Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice

Transcription

1 SciFed Obstetrics & Women Healthcare Journal Research Article Open Access Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice * Jayati Nath * Obstetrics & Gynaecology, MMIMSR, India Jayati Nath,, 2017, 1:1 Abstract Aims & Objective: The aim of this study was to evaluate the, concepts and practice of contraception among the postpartum women in North India. Materials & Methods: This was a cross-sectional study done in a tertiary care medical college in rural North India, over a one year period between January 2015 and January Five hundred (500) women who were in the postpartum and post-abortal period were randomly selected, after informed written consent, and were asked to fill a pre-formatted detailed questionnaire about contraception and the various methods available. Their, concepts and practice of emergency contraception pill and MT Pill were also noted. Results: Only 72 % of the women had heard about various methods of contraception especially about Intra Uterine Contraceptive Devices & Oral Contraceptive Pills. Most had came to know about contraception from television & doctors and other healthcare workers. 95 % patients opted for contraception after counseling, the most popular devices being-iucds, barrier method (condom) and injection Depot Provera. Only 15 % knew about emergency contraceptive pill and 36 % patients had some about MT Pill. Conclusion:There is a great lack of awareness of contraception, emergency contraception and medical abortion in the women especially from the rural background in our country. Improvement in the general health education and awareness, detailed and proper counseling is a must to all postpartum and post-abortal women which will help in improving the general health of these women and their children. Keywords: Contraception; Emergency contraception; MT Pill; Post-abortal women; Post-partum women. Abbreviations: IUCD - Intra Uterine Contraceptive Device OCP- Oral Contraceptive Pill MT Pill Medical Termination of Pregnancy Pill Introduction A woman s reproductive right is absolutely fundamental to her existence which includes when and how many times she should decide to have a baby. In the reproductive life of a woman, the postpartum and post-abortal periods are very crucial because, for many patients hailing from rural background, these may be the only opportunities she gets to come in contact with a health personnel. Therefore contraceptive counseling done at this period is very crucial and effective too. The postpartum period is an ideal time to initiate contraception because these women are accessing the healthcare system and might have increased motivation and zeal to avoid another pregnancy in the near future. As is known, non-breastfeeding women might ovulate as early as 25 days postpartum, therefore, it is imperative to initiate contraception in the postpartum period as early as *Corresponding author: Jayati Nath, Obstetrics & Gynaecology, MMIMSR, India. jayati.nath@yahoo.com Received March 15, 2017; Accepted April 4, 2017; Published April 18, 2017 Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1:1. Copyright: 2017 Jayati Nath. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. page 1 of 5

2 Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1:1. feasible [1]. Contraception use among women in the extended postpartum period (one year period after the birth of the child) is very important, since delay of contraceptive use until the return of menstruation might subject the women to the risk of unwanted pregnancy and its sequelae. Contraceptive use early in the postpartum period substantially reduces the rates of maternal and infant mortality by preventing unplanned and unwanted pregnancies and spacing new pregnancies to at least three years after the previous birth [2]. The largest population of women with an unmet and underestimated requirement for contraception is in their first year after childbirth [3]. It has been seen that mortality risks are increased for both the previous child and the newborn infant if birth intervals are smaller than recommended [4]. In India the highest percentage of unplanned pregnancies are due to shorter birth intervals. Therefore, the postpartum period becomes even more crucial for initiating contraception to space pregnancies and births so as to improve maternal and fetal health [5]. As a measure to reduce the adverse maternal, perinatal and infant outcomes, WHO (2006), recommended that the interval between a live birth and the next pregnancy should be two years (24 months) [6]. Short birth intervals (< 24 months) also lead to increased risk of maternal death and pregnancy related complications [7]. National Family Health Survey ( ) U.P, India, stated that the unmet need for family planning in the currently married women of the reproductive age group in India is 21.2 % [5]. The most common reasons suggested for this being are inconvenient, unsatisfactory services, lack of proper information, fears about side effects of using contraceptive devices and opposition from husbands and other family members [9]. Family Planning and use of birth control measures reduces unintended pregnancies and unsafe abortions, prevents maternal and neonatal deaths and reduces complications due to unsafe pregnancies and abortions [7, 8, 9]. Aims and Objectives This cross sectional study was undertaken to assess the concepts, and practice of contraception in the postpartum and post-abortal women attending a tertiary care medical college catering to rural North India. Materials and Methods This was a cross-sectional study conducted over a period of one year from January 2015 to January A total of 500 post-partum & post-abortal women attending the OPD, IPD, Emergency services were randomly enrolled in the study after taking informed written consent and were given a prestructured questionnaire to answer and their answers were noted and analyzed. These women were asked questions to know about their concepts,, awareness and practice about contraception & the various methods available thereof. They were counselled about various contraceptive methods available using the cafeteria approach and were allowed to choose a method of contraception of their choice. They were also asked if they knew about Emergency Contraception Pill & Medical Termination of Pregnancy Pill (MTPill). All the relevant data thus collected were tabulated, assorted and statistically analyzed by using SPSS version -15. Results & Observations The results obtained from our study are represented as follows Table 1 : Demographic profile of the patients A MATERNAL AGE (yrs) Number Percentage (%) B PARITY Number Percentage (%) > Table 2 : Economic background of the patients MODIFIED KUPPUSWAMY SCORE PERCENTAGE Upper (I) Upper Middle (II) Middle/Lower Middle(III) Lower/Lower Middle(IV ) Lower (V) % patients belonged to the rural areas whereas the rest 37 % hailed from the urban areas. Out of the total 500 number of women enrolled in the study, only 360 had about contraception and various devices (72 %) and the rest 140 (28 %) had no idea about the same Table 3 : Parity and of contraception OBSTETRIC HISTORY Para Multipara Table 4 : Socio-economic status & Knowledge SOCIO ECOMIC CLASS TOTAL Upper (I) Upper Middle (II) Middle/Lower middle(iii) Lower/ Upper lower(iv) Lower (V) TOTAL page 2 of 5

