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Indian Journal of Community Medicine

Contraceptive Use in Women From a Resettlement Area in Delhi

Author(s): A. Khokhar, M. Mehra

Vol. 30, No. 1 (2005-03 - 2005-03)

Abstract

Objective:

  1. To find out the prevalence of contraceptive use and study the socio-demographic profile of women within three years of their marriage.
  2. To study the reasons for not using the modern contraceptive methods. Study Design : Crosssectional study.

Setting: A resettlement colony located at Mata Sundari Road, Delhi.

Participants: All the 206 recently married women i.e. between 15th July 1998 and 15th July 2001.

Statistical analysis: Proportions, chi-square test.

Results: Out of a total of 206 women studied 53.9% were adolescents. 76.1% of the subjects had their first child when they were between 15-19 years of age. Prevalence of contraception was 45.1%. Only 2.9% had used a contraceptive to space the first child. Significantly higher proportion of women adopted contraception after the birth of first child as compared to those with zero parity (p< 0.01). Also women aged more than 19 years were more likely to use contraception as compared to the adolescents (p<0.01). Main reasons cited for not using the contraception to space the first child was being newly married (53.1%) and too soon after the marriage (22.4%). 30.6% of them had unmet need to contraception.

Key Words: Contraceptive prevalence, adolescent, spacing

Deptt. of Community Medicine, Maulana Azad Medical College,Delhi

Introduction

In most of the world, Family Planning programs have had great success in slowing population growth, yet in many countries, these programs tend to reach older women, often after they had desired number of children. Even as family planners encourage women to plan their family size and adequately space births, the youngest married couples are often overlooked1. As many as 40% of all young women aged 15-19 years in India are already married, 17% of all adolescent females aged 13-19 years are already mothers or are pregnant with their first child2. Preventing pregnancies among recently married may have a long term demographic impact3. A woman who has her first child before the age of 18 years will have an average of 7 children by the time she was completed child bearing as compared to a woman who waits until her early 20's to begin child bearing, who will have average of 5 or 6 children1. An older aged a first birth translates to longer intervals between generations. Delayed child bearing may reduce maternal and infant health risks but also provide increased opportunities for women to acquire education, skills and great aspiration for herself and her family. The present work was conducted against the above background to study the contraceptive use by recently married women.

Material and Methods

A cross-sectional study was conducted between July and December 2001 in a resettlement area located at Mata Sundari Road, New Delhi. This area came into existence 20 years back and was chosen for the purpose of the study due to it's close proximity to Maulana Azad Medical College, New Delhi. This work is a part of research project with the The Central Council of Scientific and Industrial Research, Delhi. A total of 480 ever married women in the age group of 15-49 years reside here. A total of 206 recently married women, i.e., women married between 15th July 1998 and 15th July 2001 were interviewed using prestructured, pretested oral questionnaire. Information was collected regarding sociodemographic variables, spacing of children, reasons for nonadoption of contraception and unmet need of contraception.

A respondent who had ever used modern method of contraception any time before the survey was categorized as 'ever-user'. Those using it at the time of the survey were categorized as 'current users'. Couples who wanted to postpone or avoid child bearing and were not using contraception were defined as having unmet need. The socioeconomic categories was done using Gupta et al classification4.

Results

A total of 206 recently ever married women were interviewed. Over half (53.9%) of them were adolescent (Table I).

Table I : Demographic Profile of the Study Subjects (N=206)

Age (years) n %
15-19 111 53.9
20-24 85 41.3
25-29 08 3.9
30-34 02 1.0
Religion
Hindu 151 73.3
Muslim 47 22.8
Others 08 03.9
Literacy Status
Literate 175 84.9
Illiterate 31 15.0
Work Status
Employed 81 39.3
Un-employed 125 60.7
Income
Upper Middle 138 67.0
Lower Middle 68 33.0
Type of Family
Nuclear 78 37.9
Joint 128 62.1

Mean age at marriage was 16.8 years. As many as 79 (58.9%) had the first child when they were between 15-19 years and 47 (35%) were between 20-24 years of age. 21 (10.2%) of the subjects had been married for less than a year, 87 (42.2%) for 1-2 years and 98 (47.6%) for 2-3 years. 55 (26.7%) had not borne any children. Majority 130 (63.1%) had borne one child and 21 (10.2%) had two children. Overall, 151 (73.3%) had one or more children. 93 (45.1%) were ever users of contraception and 51 (24.7%) were current users. Only 6(2.9%) women had ever used contraception before the first child birth. Maximum of 71 (34.5%) had used it after the first child birth. The difference between contraceptive use before first child and after is statistically significant, (p < 0.01) (Table II). Main reason cited for those with zero parity for non use of contraception was being newly married (53.1%) and too soon to use contraception (22.4%). For those with one child birth, main reason mentioned was perceived untoward side effects of the contraceptives (35.6%).

