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Indian Journal of Community Medicine

Prevalence of Usage of Different Contraceptive Methods in East Delhi-A Cross Sectional Study

Author(s): S. K. Bhasin, M. Pant, M. Metha, S. Kumar

Vol. 30, No. 2 (2005-04 - 2005-06)

Abstract

Research question: What is the prevalence of usage of different contraceptive methods in East Delhi? Objective: To find out the prevalence of contraceptive usage amongst eligible couples in East Delhi & to find out the reasons for non acceptance of family planning methods. Study design: Crossectional study. Setting: Four neighbourhoods in East Delhi namely Vivek Vihar, GTB Enclave, Nand Nagri (resettlement colony) and D-3 sub-block Nand Nagri jhuggi cluster (slum) representing higher, middle, lower middle & lower socioeconomic groups respectively. Participants: 764 eligible couples from 250 families each in 4 neighbourhoods. Statistical analysis: Proportion, Chi square test.

Results: Seventy five percent of the subjects were 'ever users' of any contraceptive method. 59.8% were currently using any contraceptive method. Condom was the most common method (33.4%) of contraception followed by tubectomy (27.3%), oral pills (16.6%) and intrauterine device (15.7%). Awareness about contraceptive methods was very high (more than 90%) in all the groups. Eighty percent of the subjects approved of contraceptive methods. Amongst the subjects who were not using contraceptives, the most common reason for not doing so was the desire for more children (36.4%). This was uniformly true across all the four groups. Conclusion: Contraceptive usage is moderately high in East Delhi.

Key Words: Contraceptive usage, prevalence, socio-economic status.

Introduction

According to Census 2001, Indian population stood at 1024 million1. The last decade has seen India's population grow by 21.34% which means 180 million persons were added to the population1. India is undergoing a fertility transition and an important feature of this transition is the fact that contraceptive use has spread to uneducated women also3. This augurs well for the country in the long run. Another advantage with the rising prevalence of contraceptive usage is the fact that abortion incidence has declined4. National Population Policy 2000 envisages universal access to various methods of contraception and fertility regulation. It is anticipated that if this policy is fully implemented, India's population in 2010 will be 1,107 million instead of 1,162 million2.

Despite the fact that contraceptive usage has increased over a period of time, there exists a KAP-gap i.e. a gap between the knowledge, attitude and practices regarding contraception5,6. With the above facts in consideration, we aimed to find the prevalence of contraceptive usage amongst eligible couples in East Delhi and the various factors associated with it. The study also aimed to find the reasons for non-acceptance of family planning methods and the association between contraceptive usage and socio-economic factors like literacy, income etc.

Methodology

The study was conducted in the Northeast district of Delhi. A team of 25 undergraduate medical students was extensively trained for data collection and collation. The students conducted the survey under guidance of the authors. Information was collected on a comprehensive, semistructured and semi-open ended proforma.

The survey was conducted in four neighborhoods, which were selected by stratified sampling. Each neighborhood represented particular socioeconomic strata. Thus the selected areas were- Jhuggi cluster (slums)-Representing the low socioeconomic group, Nand Nagari (resettlement colony)- Representing the lower-middle socio-economic group, G.T.B. Enclave-Representing the middle socioeconomic group, Vivek Vihar-Representing the upper-middle and the higher socioeconomic group. Thus, we selected two areas belonging to a lower-socio-economic strata and two belonging to upper socio-economic strata.

The sampling unit was a family in each socio-economic group. 250 families were randomly selected from each area (10 families per student). A sample size of 250 families was taken assuming prevalence of contraceptive usage as 50% and maximum likely error of 15%. This gave a sample size of 177. It was presumed that 250 families shall have a population of approximately 1,250. Based on current birth rates in these areas, the number of eligible couples was likely to be around 180 to 210. Thus a total sample size was 1,000 families was taken from the four areas.

The study lasted from January 2001-June 2001. The data was entered in the SPSS software program and analysed.

Results

A look at the various socio-economic variables shows a clear gradient in the income levels with majority of subjects from the Slums having an income less than Rs. 2000 as compared to the subjects from Vivek Vihar (Table 1). A similar gradient is also seen when we compare literacy status of the wives in the four groups. A greater proportion of illiterates are seen in the Slums and literacy levels rise proportionally higher in the successive groups. Most of the female respondents were more than 25 years old and had been married for more than 8 years; all four groups were similar in this regard. While most couples in the Slums and Nand Nagari had more than 2 children (60%), majority of the couples in GTB Enclave and Vivek Vihar had less than 2 children (70%).

