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Indian Journal of Community Medicine

Acceptability of Contraceptive Methods Among Urban Eligible Couples of Imphal, Manipur

Author(s): R.K. Narendra Singh, T. Ibetombi Devi, Th. Bidhumukhi Devi, Y. Manihar Singh, Th. Nonibala Devi, N. Sharat Singh

Vol. 29, No. 1 (2004-01 - 2004-03)

Deptt. of Biostatistic, Community Medicine and PP Centre, Regional Institute of Medical Sciences, Imphal - 795004

Abstract:

Research question: What is the trend of CPR and acceptability of different contraceptive devices among the urban eligible couples of Imphal.

Objective: To find out CPR and acceptability of different contraceptive devices.

Study design: Longitudinal study.

Setting: Imphal Municipality area.

Participants: Eligible couples.

Sample size: 20,629 eligible couples.

Statistical analysis: F-test, χ2 test and t test.

Results: There was an increase in the acceptance of Family Planning Methods by eligible couples during the period 1989-2000. Similarly, an equal proportional increase was also noticed in both permanent and temporary methods. However, in permanent methods, percentage of tubectomy was higher than that of vasectomy.

Key Words: CPR, Permanent method, Temporary method, Age of wife, Parity

Introduction:

In India, Family Planning Programme was started in the year 1952 and was the first country in the world to do so. Since then its name has changed to Family Welfare Programme and lastly to the present Reproductive and Child Health (RCH) programme. This change was made particularly to emphasize more and also to increase the acceptance of contraceptive methods by reproductive age group people1.

The extent of acceptance of contraceptive methods still varies within and between societies and also among different castes and religion groups. The factors responsible for such varied picture operate at the individual, family and community levels with their roots in the socio-economic and cultural milieu of India society2. Of the different methods of Family Planning, sterilization accounts for 70% of which tubectomy remains the mainstay3. From among temporary methods acceptance to condom and oral pill are about 16%4.

Inspite of substantial investment and efforts made by the government, no satisfactory result has yet been achieved and the present rate of contraceptive users is far behind the National goal of Couple Protection Rate (CPR) 60% by 2000 to achieve a Net Reproduction Rate (NRR) of 1. Keeping this in view, the present study was initiated to analyse year-wise CPR and year-wise percentage of acceptors of various methods with respect to age of wife and parity, based on a sample of urban population of Imphal, the State capital of Manipur.

Material and Methods:

The present study is based on a sample of 20,629 eligible couples undertaken by the Post Partum Programme Centre, Regional Institute of Medical Sciences, Imphal during the period from 1989 to 2000. In the beginning the survey was conducted in nine wards of Imphal Municipal Council i.e., from W. No. 1 to 9 for a period of six years(from 1989 to 1996). Then the survey area was reduced to five wards i.e., from W.No. 3 to 7 following the allocation made by the State Family Welfare Department to this centre.

Longitudinal study and personal interview method with house to house visit were adopted as the study method and survey procedure and information were elicited on the structural master record register which was supplied by the Ministry of Health and Family Welfare, Govt. of India. During the survey new couples were cumulated and women of 45 years and above were omitted for updating the earlier data and subsequently maintained year-wise data. For analysis purposes, analysis of Variance Ratio Test for two way classification, commonly known as F-test, χ2 test and t test were used where ever found suitable.

Results:

Table I: Year-wise couple protection rates (CPRs) with test values.

Year CPR by All Methods CPR by Temporary Methods CPR by Permanent Methods
1989-90 31.16 (1,192) 14.74 (564) 16.41 (628)
1992-93 30.53 (1,623) 15.61 (830) 14.91 (793)
1994-96 31.97 (1,809) 14.88 (842) 17.09 (967)
1997-98 37.03 (1,060) 15.86 (454) 21.17 (606)
1999-2000 39.03 (1,159) 17.07 (507) 21.96 (652)
x2 146.08 139.52 300.96
d.f. 4 4 4
p value <0.001 <0.001 <0.001
Figures in parentheses indicate number of acceptors.

