Abstract
Aim:
This study was planned with the objective to assess the knowledge, attitude, and practices of family planning methods among married women and to find out the factors associated with not using the family planning method.
Materials and Methods:
This community-based cross-sectional observational study was conducted in 300 married women residing in a rural area of Jaipur, Rajasthan. Written informed consent was obtained, and data were collected using a pre-tested semi-structured questionnaire. Knowledge, attitude, and practices were summarised in proportion, and their association was measured using Chi-square test.
Results:
The mean age of the participants was 26.7 years. Most of them (88.8% women) had knowledge of at least one contraception method. Almost two-thirds had positive attitude towards contraceptive use. The most used method was oral contraceptive pills, among 17.7% of participants. Knowledge was significantly associated with educational level and caste of the participants (P value <0.05), and practice was not significantly associated with any socio-demographic factors (P value >0.05).
Conclusion:
Knowledge, attitude, and practices related to modern family planning methods are still not high in rural areas. The media can play a major role in increasing awareness about family planning methods. The involvement of community and family, especially spouse, should be facilitated to maximize the understanding of family planning methods.
Keywords: Attitude, contraception, family planning, knowledge, practice, Rajasthan, rural
Introduction
In 1952, India became the first nation in the world to introduce a national programme for family planning because of its fast-growing population.[1] The focus gradually shifted from clinical to reproductive child health, and the National Population Policy (NPP) of 2000 introduced a comprehensive and goal-free strategy that assisted in lowering fertility. As the programme has grown over the years, it has infiltrated every nook and cranny of the nation, including primary health centres and sub-centres in rural areas as well as urban family welfare centres and post-partum centres in urban areas. The crude birth rate (CBR), total fertility rate (TFR), and growth rate have rapidly decreased as a result of technological advancements, better health care quality, and coverage.[2]
The Indian government has made significant efforts, but there is still a persistent need for contraception. More than one in seven of all unwanted pregnancies that occur each year around the world take place in India.[3] Studies from India show that unplanned pregnancy is linked to decreased use of maternal health services and worse results for both newborn and mother health.[4-6] In India, according to National Family Health Survey-5 (NFHS-5, 2019–21), the birth rate for women in the 15–19 age range was 43 per 1000 women, which has reduced from 51 per 1000 in NFHS-4 (2015–16).[7]
According to the NFHS-5 report for the year 2019–21, the current use of any family planning method by married women in India aged 15–49 years was 66.7%, while the current use of any family planning in Rajasthan was found to be 72.3% with an increase of 12.6% from the reported data of 59.7% in NFHS-4. The birth interval is less than 24 months in 27% of non-first-order births (NFHS-4). Female sterilisation accounts for 37.9% of family planning (FP) technique adoption in NFHS-5.[7,8]
With diverse variability and urban–rural divide in Rajasthan, the unmet need of contraception varies from 4.2% to 11.2% in different regions of Rajasthan, so it needs to be studied and addressed through appropriate policy and intervention.[9] Hence, this study was conducted with the objective of assessing the knowledge, attitude, and practices regarding family planning methods among married women residing in Nayla village, Jaipur, and to find out the factors associated with not using the family planning method among married women.
Materials and Methods
This study was a community-based, cross-sectional, analytical type of observational study conducted in a rural area under Field Practice Area of Rural Health Training Centre (RHTC), attached to tertiary care facility, Jaipur. The study was conducted for a period of 12 months from December 2021 to November 2022 after approval of the research protocol from Institutional Research Review Board and Institutional Ethics Committee with reference number 1316/MC/EC/2021 dated 03/12/2021. Additional 3 months was taken for data analysis and report writing.
Aseri G et al.[10] reported the prevalence of knowledge of at least one contraception method as 80.4% among rural women. The sample size was calculated using the formula n = z2pq/d2, and taking the value of z (standard normal deviate) as 1.96 at 95% confidence interval (α =0.05), P (prevalence) as 80.4%, q (100-p) as 19.6%, and d (allowable absolute error) as 5%, a sample size of 243 was obtained. It was further rounded off to 300 as the final sample size to accommodate for attrition. All married women residing in village Nayla for more than 1 year duration in the reproductive age group (15–49 years) and who gave written informed consent to participate in the study were included in the study. Women who were non-cooperative and pregnant and did not give consent were excluded from the study.
