Chunampet Family Planning Interns' Projectdub

PONDICHERRY INSTITUTE OF MEDICAL SCIENCES

(A UNIT OF MADRAS MEDICAL MISSION) KALAPET, PUDUCHERRY

DEPARTMENT OF COMMUNITY MEDICINE

INTERNS RURAL POSTING(STUDY PERIOD 1/2/2014-28/2/2014)-CHUNAMPET

TITLE: “DETERMINANTS AND KNOWLEDGE ON CONTRACEPTIVE USAE AMONG WOMEN OF REPRODUCTIVE AGE GROUP IN A RURAL

AREA OF KANCHEEPURAM DISTRICT, TAMIL NADU”

INVESTIGATORS:

 

Prof.Dr.(Brig)Zile Singh Dr.Venkatachalam.J

HOD Assisstant Professor

PG IN CHARGE: Dr.Vishnu Prasad, 2nd year Post Graduate

INTERNS:

Dr.Abilash

Dr.Anantha Vigneshwari

Dr.Anisha Raymond

Dr.Antony Rosario

Dr.Balraj

Dr.Nirmal Krishna

Dr.Raghuram

Dr.Umar Basha

Dr.Vutla Kavya

ACKNOWLEDGMENTS

We’d like to take this opportunity to express our heartfelt

gratitude to the Head of Department of Community Medicine, Dr.

(Brig) Zile Singh, who gave us his timely and sincere guidance in the

goings about of this project. We also thank our co-guide,

Dr.Venkatachalam.J, Assistant Professor of the Department of

Community Medicine, who was with us every step of the way with

advice and support to help us attain our objectives.

We also thank Dr. Vishnu Prasad, 2nd year Postgraduate

student of the Department of Community Medicine who supported

us in the completion of the project. We extend our thanks to

Dr.Arun.S and Dr.Gopinath, RMO, Chunampet and the support

staff at the Rural Health Center in Chunampet who helped us make

this project a success.

Finally, we are greatful to all the study participants for their

cooperation as well as for spending their valuable time in proving us

the necessary details for the purpose of our study.

S.NO PARTICULARS PAGE NO

1 INTRODUCTION

2 OBJECTIVES

3 REVIEW OF LITERATURE

4 MATERIALS AND METHODS

5 RESULTS

6 DISCUSSION

7 SUMMARY AND CONCLUSION

8 REFERENCES

9 ANNEXURE –I QUESTIONNAIRE

CONTENTS

INTRODUCTIONINTRODUCTION

Global contraceptive usage was 63.3% in 2010

which was 9% more than that in 1990. Also in the last

two decades the Unmet need for Family Planning

decreased from 15.4% to 12.3% worldwide. These

changes were seen in almost all regions of the world

except in regions where family planning coverage was

already high. However, different regions showed

different levels of changes.1 Although India was the

first nation to have an official National Family

Planning Programme in 1952, the target was on health

of the women rather than population control. Then

census of 1971 revealed an alarming population growth

which necessitated adoption of population control

strategies in India. NFHS-III 2005-06 (National Family

Health Survey) in India revealed, the contraceptive

prevalence rate was 56% while in the past decade it

was 48%. 2 Providing universal Family Planning

services is an important strategy to reduce maternal

morbidity and to control population growth. 10% of all

pregnancies are mistimed and 11% of all pregnancies

are unwanted in India.2 The number of unintended

pregnancies can be brought down

Brought down by proper utilization of family planning

services. Worldwide the unmet need for Family

Planning decreased during the past two decades, but

the number of women with unmet needs remained the

same due to population growth. In India female

sterilization is the most commonly preferred method of

contraception accounting for 76% of all methods, while

in Tamil Nadu it was 90%. But the usage of temporary

methods of contraception remains low, which is mostly

due to social stigma and cultural misbeliefs4-5, lack of

knowledge6-7 and concern about side effects.4,7-9

Women’s decision on use of contraceptive methods is

influenced by several social constraints and social

circumstances including family sex composition and

gender preference. Worldwide, when contraception is

used properly and effectively to avoid unwanted

pregnancy it can reduce maternal deaths to 25%-

35%.10,11 Thus this study aims at measuring the

prevalence of unmet needs of family planning and its

determinants in a rural area of Kancheepuram district,

Tamil Nadu, South India.

OBJECTIVES

AIM:

To study the prevalence of unmet needs of family planning and its

determinants

OBJECTIVES:

To measure the prevalence of unmet needs of family planning

To study the determinants of contraceptive usage

REVIEW

OF

LITERATUREREVIEW OF LITERATURE:

The time since family planning services stared getting attention,

there has been many studies in the past on prevalence, acceptance and

usage of various contraceptive methods. It was during the late 20th

century contraceptive usage has gained momentum. However in many

developing countries the unmet needs for family planning still remained

considerably high, which is mostly due to lack knowledge, lack of

access and social stigma. There have been a few studies in the past

which attempted to estimate the contraceptive prevalence and pattern of

contraceptive usage.

