy, poor level of living, limited use of contraceptives and traditional ways of life [1]. According to the NFHS (2005-2006), nearly 21% of pregnancies are either unwanted [3]. During 2010-11, 620472 MTPs were performed by12510 approved institutions in the country [4]. In such a scenario family planning plays a key role in deciding the desired family size and effective limitation of fertility once that size has been reached. But the NFHS-3 survey (2005-2006) indicated that the unmet need for FP in India was 13% with 6.2% for spacing and 6.6% for limiting respectively [3]. The factors that influence contraceptive practice are multifaceted and challenging. It is evident that most women’s knowledge and use of contraception is associated with socio-demographic, socio-cultural, socio economic factors and their source of information which are also contributors of high fertility rates [1,4]. Female literacy, age at marriage of girls, status of women, strong son preference, and lack of male involvement in family planning, are also considered as significant factors [1,4].

Considering the above factors, the present study was conducted with objectives: 1) To study the socio-demographic profile of married women of reproductive age group attending anganwadi centres 2) To assess knowledge and practice of contraception among them 3) To find out the unmet need of contraception from the sample and identify factors that are associated with not using any method of contraception.

Materials and Methods

Type of Study: A community based cross sectional study was conducted from May to July 2014 among married females between 15-45 years serving as inclusion criteria, while unmarried, widows, divorced and pregnant women were excluded. The questionnaire consisted of demographic characteristics including age, marital status, level of education, employment, family background and obstetric history. The knowledge and practice of different methods of contraception were also assessed.

Place of Study: Anganwadi Centres under the Urban Health Centre, Ankuli, Berhampur.

Study Population: Six anganwadi centres located in Harijana Sahi, Nua Sahi, Bada Sahi, Dhoba Sahi, Jalaswara Khandi and Kumbharapalli come under the Urban Health Centre, Ankuli which is in the field practice area of department of Community Medicine, MKCG Medical College, Berhampur. Immunisations are conducted in these anganwadi centres on alternate fixed immunisation days i.e. on Wednesdays. Daily 10-12 women visit the anganwadi centres for different health aliments. A sample of 227 eligible participants were drawn on the immunisation days of these six anganwadi centres depending on the patient load and interviewed in local language using a predesigned and pretested questionnaire after taking their informed consent.

Statistical Analysis: The participants’ responses to the questions were analysed and data were expressed as proportions and percentages.

Results

A total of 227 married women participated in the study among the study subjects, 99% were Hindu by religion. More than half of them belonged to younger age groups i.e. between 20-30 years (58.5%) and lived in nuclear families (65.6%). 18% of the women were illiterate. Majority of them were housewives (95%) and belonged to lower middle socio-economic status (75.7%) as calculated by Modified Kuppuswami Scale (Table No-1)

Table No-1: Socio -demographic profile of study Respondents

Variable

Number

Percentage

 (%)

Age

 

 

0-30

133

58.5

30-40

76

33.4

>40

18

7.9

Religion

 

 

Hindu

225

99.1

Muslim

2

0.9

Christian

--

--

Type of family

 

 

Nuclear

149

65.6

joint

78

34.3

Literacy rate

 

 

Illiterate

41

18

Primary

58

25.5

Secondary

69

30.3

Higher secondary

32

14

Graduate and above

27

11.8

Occupational status

 

 

Housewife

216

95.1

Working

11

4.9

Socioeconomic status

 

 

Lower middle

172

75.7

Upper lower

49

21.5

Lower lower

6

2.8

About 20.7% were married before their eighteenth birthday and 34.3% women had their first pregnancy before twenty years of age.53.7% of the women already had completed their family with two or more children.29% had history of induced abortions majority of which was medical abortion. Most common reason for induced abortion were cited as unintended pregnancy (48.45) followed by completed family size (37.8%). (Table No-2)

Table No-2: Marital and Obstetric history of the study participants

 

Number of responses

Percentage

Age at marriage

 

 