To select the study participants for this study, first, the houses were selected using systematic random sampling technique. The total population of the study area was 5084 at the time of data collection. The number of houses in a study area was found to be 1259 in a survey conducted by ASHA. To achieve the required sample size, every fourth house was then visited after identifying the first house which was selected in the direction pointed out by spinning bottle at the centre of the study area. From each selected house, one eligible married woman was selected by simple random technique through the lottery method. In case no eligible married woman was found in the family, the next house was surveyed and so on. A total of 22 houses were there with no eligible married women. Thus, from selected 300 houses, 300 eligible married women were selected to include in this study.
Data were collected using a pre-tested semi-structured schedule; this schedule consisted of Section A, containing the socio-demographic profile of married women including age, age at marriage, religion, educational qualification, occupation, family income, and number of family members, and Section B, comprising a schedule regarding knowledge, attitude, and practices of married women about family planning methods. Questions were asked by the investigator, and response was filled by the investigator himself. Questions had ‘Yes/No’ as options; a maximum of one mark was given for ‘Yes’ as the correct response and zero mark for don’t know or a wrong response.
Data collected were entered in Microsoft Excel sheets by the investigator himself on the same day so as to minimise data entry bias if any. Continuous data were summarised in the form of mean and standard deviation. Discrete data were summarised in the form of proportion. Chi-square test was used to find out the association of knowledge and practice with socio-demographic profile. The level of significance was kept at 95% for all statistical analyses, that is, P value <0.05.
Results
Table 1 depicts the socio-demographic profile of the participants. The mean age of the participants was 26.7 years. Most of them belonged to 18–25 years. Almost three-fourths of the participants were married between 16 and 20 years of age. One tenth of participants were illiterate. Most of the participants were homemakers.
Table 1.
Socio-demographic profile of the participants
| Variable | Groups | Frequency (n=300) | Percentage |
|---|---|---|---|
| Age | 18-25 | 138 | 46.0 |
| 26-30 | 111 | 37.0 | |
| >30 | 51 | 17.0 | |
| Age at marriage | 16-20 years | 233 | 77.6 |
| 21-25 years | 62 | 20.7 | |
| above 25 | 5 | 1.7 | |
| Education | Illiterate | 31 | 10.3 |
| Primary | 70 | 23.3 | |
| Middle | 69 | 23.0 | |
| Above secondary | 130 | 43.3 | |
| Religion | Hindu | 265 | 88.3 |
| Muslim | 35 | 11.7 | |
| Caste | General | 63 | 21.0 |
| Other Backward Caste | 120 | 40.0 | |
| Scheduled Caste | 82 | 27.3 | |
| Scheduled Tribe | 35 | 11.7 | |
| Occupation | Homemaker | 189 | 63.0 |
| Unskilled worker | 80 | 26.6 | |
| Small-scale business | 19 | 6.4 | |
| Government Job | 12 | 4.0 | |
| Socio-economic status* | I | 45 | 15.0 |
| II | 80 | 26.6 | |
| III | 82 | 27.4 | |
| IV | 83 | 27.6 | |
| V | 10 | 3.4 |
*Modified BG Prasad July 2021 was used for socio-economic status
Knowledge
Table 2 depicts the proportion of participants with knowledge of contraceptives. Most of them had knowledge of condoms (246, 82%), followed by sterilization (242, 80.7%), oral contraceptive pills (OCPs) (238, 79.3%), breastfeeding as contraceptive (213, 71%), intra-uterine contraceptive devices (IUCDs) (206, 68.7%), safe period method (142, 47.3%), non-scalpel vasectomy (NSV) (137, 45.7%), and injection depot medroxyprogesterone acetate (DMPA) (128, 42.7%), and the least had knowledge of post-partum intra-uterine contraceptive devices (118, (39.3%).
Table 2.
