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Indian Journal of Community Medicine

Knowledge & Attitude of Senior Secondary School Students of Ludhiana Regarding Population Control & Contraception

Author(s): A.I. Benjamin, P. Panda, Shavinder Singh, A.S. Bhatia

Vol. 26, No. 4 (2001-10 - 2001-12)

Deptt. of Community Medicine, Christian Medical College, Ludhiana - 141 008 (Punjab)

Abstract:

Research question: What is the knowledge and attitude of senior secondary school children of Ludhiana regarding population control and contraception?

Objective: To assess the knowledge and attitude of senior secondary school children regarding population control and contraception.

Study design: Descriptive study.

Setting: Two co-educational secondary schools of Ludhiana.

Participants: 527 students, 377 boys and 150 girls, of classes 11 and 12.

Statistical analysis: Proportions, Chi square test.

Results: A large majority of the respondents had a realization of the negative impact of uncontrolled population growth on the development of the country, but their knowledge of its adverse consequences was restricted to some socio-economic implications. Lack of employment facilities as a consequence of uncontrolled population growth was the main concern of both boys and girls. Most of them considered 20-25 years to be the desirable age for marriage of boys and 21-25 years that of girls. The 2 child norm was acceptable to most, with one son and one daughter. The majority were in favour of spacing of children. The most commonly known contraceptives were condoms and oral pills, with boys mostly favouring condoms and the girls mostly preferring oral pills to achieve spacing. Their knowledge of the advantages of contraceptives was mostly restricted to population control.

Conclusion: The study revealed gaps in knowledge of the respondents about implications of uncontrolled population growth as well as about contraception. These gaps need to be filled by including population and sex education in school curriculum at this level.

Keywords: Population control, Contraception, Adolescent

Introduction:

Global population today stands at over 6 billion, one-sixth of which is in India. Uncontrolled population growth is recognized as the single most important impediment to national development. Despite the fact that India was the first country in the world to implement a national population control programme in 1952, the country is still struggling to contain the baby boom. A lot of efforts and resources have gone into the National Family Welfare Programme but the returns are not commensurate with the inputs. The programme has targeted the married couples, i.e., the so called "Eligible Couples", in its efforts to control the population.

However, attitudes are developed much earlier. The United Nations Population Fund (UNFPA) notes that future population trends will hinge on the fertility decisions of today's men and women aged 15-24 and on their ability and freedom to act on those decisions1. Concern about adolescent fertility arises from its health implications both for the mother and the child, its demographic implications in societies with rapid population growth and its social development implications. The 1991 census estimated that those aged 0-19 years comprised 47.5% of India's population and the 15-19 years old alone were 9.7% of the population2. Because of the young age-structure of India's population, the reproductive attitude and behaviour of teenagers are likely to have an important impact on overall reproductive health, demographic and social outcome. Adolescent sex and exposure to the risk of pregnancy has attracted considerable research attention to understand its magnitude and to address it as a problem. Studies in developed countries have shown a high level of such exposure3-6, as also in Latin America7,8, China9 and some African countries like Uganda and Nigeria10-12 as well as in South Africa13-15.

In India also there is an evidence from studies amongst senior secondary school students that adolescents are increasingly becoming sexually active. A study in four public and two government schools of South Delhi conducted in 1992 showed that 63.3% of boys and 37.4% of girls were of the opinion that students of their age had sex; 17% boys and 9% girls agreed to take risk of AIDS rather than miss the chance of having sex with an attractive stranger16. In another study conducted in four senior secondary schools in rural Delhi, also in 1992, 23.4% boys and 15.1% girls admitted to have had sex, while 5.7% boys and 9.6% girls did not deny it17.

These facts warrant an investigation into the knowledge and attitude of this age-group regarding fertility control and contraception.

Material and Methods:

The study was carried out in two co-educational senior secondary schools of Ludhiana. The respondents were the students, both boys and girls, of classes 11 and 12. Data was obtained through a pre-tested questionnaire administered to the students in their class-rooms.*

Results:

Table I: Students view on consequences of uncontrolled population growth (UPG)

UPG has adverse effects Students Total (%)
Boys (%) Girls (%)
Yes / 310 (82.2) 132 (88) 442 (83.9)
No / NR / Uncertain 67 (17.8) 18 (12) 85 (16.1)
Total 377 (100) 150 (100) 527 (100)
(71.5) (28.5) (100)  

NR - No response; X2=2.64, df=1, p=0.1

A total of 527 students, 377 boys (71.5%) and 150 girls (28.5%) were studied. 310(82.2%) boys and 132(88%) girls responded that uncontrolled population growth had adverse effects.

