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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 2  |  Page : 177-181

Determinants of the “know-do” gap regarding contraceptive use among married women of an urban slum in Western Maharashtra


1 OI/C HTW, Officers' Training College, Lucknow, Uttar Pradesh, Dean, SMBT Institute of Medical Sciences and Research Centre, Nasik, Maharashtra, India
2 Brig I/c Adm, Army Hospital R&R, New Delhi, India
3 SMBT Institute of Medical Sciences and Research Centre, Nasik, Maharashtra, India
4 Professor, Department of Community Medicine, AFMC, Pune, Maharashtra, India

Date of Submission30-Dec-2018
Date of Acceptance19-Apr-2019
Date of Web Publication07-Oct-2019

Correspondence Address:
Dr. Nand Kishore Vashisht
SMBT Institute of Medical Sciences and Research Centre, Nasik, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_85_18

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  Abstract 


Context: The importance of family planning to promote the health and welfare of the family group and thus contribute effectively to the social development of a country cannot be overemphasized. It is achieved through the use of contraceptive methods. Despite being the first country to launch the Family Welfare Program in 1952, India has not been able to achieve the desired population levels. Aims: The aim was to study the knowledge and practices related to contraceptive use among married women in reproductive age group living in an urban slum with the objective of assessing the factors responsible for the use and nonuse of contraceptives. Setting and Design: A cross-sectional survey was conducted among 300 married females in the reproductive age group of an urban slum. Subject and Methods: This was an interviewer-based study using a prevalidated questionnaire. Results: Out of the 300 respondents, 150 (50%) respondents had two children, 179 (64.1%) had delivered their first child within 1 year of marriage, and 106 (35.3%) had delivered their first child as teenagers (before 19 years of age). A total of 295 (98.3%) respondents had some knowledge of the contraceptives. The preferred method of contraception was tubectomy among 118 (41.7%) respondents. A total of 139 (47.1%) respondents had preference for having a male child. The main reasons cited for not using contraception was want of more children and fear of side effects. Conclusion: Our findings suggest that there is an obvious “know-do gap” as there was a wide discrepancy between the knowledge and practice of contraceptive usage. Knowledge about contraceptives was universal in our study; however, the contraceptive users were only 52.7%.

Keywords: Contraceptive use, family planning, urban slum


How to cite this article:
Vashisht S, Prakash R, Vashisht NK, Dudeja P. Determinants of the “know-do” gap regarding contraceptive use among married women of an urban slum in Western Maharashtra. J Mar Med Soc 2019;21:177-81

How to cite this URL:
Vashisht S, Prakash R, Vashisht NK, Dudeja P. Determinants of the “know-do” gap regarding contraceptive use among married women of an urban slum in Western Maharashtra. J Mar Med Soc [serial online] 2019 [cited 2019 Oct 17];21:177-81. Available from: http://www.marinemedicalsociety.in/text.asp?2019/21/2/177/268634




  Introduction Top


Contraceptive methods are the easiest, simplest, and the most effective methods which allow couples to plan their family by spacing and timing the birth of their children and thus, attain the desired family size.[1] India, in 1952, became the first country in the world to launch the nationwide Family Welfare program.[2] Its aim was to reduce the population overgrowth and thus, achieve economic and social development. Keeping with the ideas and values of the then population, the most propagated methods were the natural methods of contraception. However, no much headway was achieved by these methods and in the following years, condoms, pills, sterilization, and other methods were introduced. Voluntary family planning program was adopted by many countries including India. Various methods such as health education regarding family planning were resorted to, to increase the awareness regarding such methods. Health education was imparted at various levels by different methods such as by the doctors and nurses in antenatal clinics, advertisements on television and radios, and pamphlets and health talks by medico-social and social workers.[3]

India has come a long way since 1952. The fertility rates of the nation had optimistically declined, and the present total fertility rate is 2.2 children per woman.[4] However, it is still the second most populated country in the world with annual population increase of 1.25% which translates into 15 million people per year.[5] The knowledge of contraceptive use is almost universal, with 99% knowing at least one method of contraception. However, the use of modern contraception, though increased, still remains under 50%. Current use of modern contraceptives accounts for 47.8%, and female sterilization rate accounts for 36%.[4] The existing trend regarding contraceptive use which has been observed by many researchers is early family size completion followed by sterilization.[5]

There is ample scope to increase the utilization of modern contraceptives, especially spacing methods among the women of reproductive age group, if the right reasons or the “know-do” gap regarding contraceptives is identified. The present study aims to measure the knowledge, attitudes, and practices (KAP) related to family planning among married women in reproductive age group living in an urban slum with the objective of assessing the factors responsible for the use and nonuse of contraceptives and to find out the influence of socioeconomic and demographic features in the family planning practices.