Distribution of knowledge regarding contraception
| Components of knowledge of contraceptives | Number (n=300) | Percentage |
|---|---|---|
| Knowledge of any family planning methods | 265 | 88.3 |
| Knowledge that modern contraceptive methods are more effective than traditional methods | 237 | 79.0 |
| Knowledge regarding condom being protective against STD and AIDS | 240 | 80.0 |
| Knowledge regarding birth spacing that provides enough nutrition for next pregnancy | 242 | 80.7 |
Attitude
In the current study, about two-thirds of participants (203/300) had positive attitudes towards the use of contraceptives. Most participants, 86.3% (259/300), had a positive attitude towards control of family size. Similarly, 83.7% (251/300) participants had a positive attitude towards the discussion of planning pregnancy. A significant proportion of women (60.3%, 181/300) had a negative attitude about the use of NSV in their partners.
Practices
Out of 300 participants, 32 (10.7%) were breastfeeding. Out of all eligible women, around two-third of them (62.3%, 167/268) were practicing any method of contraception; the most used method was OCPs in 53 (17.7%), followed by condoms in 32 (10.7%), DMPA in 31 (10.3%), IUCD in 30 (10%), and safe period method (rhythm method) in 21 (7%) women.
Table 3 shows that association of knowledge of contraceptives with age group of participants, age of marriage, religion, occupation, and socio-economic status was statistically insignificant (P value >0.05) and was significant with educational level and caste of the participants (P value <0.05). Women with higher education have higher knowledge of contraceptives, and women of general caste had higher knowledge of contraceptives compared to women of other backward class (OBC), scheduled tribe (ST), and scheduled caste (SC). Table 4 shows that association of practices of contraception with any of the socio-demographic variables was statistically insignificant (P value >0.05).
Table 3.
Association of knowledge about contraceptive methods with socio-demographic variable
| Variable | Knowledge about contraceptive methods | P* | |
|---|---|---|---|
|
| |||
| Present (n=265) | Absent (n=35) | ||
| Age Group (Years) | |||
| 18-25 years | 124 (89.9) | 14 (10.1) | 0.574 |
| 26-30 years | 98 (88.3) | 13 (11.7) | |
| Above 30 | 43 (84.3) | 8 (15.7) | |
| Age at Marriage | |||
| 16-20 years | 204 (87.6) | 29 (12.4) | 0.608 |
| 21-25 years | 56 (91.8) | 5 (8.2) | |
| Above 25 | 5 (83.3) | 1 (16.7) | |
| Educational Level | |||
| Illiterate | 14 (45.2) | 17 (54.8) | <0.001 |
| Primary | 58 (82.9) | 12 (17.1) | |
| Middle | 63 (91.3) | 6 (8.7) | |
| Secondary and above | 130 (100) | - | |
| Religion | |||
| Hindu | 238 (89.8) | 27 (10.2) | 0.056 |
| Muslim | 27 (77.1) | 8 (22.9) | |
| Caste | |||
| General | 62 (98.4) | 1 (1.6) | 0.002 |
| Other backward class (OBC) | 109 (90.8) | 11 (9.2) | |
| Scheduled tribe (ST) | 30 (85.7) | 5 (14.3) | |
| Scheduled caste (SC) | 64 (78) | 18 (22) | |
| Occupation | |||
| Government Job | 12 (100) | - | 0.799 |
| Small-scale business | 17 (89.5) | 2 (10.5) | |
| Unskilled worker | 69 (86.3) | 11 (13.8) | |
| Housewife | 167 (88.4) | 22 (11.6) | |
| Socio-economic Status | |||
| I | 37 (82.2) | 8 (17.8) | 0.321 |
| II | 75 (93.8) | 5 (6.3) | |
| III | 70 (85.4) | 12 (14.6) | |
| IV | 74 (89.2) | 9 (10.8) | |
| V | 9 (90) | 1 (10) | |
*Chi-square test was used for analysis
Table 4.
