PAKISTAN ARMED FORCES
MEDICAL JOURNAL (Category Y)

A Journal of Army Medical & Dental Corps

Being published since 1956

ISSN (online) 2411-8842
ISSN (print) 0030-9648

VOL 59, No. 4, DECEMBER 2009

ASSESSMENT OF KNOWLEDGE & PRACTICE OF CONTRACEPTIVES IN FEMALES OF REPRODUCTIVE AGE GROUP AT A TERTIARY CARE HOSPITAL

Nabeela Fazal Babar, Mahmood Ahmed, Mohammad Babar Khan*, Mohammad Wasif Khan

Abstract

Objectives: To assess the knowledge & practice of contraceptives in females of reproductive age group.
Study Design: Cross sectional descriptive.
Place and Duration of Study: OPD of Fauji Foundation Hospital from February 2008 – September 2008.
Subjects and Method: 339 Females of age b/w of 15 – 49 years attending OPD of Fauji Foundation Hospital were included in study. A structured questionnaire was used to collect data.
Results: Eighty eight percent of the females in our study sample were familiar with one or more methods of contraception (72.7%were familiar with combined oral contraceptive pill (COCP), 60.7% were aware of intra uterine contraceptive device (IUCD) &76% knew about condoms) whereas 12% showed ignorance. 64.6% of the study population was contraceptive users & 35.4% were not using any method of contraception. Regarding preferred method of contraception 34.6% of females said they are using COCP, about 21.8% females said their tubes had been liagated whereas 26.9%& 16.7% were using IUCD & Condoms respectively. Almost 46%of our study population said that contraceptive method they were using was suggested by their husbands, 44 % said by health professional .Only 10 % of the study population were using a method of their own choice.
Conclusion: The present study concludes that there is a gap between knowledge (88%) and use (64.6%) of contraceptives among females of reproductive age group. Another important inference drawn from the study is that men should be made equal targets of such programs in since 46% females in our study population were using method of contraceptive suggested by their husband.

