Assessment of Contraceptive Knowledge and Attitude Among Primiparous Women in a Postnatal Ward in India

In 2020, an estimated 287,000 women globally died during pregnancy and childbirth, with a significant proportion occurring in low- and middle-income countries. India accounted for 8% of these deaths, with a maternal mortality ratio of 103 per 100,000 live births, highlighting the urgent need for accessible healthcare and effective interventions.¹ Despite the availability of various contraceptives, India faces a 19% unmet need for family planning, contributing to women having more children than desired and often with insufficient spacing between births. India’s family planning program has shifted from population control to prioritizing maternal and newborn health. Ensuring healthy timing and spacing of pregnancies is critical for improving reproductive, maternal, neonatal, child, and adolescent health outcomes.²

This was a cross-sectional study conducted among consenting primiparous women in postnatal wards of Government Medical College, Trivandrum, Kerala, India. This was a one-year study with a sample size of 320. All information was recorded in a questionnaire designed for the analysis and completed after obtaining written informed consent. Institutional Ethics Committee clearance (HEC.No.07/03/2022/MCT) was obtained for this study, by the principles outlined in the Declaration of Helsinki. Confidentiality was ensured and maintained throughout the research process. The subjects were not exposed to any additional risks, and the participants did not incur any extra hospital expenses due to their involvement in the study.

The data collection tool included demographic variables and questions regarding knowledge and attitude toward contraceptive methods. All statistical data were entered into an Excel sheet and analyzed using SPSS Version 27 software. Qualitative variables were expressed as proportions. The correlation between knowledge and attitude was assessed using the Pearson correlation coefficient. The association with sociodemographic variables was evaluated using the chi-square test, with statistical significance set at P < 0.05.

The data collected in this study indicates that demographic variables such as age, family type, domicile, religion, education of both the mother and husband, occupation of both the mother and husband and family income have statistically significant associations with the level of knowledge, as evidenced by a chi-square test with a P value less than 0.05, showing no significant association with the level of attitude towards contraceptives (Supplementary Table 1, http://links.lww.com/MFM/A70).

The striking finding of this study was that 66.25% (212/320) of postnatal mothers had good knowledge regarding contraceptive methods, while only 33.75% (108/320) had poor knowledge. Another finding was that 96.88% (310/320) of participants held a positive attitude towards contraceptives, with only 3.13% (10/320) demonstrating a negative attitude. Regarding the sources of information on contraceptives, media topped the list, contributing 60.63% (194/320). Based on the authors’ experience, condoms were the most recognized temporary contraceptive method, with a prevalence of 84.38% (270/320), followed by oral contraceptives at 72.19% (231/320), injectables at 62.50% (200/320), and a surprising 100% (320/320) awareness of permanent methods.

These findings align with previous research conducted in Kerala by Alukal et al.³, but contrast with studies from other Indian regions, such as the research by Goel et al.⁴, suggesting significant regional variations in family planning awareness and acceptance. While contraceptive knowledge showed significant associations with demographic factors, attitudes remained consistently positive across all subgroups-a finding that diverges from the results reported by Limabenla and Nongkynrih.⁵ This discrepancy underscores the complex interplay of sociocultural and educational factors influencing contraceptive behaviors. Of particular concern is the low knowledge level regarding copper-T (43%), highlighting the necessity for method-specific educational interventions to improve comprehensive contraceptive awareness.

This study, conducted at a single tertiary care center with a relatively homogeneous population, has certain limitations that warrant consideration. The findings may lack generalizability across different regions or healthcare settings, as contextual factors could significantly influence contraceptive knowledge and attitudes. Specifically regarding contraceptive data, our study has several constraints. We lack information about participants’ previous contraceptive usage or future method preferences, as these aspects fell beyond our research scope. This limitation is particularly relevant in the Indian context, where contraceptive decisions typically emerge from joint spousal discussions rather than being made by women individually.

Despite these limitations, the study offers valuable insights with several notable strengths. Its focus on family planning—a critical public health issue—and specifically on primiparous postnatal mothers, positions it as particularly relevant for enhancing maternal and child health outcomes. The comprehensive data collection, encompassing demographic variables alongside a detailed assessment of contraceptive knowledge and attitudes, enables a nuanced analysis of influencing factors. These strengths gain additional significance when considering the broader Indian context, where school-based sex education remains inadequate and inconsistent despite ongoing improvement efforts. This educational gap, stemming from cultural sensitivities, resource limitations, and insufficient teacher training, likely contributes to the notably poor contraceptive knowledge observed among younger participants (18-23 years). The study’s findings thus underscore the need for comprehensive educational reforms alongside clinical family planning services, particularly in light of the persistent challenges in India’s reproductive health education landscape.

To conclude, primiparous mothers in a postnatal ward in India demonstrated a strong understanding and a positive attitude towards contraceptive methods. It is recommended that healthcare professionals in this setting actively engage in educating these mothers about family planning methods and the potential risks associated with short inter-pregnancy intervals. These educational efforts are important considerations in the broader goal of reducing maternal and infant mortality and morbidity rates. Addressing the unmet need for contraception in this population can be approached through a combination of effective motivation, counseling, the implementation of awareness programs, and the improvement of facilities in both the public and private healthcare sectors.

Acknowledgment

We would like to acknowledge the support offered by Dr Betsy John and Dr Cinoy Xavier for this manuscript.

Funding

None.

Conflicts of Interest

None.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.