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Indian Journal of Community Medicine

Study of Unmet Need for Family Planning among Women of Reproductive Age Group Attending Immunization Clinic in a Medical College of Kolkata

Author(s): S. K. Bhattacharya1, R. Ram1, D. N. Goswami1, U. D. Gupta1, K. Bhattacharyya1 S. Ray2

Vol. 31, No. 2 (2006-04 - 2006-06)

Abstract

Research Question: What are the extent and reasons of unmet need for Family Planning among urban mothers of reproductive age group and its association with some demographic and social factors? Objectives: I. To estimate the magnitude of unmet need for family planning among married women of reproductive age group. 2. To identify socio-demographic factors associated with unmet need for family planning and contraceptive users. 3. To explore common reasons for unmet need for family planning. Setting: Immunization Clinic and Post-Partum unit of Calcutta National Medical College, Kolkata. Study design: Cross-sectional study. Sample size: 10% sample or all mothers attending the clinics for a period of 1 month were selected by systematic random sampling method. Study variables: Age, Parity, Literacy, Lack of information, Unsatisfactory services etc. Results: Extent of unmet need for family planning is 41.67% of which 25.84% are limiters and 15.83% are spacers. Only 45.83% women are contraceptive users. Contraceptive rate increases with advancement of age and prevalence of unmet need is significantly higher in younger age group. With increase in literacy level tile prevalence of Spacers in the unmet need group has significantly increased and that of limiter decreased. The prevalence of spacers significantly decreases and limiter increases with, increase in numbers of living children. The major reason for unmet need is opposition from husband/ family and community (32%). Conclusion: IEC activities are to be improved focusing on men as well as, women associated with good quality, easily accessible convenient methods for family planning.

Key words: Family Planning, Unmet Need

Introduction

Inadequate attention to alarmingly rising population and its deleterious effect on developmental effort and food situation, has led us to a disastrous situation. Contraception is the best development.1 Many women who are sexually active would prefer to avoid becoming pregnant but are not using any method of contraception. These women are considered to have an unmet need for family planning. The concept of unmet need points to the gap between some women's reproductive intentions and their contraceptive behaviours.2

Unmet need rises as more women want to control their fertility and it falls as more use contraception3 . Even where the proportion of women with unmet need is declining, the absolute number with unmet need may be growing because the population is growing.4 Among the common reasons for unmet need for family planning are inconvenient, unsatisfactory services, lack of information, fears about contraceptive side effects and opposition from husbands, relatives or others.4

In developing countries, average level of unmet need is about 20% 4. By responding to the concerns of women with unmet needs, programme can serve more people and in a better way. In view of the above, the present study was carried out with the objectives to estimate the magnitude or unmet need for family planning among married women of reproductive age to identify socio demographic factors associated with unmet need for family planning and contraceptive users, and to explore common reasons for unmet need for family planning.

Materials and Methods

The study was undertaken in the immunization clinic and postpartum unit of Calcutta National Medical College, Kolkata among mothers of reproductive age who are attending the clinic either for vaccination or for follow up for about a month having 24 working days. As the daily average attendance of each of the immunisation clinic and post partum unit is about 50, the total number of attendees came out to be round about 2400. By taking 10% sample using systemic sampling method, 240 mothers were chosen for study. Mothers were interviewed to screen out the unmet need group, contraceptive user group and intended group using the standard formulation. Unmet group included all fecund women who were married and presumed to be sexually active, who were not using any method of contraception and who either did not want to have any more children or wanted to postponed their next birth for at least two more years. Those who want to have no more children are considered to have unmet need for limiting birth or limiters, while those who want more children but not at least two more years are considered to have unmet need for spacing birth or spacers. The unmet need group also included all those pregnant and lactating mothers whose current or previous pregnancies were unwanted or mistimed and who became pregnant because they were not using contraception. Similarly, women who recently have given birth but are not yet at risk of becoming pregnant because they are amenorrhic postpartum are considered to have an unmet need if their pregnancy were unintended. Those whose pregnancies are unwanted are considered to have unmet need for limiting birth, while those pregnancies are mistimed are considered to have unmet need for spacing birth4 . Intends are those non pregnant women who want child soon (within 2 years) and not using contraception or pregnant and lactating women whose pregnancies are intended.

By interviewing the women, information was collected about different socio demographic factors and about the main reasons of not using contraception on predesigned and pretested Performa. Data were analysed using standard statistical techniques.

