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Indian Journal of Community Medicine

Awareness and Practices Regarding Spacing Methods in Urban Slums of Rohtak

Author(s): N.K. Saini1, M. Singh2, D.R. Gaur1, R. Kumar1, M.Rajput1

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

The single greatest threat to India's health political, economic and social development is uncontrolled population growth. With its population already exceeding one billion, it is all set to overtake China and become the most populous country in the world in 20451.

India was the first country in the world to launch a National Family Planning Programme with the aim to reduce the birth rate to stabilize population. The approach changed from clinic to extension education approach in the third five year plan and later on it was made an integral part of MCH activities but it could not make much impact. Programme suffered a setback in 1976 due to the element of coercion introduced in the programme and because of its political fallout; the political support for the programme was lost. Undue emphasis on terminal methods of contraception in the programme resulted in neglect of the need of young couples for spacing methods, use of which not only decreases total fertility but also improves the health of mother by delaying the next birth.

To improve the effectiveness of the programme there is need to know the awareness, practice and various other factors affecting the use of these methods in different segments of our population because of vast socio cultural variations within these.

Material and Methods

A study was conducted in urban slums attached to the S.P.M Deptt. of Pt. B.D. Sharma P.G.I.M.S Rohtak, taking operational feasibility into consideration. 840 couples in reproductive age group were randomly selected from 29 anganwadis located in these urban slums. The data was collected on a semistructured performa by interview method. Couples using permanent methods and couples in which female was pregnant were excluded from the study.

Results

The couple protection rate in the study population was about 53% which is still lower than required to achieve a stable population. 17.1% of the couple were protected by terminal methods and 36.1% were using spacing methods. CuT was the most popular spacing method followed by condoms and oral pills.

Table I: Distribution of couples by the type of contraceptive method used.

Type of Method Number %
Terminal 144 17.1
Spacing
CuT 134 16.0
Condoms 108 12.9
Oral Pills 61 7.3
Not using any method 393 46.8
Total 840 100

The study revealed the couples who did not use any spacing method of contraception did not perceive any risk of pregnancy because either they were breast feeding their child or their husbands were living away or they thought that they were too old to conceive. The other important reasons for non use were need of a child / male child.

All the couples had knowledge regarding at least one spacing method of contraception, Maximum users (81.8%) were among those who knew all the three approved methods of contraception. Non users (94.1%) were more in the group who were having knowledge of only one method. The difference of knowledge between the users and non-users was statistically significant.

Maximum users of spacing methods were in the age group of 20-29 years (63.7%) followed by 21.7% in 30-34 years age group. The proportion of users increased upto 34 years and then it decreased.

It can be observed that the users were minimum (11.3%) in those couples who were not having any child. The number of users increased as the number of living children increased. Maximum user (65.7%) were among those couples who were having 2 living children. Similarly it was also observed that majority of those who were married below the legal age prescribed by the government, were not using any spacing methods. The number of spacing methods users increased significantly as the age at marriage increased.

The number of users was significantly more among literates as compared to illiterates both in husband and wife. The number of users increased as the level; of education increased.

Discussion

In the present study, the couple protection rate (CPR) was 53.2%, which is almost same as reported by NFHS-II2 for the State of Haryana. However the users of spacing methods were more in the present study.

This can be due to the fact that the study was carried out in an urban area. Moreover the area is under the supervision of SPM Deptt. and availability of spacing methods is better. CuT was the most popular spacing method being used by 16% persons. The possible explanation for popularity of CuT could be that it is a one time procedure and gives protection for a longer time. The most important reason for non-use of spacing methods was little perceived risk of pregnancy. Desire of more children is a significant factor, also found in another study conducted by Alagh et al5. The present study indicates a need to educate and motivate the non-user couples who desire more children to adopt the small family norm. The lactating mothers should also be motivated that breast feeding alone cannot prevent conception.

Knowledge regarding spacing methods was universal. Use rate was significantly more in those having knowledge of all three approved spacing methods of contraception showing the value of knowledge in increasing the acceptance of spacing methods. More acceptance in more knowledgeable group was also observed in the study conducted by Jain et al3 although the study was conducted in rural area.

Maximum users of spacing methods were those couples with wife's age between 25 -34 years. Use was low in younger age groups. Studies conducted by Singh et al4 and Alag et al5 also showed low incidence of use of spacing methods in younger couples. This shows that intensive efforts are needed to popularize spacing methods among younger couples, as this is a more fertile group.

The study revealed that age at marriage of wife was significantly affecting the use of spacing methods. Acceptance increased with increased age at marriage of wife. Further increase in age at marriage and strict enforcement of law meant to discourage child marriages is suggested. Maximum users of spacing methods were among those having 2 living children and were least among those who did not have a child or having 4 or more children. Singh et al4 reported similar finding. This indirectly shows that the use of spacing methods was low in the early years of married life, which has a positive impact on total fertility. Therefore it is important to target these groups if we wish to decrease the total fertility. The study demonstrated the positive relationship between education level of both husband and wife and use of spacing methods. Other investigators6,7 have reported similar findings and NFHS-2 also shows similar results.

References

  1. Park K. Text Book of Preventive and Social Medicine. 15th ed. Jabalpur. M/S Banarsidas Bhanot; 1997.p.311-41.
  2. Indian Institute of Population Sciences and ORC Macro. National Family Health Survey-II 1998-99. Mumbai ; IIPS: 2001
  3. Jain S, Singh JV, Bhatnagar M, Garg SK, Chopra H, Bajpai SK. Attitude of rural women towards contraceptive and its use. Indian J Maternal and Child Health 1999; 10;18-9.
  4. Singh P, Kumar P, Goel U, Yadav RJ, Agarwal A. Adoption of family planning practices and associated factors in Pharganj area of Delhi. The Journal of Family Welfare 1990;36: 36-42.
  5. Alag V, Banerjee A. Acceptance of spacing methods of contraception in Municipal Corporation of Delhi. Health and Population-Perspectives and Issues 1995; 18:56-2.
  6. Sunder R. The status of women and family planning acceptance: Some field results. The Journal of Family Welfare 1990:36:60-8.
  7. Shyamini KA, Helen H. A study of some of the factors relating to contraceptive use in an urban slum. Health and Population- Perspectives and Issues1995:18:176-89.

1. Deptt. of SPM, Pt. B.D. Sharma PGIMS, Rohtak.
2. CHC Purkhas, Distt. Sonepat, Haryana.
Received: 7.10.2004

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