Association of practice of contraception with socio-demographic variable
| Variable | Practice of contraceptive methods | P* | |
|---|---|---|---|
|
| |||
| Present (n=199) | Absent (n=101) | ||
| Age Group (Years) | |||
| 18-25 years | 93 (67.4) | 45 (32.6) | 0.832 |
| 26-30 years | 74 (66.7) | 37 (33.3) | |
| Above 30 | 32 (62.7) | 19 (37.3) | |
| Age at Marriage | |||
| 16-20 years | 153 (65.7) | 80 (34.3) | 0.334 |
| 21-25 years | 44 (71) | 18 (29) | |
| >25 | 2 (40) | 3 (60) | |
| Educational Level | |||
| Illiterate | 22 (71) | 9 (29) | 1.000 |
| Primary | 47 (67.1) | 23 (32.9) | |
| Middle | 44 (63.8) | 25 (36.2) | |
| Secondary and above | 86 (66.2) | 44 (33.8) | |
| Religion | |||
| Hindu | 175 (66) | 90 (34) | 0.914 |
| Muslim | 24 (68.6) | 11 (31.4) | |
| Caste | |||
| General | 46 (73) | 17 (27) | 0.538 |
| Other backward class (OBC) | 81 (67.5) | 39 (32.5) | |
| Scheduled tribe (ST) | 20 (57.1) | 15 (42.9) | |
| Scheduled caste (SC) | 52 (63.4) | 30 (36.6) | |
| Occupation | |||
| Government Job | 8 (66.7) | 4 (33.3) | 0.196 |
| Small-scale business | 8 (42.1) | 11 (57.9) | |
| Unskilled worker | 54 (67.5) | 26 (32.5) | |
| Housewife | 129 (68.3) | 60 (31.7) | |
| Socio-economic Status | |||
| I | 32 (71.1) | 13 (28.9) | 0.109 |
| II | 57 (71.3) | 23 (28.8) | |
| III | 47 (57.3) | 35 (42.7) | |
| IV | 49 (59) | 34 (41) | |
| V | 4 (40) | 6 (60) | |
*Chi-square test was used for analysis
Discussion
This study was designed to understand the knowledge and practices of women regarding family planning methods in the rural area of Jaipur. In this study, about two-third participants were married by the age of 20 years and almost half of the participants belonged to the age of 18–25 years, which was an important finding and emphasizes that success of the family planning programme lies in focussing on this age group of participants.
In the present study, 88.3% women had knowledge about any family planning methods. Among them, maximum women had knowledge about condom (82%), followed by sterilization (80.7%), OCPs (79.3%), breastfeeding (71.0%), IUCD (68.7%), safe period method (47.3%), NSV (45.7%), Inj. DMPA (42.7%), and post-partum intra-uterine contraceptive devices (PPIUCDs) (39.3%).
This result contrasted with the study done by Daya PA et al.[11] (2018), which concluded that 56.0% women had knowledge about IUCD, 38.0% knew about permanent sterilization (38%), 21.0% knew about pills, and only 14.0% knew about condoms. Srivastav A et al.[12] (2014), in his study, reported that 71.22% women knew about contraception. In a study by Devaru JS et al.[13] (2020), the knowledge of contraception was 88.7% among women; Gupta V et al.[14] (2016) reported that all participating women knew about any contraception method with maximum knowledge of OCPs (97.7%), sterilization (95.6%), condom (92.4%), male sterilization (89.6%), and IUD 284 (89.3%). A study by Shumayla S et al.[15] (2017) found that 87% women had knowledge of contraception, which was like the present study. Knowledge of contraceptive was higher in women with higher education compared to illiterates; this indicates that education plays a significant role and education provides individuals with accurate information about contraception, including different methods, their effectiveness, and potential risks and benefits. With proper education, people can make informed decisions about their reproductive health. They learn about the importance of family planning, the consequences of unplanned pregnancies, and the various options available to them. Knowledge empowers individuals to take control of their sexual and reproductive lives, make responsible choices, and protect themselves from unwanted pregnancies and sexually transmitted infections.