Table II: Students knowledge of consequences of uncontrolled population growth (UPG).

Consequences of UPG Boys
n=310
(%) Girls
n=132
(%) Total
n=442
(%) p value
Lack of jobs / employment opportunities 244 (78.7) 105 (79.5) 349 (78.9) 0.89
Inflation 235 (75.8) 93 (70.5) 328 (74.2) 0.22
Shortage of food 127 (41.0) 53 (40.1) 180 (40.7) 0.90
Lack of education facilities / opportunities 118 (38.1) 60 (45.4) 178 (40.3) 0.15
Shortage of housing 111 (35.8) 56 (42.4) 167 (37.8) 0.20
Overcrowding 75 (24.2) 32 (24.2) 107 (24.2) 0.97
Poor Sanitation 79 (25.5) 5 (3.8) 84 (19.0) 0.0000
Spread of infectious diseases 33 (10.6) 29 (22.0) 62 (14.0) 0.002
Lack of clean / potable water. 14 (4.5) 2 (1.5) 16 (3.6) 0.20
Increase in crime rate 9 (2.9) 5 (3.8) 14 (3.2) 0.85
Shortage of electricity 5 (1.6) 2 (1.5) 7 (1.6) 0.74
Others 84 (27.1) 40 (30.3) 124 (28.0) 0.49

The most commonly mentioned consequences by both boys (78.7%) and girls (79.5%) was lack of jobs or employment facilities, followed by inflation (75.8% boys and 70.5% girls) and food shortage (41% boys and 40.1% girls) etc. Knowledge on other aspects like lack of clean/potable water, increase in crime rate, shortage of electricity, poor sanitation and spread of infectious diseases, was poor.

Table III: Students view regarding age at marriage.

Age at marriage Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Legal age of marriage for boys: 21 years. 205 (54.4) 105 (70.0) 310 (58.8) 0.004
Legal age of marriage for girls: 18 years. 233 (61.8) 122 (81.3) 355 (67.4) 0.0000
Desirable age of marriage for boys.
<20 years 14 (3.7) 11 (7.3) 25 (4.7) 0.14
20-25 years 321 (85.1) 119 (79.3) 440 (83.5)
26-30 years 42 (11.1) 20 (13.3) 62 (11.8)
Desirable age of marriage for girls:
<18 years 28 (7.4) 9 (6.0) 37 (7.0) 0.03
18-21 years 302 (80.1) 109 (72.7) 411 (78.0)
22-25 years 46 (12.2) 29 (19.3) 75 (14.2)
>25 years. 1 (0.3) 3 (2.0) 4 (0.7)

Only 54.4% boys and 70% girls knew the correct legal age of marriage for boys (p=0.004), 61.8% boys and 81.3% girls knew the correct legal age of marriage for girls (p=0.0000). Hence, the girls' knowledge in this respect was significantly higher than the boys. Majority of boys (85.1%) and girls (79.3%) indicated 20-25 years as the desirable age of marriage for boys, however, about one-tenth of both boys and girls preferred 26-30 years for it. 80.1% boys expressed 18-21 years as the desirable age of marriage for girls, 12.2% favoured the age-group 22-25 years. In comparison, 72.7% girls favoured the age group 18-21 years and 19.3% indicated 22-25 years as the desirable age of marriage for girls. These gender differences in responses were statistically significant.

Table IV: Students view regarding the ideal number of children a couple should have.