Results and Discussions

Table No. 1 shows 45.83 % women are contraceptive users. Among the non pregnant women not using contraception 58(24.17%) want to have no more children and out of the pregnant women 4(l.67%) had their pregnancies unwanted and so both of them (25.84%) have unmet need for limiting births. On the other hand 36(15%) non pregnant women do not want child for at least two more years and in case of 2(0.83%). pregnant women pregnancies were mistimed; so both of them (15.83%) have unmet need for spacing births. Hence, in total, 41.67% constitute unmet need group for family planning. Only the rest 12.5% are intenders, as either they want child soon or their present pregnancy status is intended.

Table I: Distribution of Women according to Status of Unmet Need for Family Planning

Women No. Percentage
Pregnant
Intender 8 3.32
Unwanted
(unmet need for limiting birth)
4 1.67
Mistimed
(unmet need for limiting birth)
2 0.83
Non Pregnant
Contraceptive User 110 45.83
Nonuser Want no more (unmet need for limiting birth) 58 24.17
Do not want child for at least 2 more years
(unmet need for spacing birth)
36 15
Intender 22 9.17
Total 240 100

Based on the survey data for 60 developing countries, an estimated unweighed average 21% of married women of reproductive age group have an unmet need for family planning; 12% for limiting births and 9% for spacing. NFHS- 2 survey (1998-99) shows that 16 per cent of currently married women in India have an unmet need for family planning. The unmet need for spacing births is the same (8%) as the unmet need for limiting births5 .

Table No. II shows that 77.5% of the mothers belonged to the age group of 20-29, which is the most active period and most important for child bearing.

Table II: Age wise Distribution of women according to Unmet Need and Contraceptive practices

Age Group
in years
Unmet Group Contraceptive
User
Intender Total
Limiter Spacer Total
15-19 6 (50) 6 (50) 12 (100) 10 6 28
  (21.4) (21.4) (42.8) (35.7) (21.4) (100)
20-24 26 (48) 28 (52) 54 (100) 48 12 114
  (22.8) (24.5) (47.3) (42.1) (10.5) (100)
25-29 26 (86) 4 (14) 30 (100) 32 10 72
  (36.17) (5.55) (41.6) (44.4) (13.8) (100)
30-34 4 (100) - - 4 (100) 18 2 24
  (16.6)   (16.6) (75) (8.33) (100)
35+   -   -   - 2 - 2
              (100)   (100)
Total 62 38 100 110 30 240

(For unmet group, x=15, p < 0.001; For whole group, x=14.43, p < 0.05)

Contraceptive use rate increases significantly with the advancement of age and prevalence of unmet need is significantly higher in the age group below 30. In the unmet need group of 15-19 years, the proportions of limiters and spacers are equal (50%), but in the later age groups 20-24 years, 25-29 years and 30-34 years, the proportions of limiters are 48%, 86%, 100% respectively, increasing significantly with advancement of age with proportionate decrease of spacers. Studies show that clear relationship emerges between women's age and level of unmet need when unmet need is divided into its spacing and limiting components. NFHS-2 survey (1998-99) shows that unmet need is highest (27%) among women below age 20, the need is almost entirely for spacing rather than for limiting, the need getting reduced with advancement of age. Most unmet need among younger women is for spacing birth because younger women still want to have more children. Among older women, most unmet need is for limiting births because older women have had as many children as they want and often more. So family planning programme should concentrate on younger age group and spacing method is more applicable to younger age group and permanent method to older age group.

Table No. III shows that 43.3 % of the women are illiterate. Prevalence of unmet need is high among illiterate women (46.1 %) and primary literacy group (52.1%), compared to that in the higher educational groups. Contraceptive use rate increases significantly as educational status gets improved, the use rate being 36.5% in illiterate, 43.4% in the primary group, more than 50% in middle and secondary group and 100% in the Higher Secondary and above. With higher educational level, proportion of spacer in the unmet group is significantly increasing from 33% in the illiterate group to 100% in the highest educational status group with reciprocal decrease in the proportion of limiter. Studies in Turkey have shown that better educated women have somewhat less unmet need than women do with little or no education6. Unmet need for family planning varies by woman's education, but only within a narrow range of 14 to 17 percent5.

