Descriptive Study of Family Planning s and Factors Influencing Their Usage Among Areej Mothanna Noaman, MSc Community Medicine. College of Medicine. Tikrit University. Abstract Fertility control had been used for thousands of years in different forms. Adequate child-spacing is considered a positive factor on the health of mothers and their children. The current work is a cross-sectional study done in Tikrit Teaching Hospital, Obstetrics unit included 270 married women in the period between 1 st of February 2010 to the 30 th of April 2010. The aim of this work was to study the family planning methods and factors influencing using it by women attending Tikrit Teaching Hospital. The study found that the prevalence of using contraception was (74.1%), the IUCD type was the most common type used by the participants. The most common reason of choosing a specific method of contraception was the advice of doctor (35%). With increasing age there is increasing use of contraception. There was a high percentage of using contraception in high parity mother. The educated women use contraception more than non-educated women, in regard to residency, urban women use contraception more than rural women. In conclusion, there are sociodemographic factors affect using contraception. It is recommended to improve health education concerning contraception among married women. Introduction Family planning has been identified by the World Health Organization (WHO) as one of the six essential health interventions needed to achieve safe motherhood (1). Birth control began with the discovery of the connection between coitus and pregnancy. The oldest forms of birth control included coitus interruptus, pessaries, and the ingestion of herbs that were believed to be contraceptive or abortifacient. The earliest record of birth control use is an ancient Egyptian set of instructions on creating a contraceptive pessary. Effective contraception for the masses has been around only since the 1960s (2). Family planning is adopted voluntarily through the practice of contraception or other methods of birth control on the basis of knowledge, attitude and responsible decision by individuals and couples, in order to promote the health welfare of the family and contribute to the social and economic development of the country (3). The most important problem of human beings today is not infectious diseases but population. The world population now is higher than at any time in its history. The main problem is the rate of population increase. Statistics show that the population of the world was about 1 billion in 1850. Eighty years later, in 1930, the population had doubled (2 billion). Only 46 years after that, in 1976, it had doubled again. Today, it is more than 6 billions. Increase in population has been deemed the most important socioeconomic and cultural phenomenon in recent decades (4) The region s population growth rate currently stands at about 3% per year, and the population of the Arab world is expected to reach 400 million by 2010. The factors associated with family planning practice can be divided into personal, demographic, socio-cultural, religion, economic, and health services (3). Over the last 30 years there has been a significant increase in the use of contraception (5). 100
Aim To study the contraception and factors influencing using it among married women attending Tikrit Teaching Hospital. Objectives 1. Identify some sociodemographic characteristics of the studied sample. 2. Clarify the knowledge and practice of contraception among studied sample. 3. Recognize the effect of age, parity educational level, and residency on use of contraception. Subjects and s A cross-sectional study done in Tikrit Teaching Hospital, included (270) married women who were interviewed in the outpatient clinic of gynecology and obstetrics during the period between (1 st of February 2010) to (30 th of April 2010). The interviews were done by using a designed questionnaire which included information about the demographic characteristics (age, occupation, residency, parity, educational level) of the study sample, as well as questions in relation to the knowledge (any information the participant knows about contraception) and practice (if the participant used at least one of these methods of contraception) and the factors which influence the use of contraception methods such as the age, educational level, parity, residency and occupation. Also the questionnaire included questions which point to the reasons why the women chose a specific method of contraception. The data was represented by using tables, charts, and graphics. Comparison was done by using numbers and percentages. Results The sociodemographic characteristics of contraception users among the study sample was as following, most of the women were from the age group 35 years which comprised 72 (36%). Majority of the users were housewives in regard to occupation, 164 (82%). High percentage of women were from urban areas, 156 (78%). In regard to parity, the high percent was in the