|Year : 2021 | Volume
| Issue : 2 | Page : 92-99
Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India
Priyanka Khuda1, Nand Lal Gupta1, Nishikanth Palaka2, Gurjeet Kaur1
1 Centre for Public Health and Healthcare Administration, Eternal University, Baru Sahib, Himachal Pradesh, India
2 Department of Informatics, Osmania University, Hyderabad, Telangana, India
|Date of Submission||02-Nov-2020|
|Date of Acceptance||21-May-2021|
|Date of Web Publication||24-Dec-2021|
Dr. Priyanka Khuda
Centre for Public Health and Healthcare Administration, Eternal University, Baru Sahib, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Promotion of family planning, especially the use of contraceptive methods is essential to secure the well-being and development of society. Despite rise in the temporary contraceptive usage over the years, the implementation of the spacing method has been indicated lower in rural as compared to the urban areas of India. This study aims to find out the prevalence and determinants of current use of spacing contraceptives among married rural women of Jammu district, Jammu and Kashmir.
Material and Methods: A community-based, cross-sectional study was conducted from January to June 2018 among married rural women. The survey was conducted house to house, and data were collected with the help of a questionnaire and BG Prasad Scale. Multi-stage sampling procedure was adopted to select the participants. Bivariate and multivariable logistic regression model was fitted to identify the factors associated with the current use of spacing contraceptive methods.
Results: The current use of spacing contraceptive among married women was found to be 16.4%. The male condom was the most used method (55.7%) as well as most preferred contraceptive (46.8%). Lack of knowledge was reported as the main reason for not using contraceptive method. The current use of spacing contraceptive method was significantly higher among the upper socioeconomic status (adjusted odds ratio (AOR) 2.37(1.06–5.29), women with higher education (AOR ) 5.04 (0.68–37.18), living in nuclear family (AOR 1.90; CI: 1.01–3.60), with 2 or more surviving children (AOR ) 2.45 (1.27–4.73), and living near health center (AOR) 1.69 (0.91–3.14).
Conclusion: Effective targeted programs along with conduction of more field researches that give scientific information should be implemented to achieve the desired goal of contraceptive usage in the rural area among married couples.
Keywords: Family planning, married women, spacing contraceptives, temporary, trends
|How to cite this article:|
Khuda P, Gupta NL, Palaka N, Kaur G. Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India. Indian J Community Fam Med 2021;7:92-9
|How to cite this URL:|
Khuda P, Gupta NL, Palaka N, Kaur G. Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jan 23];7:92-9. Available from: https://www.ijcfm.org/text.asp?2021/7/2/92/333658
| Introduction|| |
Contraceptive use is helpful for a couple to have the desired number of children by maintaining interpregnancy intervals. It is a pivotal dimension of overall family and child well-being and female reproductive health as it prevents unwanted pregnancies, unsafe abortions, and HIV/acquired immunodeficiency syndrome or sexually transmitted diseases. It has benefited women by creating opportunities, reducing poverty, improvement of economic security for families, communities, and countries. Despite five decades of government-initiated family welfare program, the increase in the use of temporary contraceptives in India has been slow from 5.5% in 1992–92 to 11.4% in 2015–16, as shown in [Table 1]. The use of spacing method among married women varied widely by state ranging from 0.6% in Andhra Pradesh, 1.2% in Telangana, 28.9% in Tripura, to 36.3% in Chandigarh. There is wide variations and diversities in the demographic, cultural, and socioeconomic context within the states of the country. The use of contraceptive methods in the majority of Indian states has been reported to be attributable to age,, residence, wealth status,, type of family, religion,, education of woman,, occupation of woman, education of husband, occupation of husband, number of living children,,, and distance from health center.
In Jammu and Kashmir, the proportion of couple protection by spacing methods was stagnant from 10.0% during 1992–93 to 11.1% during 1998-99 an which increased to 15.9% was observed during 2005–2006 and an increase of 21.3% during 2015–2016. In case of contraceptive methods, the usage has declined from 49.4% in 1992–1993 to 49.1% in 1998–1999. An increase to 52.6% has taken place in the period 2005–2006 to 57.1% during 2015–2016, as shown in [Table 1].
According to the district level household survey, the past trends of the use of spacing method in Jammu district have decreased from 55.7% in 2002–2004 to 16.5% in 2007–2008. The use of any contraceptive method (73.2% to 59.5%), any modern method (69.7% to 51.3%) has also decreased during 2002–2008, any traditional method (3.5%–8.0%) has only increased from 2002 to 2008, as shown in [Table 2].