Unmet Needs of family planning:

Varying levels of unmet needs of family planning have been

reported from different regions of the country. National Family Health

Survey (NFHS) reported the prevalence of unmet need for family

planning as 13% during the year 2005-06 while it was 16% during 1998-

99 in India. 2,12 Though in Tamil Nadu the unmet need was much less,

that is 9% during the year 2005-06, which reduced from 13% in the year

1998-99.13

In a study by Ilene S et al done in 6 cities of Uttar Pradesh, the most

populous state of India showed a varying prevalence of unmet need for

family planning from 12% in Moradabad to a maximum of 20% in

Aligarh. In Allahabad and Moradabad more percentage of women in the

slum have an unmet need for

family planning when compared to non-slum people. Also the unmet

need for limiting was more when compared to spacing .14

Yadav K et al in a study observed that prevalence of unmet needs

of family planning in Haryana to be 17.5% for married women, and also

unmet need was significantly higher among married women when

compared to men.15

A study done in Kancheepuram district by Prateek SS et al

revealed that the unmet need for contraception was 51.6% among

women of reproductive age group (15-49) years attending general

outpatient department in Urban Health Center.16

Contraceptive usage pattern and its prevalence:

Female sterilization remains the most preferred method of

contraception among married women, which accounted for 87% of

contraceptive use during 1998-99 and it became 90% during 2005-06 in

NFHS III in Tamil Nadu. But nationally female sterilization accounted

for 71% of all contraceptive use in NFHS II and 66% in NFHS III. 77%

of the female sterilization operations were acquired from Government

facilities in Tamil Nadu, however nation-wide it was 84%.2,12,13

In a study done by Srividhya V et al in Bangalore, 73.9% of the

study participants have not used any method of contraception before

sterilization.

while 15.8% of the study subjects used IUD, the commonest method of

contraception used for spacing.17

Patro BK in a study in Delhi observed that nearly 74% of the

women already

had 2 children when they first used a contraceptive method and 21%

used a contraceptive method for the first time after first child birth. Also

most of the study subjects used contraception to limit the family size

than for spacing. Only 2% of them used contraception before the first

child was born.18

Sharma V et al in a study done in Lucknow found that 47% of

women in rural area haven’t used any family planning method in the

past.19

68% of the married woman in a Mumbai slum are currently using a

contraceptive method as observed by Makade KG et al in their study.

The study results also show that 28% of them are using Oral

Contraceptive Pills followed Condoms (18%) and female sterilization

(11%). Although Copper-T was the most preferred method of

contraception it was used by only 9% of the married woman.20

Perceptions and Knowledge of Contraception:

Almost all women have knowledge about contraceptive methods in

India, females sterilization is the most known contraceptive method.

However the knowledge on temporary methods of contraception was

still considerably low.

61% of women have heard or seen a message about contraception in

media in the recent past, while this percentage was much higher among

males (92%).2 A study done in Lucknow by Sharma V et al indicates that

more than 90% women are aware of the male and female sterilization

methods, Condoms, IUCD (Intra-Uterine contraceptive devices) and

traditional methods of contraception. Health workers in rural area

and media in urban area remained as a major source of Information

about family planning to the women. 19

Makade KG et al in a study done in a Mumbai slum reported that

87% of the married woman are aware of Oral Contraceptive Pills and

Copper-T (Cu-T) and 80% of them are aware about female sterilization.

Decision on contraceptive usage is taken mutually by Husband and Wife

in in 41% of the cases and in 30% of the cases the decision was taken by

the husband. Nearly 85% of the study subjects are aware about the place

of availability of contraceptive services.20

MATERIALS

AND

METHODSMETHODOLOGY:

Study Setting: The Study was carried out in Chunampet panchayat, a

rural area in Kancheepuram District, Tamil Nadu, South India. Also the

field practice area of Rural Health Training Center, Pondicherry Institute

of Medical Sciences.

Study Design: Community Based Cross Sectional Study

Study Population: All women between 15-49 years of age in the study

area, who gave consent to participate are included in the study

Study Period: 1st Feb 2014 to 28th Feb 2014

Study Tool: Pretested Structured Questionnaire

Study Variables: Socio-Demographic profile, Personal details,

Knowledge about Contraceptives, Contraceptive usage pattern,

Perceptions on Family planning and family size were studied.

Sample Size: The required Sample Size was calculated to be 452, based

on the National prevalence of Unmet needs for family planning, 13%

from NFHS III2, with precision taken as 10%. Sample size was

calculated using the formula Z2PQ/d2

Sampling: Streets were selected randomly and all the households in the

street were included in the study. In every household all the available

and

eligible women were explained about the study and recruited. The study

was explained regarding the benefits and implications of study to all the

participant in their own language and their voluntary informed written

consent was sought before interviewing the participants.