  Subject and Methods Top


This was a community-based, descriptive, cross-sectional study conducted over a period of 12 months in an urban slum of Western Maharashtra. To check the KAP, an investigator-administered, pretested structured questionnaire having close-ended questions was used. Approval of the institutional ethics committee was obtained for the study. The sample size was estimated as 296 by assuming: α = 5% (for 95% confidence interval), expected proportion = 0.57 (80), and expected deviation (absolute) = 0.05. However, 300 married females in the age group 15–49 years were studied for this project. Systematic random sampling was then carried out. Inclusion criteria included all married females in the reproductive age group (15–49 years) of an urban slum. Married women in the age group of 15–49 years who had attained menopause or had undergone hysterectomy for any reason or those who were divorced or widowed were excluded from the study. To calculate the socioeconomic status of the respondents, Kuppuswamy scale was used as the study area was an urban slum. Various questions with close-ended options were asked to the respondents. Proper timing of contraceptive use included options such as soon after marriage to delay child birth, after the birth of the first child to delay the birth of the second child, or after having desired number of children to prevent further births. The collected data were entered in excel sheet. SPSS software (version 22, Chicago, USA) was used for analysis.


  Results Top


In our study, the mean age of the respondents was 28.02 ± 5.9 years. Out of the 300 respondents, majority were educated up to middle class (95 [31.7%]) and were unemployed (256 [85.3%]). Out of the 300 respondents, 15 (5%) had been married for less than a year and had no children and six respondents were pregnant at the time of study. Of the remaining 279 respondents, 106 (35.3%) respondents had delivered their first child at or before 19 years as adolescents and 179 (64.1%) of them had delivered their first child within 1 year of married life. Almost half of the respondents in our study group had two children [Table 1].
Table 1: Sociodemographic profile of the study respondents (n=300)

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In our study, 295 (98.3%) respondents had knowledge of contraceptives. The remaining five (1.7%) who had no knowledge on contraceptives were not included in the further analysis. Awareness about the various contraceptives is shown in [Figure 1].
Figure 1: Awareness of contraceptives among the respondents

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Out of the 295 respondents, 193 (65.4%) knew that the contraceptives could be procured from the government hospitals. A total of 261 (88.5%) respondents opined that eligible couples should use contraception. Regarding perceived use of contraception, 166 (56.3%) respondents believed that contraception should be used to avoid pregnancy and 133 (45.1%) opined that it should be used after having desired number of children. The most common source of information regarding various contraceptives was media (television, radio, and newspapers) for 159 (53.8%) and friends/relatives for 107 (36.3%) respondents. Out of the 57 respondents who had more than two children, the desire for having a son was the most common reason in 39 (68.4%) respondents for not following the two-child norm [Table 2].
Table 2: Opinion of the respondents regarding contraceptive use

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In our study, 177 (60.0%) respondents were practicing some contraceptive method. Tubectomy was the most common method of contraception in 118 (41.7%) respondents. This was followed by the use of condoms, 48 (16.9%). There was no couple that practiced vasectomy or any traditional method of contraception. Knowledge regarding contraceptives was 98.3% among the respondents, whereas only 52.7% of respondents were the current users [Table 3]. The most common reasons cited for not using the contraceptives are shown in [Table 4].
Table 3: Contraceptive use among the study respondents and its association with variables

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Table 4: Reasons for nonuse of contraceptives

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  Discussion Top


In this study, of the total sample of 300 respondents, sociodemographic variables [Table 1] were similar to the national figures.[4] The mean (standard deviation) age of the respondents was 28.0 (5.9) years and 185 (61.7%) respondents were in the age group of 25–34 years. There was a significant association between the age group of the respondents and contraceptive use (P = 0.00). Gupta et al. in their study noticed that, with the advance in age, adoption of family planning increased.[6] In our study, 96.7% of the respondents were literate and 95 (31.7%) had been educated up to middle class. The contraceptive use showed a statistically significant association with educational status of the respondents (P = 0.00). The highest fertility rate of 3.6 was found among women with no education. Basu et al. in their study elicited that education appears to have an impact on the average number of children among women.[7]