In Jammu and Kashmir slow increase in spacing contraceptive use over the years, and the total fertility rate (2.2 per woman) in a rural area is slightly above the replacement fertility level (2.1 per woman) have been major concerns. There is also the issues of poor use of the spacing method in the rural areas (19.9%) compared to urban (25.0%) and the unmet need for the spacing method is 4.2% in urban and 6.4% in the rural area of Jammu and Kashmir.
As of now, there has been a dearth of research studies done on current spacing contraceptive use in rural Jammu and Kashmir. Therefore, this study was conducted to find the prevalence of the current use of a spacing contraceptive method and its determinants among married women in the disturbed rural area (Marh, Bhalwal, R S Pura and Bishnah) of Jammu, India.,
| Material and Methods|| |
Jammu province, the winter capital of Jammu and Kashmir State of India which is bordered by Udhampur district in the north and northeast, Kathua district in the east and southeast, by Pakistan in West and Pakistan Occupied Kashmir in the Northwest. A community-based, cross-sectional study was conducted from January to June 2018 in the rural area of Jammu district, one of the 10 districts of this province in India. It has eight community development blocks, and half of the population lives in the rural areas of the district with majority of the people engaged in agriculture activities and following Hindu religion. There are 74 primary health centers in the district that are owned by the government.
The sample size was calculated on the infinite population of the study using Cochran's Formula: n = Z2p (1 − p)/e2. Using P = 0.5 and d=5% . Adding 10% of non-response, total sample size was calculated to be 422.
The list of married women (18–49 years) of rural area of Jammu district was first obtained from the concerned health authorities. Based on the inclusion and exclusion criteria, the women who were willing to participate and who had or had not child/children were included in the study. Unmarried, widow, or divorced persons were excluded from the study. A multistage sampling technique was used to identify the study participants. First, four blocks out of the 8 in rural Jammu were selected using a simple random sampling method. From the 4 selected blocks, 94 subcenters were identified, out of which 24 subcenters were selected by the systematic random sampling technique. Finally, a sample of 422 was selected using a proportionate sampling technique from the number of participants living in these 24 selected subcenters. In case of presence of more than one married couple in a household, only one married couple were taken for the study using the lottery method [Supplementary File 1].
The survey was conducted house to house, and data were collected with the help of a structured interview schedule consisting of three sections, Section A, B, and C. Section A included questions to elicit information regarding sociodemographic variables. For the classification of socioeconomic status (SES) of the study participants, Modified BG Prasad scale was used. Section B included questions to elicit information regarding contraceptives (knowledge, practice, and behavior). Section C included question to elicit information regarding barriers to contraceptive use. Collected data were verified and coded daily after completing the field activities; data entry and analysis were done in SPSS (Statistical Package for the social sciences) Version 23; Released in 2015, IBM Corp., Armonk, New York, USA. The descriptive analysis such as percentages and measure of central tendency were used. Bivariate technique cross-tabulation was used for understanding, differential levels of the use of spacing contraceptive method among respondents by different variables. Bivariate analysis was performed to see the associations along with their odds ratios (OR) at 95% confidence intervals (CI) and P values were obtained to identify the associations. All variables that were found to be significant at the bivariate level (P < 0.05) were entered into the multivariate analysis using the logistic regression model to test the strength of the association.
The dependent variable had two categories using spacing method and not using spacing methods. Since the focus was on spacing methods, sterilization cases (n = 19) were dropped from the analysis. The independent variables considered were the age of women, residence, SES, type of family, education of woman, occupation of woman, education of husband, occupation of husband, number of living children, and distance from the health center.