Table II : Parity-Wise Ever Use of Contraception (N=206)

Parity Contra Use+ Contra Use- Total
0 06 (2.9) 49 (43.4) 55
1 71 (34.5) 59 (52.2) 130
2 16 (7.8) 05 (4.4) 21
Total 93 113 206
  (45.1) (54.8)  
Chi - square = 35.51 d.f. = 1 P < 0.01, significant

Table III : Parity-Wise Reasons For Not Using Modern Contraceptive Method (n=113)

Reasons Parity
  0 1 2
  n (%) n (%) n (%)
Newly married 26 (53.1) 00   00  
Too soon 11 (22.4) 00   00  
Using trad. method 02 (4.1) 04 (6.8) 00  
Want a child 15 (30.7) 18 (30.5) 1 (20)
Want a Male child 00   09 (15.2) 2 (40)
Not co-habitating 00   02 (33.9) 00  
Perceived untoward 00   21 (35.6) 2 (40)
Side effect of contr. Opposition from Family members 03 (6.1) 17 (28.8) 00  
Total 49 59 05

Of those aged 15-19 years, 35 (37.6%) were ever users as against 58 (62.4%) of those more than 19 years of age and the difference is statistically significant, (p < 0.01). 63 (30.6%) of the women had unmet need of contraception and 28 (13.6%) had M.T.P. at one time or another. 21 (33.3%) mentioned the reasons to be fear of side effects, 14 (22.2%) dissatisfaction with the available contraceptives, 11 (17.5%) inconvenient or unsatisfactory services. 10 (15.9%) perceived themselves to be at low risk of conception. 7 (11.1%) cited the reason to be non availability of the desired contraceptive. Religion was highlighted as a reason by 6 (9.5%) of the subjects, all of whom were Muslims. In case of 4 (6.3%) opposition from husband and other family members was the reason for their unmet need (Table III).

Discussion

Marriage is early and almost universal in India. In the current study mean age at marriage was 17.2 years which is less than the legal age of marriage. The age at marriage has been rising steadily over time nonetheless, 30% women aged 15- 19 years have married and even among women aged 20-24 years almost one quarter married before age of 15 years and half married before the age of 18 years5. Kanan in a study conducted in slums of Delhi observed that more than 76% of the girls married before the age of 18 years6. In the present study population the proportion of Muslim is higher than 11.4% which is the proportion for the country as a whole7. 84.5% of the subjects are literate as against 75% for the women in Delhi, according to Census 20018. Age at first child birth was between 15-19 years for 58-9% of the subjects. NFHS-II has reported that age group of 15-19 years contributes to 19% of the total fertility in India5. Kanan states that more than 80% of the married subjects had children within first year of marriage6. Also according to Jejeebhoy 17% of all adolescent females aged 13-19 are already mothers or pregnant with their first child2. In Bangladesh also more than 70% of the married adolescents become pregnant before their first marriage anniversary and the mean age at first pregnancy was observed to be 15 years. Population pyramids of such developing countries show that adolescent population is growing in sheer number and sometimes as a proportion of the total population. Thus, the number of married adolescents will continue to increase, making the need to reach them with services all the more compelling.

A total of 73.3% had one or more children within three years of marriage. Social and religious norms support demonstration of fertility soon after marriage. Motherhood may be one way in which a young married woman can affirm her value and identity to herself and her community. In a few societies if a female fails to give birth with in a few years of marriage, she encounters difficulty with her husband and in-laws and may even by rejected1. This has also been observed in this study where women having no children had quoted for non adoption of contraception 'recently married' (53.1%) and 'too soon to use contraception after marriage' (22.4%). Resistance from family members was also cited by 6.1% of the subjects.

Main reason cited for non use of contraception for those with one or more children was intention to have more children and preferably male child (Table II). Among those women with unmet need of contraception also contraceptive use increased appreciably after the first child birth. Statistically significant higher proportion of women aged more than 19 years used contraceptives as compared to younger population. According to NFHS - II contraception was practiced by 2% with no children and 24% with one child birth5. According to Jain et al only 8.4% of the subjects spaced their first child8.

In the present study 30.6% of the subjects had unmet need of contraception. A national survey found that as many as 30% of the women aged 15-19 years had the unmet need. According to NFHS-II only 30% of the demand for spacing is being met. Notably, unmet need is highest among the youngest women with one child, who also have the unmet need of spacing5. This indicates that there is still substantial scope for improvement to meet the needs of women. Reproductive health programmes and field workers should be re-oriented to motivate newly married young couples. Premarital counselling to those preparing to marry especially adolescents should be imparted. Newly weds, their husbands and in-laws should attend orientation meeting where education about family planning and reproduction should be imparted. Newly married who use contraception to space the first child can be encouraged to act as agents of community change. They can be trained as peer educators. Efforts to improve education, training and job opportunities for young women as child bearing becomes a lesser focus are also crucial.

While work with recently married is becoming better establishing, little is known about factors that influence adolescent married couples decision making in most contexts. Moreover, approaches have focussed mostly on increasing the contraceptive use; more needs to be done to address the gender inequities that result in young women's lack of autonomy, as well as to broaden the spectrum of reproductive health services programme provides.

References

  1. Alaudin M and Maclaren L. Reaching newly wed and married adolescents. In Focus: Focus on young adults. July 1999:1- 8.
  2. Jejeebhoy S J. Adolescent sexual health and Reproductive Behaviour. A review of the Evidence from India. ICRW Working Paper No. 3, Washington. International Centre for Research on Women, 1996.
  3. Singh S. Adolescent child bearing in developing countries. A global review. Studies in Family Planning, 1998; 29(2) : 117-136.
  4. Gupta M C. Modified scale for determining socio-economic status of urban families. Mahajan BK. Textbook of Preventive and Social Medicine. First edition, Jaypee Brothers, Daryaganj, Delhi - 86. 1991.
  5. National Family Health Survey II : Key findings. International Institute for Population Sciences, Govandanj Station Road, Deonar, Mumbai, India, 1998-1999:8-10.
  6. Kanan K. Delhi slum Girls marry early : Report, The Hindu. August 26, 2002.
  7. Manorama year Book, Religious Communities, Malalya Manorama Press, Kottayam, India 1996:461.
  8. Census of India 2001, Series I, Provisional Population Totals. Directorate of Census Operations, Aravali Printers and Publishers Pvt. Ltd., Published by the Controller of Publications, Delhi-117.
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