Students views Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Ideal number of children
One 21 (5.6) 18 (12) 39 (7.4) 0.005
Two 345 (91.5) 132 (88) 477 (90.5)  
Three or more 11 (2.9) 0 (-) 11 (2.1)  
Ideal number of daughters
Nil 4   1 (0.7) 5 (0.9) 0.67
One 352 (93.4) 143 (95.3) 495 (93.9)  
Two 18 (4.8) 6 (4) 24 (4.5)  
Three or more 3 (0.8) 0 (-) 3 (0.6)  
Ideal number of sons
Nil 1 (0.3) 2 (1.3) 3 (0.6) 0.12
One 338 (89.6) 136 (90.7) 474 (89.9)  
Two 29 (7.7) 12 (8) 41 (7.8)  
Three or more 9 (2.4) 0 (-) 9 (1.7)  

Amongst the boys, 91.5% preferred two children, 5.6% preferred one and 2.9% preferred three as being the ideal number of children a couple should have. 88% girls preferred two and 12% preferred one child. Hence, a significantly higher proportion of girls preferred one child (p=0.005), though the preference in both sexes was still overwhelming for two children. The choice of ideal number of daughters and sons was similar in both sexes, the differences in choices being statistically insignificant. The majority of both boys and girls preferred one daughter (93.4% boys, 95.3% girls) and one son (89.6% boys, 90.7% girls).

Table V: Students knowledge regarding spacing of children.

Students Knowledge Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Should there be a gap between marriage and the first child?
Yes 365 (96.8) 145 (96.7) 510 (96.8) 0.85
How much gap?
1 year 95 (26.0) 27 (18.6) 122 (23.1) 0.18
2years 191 (52.3) 80 (55.2) 271 (53.1)  
>2 years 79 (21.6) 38 (26.2) 117 (22.9)  
Should there be a gap between the first and second child?
Yes 377 (100) 150 (100) 527 (100)  
How much gap?
1 year 18 (4.8) 6 (4) 24 (4.5) 0.02
2years 173 (45.9) 51 (34) 224 (42.5)  
>2 years 186 (49.3) 93 (62) 279 (52.9)  

96.8% boys and 96.7% girls preferred a gap between marriage and the first child (Table V). 26% boys and 18.6% girls preferred this gap to be 1 year and more than half of the students (52.3% boys and 55.2% girls) wanted this gap to be 2 years, it is encouraging to note that more than one-fifth of the boys (21.6%) and more than a quarter of the girls (26.2%) preferred this gap to be more than 2 years. All the respondents were unanimous in their desire for a gap between the first and the second child, with most of them, but girls significantly more (62%) than boys (49.3%), preferring a gap of more than 2 years between the children (p=0.02).

Table VI: Students knowledge regarding contraceptive methods:

Contraceptive
Method
Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Condoms 321 (85.1) 71 (47.3) 392 (74.4) 0.0000
IUCD 13 (3.4) 0 (-) 13 (2.5) 0.02
Oral Pills 296 (78.5) 131 (87.3) 427 (81) 0.0000
Tubal ligation 26 (6.9) 12 (8) 38 (7.2) 0.64
Vasectomy 34 (9) 10 (6.7) 44 (8.3) 0.39
Abstinence 19 (5) 1 (0.7) 20 (3.8) 0.02
Coitus interruptus 1 (0.3) 0 (-) 1 (0.2) 0.53
Others 33 (8.7) 10 (6.7) 43 (8.1) 0.43

The students were asked to list the contraceptive methods they knew. A significantly higher proportion of boys (85.1%) than girls (47.3%) knew about condoms (p=0.0000), but more girls (87.3%) than boys (78.5%) knew about oral contraceptive pills (p=0.0000). Knowledge of other contraceptive methods in both sexes was very poor.

Table VII: Students knowledge of advantages of contraception.

Advantage of contraception. Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Controls population 172 (45.6) 50 (33.3) 222 (42.1) 0.002
Improves mother's health 14 (3.7) 26 (17.3) 40 (7.6) 0.0000
Improves child's health 90 (23.9) 51 (34) 141 (26.7) 0.03
Prevents unwanted pregnancies 24 (6.4) 4 (2.7) 28 (5.3) 0.07
Protects against STDs / HIV 29 (7.7) 1 (0.7) 30 (5.7) 0.001
Others 206 (54.6) 88 (58.7) 294 (55.8) 0.68

45.6% boys and 33.3% girls mentioned population control (p=0.002), only 3.7% boys and 17.3% girls mentioned improvement of maternal health (p=0.0000), 23.9% boys and 34% girls mentioned improvement of child health (p=0.03), as advantages of contraception. Surprisingly, only 4(2.7%) girls and 24(6.4%) boys mentioned prevention of unwanted pregnancies (p=0.07) and only 29(7.7%) boys and 1(0.7%) girl mentioned protection against STDs/HIV as advantages of contraception (p=0.001).