Figures parentheses indicate number of acceptors. The rate of acceptance of Family Planning methods by couples has increased from 1989-90 to 1999-2000 except a slight downfall during 1992-93. Similarly, CPRs by permanent methods as well as by temporary methods, when observed separately also increased dramatically during the years except some downfalls in the years 1995-96 for the former and in 1992-93 for the latter respectively. The respective figures of CPR by all methods, by permanent methods and by temporary methods during the years 1989-90 were 31.16, 14.74 and 16.41 and in the year 1999-2000 their corresponding figures were 39.03, 17.07 and 21.96 respectively. This rising trend in CPR over the years was found statistically highly significant (p<0.001).

Table II: Year-wise percentage distribution of family planning acceptors by permanent methods with respect to age of wife and parity.

Methods and Years Number of Number of Age of Wife (yrs) Parity
Eligible Couples Acceptors 15-19 20-24 25-29 30-34 35-39 40-44 1 2 3 4 5
Vasectomy
1989-90 3,825 44 - - 0.35 2.66 3.19 1.60 - 0.63 2.06 2.03 1.14
1992-93 5,316 70 - 0.12 0.6 3.01 2.89 1.81 0.12 0.51 2.15 2.36 1.95
1995-96 5,657 62 - - 0.48 1.07 4.16 1.66 0.09 0.45 1.99 2.18 1.55
1997-98 2,862 37 - - 0.17 0.55 2.76 2.56 - 0.70 2.97 2.19 2.20
1999-2000 2,969 32 - - 0.17 0.52 20.26 1.18 - 0.64 2.52 1.95 1.93
Tubectomy
1989-90 3,825 520 - 1.43 8.87 26.77 37.23 17.90 0.17 5.46 12.02 23.80 30.30
1992-93 5,316 760 - 0.12 8.68 23.86 25.90 23.01 0.17 6.16 14.18 27.67 30.41
1995-96 5,657 780 - - 6.29 20.55 32.78 33.02 0.28 7.41 15.59 30.46 29.81
1997-98 2,862 417 - - 2.32 10.37 18.22 46.54 0.31 10.25 19.38 33.33 42.29
1999-2000 2,969 475 - - 2.58 10.29 18.00 52.04 0.29 11.37 23.34 35.38 52.66

A noticeable evidence of starting permanent method of family planning was found at the early age of 25 years of wife. Thereafter, the percentage gradully increased with the advancement of age of wife. However, during the whole period of study it was observed that the percentage of acceptance to vasectomy has increased upto 35-39 years of age of wife and then tapered thereafter. Similar trend was also found in tubectomy too in the years 1989 to 1993. However, during the remaining years i.e. from 1995 to 2000 there was a gradual rise in tubectomy acceptance with increase in the age of wife without any tapering throughout the reproductive period of wife. These variations in sterilisation percentages over the various age groups of wife as well as over the years under study were highly significant (p<0.01).

It was further observed that there was a great variation in the acceptability of tubectomy and vasectomy with a higher percentage in tubectomy than vasectomy. In case of vasectomy the method was practiced by maximum of male population when the couple had 2 children with a few exceptions where it was found started at first parity in the year 1992-93 and 1993-96. Thereafter, the adoption trend rose as parity advanced up to 4th parity and then tapered. This was true over the years under study. However, in tubectomy, females had started using this method at 1st parity and then the trend rose sharply as parity advanced. This was true over the years. The test values suggest that the percentages of adoption of vasectomy as well as of tubectomy varied over different parities (p<0.001) and there were variations in percentages of vasectomy over the years (p<0.001) but no variation in percentages of tubectomy took place over the reported years (p>0.005) despite some visible differences.

Table III: Year wise percentage distribution of family planning acceptors by temporary methods with respect to age of wife and parity.