Table I - Socio-demographic profile of the study population (n=764)

  Slum
(%)
Nand Nagari
%
GTB Enclave
%
Vivek Vihar
%
(n=197) (n=202) (n=186) (n=179)
Monthly family income
< 2500 66.0 34.2 0.00 0.00
2500-4999 25.9 37.6 2.2 0.00
5000-9999 8.1 21.3 7.53 3.4
≥ 10,000 0 6.9 90.3 96.6
Wife's age (years)
<020 3.6 2.5 1.1 0.00
20-24 19.3 19.3 8.6 10.1
25.29 27.4 26.2 21.5 21.8
30-34 21.8 22.3 27.4 18.4
≥ 35 27.9 29.7 41.4 49.7
Literacy status of wife
Illiterate 68.0 37.1 1.1 1.1
Upto 5th class 17.3 14.9 0.0 0.0
6th-12th class 14.7 45.5 31.7 14.0
≥ Graduate 0.00 2.5 67.2 85.9
Duration of marriage (years)
Less than 1 Year 1.0 5.1 1.1 4.4
1-4 Years 13.2 16.3 12.4 16.8
5-8 Years 19.3 16.8 21.5 12.3
> 8 Years 66.5 61.8 65.0 66.4
Number of living children
None 3.6 3.5 4.8 8.4
Less than 2 40.1 37.1 69.9 75.4
3-4 43.1 50.5 25.3 15.6
5 or more 13.2 8.9 0.00 0.6

Seventy five percent of the subjects were 'ever users' of any contraceptive method (88% in Vivek Vihar and 58% in Slums). 59.8% of the couples were current users of contraception, the prevalence being highest in Vivek Vihar (65.9%) and low in Nand Nagri (56.4%) and slums (56.8%). A higher proportion of couples in the Slums (46%) and Nand Nagari (34%) were current users of a contraceptive method for the last 1-3 years while a greater proportion of the couples in GTB Enclave (41%) and Vivek Vihar (48%) had been current users for more than 5 years.

Amongst the different methods of contraception used, condom was the most common method (33.4%) of contraception followed by tubectomy (27.3%), oral pill (16.6%) and intrauterine device (15.7%). While condom was the most preferred method in the Slums and Vivek Vihar, tubectomy was the most preferred choice in Nand Nagari and GTB Enclave. Few couples practiced the withdrawal and safe period methods as well. Awareness about contraceptive methods was very high (more than 90%) in all the groups. Eighty percent of the subjects approved of contraceptive methods. However, we saw a gradation in the approval as we moved from the Slums (only 49% approved) to Vivek Vihar (99% approved).

Amongst the subjects who were not using contraceptives, the most common reason for not doing so was the desire for more children (36.4%). This was uniformly true across all the four groups (Table II).

Table II - Reasons for not using contraceptives amongst current users (n=307)

  Slum
(%)
Nand
Nagari
(%)
GTB
Enclave
(%)
Vivek
Vihar
(%)
Husband away 4.7 0.9 0 6.5
Not having sex 3.5 5.6 16.4 9.8
Infrequent sex 4.7 0.9 5.4 13.1
Menopusal 2.3 0.9 1.3 1.6
Hysterectomy 3.5 0 1.3 0
Breast feeding 2.3 7.9 6.8 6.5
Want more children 38.8 23.8 41.1 45.9
Opposed to family planning 2.3 0.9 2.7 3.2
Anti religion 2.3 0 10.9 0
No knowledge about source 2.3 11.3 0 0
Worry about side effects 4.7 14.7 0 3.2
Cost too much 2.3 0.9 0 0
Inconvenient 5.8 0 0 0
Others 18.9 14.7 13.5 9.7
Total 100 100 100 100