Table VIII: Students knowledge of source of contraceptives.

Source Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Hospital 228 (60.5) 121 (80.7) 349 (66.2) 0.005
Chemist shop 244 (64.7) 89 (59.3) 333 (63.2) 0.0000
Health Centre 116 (30.8) 84 (56) 200 (37.9) 0.0000
Doctor 66 (17.5) 67 (44.7) 133 (25.2) 0.0000
Kiryana Shop: General Store 74 (19.6) 21 (14) 95 (18) 0.024
Health Worker 7 (1.8) 2 (1.3) 9 (1.7) 0.53
Others 8 (2.1) 9 (6) 17 (3.2) 0.055

Table VIII summarizes the respondents knowledge of sources of contraceptives. More girls (80.7%) than boys (60.5%) indicated the hospital as a source (p=0.005), more boys (64.7%) than girls (59.3%) mentioned the chemist's shop (p=0.0000), more girls (56.0%) than boys (30.8%) mentioned the health centre (p=0.0000), similarly, more girls (44.7%) than boys (17.5%) knew of the doctor as a source of contraceptives (p=0.0000).

Table IX: Students attitude regarding spacing of children.

Students Attitude Boys
n=377
(%) Girls
n=150
(%) Total
n=527
(%) p value
Would you delay the first child?
Yes 259 (68.7) 116 (77.3) 375 (71.1) 0.92
Preferred contraceptive method
Condom 212 (81.8) 17 (14.6) 229 (61.1) 0.0000
Oral Pills 40 (15.4) 95 (81.9) 135 (36)  
Others 7 (2.7) 4 (3.4) 11 (2.9)  
Would you delay the second child?
Yes 261 (69.2) 125 (83.3) 386 (73.2) 0.001
Preferred contraceptive method
Condom 175 (67) 20 (16) 195 (50.5) 0.0000
Oral Pills 75 (28.7) 91 (72.8) 166 (43)  
IUCD 1 (0.4) 0 (-) 1 (0.3)  
Others 10 (3.8) 14 (11.2) 24 (6.2)  

68.7% boys and 77.3% girls said that they would delay the first child (p=0.92). 69.2% boys and 83.3% girls said that they would delay the second child (p=0.001). The most preferred contraceptive to achieve this spacing was condom in the case of boys and oral pills in the case of girls (p=0.0000). A comparison of their responses in Table V (knowledge) and Table IX (attitude) shows a gap between knowledge and attitude of the respondents in relation to child spacing. While 96.8% boys and 96.7% girls knew that there should be a gap between marriage and the first child, only 68.7% boys and 77.3% girls were willing to delay their first child. Similarly, while there was complete agreement in both boys and girls that the second child should be delayed, only 69.2% boys and 83.3% girls were willing to do so when they get married. This gap can and must be eliminated. These youngsters need more motivation to develop attitudes commensurate with their knowledge, which is likely to have an impact on their practices a few years hence.

Conclusions:

The study shows that a large majority of the senior secondary school students surveyed had a realization of the negative impact of uncontrolled population growth on the development of the country and had the knowledge of its adverse socio-economic consequences, though in terms of the wider implications of uncontrolled population, like poor sanitation, lack of potable water, spread of infectious diseases and increase in crime rate their knowledge was restricted. Lack of employment facilities as a consequence of uncontrolled population growth was the main concern of both boys and girls. Most of them considered 20-25 years to be the desirable age of marriage for boys, and 21-25 years that of girls. The 2 child norm was acceptable to most, with one son and one daughter. The majority were in favour of spacing of children. The most commonly known contraceptives were condoms and oral pills, with boys mostly favouring condoms and the girls mostly preferring oral pills to achieve spacing. However, their knowledge of the advantages of contraceptives appeared to be restricted to population control, with very few citing prevention of unwanted pregnancies, protection against STDs/HIV and improvement of maternal and child health as the advantages of contraception. These gaps in knowledge need to be addressed by including population and sex education in the school curriculum at this level. Education and motivation of the adolescents will go a long way in influencing their reproductive attitudes and behaviour, which in turn is likely to have an important impact on overall reproductive health, demographic and social outcomes.

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