In the present study, it was observed that 67.7% of women had favourable attitude towards contraceptive use. It may be because either they are willing to use birth control but not have sufficient knowledge to decide which planning methods are available and best for them or it may be the result of investigator-induced bias. Most women were in favour of controlling family size, and 83.7% were in favour of discussing their partner about a planned pregnancy. On the contrary, only 39.7% of women had favourable attitude towards the effect of NSV on sexual performance. As attitude has a significant and robust impact on practicing health behaviours, the majority of women believed that NSV will have poor effects on sexual performance. Srivastav A et al.[12] (2014) reported that 71.22% participants had favourable attitude towards contraceptive methods. In yet another study by Nisha C et al.[16] (2018), maximum participants had favourable attitude about post-partum sterilization (94.8%), followed by IUCD (13.2%), periodic abstinence (3.2%), condoms (2.8%), and OCP (2.0%). Quereishi MJ et al.[17] (2017) reported that 62% of respondents showed favourable attitude towards family planning methods; in a study by Gupta V et al.[14] (2016), 83.1% participants had favourable attitude.
Most (82.7%) of the women were discussing about the family planning method with their husband, and 26.6% women were using OCPs as the family planning method. Out of all women using contraceptive methods, 91.0% of them were satisfied with the current contraceptive method. It was observed that 90.9% women faced no problem while using the current contraceptive method, but there were a few women who faced some minor problems like bleeding (3.0%), hormonal imbalance (4.5%), and pain (1.5%). Around half (45.5%) of study participants did not use any contraceptive method. The major reasons stated for not using any contraceptive were that first, they wanted to have a child, and second, non-availability of contraceptives (36.6%), followed by rejection of conceptive use by their families (12.9%), and about 5.0% women believed that contraceptive use was against their religion. It indicates that besides having a national programme, there is non-availability of contraception for almost one-third of married women, which is a significant proportion, and 12.9% women stated opposition of families; it signifies the fact that along with married women, we have to counsel husbands and family members along with married women.
In a study of Daya PA et al.[11] (2018), it was observed that the major reasons preventing the women from using contraceptive methods were having desire to have a child (60.5%), followed by lack of knowledge among women (42.4%). In a study by Srivastav A et al.[12] (2014), 48.3% women were not practicing any contraceptive method and the rest were using contraceptives; the majority of them used sterilization (62.9%), barrier (51.2%), OCPs (45.4%), and IUDS (36.6%), and no one was using injectable contraception methods; in a study by Gahlot A et al.[18] (2017), it was revealed that condom was the most common contraceptive method in 27.2% participants, followed by IUCD in 22.8%, OCP in 21.0%, sterilization in 13.5%, and DMPA in 9.8%, but 36% participants were not using any type of contraceptive method. The most common (90.4%) practicing contraceptive method in a study by Nisha C et al.[16] (2018) was post-partum sterilization, followed by IUCD (4.4%), periodic abstinence (2.6%), condoms (1.8%), and others (0.8%). In a study by Quereishi MJ et al.[17] (2017), 53% of respondents were using any one of family planning methods.
Strengths and limitations
This study was conducted with a well-designed schedule by taking a proper sample size with proper sampling techniques and using pre-designed proformas which were validated, but there are a few limitations of the study; for example, this study was done only among married women in rural areas. Therefore, the findings of the study cannot be generalized to the whole population. Practice was evaluated as verbal responses as the women were shy to talk about family planning. Further objectives like the effect of the health education programme are not taken up.
Conclusion
The impact of knowledge on health behaviours has been validated in many public health areas based on the idea that the public can make “informed decisions” about health behaviours by utilising their knowledge of pertinent health issues. To increase family planning options and close the knowledge–practice gap in Rajasthan’s rural areas, government and non-government organisations should organise health education and awareness campaigns in addition to information, education, and communication (IEC) and behaviour change communication (BCC). From the time a person reaches puberty, both formal and informal education regarding family planning methods must be provided. The media can significantly contribute to raising public knowledge of family planning options. To ensure that the community, family, and spouse are involved, family planning methods should be explained as thoroughly as possible. The service provider must guarantee that family planning options are always available. Therefore, they must be inspired to do their work for the community. Health care professionals, notably front-line health workers, must play a vital role in educating the public.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Kongawad DP, Boodeppa GK. National family planning programme--during the five year plans of India. J Evol Med Dent Sci. 2014;3:5172–9. [Google Scholar]
- 2.Annual Report 2014-15 – Family Planning. National Health Mission. [[Last assessed on 2023 Apr 15]]. Available from: https://nhm.gov.in/images/pdf/programmes/family-planing/annual-report/annual-report-fp-division-2014-15.pdf .