3 Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1:1. Table 5 : Knowledge based on Occupation OCCUPATION TOTAL Housewife Skilled personnel Professional TOTAL CONTRACEPTIVE METHODS PERCENTAGE(%) IUCD (CuT / multiload) Barrier Method (male condom) OCP (POP) DMPA Injection- Depo Provera/ Khushi Lactational Amenorrhoea Method (LAM) Table 6 : Source of SOURCE OF KWLEDGE CONTRACEPTIVE METHODS IUCD (Cu T / multiload) 298 Barrier Method (condom) 275 OCP (POP) 153 DMPA Injection /Depo Provera/ Khushi Lactational Amenorrhoea Method (LAM) Family / relatives 100 Doctor / health care provider 125 ASHA Worker 45 Books & news 50 Television & Radio 180 Table 7 : Knowledge about Contraceptive methods Safe Period Method No Method Safe period Method 10 TOTAL 360 After family planning counseling on post-partum contraception & an informed choice, 95 % patients (345/500) patients wanted contraception. The preferred methods of contraception as opted by these women are as shown in Table 8 Table 8 : Methods of Contraception chosen The two most important deciding factors which influenced the of contraception were education level & occupation of the woman and the socioeconomic status as calculatedv by the Modified Kuppuswamy Score KWLEDGE EMERGENCY CONTRACEPTIVE PILL TOTAL % 7.2 % % % 18.1 % % TOTAL Table 9: Emergency Contraception Pill 85.0 % 15.0 % % Table 10 : Knowledge about MTPill KWLEDGE MTPill TOTAL % 14.0 % % % 33.3 % % TOTAL % 35.0 % % MT Pill was known to only 35 % patients (175/500 ) & Emergency Contraceptive Pill was known to 15 % patients (75 /00) Discussion Out of the total 500 patients, only 72 % (360/500) had heard about various methods of contraception. IUCD (CuT / Multiload) was known to %, OCP (Mala N & Mala- D) to 42.5 %, Barrier method (Nirodh / condom) to %, lactational amenorrhoea method was known to 9.72 %, Inj Depo Provera (DMPA / Khushi) to % and only % were aware of the Safe Method. The main source of information was television, radio, ASHA workers, doctors and other healthcare personnel. After post-partum contraception counseling, 95% women were willing to use some method of contraception. The choice of contraception was % opted for IUCD, 17.4 % for barrier method (Male condom) DepoProvera injection was chosen by 27.6 % Progesterone Only OCP by 10.4 % lactational amenorrhoea method was chosen by 4.4 % Safe period method was chosen by 3 % of the patients. However 5 % patients did not go for any contraceptive method but opted for abstinence for the page 3 of 5

