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Indian Journal of Community Medicine

A Study of Never Users of Contraception from an Urban Slum of Delhi

Author(s): A. Khokhar, N. Gulati

Vol. 25, No. 1 (2000-01 - 2000-03)

Department of Preventive and Social Medicine Maulana Azad Medical College, Delhi.

Abstract:

Research question: What are the factors which influence women from an urban slum of Delhi not to use a method of contraception?

Objective: To study the reasons for never use of contraception by ever married women in the age group of 15-49 years.

Study design: Cross-sectional.

Setting: An urban slum located at Deen Dayal Upadhyay Marg, Delhi.

Participants: All the 440 ever married women in the age group of 15-49 years.

Study variables: Literacy status, religion, work status, reasons for never use, knowledge about contraception.

Statistical analysis: Percentages, chi-square test.

Results: 61.36% of the study subjects were never users of contraception. Literacy status of self, spouse, religion and work status were associated with contraceptive use and the difference was statistically significant (p<0.001). 75% of the never users had mentioned the reason to be fear of side effects of contraceptives and 43.7% were ignorant about use of contraceptives. 15.9% of the total subjects had no knowledge of any method of contraception.

Keywords:Never users, Contraception, Side effects, Knowledge about contraception, Slum dewellers.

Introduction:

Since the launch of the nationwide family planning programme in 1951 attempts have been made from time to time to encourage the women to accept and adopt contraception. Inspite of efforts of the programmers there are women who have never used a method of family planning throughout their reproductive life and there are many who are likely to follow their footsteps. Reports from other parts of the world i.e. Guatemala, Mali, Senegal, Nigeria and Pakistan have shown that more than 80% of the women with unmet need have never used contraception1. The reasons for never use of contraception may be multiple which if studied in detail can help the programmers to devise specific strategies to overcome these barriers and help in better implementation of the programme. Therefore, the present study was undertaken amongst slum dwellers to reveal the various factors which have a bearing on use of contraception.

Material and Methods:

The present study was conducted in an urban slum located at Deen Dayal Upadhyay Marg, Delhi. The area has a total population of approximately 3,500 and consists mainly of migrants from neighbouring states of UP, Bihar and HP. All the 440 ever married women in the reproductive age group of 15-49 years were included. It was a community based cross sectional study conducted during 1996-97. A pretested prestructured proforma was used to collect the information from the target population.

Results:

Table I: Distribution of study subjects by socio demographic factors

  Ever users 170(38.64%) Never users 270(61.36%) Total
No. (%) No. (%)
Literacy
Self Literate 44 (55) 36 (45) 80
  Illiterate 126 (35) 234 (65) 360
Husband Literate 88 (66.66) 44 (33.33) 132
  Illiterate 82 (26.62) 226 (73.37) 308
Religion Hindu 109 (45.99) 128 (54) 237
  Muslim 61 (30.04) 142 (69.95) 203
Work status of self Employed 48 (63.16) 28 (36.84) 76
  Unemployed 122 (33.52) 242 (66.48) 364
Type of family Nuclear 80 (39.6) 122 (60.4) 202
  Joint 90 (37.8) 148 (62.18) 238
Income Upper lower 114 (40.14) 170 (59.86) 284
  Lower 56   100 (64.1) 156

Out of a total 440 ever married women 170(38.64%) were ever users of contraceptives and 270(61.36%) were never users. Literacy status of the study subjects and that of their spouses showed an association with the contraceptive use and the difference was statistically siginficant (p<0.001). Religion and work status of the study subjects also showed an association with the contraceptive use which was statistically significant (p<0.001).

Table II: Never users of contraception by reasons

Reasons for never use of contraception* No. %
Scared of side effects 204 75.55
Ignorance (About use) 118 43.70
Religion 86 31.85
No Knowledge 70 25.92
Opposition from other family members 38 14.07
Opposition from husband 24 8.88
Total 540*  

Never users n=270; *Multiple responses

As many as 204(75.55%) women mentioned the main reason for never use of contraception to be fear of side effects. 62(22.9%) women felt opposition from their husband or other family members.

Table III : Proportion of never users of contraceptive method by their reason for never use of these methods

Contraceptive method No. % Contraceptive method No. %
(i) Oral contraceptive pills (n=204) (iii) Copper-T
Menstrual disturbance 32 15.69 Increased 112 54.9
Weakness 15 7.35 Backache 94 46.08
Headache/nausea 10 4.91 Displaces into abdomen 64 31.37
Weight gain 04 1.96 Fear of pregnancy 28 13.72
Pain abdomen 24 11.76
Falls 23 11.27
Total 61 Total 345
(ii) Condom No. % (iv) Sterilization No. %
Pregnancy 26 12.75 Loss of wages 144 70.59
Pain 14 6.86 Pain abdomen 141 69.12
Dis-satisfaction 7 3.43 Scared of the 128 62.86
Burst 4 1.96 Procedure/anaesthesia 116 56.86
Inconvenience 3 1.47 Weakness 49 24.02
Menstrual disturbance 28 13.72
Pregnancy ? ?
Total 54 Total 606

Out of total of 204 women who had cited fear of side effects to be the reason for never use of contraception as many as 144(70.58%) of them mentioned loss of wages to be the reason for non adoption of sterilization, 112(54.9%) revealed that increased bleeding associated with CuT insertion was an important factor. With condom use fear of pregnancy was cited as the main reason while for oral contraceptives menstrual disturbance was mentioned by 15.69% of the subjects.