The study was done after taking approval from the Ethical Committee of the Eternal University, Baru Sahib, Himachal Pradesh, India, and the Directorate of Health Services/Block Medical Officers, Jammu. Informed verbal consent was obtained for voluntary participation from individuals before the administration of the questionnaire. The confidentiality of the participants was maintained, and data were used only for the research purpose.
| Results|| |
A total of 422 married women were interviewed during the course of this study. Half of the study population were in the age group of 26–35 years. The 82.2% participants had secondary education and 89.6% were homemakers. The majority (84.4%) of the husbands of the participants had secondary level of education, and almost all (96.2%) were working. The majority were Hindu (89.8%), belonged to a joint family (77.5%), less than one-third (31.3%) were from the upper class, and 41% respondents had 2 children. More than half of participants (59.2%) were residing within 3 km area of the health center [Table 3].
|Table 3: Sociodemographic and obstetric characteristics of respondents (n=422)|
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In this study, the majority reported that they have heard about any contraceptive methods. The male condom (97.2%) was the main contraceptive method heard by the participants, followed by female sterilization (82.9%); Out of these, 77.2% reported mass media & 42.15 reported health personnel as the main source of information on any contraceptive method. Only about one-fifth (20.8%) were using any contraceptive method at the time of the interview. Out of those who were using, 16.4% were relying on spacing method and 4.5% had permanent sterilization. Among women who were involved in temporary contraceptive method, the male condom was the most used method (55.7%), followed by the oral pill (13.6%). Among the nonusers of contraceptive method, less than one-third (31.7%) gave the reason of not using that they did not know about any contraceptive method and about one-fourth (24.2%) were currently pregnant/breastfeeding their child. More than two-fifth of them wanted to use contraceptive in future. Among married women reporting future use for contraceptive method, the most preferred method was male condom (46.8%) and female sterilization (41.6%). Among the respondents, who did not want to use any method in future, 46% said that they did not know about the contraceptive method while 26.5% gave the reason of fear of infection/side effects [Table 4].
|Table 4: Patterns of contraceptive use, awareness, sources of among study sample population Jammu distric|
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[Table 5] revealed the use of temporary contraceptive methods among participants; the various methods varied with age. Less than one-third (30.3%) participants using the spacing method were in the age of ≥36 years with mean age was 29.6 ± 7.04 years. The respondents (17.7%) using spacing contraceptive methods were Hindu, 29.8% were from nuclear family, and 28.3% belonged to the upper class. Among the contraceptive user for spacing, 33.3% had higher education, 27.0% were working and 28.8% had two children, and 20.6% of users were living ≤3 km far from the health center.
|Table 5: Differentials and determinants of spacing methods of contraceptive use among the study population according to select characteristics, Jammu district|
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In unadjusted odds ratio, age of women [OR: 4.54 (2.01 to 10.23)], type of family [OR 2.64 (1.50 to 4.66)], SES (adjusted odds ratio [OR: 3.77 (1.95 to 7.27)] education of women [OR 5.33 (1.35 to 21.01)], education of husband [OR 4.66 (1.15 to 18.79)], number of living children [OR 2.60 (1.43 to 4.71)], and distance from health center [OR 1.88 (1.07 to 3.30)] were found to be significantly associated with spacing contraceptive method use in bivariate analysis, as shown in [Table 5].
Taking into account the influence of all other covariates simultaneously, multivariate logistic regression was conducted to identify the independent predictors for current use of the spacing contraceptive. These included age of women, education of women, education of husband, SES, number of living children, type of family and distance from health center with current use of spacing methods, except religion and occupation of women and husband.
The results revealed five significant predictors for the current use of spacing contraceptive methods: nuclear family [OR 1.90 (1.01 to 3.60)], upper class in SES [OR 2.37 (1.06 to 5.29)], more than secondary educated women [OR 5.04 (0.68 to 37.18)], ≤3 km distance form health center [OR 1.69 (0.91 to 3.14)], and having two or more living children [OR 2.45 (1.27 to 4.73]. As such, women living in the nuclear family, as well as belonging to upper class, were more likely to use temporary contraceptive method as compared to other classes. Besides lesser, the distance from the health center, higher the chance of adopting a spacing method, and women with higher education were more likely to use spacing method. Finally, the number of living children increased, women were more likely to rely on temporary method than women having one child, as shown in [Table 5].
| Discussion|| |
Although family planning program has been extensively implemented and has led to the steady increase in the prevalence of contraceptive use, with variation at different places in India, yet the progress of family planning program shows higher unmet of need in rural areas (13.7%) as compared to urban areas (8.8%) of Jammu and Kashmir. The past trend of fertility rate has also declined from 3.36 to 2.2 during 1992–2016 and 2.1 to 1.8 during 2011–2017 in rural Jammu and Kashmir.