Methods Number of Number of Age of Wife (yrs) Parity
And years Eligible Couples Acceptor 15-19 20-24 25-29 30-34 35-39 40-44 1 2 3 4 5
IUCD
1989-90 3,825 570 1.11 10.3 29.94 26.27 19.27 4.14 13.90 26.91 26.59 15.13 9.23
1992-93 5,316 736 1.27 8.83 27.71 31.65 22.45 6.18 11.48 26.61 26.61 16.90 7.94
1995-96 5,657 822 0.10 7.96 19.65 25.65 23.16 8.48 12.93 23.37 23.37 12.10 5.69
1997-98 2,862 487 2.17 9.93 15.89 19.92 19.72 14.83 12.26 22.34 22.34 16.39 11.45
1999-2000 2,969 520 6.82 12.8 19.79 20.31 19.07 10.86 15.92 21.29 21.29 16.99 10.14
CC
1989-90 3,825 47 0.16 0.16 2.07 2.87 1.43 0.80 0.80 2.07 2.23 1.27 1.11
1992-93 5,316 39 - - 0.88 1.51 2.4 0.12 0.12 1.77 0.63 1.51 0.88
1995-96 5,657 81 - 0.72 1.96 2.48 2.38 0.83 1.34 3.00 2.17 1.34 0.52
1997-98 2,862 67 - 2.4 2.65 2.73 2.26 1.53 2.04 3.65 2.66 2.73 1.32
1999-2000 2,969 80 2.27 2.71 2.93 3.26 2.62 1.58 2.32 3.83 2.84 3.06 1.45
OP
1989-90 3,825 11 - 0.16 1.11 0.32 - 0.16 0.15 0.96 0.32 0.16 0.16
1992-93 5,316 18 - 0.13 0.63 1.13 0.28 - - 0.75 0.63 0.76 0.12
1995-96 5,657 64 - 0.72 1.55 2.17 1.76 0.41 0.41 2.07 2.28 1.34 0.52
1997-98 2,862 52 - 1.71 1.99 2.18 1.88 0.63 0.63 2.11 2.81 2.73 2.20
1999-2000 2,969 52 - 2.03 1.89 2.34 1.67 0.58 0.58 1.92 3.00 3.06 1.45

It was observed that among the temporary methods, women started using Intra Uterine Contraceptive Devices (IUCD) as early as 15-19 years. The trend of using IUCD followed a reverse U-shape, that is, it increased from 15-19 years up to 30-34 years and tapered thereafter. The pattern was almost similar in case of conventional contraceptives (CC) and oral pills (OP). Nevertheless the percentages of using conventional contraceptives (CC) and oral pills (OP) started at the age of 20-24 years except a negligible percentage where CC was started at 15-19 years during the years 1989-90 and 1999-2000. These variations in percentages of using IUCD, CC and OP over the age of wife as well as over the years of study were found to be highly significant (p<0.001).

The percentage variation of temporary methods over parities and years of study were statistically significant as evidenced by the test values. In all the years, maximum adoption of IUCD was found at the 2nd and 3rd parities. The pattern was almost similar in cases of CC and OP too.

Table IV: Results for analysis of variance ratio test.

  Age of Wife Parity
Permanent Temporary Permanent Temporary
Vasect. Tubect. IUCD CC OP Vasect. Tubect. IUCD CC OP
F value Between
Age of wife/Parity 92.65 16.12 42.18 35.70 11.22 24.48 18.99 44.37 10.31 12.22
(<0.001) (<0.001) (<0.001) (<0.001) (<0.001) (<0.001) (<0.001) (<0.001) (<0.001) (<0.001)
Between Years 15.94 2.72 4.93 `0.30 12.04 7.65 3.48 7.82 3.50 10.63
(<0.001) (<0.05) (<0.01) (<0.001) (<0.01) (<0.05) (<0.01) (<0.01) (<0.05) (<0.001)
Figures in parentheses indicate p value. Test results as mentioned are shown in Table IV.