Discussion:

Table IV : Contraceptive use by number of methods heard

No. of methods heard OCS No. (%) CUT No. (%) Condom No. (%) Others No. (%) Tubectomy No (%) Total ever users No. (%) Total never users No. (%) Total
0             70 (25.93) 70 (15.91)
1             36 (13.33) 36 (8.18)
2         7 (11.67) 7 (4.12) 82 (30.37) 89 (20.23)
3   6 (15.79) 46 (60.53)   13 (21.67) 53 (31.18) 26 (9.63) 79 (17.95)
4 20 (71.43) 20 (52.63) 16 (21.05) 5 (41.67) 10 (16.66) 56 (32.94) 19 (7.04) 75 (17.05)
≥5 8 (28.57) 12 (31.58) 14 (18.42) 7 (58.33) 30 (50.00) 54 (31.76) 37 (13.70) 91 (20.68)
  28 38 76 12 60 170 270 440

All percentages are calculated column-wise

70(15.91%) of the study subjects had not heard of any method of contraception. All the ever users had heard about at least two methods and 163(95.89%) of them had heard about three or more methods whereas only 82(30.37%) out of never users had heard about three or more methods.

Discussion:

The present study revealed an inverse relationship between literacy status of self, literacy status of spouse and contraceptive use, a fact supported by many other studies2-5. Women who were gainfully employed were more likely to have ever used a contraceptive method as also observed by Lloyed, Schuler and Hashemi6,7.

Majority (75.5%) of the women mentioned fear of side effects of the contraceptives to be the reason for never use. In many other countries such concern about side effects of contraceptives originating from experience of friends and rumours which are told and retold through the communities have contributed to low contraceptive acceptance8. In the present study 62.75% of the never users who were scared of side effects mentioned fear of the procedure and anesthesia to be the reason. In Nepal also concern about surgery and its complications was cited as an important reason for non adoption of sterilization9,10. Also the fact that sterilization led to weakness (56.86%) was also observed in Nepal11. In the present study, 12.75% of the women who were afraid of side effects fared pregnancy and 3.43% expressed concern about sexual dissatisfaction with condom use. Khan et al10 also made similar observations in U.P.

Never users of contraception were aware of fewer contraceptive methods as compared to ever users as also revealed by the Demographic and Health Survey conducted in Kenya where contraceptive users mentioned on an average four methods and non users less than three1.

8.88% of the never users stated the reason to be husbands' opposition which can have serious consequences as observed in Sub Saharan countries were contraceptive use among women whose husbands disapproved of family planning averaged only one third as much as among women whose husbands approved of it12.

Religion was cited as a reason for opposition of contraceptive use by 31.85% of the subjects in the present study. Also muslims were less likely to be ever users (p<0.001). DHS reports from Bangladesh, Nigeria, Pakistan and Senegal reveal that more than 10% of the women with unmet need who did not intend to use contraception cited religious objections.

A multi pronged strategy aimed at sustained IEC efforts focussing on safety and beneficial effects of various contraceptives, clearing of miscontraception about side effects of contraceptives by family planning counsellors and equal involvement of both husband and wife as one unit should be able to bring out an outcome favourable in terms of contraception use.

References:

  1. Meeting unmet need: New strategies, Population Reports series J No.43, 1997; 19-20.
  2. Bulatao RA, Levin A, Boser, Green C: Effective family planning programs. Washington D.C., World Bank, 1993: 110.
  3. Devi DR, Rastogi SR, Retherford RD: Unmet need for family planning in Uttar Pradesh (1996): 46 unpublished.
  4. Westoff CF, Pebley AR: Alternative measures of unmet need for family planning in developing countries. International Family Planning perspectives 7(4) 1981: 126-136.
  5. Lakshmi GR, Bandopadhyay SS: Effect of education, economic status and occupation on fertility, Health and population - Perspectives and issues 1986; 9(1): 42-51.
  6. Lloyd CB: The contribution of world fertility surveys to an understanding of the relationship between women's work and fertility. Studies in Family Planning 1991; 22(3): 144-161.
  7. Schuler SR, Hashemi SH: Increasing use of contraception by decreasing women's dependence and isolation: Credit programs and family planning outreach in Bangladesh Boston, John Snow 1994; 7: 19.
  8. Nag M: Some cultural factors affecting costs of fertility regulation. Population Bulletin of the United Nations 1984, 17: 17-38.
  9. Stash S: Reason for unmet need in Nepal: An attempt to pick up where fertility surveys leave off 1995: 45 Unpublished.
  10. Khan ME, Dastidar SK and Bainathi S: Not wanting children yet not practising family planning. The journal of family welfare XXXII No. 3(12) 1985: 8.
  11. Shrestha A, Stoeckel J, Taladhar JH: Factors related to non use of contraception among couples with an unmet need for family planning in Nepal, Kathmadhu, Nepal, New Era 1988: 81.
  12. Ravindran TKS: Users perspectives on fertility regulation methods. Economic and political weekly Nov 13-20, 1993: 2508-2512.
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