Operational Definitions:

Unmet Need for Family Planning: The percent with an unmet need for

family planning is the number of women with unmet need for family

planning expressed as a percentage of women of reproductive age who

are married or in a union. Women with unmet need are those who are

fecund and sexually active but are not using any method of

contraception, and report not wanting any more children or wanting to

delay the birth of their next child.21

Statistical Analysis: MS Excel 2010 was used for data entry. Data

validation is MS excel was used to avoid errors in data entry. SPSS

Version 21 was used for statistical analysis.

RESULTS

RESULTS:

Figure 1. Education status of study respondants (n= 505)



Maximum (26%) of our study respondants completed high school followed by

middle school. 25% of the study population were illiterate.

Figure 3. Distribution of study respondants based on Religion (n= 505)

Most of the study participants were Hindus (97.4%), while Muslims and Christians

were

1% each.

Figure 4. Distribution of the study respondants base on the Marital status (n=

505)



Nearly 90% of our study participants are married, while 5% of them were widow

and 2% are separated.

Figure 5: Perception of the study subjects on Ideal age for marriage for

Women

(n = 505)



Nearly 70% of the study participants responded that 20-23 years is the ideal age for

a Girl to get married

Figure 6: Perception of the study participants about ideal no of children a couple can have (n=505)



Nearly 77% responded that ideal number of children a couple can have is 2 and 17% of the participants responded that ideal number of a children a couple

can have is 3.

Figure 8: Perception about spacing between two children can cause health problems (n=505)



About 45% responded that less spacing between two children can lead to health problems and 35% of our participants did not know that whether less spacing

between two children leads to health problems Figure 10: Pattern of Gender preference (n=505)



Only 29% of our participants prefers to have male child while 56% have no preference.

Figure 12: Insisted Gender (n=42)



Majority of our participants (80%) have been insisted to having a male child and the rest (20%) have been insisted to have a female child.

Figure 14: Contraceptive preference of our participants (n=427)



Approximately 81% of our respondents prefer to use sterilization as a

contraceptive method and 9% prefer to use Intrauterine contraceptive devices.

Figure 15: Knowledge about using contraceptive methods can prevent Sexually Transmitted Diseases (n=427)



Among those who have heard of a contraceptive method, about 22% of them responded that contraceptives can prevent STD

Figure 16: Knowledge about the contraceptive method that can prevent Sexually Transmitted Diseases (STD) (n=97)



Nearly 51% of the participants those who said STDs can be prevented by the use of

Contraceptive methods, responded that condoms can prevent STD.

Figure 17: Participants who have ever used a contraceptive measure

(n = 505)



Nearly 72% of the respondents have ever used atleast one form of contraceptive

method, whereas rest of the study participants have not used any contraceptive

method.

Figure 18: Source of information about contraceptive method (n=310)



Nearly half of the respondents have stated that the source of information about the

contraceptive methods was obtained through media and 29% of the respondents have gained knowledge about contraceptive methods from Doctors/ Nurses, the

rest from health worker, friends and relatives. Figure 19: Place from where the contraception facility was obtained (n=309)



Majority of our participants have obtained contraception from government

facilities.

Figure 20: Perception regarding failure of contraceptive measures (n=287)



Majority of our participants have never had a contraceptive failure while only a 2% had experienced contraceptive failure.

Figure 22: Decision regarding usage of contraception (n=309)

Majority of our study population have made their decision on contraceptive usage

mutually by both husband and wife, and 7.76% of the women made their own

decision regarding contraceptive usage.

Figure 23: Usage of contraceptive measure by partner (n=457)

In our study population, majority of participant’s partner did not use any form of contraceptive measures

Figure 25: Current usage of contraceptive measure (n=505)



Nearly half of our participants were currently using contraceptive measure and 48% of them were not using contraceptive measure now.

Figure 27: Prevalence of Unmet Needs of Family Planning among women of reproductive age group (15-49) years





Unmet need for Family Planning =

Women (Married or in an Union), who are not using contraception, are fecund, and desire to either stop childbearing and postpone their next birth for atleast 2 years + Pregnant women whose current pregnancy was unwanted or mistimed + women in postpartum amenorrhoea who are not using contraception and, at the time they became pregnant , had wanted to delay or prevent pregnancy___________________________________________

Total number of women of reproductive age (15-49) who are married or in an union

Figure 28: Unmet needs of family planning for spacing and limiting (n=135)



54% of the Unmet need was for Limiting and 45% of the Unmet need was for

Spacing.



The unmet need for family planning was more for individuals aged 15-25 years

when compared to older age groups and the difference was found to be

statistically significant. This shows the younger age group requires more emphasis

on family planning and adequate fertility control.

Table 1. Association

between current age

of the participant and Unmet

Need for Family

PlanningCurrent Age

of the Participant(in years)

Unmet Need for Family Planning

Total p - Value

Present (%) Absent (%)

15-25 55 (47.4%) 61 (52.6%) 116 (100%) p < 0.0001

26-35 48 (26.8%) 131 (73.2%) 179 (100%)

36-49 32 (22.9%) 108 (77.1%) 140 (100%)

Total 135 (31%) 300 (69%) 435 (100%)