4 Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1:1. same purpose. Only 15 % of the patients (75 / 500) were aware of Emergency contraceptive Pill. 35 % had heard about MT Pill (175/500). In their study, Syed Esam Mahmood et al, stated the prevalence of post-partum contraception as 13.8 % in the rural females of Bareilly district of U.P [11]. Goel et al (2010) in their study reported it as 28.0 % [10]. A higher post-partum contraception prevalence of 41.0 % has also been reported from a population council study [12]. Around 20.0 % of post-partum contraception has been reported by NFHS-3 ( ) for rural U.P [1]. Kiran G et al who conducted a study on contraception use among married women in a slum in Mumbai stated that as many as 87.7 % of women were aware of at least one method of contraception, 68.4 % women were using a contraception at the time of study, 87.7 % were aware of OCP & Cu-T, followed by female sterilization (80.4 %) & male condoms (77.5 %) [13]. A very low level of awareness were noted by several other studies regarding emergency contraception [16, 17, 18, 19]. From our study, we found that the key factors which influenced the of contraception were education and occupation of the woman & socio-economic status as calculated by the Modified Kuppuswamy Score. A significant association between contraception acceptance & type of family, socio-economic status & age at marriage were observed in a study among the women of reproductive age group in rural Maharashtra [14, 15]. It has been seen that contraception use was significantly higher (19.1 %) among the women who were delivered at a hospital or health centre as compared to those who delivered at home (8.3 % ). This is mostly because of the the antenatal and post-natal family planning advice given to the patients delivered at a hospital or health care centre. In a study conducted in Mexico [16]. It was found that women who received family planning advice during post-natal period were more likely to use a contraceptive than those who did not receive such advice. A strong association between maternal health care & family planning practice has been established in many previous studies [17, 18, 19]. Conclusion It is a fact that that there is a great lack of awareness and of contraception in post-natal and post-abortal women, especially those who reside in the rural areas. Regular and comprehensive counseling should be done to all pregnant women-whether attending a small health centre in a village or super-speciality facilities in cities- at every level of health care system. Proper & correct information should be provided about various methods of contraception available & the patients should be able to choose a method of their choice after being given the same. More emphasis should be given to the spread of about Emergency Contraception & MT Pill. Women who have recently undergone a pregnancy event whether birth or abortion- need extra attention and care from the health care providers so as to reduce their number of unwanted births & abortions and to increase the subsequent birth intervals. For this, regular and proper post-natal visits, delivery services & subsequent health system contacts are must to help us reach post-partum women with an unmet need for and a desire to use family planning and contraceptive services [19]. Women who receive counseling during their hospital stay for delivery are more receptive to the idea of using contraception in the post-partum period. Such an approach will break all the myths and wrong beliefs among the women about contraception and the various devices that are available and help improve the general health of the women and their children.the need of the hour is to target the poor and less educated women, hailing from the rural background for the success of the postpartum family planning programmes in India. References 1. Laurie (2011) CDC updates guidelines for postpartum contraceptive use. Medscape. 2. Vernon R (2009) Meeting the family planning needs of postpartum women. Stud Family Planning 40: John A Rose (2001) Contraceptive use, intention to use and unmet need during the extended postpartum period. Int Family Planning Persp 27: Hob craft J (1994) Demographic and health surveys, Int health Rationale for Family Planning, 1st Ed, New York: United Nations International Institute for Population Sciences (IIPS) (2007) The3rd national family health survey (NFHS-3), India, Int Insti Sci Mumbai 2: World Health Organization (2006) Report of a WHO technical consultation on birth spacing, in: WHO, Eds, WHO report, Geneva: WHO Maternal morbidity and mortality associated with inter pregnancy interval (2009) Br med j 321: Effects of birth intervals on infant and under-five mortality rates (2005) Int J of Gyn Obst 89: Husain Zakir (1997) Population report: Series J 43: Goel (2010) Increasing postpartum contraception in U P. J Family Welfare 56: Syed Esam Mahmood (2011) Post-partum contraceptive use in rural Bareilly. Indian J of Comm Health 23: page 4 of 5

5 Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1: International Insti of population Sc (2007) Mumbai, National Family Health Survey 2: Kiran G (2012) Study of contraceptive use among married women in a slum in Mumbai. Nat J of Comm Med 3: Murarkar SK (2011) Epidemiological correlates of contraceptive use in married women of reproductive age group in rural India. Nat J of Comm Med 2: Chankapa YD (2011) Socio-demographic variables of contraceptive practice in Sikkim, J Pharma Bio all Sci 3: Barber (2007) Family Planning and postartum contraception in low-income women in Mexico. Int Fam Planning Persp 33: Chopra (2010) Knowledge, attitude and practice of contraception use in urban population of North India, Arch Gynecology Obste 281: Tripathi R (2003) Emergency contraception in North India, Ind J of Obste Gynecology Res 29: Citation: Jayati Nath (2017) Contraception in Postpartum Women of North India A Study of Knowledge, Concepts and Practice. 1:1. page 5 of 5