The knowledge about the use of contraceptives was 98.3% in our study population, which is similar to the study by Hazarika.[8] The findings are similar to the prevalence of knowledge reported by the National Family Health Survey (NFHS)-4 and other studies done by Gupta et al.,[6] but higher than the studies done by Patro et al. (95%)[9] and Khan et al. (85%).[10]

The awareness of respondents about condoms (98.3%), pills (95.3%), intrauterine devices (IUDs) (93.7%), female sterilization (91.0%), injectables (59.7%), and emergency contraception (57.7%) was similar to the results of Anupamaet al.[11] However, Gupta et al. and NFHS-4 data showed higher results for female sterilization.[6] As our study population is placed nearer to the hospital, the increase in knowledge about various contraceptives including temporary methods can be accounted for.

Female sterilization/tubectomy was the most common method of contraception (41.7%) in this study, followed by 16.9% of respondents using condoms. It could be because women generally want to complete their families and then opt for permanent methods like sterilization. A study conducted in Mumbai slums shows usage of female sterilization in 42.2%, condoms in 11.5%, and IUD in 6.7% of respondents.[10] Gupta et al. showed female sterilization usage up to 45.6%.[6] The percentage of respondents who were in favor of contraceptive use and showed positive attitude was 88.5% in our study, whereas it was 83% in a similar study conducted by Gupta et al.[6]

Contraceptive prevalence rate (CPR) came out to be 52.7% in our study. The CPR by NFHS-3 and 4 among currently married women was 56% and 54%, respectively, in India.[4] Hazarika found CPR to be 49.87% among women of reproductive age group living in urban slums of India.[8] Regular motivation by the medico-social workers for adopting small family norms, personal counseling of the eligible couples, and availability of quality health services free of cost with explanation of advantages and various side effects in the vicinity of these communities can be the major motivators for the use of contraception. Only one study reported CPR of 65.7% which was done in Mumbai slums by Khan et al.[10]

In the present study, the prevalence of contraceptive use was 13.8% in respondents with one child, and it increased to 31.8% in respondents with two children. Similar results were obtained in other studies where there was a positive association between the number of living children and contraceptive use. Furthermore, women in India are more likely to use contraception if they already have a son.[12],[13]

Nearly, 43.4% of the nonusers wanted more children and cited this as the main reason for not using contraceptives. Husband's unwillingness or dislike and fear of side effects were the reasons of nonuse of contraception in 11.3% and 26.4% of respondents, respectively. Fertility-related reason, i.e., need for more children (31.3%), partner's opposition (28.4%), and fear of side effects (20.6%) were the reasons found for nonuse of contraception in the study done by Saluja et al.[14] Other reasons included were nonaccess to health facility, preference of male child, religious beliefs, cost, and family pressure. Some respondents also felt that the process of acquiring contraceptive is often embarrassing.

The desire for having a son was the most common reason in 68.4% of respondents for not following the two-child norm, in the present study. Similar studies show that childbearing continues if the women have no son or do not have the desired number of sons.[15]

There appeared a wide discrepancy between the knowledge and the practice of contraceptive usage. Knowledge about contraceptives was universal in our study, and the number of current users was 62.5%. Khan et al. in their study elicited similar findings that 88.23% of the women had knowledge, but only 65.68% were currently using a contraceptive method.[10] Similar results were found between the knowledge and practice of contraception in other studies.[16] Thus, it was observed that adequate knowledge did not necessarily lead to appropriate practices.

This study suffers from certain limitations. As it included interviewer-administered questionnaire, the respondents may have been biased into giving more socially acceptable answers than the truth. A recall bias into the use of contraceptives can also modify the results.