category of 5 which comprised 60 (30%). Concerning the educational level the high percent was for those who have primary education, 92 (46%). These results are displayed in table (1). Concerning the distribution of women knowledge and practice of contraceptive methods, it was found that 162 out of 270 women (60%) have knowledge about contraception as shown in table (2). There were 93 (46.5%) current users (out of a total of 200 who used contraception at any time of their life). The percentage of using methods are IUCD 68(34%) followed by oral pills 52(26%), coitus interruptus 20 (10%), condom 20(10%), safe period 24(12%), injection 8(4%), and sterilization 8(4%). These results are shown in figure (1). Figure (2) shows the reason of choosing the way of contraception method, it was found that (35%) of women use it because it was advised by a doctor followed by preference of husband for the method (30%). Twenty percent of them use their method because it is safe and easy and (15%) by advice of others. Concerning the age of women, it was found that women less than 19 years old prefer the use of injection and condom equally, (50%) for each as a way of contraception, while in the age group 20-24 years the preferred way of contraception was IUCD 16 (36.4%), but in the age group 25-29 years the most preferred ways of contraception were IUCD and oral contraceptives, 12 (25%) for each. In age groups 30-34 years and 35 years, the preferred method was IUCD, 16(57.2%) and 24(33.3%) respectively as shown in table (3). In regard to the parity and the use of contraceptive method, it was found that women who are para 1 use oral contraceptives, injection, sterilization, coitus interruptus and safe period equally 4(20%) for each. Women 101
with para 2 prefer the use of IUCD 20(41.7%), while women with para 3 use oral contraceptives 12(50%), and those with para 4 prefer the use of IUCD 28(58.3%). Those in group 5 prefer the use of oral contraceptives 20(33.3%). These results are shown in table(4). Concerning the frequency distribution of educational level and the method of contraception, it was found that women who do not read or write use oral contraceptives, injection and coitus interruptus equally 4(33.3%) for each method but those women with primary level of education mostly prefer the IUCD, 40(43.5%) followed by oral contraceptives 20(21.8%) while those with secondary level prefer the oral contraceptives 28(46.7%). Those women who have high level of education prefer the use of IUCD. These results are shown in table (5). In regard to residency and the use of contraceptives, it was revealed that women who use IUCD are more from urban areas than rural, 60(38.5%) and 8(18.2) respectively. Those who use oral contraceptives are from rural areas mostly 16(36.3%). Injection and sterilization are exclusively used by urban women both have the figure of 8(5.1%), as shown in Table(6). Discussion Promoting family planning among married women is an effective intervention to prevent many avoidable deaths among children and mothers. The current study showed that women who use contraception comprised 200 out of 270(74.1%), this figure is near that obtained by a study in Saudi Arabia where they found the use of contraception was (78.24%) (11), while in Jordan it was (88.3%) (5). This study demonstrated that (60%) of study sample have a knowledge about one or more than one method of contraception, this result agree with other studies done in Iran (63%) (4) and in Syria (8) and Saudi Arabia (7). On other hand it differs from other studies done in Jordan (93%) (5), Malaysia (86%) (6), this difference may be explained by lack of education about family planning toward contraception. There were (46.5%) current users of some contraception, a similar finding was found in other study (6). Most type of contraception favored by study sample was IUCD followed by oral pills, their choosing was due to its safety and preferred by their husbands these in agreement with other study in Bangladesh (10). The current work showed that (35%) of reasons of choosing contraception were the advice of a doctor followed by preference of the husband. This result is in difference with a study in Jordan which showed that most women use the contraception method by self-motivation followed by husband preference (5). In Iran the source of information in regard to the use of contraception was through television (4). These differences may be to differences of social attitudes toward contraception which differs from one community to another. Concerning level of education, it was found that the non educated women had less use of contraception in comparison with educated women, same result was documented by a Jordanian study (15). In regard to the educational level and the method of contraception, it was found that women who do not read or write use oral contraceptives, injection and coitus interruptus equally but those women with primary level of education mostly prefer the IUCD while those with secondary level prefer the oral contraceptives. Those women who have high level of education prefer the use of IUCD. This study shows that women of child-bearing age had high percentage of using contraception in comparison with younger age group (less than 19) years, similar finding was documented by a study done Saudi Arabia (14). Another study done in Saudi Arabia which 102