- 3.FP2020. India: FP2020 Core Indicator. 2015–16 Summary Sheet. [[Last assessed on 2023 Apr 15]]. Retrieved July 2018, Available from: http://www.familyplanning2020.org/entities/76 .
- 4.Singh A, Chalasani S, Koenig MA, Mahapatra B. The consequences of unintended births for maternal and child health in India. Popul Stud (Camb) 2012;66:223–39. doi: 10.1080/00324728.2012.697568. [DOI] [PubMed] [Google Scholar]
- 5.Singh A, Singh A, Mahapatra B. The consequences of unintended pregnancy for maternal and child health in rural India: Evidence from prospective data. Matern Child Health J. 2013;17:493–500. doi: 10.1007/s10995-012-1023-x. [DOI] [PubMed] [Google Scholar]
- 6.Dehingia N, Dixit A, Atmavilas Y, Chandurkar D, Singh K, Silverman J, et al. Unintended pregnancy and maternal health complications: Cross-sectional analysis of data from rural Uttar Pradesh, India. BMC Pregnancy Childbirth. 2020;20:188. doi: 10.1186/s12884-020-2848-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS; 2017. [[Last assessed on 2023 Apr 15]]. Available from: https://dhsprogram.com/pubs/pdf/fr339/fr339.pdf . [Google Scholar]
- 8.International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21: India: Volume I. Mumbai: IIPS; 2021. [[Last assessed on 2023 Apr 15]]. Available from: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf . [Google Scholar]
- 9.Raj TPS, Tiwari VK, Singh JV. Regional variations in unmet need of family planning in Rajasthan. Health Popul Perspect Issues. 2013;36:26–44. [Google Scholar]
- 10.Aseri G, Agrawal S. Knowledge, attitude, and practices about contraceptive in Western Rajasthan, India. Int J Reprod Contracept Obstet Gynecol. 2018;7:2786–91. [Google Scholar]
- 11.Daya PA, Priya PG, Karthikeyan G. Knowledge and practice about contraception among married women in reproductive age group in a rural area of Tirunelveli district, Tamil Nadu, India: a cross-sectional study. Int J Reprod Contracept Obstet Gynecol. 2018;7:2732–6. [Google Scholar]
- 12.Srivastav A, Khan MS, Chauhan CR. Knowledge, attitude and practices about contraceptive among married reproductive females. Int J Sci Study. 2014;1:2–4. [Google Scholar]
- 13.Devaru JS, Jabeen B, Mayanna P. A cross sectional study on knowledge, attitude and practice of family planning method usage among urban women of Dr. B. R. Ambedkar Medical College field practice area. Int J Community Med Public Health. 2020;7:981–6. [Google Scholar]
- 14.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;5:627–32. [Google Scholar]
- 15.Shumayla S, Kapoor S. Knowledge, attitude, and practice of family planning among Muslim women of North India. Int J Med Sci Public Health. 2017;6:847–52. [Google Scholar]
- 16.Nisha C, Kerline PJ, Sunil A. Knowledge attitude and practices regarding family planning methods in a rural area in Thrissur district Kerala, India. European J Biomed Pharm Sci. 2018;5:224–7. [Google Scholar]
- 17.Quereishi MJ, Mathew AK, Sinha AC. Knowledge, attitude and practice of family planning methods among the rural females of Bagbahara block Mahasamund district in Chhattishgarh State, India. Glob J Med Public Heal. 2017;6:1–7. [Google Scholar]
- 18.Gahlot A, Nath S, Kumar P, Nath M. Study of prevalence of different contraceptive methods feasibility of DMPA among married women in urban area of Rama Medical College, Kanpur. Indian. J Forensic Community Med. 2017;4:90–4. [Google Scholar]