The present study showed that 16.4% of participants were currently using spacing contraceptive method. This result is almost similar to National Family Health Survey (NFHS)-4 report (19.2%), whereas other studies showed a higher prevalence in Ludhiana (49.5%), Mangalore (51.9%), and Pune (81.5%), contrary to our finding. This difference might be due to variation in the awareness of the people, availability of the contraceptive methods, and the difference in the study settings to access the service or change in sociocultural beliefs over time.
In the current study, it was observed that more than two-thirds of study participants were aware of any contraceptive method, a comparable finding of the study conducted in Bangalore. However, contraceptive awareness was found higher in other parts of India, i.e. from 81% to 95.2%.,,, Some studies in Chandigarh (55.0%) and Madhya Pradesh (58.0%) had shown lower knowledge as compared to our findings. In the present study, the mass media (77.2%) turned out to be the main source of information regarding contraceptives, similar to the result of the studies conducted in various states of India, i.e. Karnataka, Tamil Nadu, Uttar Pradesh, Chandigarh, and Kashmir. However, some studies conducted in Tamil Nadu, Gujarat, and Chhattisgarh reported that health professional was the main source of information which was the second main source of information in our study.
The male condom (55.7%) found to be the most commonly used contraceptive in this study, similar to the study conducted in Pune, and Chandigarh.
The current study reported the main reason for the nonuse of the contraceptive method as lack of knowledge (31.7%). This finding was concordant with some studies done in Pune, Chandigarh, Vadodara, and Jammu, while others reported fear of side effects and want of more children,, were the main reasons for nonuse of the contraceptive method.
In the current study, the most preferred contraceptive for future was condom (46.8%), which got support from the finding of NFHS report. Whereas, studies conducted in Maharashtra and Jammu revealed that female sterilization was the most commonly preferred method for future use. Moreover, a study from Karnataka showed that oral pill found out to be the most preferred method for future use.
In the multivariate analysis, it was found that there was a highly significant association between temporary contraceptive usage and number of living children. Similar findings were also supported by the study done in Mangalore where it was found to be higher in women having two or more children (93.9%) than women having one children (69.6%). Similarly, a study done in Pune showed the significant association between the number of children and the use of temporary contraceptive methods.
A highly significant association was found between higher income class and use of temporary contraceptives. Two studies have also found the similar findings where the temporary methods were directly associated with SES of the respondents. The use of temporary contraceptive was 66.1% and 90.5% among higher income group than low income group.
There was a significant association found between the education of woman and the use of temporary methods of contraception. The women who attained higher levels of education were practicing temporary contraceptives more than woman with less and no education. This findings was consistent with earlier conducted study in Mangalore where the use of temporary methods in the women of higher education were significantly higher (100%) than illiterate (23.8%).
Logistic regression analysis revealed that married women living in the nuclear family, belonging to high SES, more than secondary educated women, residing at ≤3 km distance from health center and having two or more living children were more likely to use temporary contraceptive methods. Married women from the nuclear family are relatively free to talk on sex issues with husband, than the women residing in joint family where they might feel ashamed of or fear to discuss the same and also find less time with husband due to multiple tasks for many people in the family. Hence, women from nuclear family are more likely to use contraceptive than women of joint family. Similarly, women with higher education and belonging to upper class income state are more likely to do the same with more knowledge and exposure to discussion on family planning and latest developmental issues as they may feel pride in experimenting in more free time than woman of poor family and less education. Those staying near the health center get more opportunity to health information than those staying far away and hence are more likely to use more contraceptive.
Strength and limitations
It was a community-based study covering a difficult geographical area. Although the sample size was adequate, the large population of the area could have been covered. Design effect was not used, even though multistage sampling was applied.
| Conclusion|| |
Despite India being the first nation in the world to launch family planning program in 1952, it has still not attained the desired level of temporary contraception usage in certain parts of India. J and K is a declared difficult area under the Indian Act and this study focused on married women of rural area of Jammu and found temporary contraceptive usage prevalence with its determinants. Only one eighth of the married women of the rural Jammu were currently using temporary contraceptive. The mass media was reported to be the main source of information followed by health personnel regarding contraceptive use. SES, education of women, number of living children, type of family, and distance from health center were found to be strong five predictors of the use of spacing contraceptive methods. Dissemination of the scientific information through regular awareness campaigns and educational sessions regarding contraceptive use needs to be tailored to community by the devoted health-care personnel and mass media. Field researches need to enhance to unfold intricacies involved in this context to integrate new information that may emerge into the future programs to help create healthy society.
We would like to thank all the participants without whom this study could not have been possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]