<18

 47

 20.7

>18

 180

 79.2

Duration of marriage

 

 

<5yrs

 37

 16.2

6-10yrs

 69

 30.3

>10yrs

 101

 44.4

Age at first pregnancy

 

 

<20

 52

 22.9

20-30

 78

 34.3

30-40

 140

 64.8

Number of children

 

 

0

 09

 3.9

1

 96

 42.2

2-3

 118

 51.9

>3

 4

 1.7

Abortion history

 

 

Yes

 93

 40.9

No

 134

 59

Cause of induced abortion

 

 

Unplanned pregnancy

 32

 48.4

Socioeconomic factor

 4

 6

Family complete

 25

 37.8

Contraceptive failure

 3

 4.5

Medical condition

 2

 3

Most of the women (96.9%) were aware about one or other methods of contraception. Majority of them aware about OCPs (96.9%) and Condom (90.3%) as temporary methods of contraception and female sterilisation as permanent method of contraception were known to 96.9% of them. Major source of information regarding different methods of contraception were through friends and relatives (47.5%) followed by husband (41.4%) (Table No-3)

Table No-3: Awareness and Source of Knowledge of contraception

 

Response

Percentage

Awareness

 

 

yes

220

96.9

No

07

03

Methods known*

205

90.3

Condom

220

96.9

OCP

34

14.9

ECP

110

48.4

IUCD

39

17.1

Injectable

32

14

Male sterilization

153

67.4

Female sterilization

220

96.9

Source of knowledge*

 

 

husband

94

41.4

doctor

18

7.9

Health worker

57

25.1

Friends and relatives

108

47.5

Magazine and newspaper

32

14

Media, Television & radio

42

18.5

Contraception was practiced by 48% of the respondents. Majority of them (26.8%) were OCP users followed by condom (8%).18 out of 61 (29.5%) OCPs users used it inconsistently. Male sterilization was not practised at all. 3.9% of the study participants used abstinence, coitus interruptus and safe period as natural methods of contraception. 99% of the couples mutually decided to adopt any one form of contraceptive methods. (Table No-4)

Table No-4: Contraceptive Practice among respondents
      

 

Response

Percentage

Contraceptive practice

 

 

Yes

109

48

No

118

51.9

Methods used

 

 

condom

19

18.3

OCP

61

26.8

ECP

5

2.2

IUCD

3

1.3

Injectable

-

-

Natural methods

9

3.9

Male sterilization

-

-

Female sterilization

12

5.9

Decision maker(N=109)

 

 

Self

 

 

Husband

 

 

Mutual

 

 

Any other family members

 

 
 
About 34.3% of women who were not using any methods of contraception did not have any desire to have children and major cause of non-use of any contraception was due to fear of side-effects(38%). The unmet need of contraception was found to be 34.3% out of which 11% was for spacing and 23.3% for limiting.(Table No-5)

Table No-5: Reasons behind non-use of contraception

 

Response

Percentage

Desire for child among Non users

 

 

Yes

40

17.32

No

78

34.36

Reasons for no use

 

 

Unaware Myth

7

5.9

Fear of Side-effects

45

38.1

Family pressure

16

13.5

Does not want to use

24

20.3

Side-effects

71

5.9

Husband Stays away

9

16

Unmet need

 

 

Spacing

25

11

Limiting

53

23.3

Discussions

The current study was conducted to study the socio-demographic profile and contraceptive use among married women attending an urban health centre. More than half of them were between 20-30 years (58.5%) and 99.1 % belonged to Hindu family. Majority of them had a secondary education (30.3%) followed by primary education (25.5%). 18% of the women were illiterate. In an observational study conducted by Arti Sharma et al in the outpatient clinic of OBG Department of SGRR Medical College, Dehradun, Uttarakhand, India in 2013 found that 56.8% of women were in the age group of 26–35 years and 78.44% women belonged to Hindu religion. Totally, 81.89% women were housewives and 75.8% women had parity of more than two [5].