  Conclusion Top


Family planning is of prime concern in India, and it has been over seven decades that the efforts to achieve population stabilization are being undertaken. A wide discrepancy appeared between the knowledge and the practice of contraceptive usage in the present study and other similar studies. Thus, it was observed that adequate knowledge did not necessarily lead to appropriate contraceptive practices. In most studies, areas next to medical colleges which have the involvement of medico-social workers, interns, and residents have shown better results as compared to other areas. The possibility of adopting more areas by colleges and distribution of medico-social workers, interns, and residents for the purpose of health education can be looked into by the bureaucrats to decrease substantially the know-do gap in the contraceptive use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Technical Report Series No. 48. World Health Organization; 1971.  Back to cited text no. 1
    
2.
Park K. Indicators of MCH care. In: Park's Textbook of Preventive and Social Medicine. 23rd ed. Jabalpur: Banarsidas Bhanot; 2015.  Back to cited text no. 2
    
3.
Puja D, Ashok J. Family Planning Practices in Two Semi Urban Communities of Pune: LAP Lambert Academic; 2012. p. 140. Available from: http://Store/gb/book/978-3-659-30108-7/family planning. [Last accessed on 2018 Jul 03].  Back to cited text no. 3
    
4.
Indian Institute for Population Sciences. National Family Health Survey (NFHS-4) 2015-16 India. Indian Institute for Population Sciences; 2017. p. 1-192. Available from: http://rchiips.org/NFHS/ NFHS 4Reports/UttarPradesh.pdf%0Ahttps://dhsprogram.com/pubs/ pdf/FR338/FR338.UP.pdf. [Last accessed on 2018 Apr 15].  Back to cited text no. 4
    
5.
Smith E, Charantimath US, Wilson SF, Hoffman MK. Family planning in Southern India: A survey of women's attitudes. Health Care Women Int 2017;38:1022-33.  Back to cited text no. 5
    
6.
Gupta V, Mohapatra D, Kumar V. Family planning knowledge, attitude, and practices among the currently married women (aged 15-45 years) in an urban area of Rohtak district, Haryana. Int J Med Sci Public Health 2016;5:627. Available from: http://www.scopemed.org/fulltextpdf. php?mno=199530. [Last accessed on 2018 Apr 17].  Back to cited text no. 6
    
7.
Basu AM, Stephenson R. Low levels of maternal education and the proximate determinants of childhood mortality: A little learning is not a dangerous thing. Soc Sci Med 2005;60:2011-23.  Back to cited text no. 7
    
8.
Hazarika I. Women's reproductive health in slum populations in India: Evidence from NFHS-3. J Urban Health 2010;87:264-77.  Back to cited text no. 8
    
9.
Patro BK, Kant S, Baridalyne N, Goswami AK. Contraceptive practices among married women in a resettlement colony of Delhi. Health Popul Perspect Issues 2005;28:9-16.  Back to cited text no. 9
    
10.
Khan MM, Shaikh ST, Shroff AG. Study of knowledge and practice of contraception in urban slum community, subject: Applied sciences. Int J Curr Med Appl Sci 2014;3:35-41.  Back to cited text no. 10
    
11.
Anupama S, Mohammad K, Chauhan CR. Knowledge, attitude and practices about contraceptive among married reproductive females. Int J Sci Study 2014;1:2-4.  Back to cited text no. 11
    
12.
Dudeja P, Singh A, Jindal A, Bhatnagar N. Preference for male child in two semiurban communities of Pune. J Postgrad Med Edu Res 2013;47:144-7.  Back to cited text no. 12
    
13.
Jahan U, Verma K, Gupta S, Gupta R. Awareness, attitude and practice of family planning methods in a tertiary care hospital, Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol 2017;66:500-6. Available from: http://www.ijrcog.org. [Last accessed on 2018 Apr 27].  Back to cited text no. 13
    
14.
Saluja N, Sharma S, Choudhary S, Gaur D, Pandey S. Contraceptive knowledge, attitude and practice among eligible couples of rural Haryana. Internet J Health 2011;12:1-6. Available from: http://www. ispub.com/doi/10.5580/156e. [Last accessed on 2018 Apr 29].  Back to cited text no. 14
    
15.
Rajan S, Nanda P, Calhoun LM, Speizer IS. Sex composition and its impact on future childbearing: A longitudinal study from urban Uttar Pradesh. Reprod Health 2018;15:35.  Back to cited text no. 15
    
16.
Singh A, Singh KK, Verma P. Knowledge, attitude and practice GAP in family planning usage: An analysis of selected cities of Uttar Pradesh. Contracept Reprod Med 2016;1:20.  Back to cited text no. 16
    


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