Discussion

In our study 59.8% of the couples were current users of contraception, the prevalence being highest in Vivek Vihar (65.9%) and low in Nand Nagri (56.4%) and slums (56.8%). NFHS-2 has documented a couple protection rate of 63.2% in Delhi which is considerably higher than that of India as a whole (48.2%)7. Thus our findings of 60% contraceptive usage is quite similar to many other studies in India 7, 8, 9, 10, 11, 12. The reason for so low prevalence of contraception in that study could have been due to low awareness in the slum dwellers. NFHS-2 has reported that in Delhi, the commonest method of family planning was female sterilization (26.3%) followed by condoms (17.5%). However, condom was the commonest method used (33.4%) followed by permanent method of sterilization i.e. 32.1% in our study. However among present study subjects, tubectomy was the most preferred method (27.7%). Vasectomy was used by only 4.8% men. Similar results have been reported in NFHS-2. Obviously this relflects the prevailing gender bias in reproductive health participation by men. Different studies have shown different preferences for methods of contraception used e.g.in Kanpur slums dwellers11 the commonest method was condom (58.7%) while in Calcutta middle class respondents 80.5% were practicing natural methods of family planning. In Bombay8 and Delhi12 slum dwellers, the commonest method was permanent method (39-43% in different slums). Low use of vasectomy (4.3%) compared to tubectomy (27.5%) in our study has also been reported from Bombay8.

In another study amongst Delhi slum dwellers two third of the respondents were aware about one or more contraceptive methods12. This is much lower than our study where a very high awareness across all socio-economic strata has been observed. Even the slum dwellers had a high awareness of 94.4%. The reason could be that all areas surveyed by us are well served by MCH and Family Welfare Services and most of these areas are just adjoining GTB Hospital which is referral hospital for these populations. Similar high level of awareness have also been reported from Kanpur11 and Calcutta10.

While awareness as mentioned earlier was very high, the attitude towards family planning varied in different neighbourhoods. While it was very favourable (98.8%) in Vivek Vihar, in GTB Enclave it was approved by 91.9% respondents while 4.3% of the respondents disapproved of family planning. All these eight respondents who disapproved were Roman Catholzcs while in Nand Nagri 85.6% had favourable attitude, in slums it was extremely low at 48.2%. Though they did not disapprove of family planning methods, many of them had not formed any opinion regarding family planning method. Almost similar results have been reported from Kanpur11where 83% respondents clearly favoured family planning while 3.5% were opposed to it. The commonest reason in our study for not using contraception in our study was desire for more children (32.4%). In another study Delhi12 (35.9%) of the nonacceptors did not use any method due to ignorance and lack of communication.

References

  1. Census 2001. Web Ediiton. Provisional Population totals. Series 1, India.
  2. National Population Policy, 2000. Deptt. of Family Welfare, Ministry of Health and Family Welfare, Govt. of India, New Delhi.
  3. McNay K, Arokiasamy P, Cassen R. Why are uneducated women in India using contraception? A multilevel analysis. Popul. Stud. (Camb.). 2003;57 (1): 21-40.
  4. Marston C, Cleland J. Relationships between contraception and abortion: a review of the evidence. Int Fam Plan Perspect. 2003 Mar; 29(1):6-13.
  5. Charles W, Ann P. Alternative Measure for Unmet Need for Family Planning in Developing Countries. Int Fam Plan Perspect, 2000; 7(4): 126-135.
  6. Ashoke S, John S. and Jayanti M.T. The KAP-Gap in Nepal: Reasons for Non-use of Contraception Among Couples with an Unmet Need for Family PLanning. Asia-Pacific Population Journal, 2000; 6(1): 25-38.
  7. National Family Health Survey-2(1998-99) India. International Institute for Population Sciences. ORC New Mumbai 2000.
  8. Balaiah D, Hazari K, Baji S. Contraceptive use differentials in two slums populations of Greater Bombay. J Family Welfare 1995; 41(3): 27-32.
  9. Prasad CVS, Somayajulu UV. A comparative study of the accessibility of health and family welfare services amongst slum dwellers. J. Family Welfare. 1992; 38(4) : 15-18.
  10. Sen N. Differences in family plaining status between the middle class and poor in Calcutta. Reason and remedies- A contraceptive study. J. Family Welfare. 2001; 47(1): 14- 27.
  11. Upadhyay J, Sharma AK. Fertility patterns and family planning acceptance among slum deliveries in Kanpur. J. Family Welfare, 1995; 41(2): 61-68.
  12. Ingle GK, Kumar A, Singh S, Gulati N. Reasons for non acceptance of contraceptive methods among jhuggijhompri deliveries of Delhi. Indian J. Prev. Soc Med. 1999; 30(1): 32-37.
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