Table V: Distribution of Mean±SD of age of wife and parity by various contraceptive methods.

  Permanent Methods Temporary Methods
Vasectomy Tubectomy Combined IUCD CC OP Combined
Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD
(n=245) (n=2,952) (n=3,197) (n=3,135) (n=314) (n=197) (n=3,646)
Age 368±4.13 35.76±4.91 35.80±4.86 31.99±5.56 32.33±5.50 31.56±5.36 32.00±5.55
Parity 3.53±0.95 3.80±1.03 3.78±1.02 2.63±1.12 2.66±1.16 2.91±1.04 2.65±1.12
tAge = 30.15; p&lt;.001; tParity = 43.46; p&lt;0.001.

Couples had adopted permanent methods at an average age of 35.80 years of wife while adoption to temporary methods had started at 32 years of age of wife. This age variation was also found highly significant (p<0.001). In the case of parity too, they adopted permanent methods at the average parity of 3.78 while it was 2.65 for temporary methods. The variation in parities between permanent and temporary methods was also highly significant (p<0.001).

Discussion:

In the present study it was found that more number of couples had adopted permanent family planning methods (vasectomy and tubectomy) i.e. 7.75% compared to temporary methods (5.89%). This finding is in agreement with other studies conducted in different parts of India.

For both permanent and temporary methods there was a rising trend in CPR from 1989 to 2000 i.e. 31.16 during 1989-90 to 39.03 during 1999-2000. This trend is also in accordance with the findings of entire Manipur State (based on the data of Family Welfare Programme in India, Years Book) i.e., 13.11 in 1983 to 23.5 in 1993. However, this increase in CPR in Manipur and also in our study is far behind the All India figure i.e., 25.9 in 1983 to 41.0 in 1999. This clearly indicated that Manipur was able to achieve only about 2/3rd of the national goal i.e., CPR of 60% by 2000.

In permanent methods, both vasectomy and tubectomy were adopted by maximum number of couples while they had 3 children. This finding is against the Small Family Norm of India where couples are expected to adopt permanent methods while they have not more than 2 children. This finding is again supported by the fact that maximum percentage of couples adopted sterilisation at 35-39 years of age of wife (35.80 years average). This shift of high age of mothers at 3rd parity may be due to late marriage of girls particularly in urban population of Imphal city.

It was also observed that compared to vasectomy (1.19%), percentage of tubectomy was far greater (12.37%). This difference in vasectomy tubectomy ratio might be due to the male dominant nature of Indian society which also prevailed in the study area. Also there was a wrong belief among the people that males were usually engaged in active physical works and any kind of operation on them will definitely reduce their capability as a man.

Among the temporary methods, maximum number of couples had adopted IUCD as spacing method (15.20%), followed by CC (1.56%) and OP (0.95%). This might be due to technical advantage and personal comfort of IUCD over other methods. None of the eligible couples had used any kind of temporary methods at zero parity. In this study, it was observed that after first issue, couples started using temporary methods reaching a maximum percentage of adoption during the age range of 30-34 years of wife which usually corresponds to 2-3 children of their own.

References:

  1. Arvind V Zodgekar. Family Welfare Programme and population stabilization strategies in India. Asia Pacific Population Journal, 1996; 11(1): 3-24.
  2. Rao AP, Somayajulu VV. Factors responsible for Family Planning acceptance with single child - findings from a study in Karnataka. Demography India, 1999; 28(1): 65-73.
  3. Robey B, Rutstein SO, Moris I, Blackburn R. The reproductive revolution: new survey findings. Population Report, 1992, M, No. 11.
  4. Mishra SB: Birth spacing methods in the Indian Family Welfare Programme. In: Khan ME and Cernada G, Ed, Spacing as an alternative strategy - India's Family Welfare Programme, BR Publishing Corporation, Delhi 1996.
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