As per this study 20.7% were married before the age of 18 and about 34.3% women had their first pregnancy before 20 years of age. 53.7% of the women already had completed their family with two or more children. 29% had history of induced abortion mostly terminated medically. Most common reason for induced abortion were cited as unintended pregnancy (48.45) followed by completed family size (37.8%). Anupama Bahadur et al in their cross-sectional study conducted among women requesting an abortion in 2007 in the Family Planning Clinic at AIIMS, New Delhi found that the mean parity of the women were 2.8 (range 1–6, SD ± 0.9). 34% of them reported a previous abortion in the preceding 2 years. The reasons cited for terminations of pregnancy were unplanned pregnancy (32.8%), inadequate income (24.6%), family complete (20.3%) and contraceptive failure (22.3%) [6]. However Ramesh Holla et al in a registry-based retrospective study carried out at a tertiary care teaching hospital in Mangalore(2011-2012) among women seeking medical termination of pregnancy (MTP) observed medical reasons as the major reason for undergoing MTP (39.3%), followed by unplanned pregnancy(34.8%) [7] in contrary to the findings of another hospital-based Cross sectional study conducted by Shipra Guptaet al found the reasons for undergoing MTP by these women were “family size completed” in 63%, “previous baby too young” in 20%, “economic reason” in 18%, and “contraceptive failure” in 9% [8].

Majority of the women (96.9%) in the present study knew about one or other methods of contraception. OCPs and female sterilisation were known to96.9% of the women followed by Condom(90.3%).The information regarding various methods of contraception mostly came through friends and relatives(47.5%) followed by husband (41.4%).A study conducted in rural population between 2005 to 2007 by Sunita Ghike et al in Nagpur, Maharashtra had found that 67.5% of the women were aware about temporary methods of contraception mostly Cu-T(67.1%) followed by condom (57.9%) while 100% were aware about permanent methods. Media i.e .television and radio were the major source of knowledge (70%) [9].

In the present study 48% of the women practised any one method of contraception. Majority of them (26.8%) were OCP users followed by condom (8%).18 out of 61 (29.5%) OCPs users used it inconsistently. 99% of the couples mutually decided to adopt any one form of contraceptive methods. A community based cross sectional study conducted by Kiran K Makade et al in Mumbai had found that couples who were using contraceptives, the practice was maximum for OCPs (28.07%) followed by condoms (18%). In 41.45% cases decision about family planning was taken mutually by the husband and wife; in 30.77% cases taken independently by the husband, in 26.07% cases by the wife and in 1.71% cases by in-laws. Male sterilization was not practised at all in both the studies [10].

In this study about 34.3% of women who were not using any methods of contraception did not have any desire to conceive reflecting the unmet need of contraception of which 11% was for spacing and 23.3% for limiting. Major cause of non-use of any contraception was due to myth/fear of adverse/ side-effects (38%). According to a cross-sectional study conducted by Mallini M Battathiry and Narayanan Ethirajan in urban Tamil-Nadu (2008-2009) found the prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as 27%. The major reason for unmet need for FP was 18% for low perceived risk of pregnancy, 9% feared the side effects of contraception, 5% lacked information on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons [11].

Conclusion

The results clearly indicate that awareness about contraceptives is not sufficient for its actual use in this community for which more efforts are needed to make people aware for practical use of these methods. New ways of motivating people to adopt and sustain family planning methods should be considered. Converting knowledge into practice is the real challenge for India as far as family planning is concerned. So understanding how choices regarding family planning are made based on socio-economic, socio-cultural and socio-demographic factors will help in accelerating the process of fertility decline. Special emphasis should be given on post-abortion contraception, IUD, vasectomy and emergency contraceptives.

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

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How to cite this article?

Padhy S, Nayak R, Tripathy R.M. Study of socio-demographic profile and contraceptive use among married women attending an Urban Health Centre, Berhampur. Int J Med Res Rev 2016;4(12):2211-2216.doi:10.17511/ijmrr. 2016.i12.22.