Table III: Literacy wise Distribution of Women According to Unmet Need and Contraceptive Practices

Literacy
of Mother
Unmet Group Contra
ceptive
User
Intender Total
Limiter Spacer Total
Illiterate 36 (66) 12 (33) 48 (100) 38 18 104
  (34.6) (11.5) (46.1) (36.5) (17.3) (100)
Primary 16 (66) 8 (33) 24 (100) 20 2 46
  (34.1) (17.3) (52.1) (43.4) (4.3) (100)
Middle 4 (25) 12 (75) 16 (100) 30 6 52
  (7.6) (23.07) (30.7) (57.6) (11.5) (100)
Secondary 6 (60) 4 (40) 10 (100) 14 4 28
  (21.4) (14.2) (35.7) (50) (14.28) (100)
Higher Secondary & above   - 2 (100) 2 (100) 8 - 10
    - (20) (20) (80) - (100)
Total 62 38 100 110 30 240

(For unmet group, x=15, p < 0.001; For whole group, x=14.43, p < 0.05)

Table No. IV shows that in case of women having one child, the unmet need for spacing is seen to be highest (26.5%) and gradually decreases with each additional child.

On the other hand unmet need for limiting births is low (18.30%) in women having one child and is gradually increases with each additional child. Thus the trend for spacing and limiting are opposite to each other and being statistically significant. Women having no living child are fully intender. As the trend for limiting and the trend for spacing are opposite to and cancel each other out, there is no apparent relationship between the number of children and the overall level of unmet need. 44% of the women of unmet group had one child so it indicates even after first child the women are interested in controlling fertility. But in Ram et al study, 92% of the mothers with unmet need had 2 or more children7.

Table IV: Distribution of Women According to Number of Living Children, Unmet Need and Contraceptive Practices

No. of
living
children
Unmet Group Contraceptive
User
Intender Total
Limiter Spacer Total
0 - - - - 4 4
1 18 26 44 36 18 98
  (18.30) (26.53) (44.34) (36.73) (18.3)  
2 28 10 38 54 4 96
  (29.16) (10.41) (39.58) (56.3) (4.1)  
3 14 2 16 14 2 32
  (43.75) (6.25) (50) (43.75) (6.25)  
≥ 4
2 - 2 6 2 10
  (20) - (20) (60) (20)  
Total 62 38 100 110 30 240

(For unmet group, x=15, p < 0.001; For whole group, x=14.43, p < 0.05)

The study shows that the major reason for unmet need is opposition from husband, family and community (32%). The next reason is found to be lack of information in 24% of women who are either not aware of contraceptive methods or do riot know from where these can be obtained. 10% mothers found services were unsatisfactory and 19% had health concerns about side effects of the methods.

Ram et al noted in Kolkata that 12% of women had suggested the reasons for unmet need to be opposition from family members, 26% mothers had no information regarding the different methods and 20% women found methods available to be inconvenient7. Nag noted that a woman may have unmet need for family planning because of high social cost of challenging the opposition from her spouse or anyone else in her social influence group8. Reasons behind opposition may be that they want more children, do not accept that male physicians would examine their wives or worried that their wives might be protected from pregnancy.

References

  1. Singh Dr Karan: Population, the forgotten factor- Quarterly Journal of Public Administration, July Sep 1992; 38I No. 3.
  2. Conception MB Family formation and contraception in selected developing Countries; Policy implications of WFS findings.World fertility survey conference, London, July 7- 11, 1980, Plenary session No. 3 Voorburg, Netherlands, International Statistical Institute, 1989; 62.
  3. West off CF, Bankola A. Unmet need, 1990-94. Converton, Maryland, Macro International, June 1995.
  4. Population Report: Meeting Unmeet Need, New strategies; Series J, June 1997; 43: 3-9.
  5. National Family Health Survey, NFHS-2, India, 1998-99. International Institute of Population Sciences, Mumbai, India.
  6. Bhhushan I Contraceptive Use and Unmet need, A microeconomical model and its application to Egypt, Doctoral dissertation , John Hopkins University, Baltimore, 1995.
  7. Ram R, Ghosh M N, Bhattacharya S, Haider A, Chatterjee C, Naskar N. Study of unmet need for family planning among married women of reproductive age attending Immunisation clinic in a Medical College of Calcutta. Indian J. of Community Medicine, 2000; 25: 22-25.
  8. Nag W., Some cultural factors affecting cost of fertility regulation, Population Bulletin of the United Nation, 1984: 17-38.

1. Deptt. of Community Medicine Calcutta National Medical College, Kolkatta.
2. N.R.S. Medical College, Kolkatta.
Received : 8-5-2004

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