Keywords : Contraceptives, assessment, knowledge

Article

INTRODUCTION
International consensus explicitly recognizes the importance of demographic trends on all aspects of development. Ever increasing population rates are a major issue for many countries. The world population is growing at an annual rate of 1.2%. Pakistan is amongst six countries that account for half of the annual growth, with an annual growth rate of 1.78 % [1].. Whereas, the annual growth rate of USA is 0.7 and that of China is 0.9 [2]. High population growth and economic backwardness are dependent variables which contribute significantly to rapid resource depletion, and hence to environmental degradation [3], is a serious challenge hence needs to be addressed through family
Correspondence: Dr Nabeela Fazal babr, Senior Lecturer, Community Medicine Dept, Foundation University Medical College, Rawalpindi
Received: 05 March 2009;
Accepted: 03 July 2009
planning information and services. Family planning is not synonymous with birth control. It has been defined by WHO as, “a way of thinking and living that is adopted voluntarily upon the basis of knowledge, attitude and responsible decisions by individuals & couples, in order to promote the health & welfare of the family groups and thus contribute effectively to the social development of a country [4]. Modern contraceptive technology is more than a technical advance, it has brought about a true social revolution, the 'first reproductive revolution' in the history of mankind [5]. Developing countries which account for three fourth of the world’s population have shown substantial decline in fertility since 1960. The increased practice of contraception as primary direct cause of this historic development has been little disputed.
In Pakistan, studies show that more than 90% of the populations is aware of at least one method of family planning. The Pakistan Contraceptive prevalence Survey (PCPS) 1994-95 showed that familiarity with contraceptive pills, intrauterine contraceptive devices (IUCD) injectables and female sterilization was over 70% for each method, which is considerably higher than in past years. Fifty two percent of married women in reproductive age said they wanted no more children. However CPR of Pakistan in the year 2006 was 36 only [6].
The contraceptive prevalence rate (CPR) in Pakistan was 24 [7] in the year 1997 compared to 54 in less developed and 66 in developed countries. Current contraceptive prevalence rate is 36 [8]. Whereas CPR in USA among married women is 73 [9]. CPR in Australia is 76 & in UK is 84 [10]. Thus in Pakistan the level of contraceptive use remains low both by international standard & in terms of developmental needs of the country. An analysis of survey and qualitative data in Punjab, Pakistan, determined that the social costs of contraception (e.g., fear of side effects and spousal, cultural and social acceptance) were the decisive obstacles to its use, rather than the monetary and related direct costs of obtaining supplies [11]. The report on the International Conference on Population and Development held in Cairo, Egypt in September 1994 issued the following directive.
“Recognize that appropriate methods for couples and individuals vary according to their age, parity, family size preference and other factors, and ensure that women and men have information and access to the widest possible range of safe and effective family planning methods in order to enable them to exercise free and informed choice [12].”
SUBJECTS AND METHODS
A cross sectional descriptive study was conducted on Women between age of 15 – 49 yrs attending OPD of Fauji Foundation Hospital Rawalpindi from Feb. to Sep 2008. Non Probability Convenient Sampling Techniques were used. Structured questionnaire designed regarding the knowledge and practice of contraceptives in females of reproductive age group Total time for collection and analysis of data was 8 months. The questionnaire was administered to the study population in such a way that helped in collecting adequate information to assess knowledge and practice of contraceptives in females of reproductive age group. Data was analyzed on SPSS -10. Descriptive statistics were used to describe the data i.e. mean & standard deviation (SD) for numeric variables and frequencies along with percentages for categoric variables.
RESULTS
The data was obtained on knowledge and practice of contraceptives from 339 females of reproductive age group (15 – 49Yrs). Mean age of our study population was 32 years (SD = 8). When asked about familiarity of any contraceptive method majority 88 % responded that they were familiar with one or more methods only 12% showed ignorance (Table. 1). About 65% of females said they were practicing one or other method of contraception where as 35% were not practicing any method of contraception. Analyses of awareness of the various contraceptive methods were as follows, 72.7%were familiar with combined oral contraceptive pill (COCP), 60.7% were aware of IUCD’s. 71.3% with injections, 24.3% with Sterilization, 18.3% with breast feeding (Figure 1). On inquiring these females about knowledge of contraceptive methods used by males about 76% knew about condoms, 18.9% were familiar with withdrawal method and 5 .1% were familiar with vasectomy (Figure 2.).When asked from respondents about preferred method of contraception used by them 34.6% said they use COCP, about 21.8% said they had their tubes liagated whereas 26.9% and 16.7% were using IUCD and Condoms respectively (Table 2). When inquired from our respondents who proposed the contraceptive method they were using, almost half them i.e. 46% said method was suggested by their husbands, 44% said health professional only 10% were using a method of their own choice (Table.3).
DISCUSSION
The present study highlight the gap between knowledge (88%) and use of contraceptives (65%) amongst female of the reproductive age group attending OPD of F.F.H. Reproductive health and Family Planning Survey highlighted the wide gap between knowledge (97%) and use of contraceptives (28%) amongst currently married women in Pakistan [13]. Another survey depicted that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception [14]. Studies have shown that the large population of people in the developing countries did not have ready access to a variety of contraceptive methods. Asia alone contains 61 million married women with unmet needs [15]. WHO reports that an estimated 94% of world’s population lives in countries with policies that favor family planning. Despite these policies 5 of every 6 couples in reproductive age do not use adequate methods. Possible reasons are availability affordability and access to contraceptives as well as cultural, social &health concerns [16].
Knowledge regarding contraception, as specific method, its availability and affordability was high in our survey population. This was in contrast to the results of the study that says most developing countries only offer a limited choice of contraceptive methods, and couples cannot easily choose the method that best suits their reproductive needs. In a similar study in Karachi, nearly half of the sampled men (56%) and women (48%) were contraceptive users. Appropriate knowledge for condoms was 73% among men (users 78%, non-users 60%) and 5% among women [17].
When inquired from our study population about their source of advice on contraception method you are using almost half of our study population i.e. 46% said that the method was suggested by their husbands, 44% said health professional, while 10% were using a method of their own choice. The gap can be attributed to the obstacles faced by the Pakistani women to the usage of the contraceptives, which have been identified as the motivation to avoid pregnancy, awareness and knowledge of the contraception, the social and cultural acceptability of contraception, perceptions of the husbands’ preferences, health concerns, and the perceived access to services.
CONCLUSION
The present study concludes that there is a gap between knowledge and use of contraceptives among females of reproductive age group. Another important factor is that men should be made equal targets of such programs in Pakistan as 46% females in this study population point out that the method they were using was suggested by their husband.
RECOMMENDATION
Substantial evidence suggests that by improving knowledge about contraceptive techniques or by establishing the social legitimacy of using contraceptives family planning programs can increase contraceptive prevalence. Family planning facilities may be able to increase clients' contraceptive use by providing diversity in method choice, keeping offered methods in stock, displaying informational materials, and keeping in view the contraceptive needs of women with all levels of education and increasing social and cultural acceptability of different family planning methods. Majority off women never talked in the past year with their husbands about family planning. The couple’s sense of understanding and communication also influence the usage. Hence implying that men should be made equal targets of such programs in Pakistan

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