showed that age has a significant effect on birth interval and those women who are 30-34 years have eightfold likelihood of increased birth interval (9). The current study showed that the preference of a method is different from age group to another as shown women younger than 19 years old preferred injection and condom, while in child-bearing age the women preferred IUCD type.this finding is similar to a finding of a Jordanian study (15). But this result does not agree with a study done in Bangladesh where they found that with increasing age the preferred way of contraception was sterilization (10). This study showed that with increasing parity the use of contraception increases, as multiparas have high figure of using contraception, same result was documented in a study done in Saudi Arabia (12) and Sudan (13). But this result was not in agreement with a finding of a Syrian study (8). This may be due to cultural perception about contraception. In regard to residency it was found that urban women use contraception more than rural women. They mostly use the IUCD (38.5%) in comparison to rural women who mostly use oral contraceptives, similar observation was found in Jordanian study (15). Conclusions and recommendations The study concluded that there is a good number of women using contraception but their knowledge about it is not that sufficient, and there were sociodemographic factors which influence the use of contraceptive method such as age, number of living children, educational level and residency. It is recommended to improve family planning services of contraception in addition to improve health education of such subject. Also it is recommend to carry out further studies dealing with this subject. References 1. L.O. Chichakli, H.K. Atrash, A.S. Musani, J.T. Johnson. Family planning services and programmes in countries of the Eastern Mediterranean Region. Eastern Mediterranean Health Journal. Volume 6, Issue 4, July 2000, Page 614-624. 2. Wikipedia. Article: Birth Control. http://en.wikipedia.org/wiki/contrace ption#cite_note-0. Accessed : October 15, 2010. 3. Yahya Khamis Ahmed Almualm. Knowledge, Attitude and Practice of Husbands Towards Modern Family Planning in Mukalla, Yemen. Thesis submitted in fulfillment of the requirements for the degree of 1. Master of Science (Family Health). Universiti Sains Malysia. May 2007: Pages 6,9,19. 4. Tavakoli and H. Rashidi-Jahan. Knowledge of and attitudes towards family planning by male teachers in the Islamic Republic of Iran. East Meditarean Health Journal. 2003. Volume 9 No.5-6. 5. Najla Nour Thalji. Knowledge, Attitude and Practice of women towards family planning methods in Tafila-Jordan, JRMS. 2003;10(1): 40-44. 6. C.K. Lam. Family planning knowledge, attitude and practice in the rural areas of Sarawak. Journal of Biosocial Science (1979), 11:315-323. 7. Zohair A. Sebai. Knowledge, attitudes and practice of family planning: profile of a Bedouin community in Saudi Arabia. Journal of Biosocial Science (1974), 6:453-461 8. Samman ML. Family size and attitude of Syrian women toward contraception. Popline Document Number: 775473. Population, 1977 Nov-Dec;32(6) 103
9. N.N.A. Al-Nahedh. The effect of sociodemographic variables on childspacing in rural Saudi Arabia. Eastern Mediterranean Health Journal. Volume 5, Issue 1, 1999, Page 136-140. 10. Haider Rashid Mannan. Factors in contraceptive method choice in Bangladesh: goals, competence, evaluation and access. Contraception. Volume 65, Issue 5, (May 2002) Pages 357-364 11. Farrag OA. Attitudes toward control in Eastern province of Saudi Arabia. Saudi Medical Journal,1983;4(2): 111-116. 12. Al-sibai MH Khwaja SS. Parity, related sociodemographic factors and contraceptive use in Saudi Arabia. Biol Soc. 1986 Sep;3(3):130-5. 13. El Tom AR, Farah AA, Lauro D, Fenn T. Community and individual acceptance: family planning services in the Sudan. Ahfad J. 1987 Jun;4(1):12-30. 14. Al-Sekait MA. Prevalence of contraception used among Saudi Arabian women. Saudi Medical Journal. 1999;20(9):987-690. 15. Farouk M. Shakhatreh. Contraceptive use in Jordan. Saudi Med J 2001; Vol. 22 (6): 512-515. Table (1): Sociodemographic characteristics of the studied sample. Sociodemographic character Studied Sample Contraception Users Age No. (%) No. (%) 19 22( 8.1) 8(4 ) 20-24 58( 21.5) 44(22 ) 25-29 62( 22.9) 48( 24) 30-34 42( 15.7) 28( 14) 35 86( 31.8) 72( 36) Total 270(100 ) 200( 100) Occupation No. (%) No. (%) Housewife 199(73.7 ) 164( 82) Worker 71( 26.3) 36( 18) Residence No. (%) No. (%) Rural 79(29.3 ) 44( 22) Urban 191( 70.7) 156( 78) Parity No. (%) No. (%) 1 34( 12.7) 20( 10) 2 62( 22.9) 48( 24) 3 38( 14.1) 24( 12) 4 62( 22.9) 48( 24) 5 74( 27.4) 60( 30) Educational Level No. (%) No. (%) Illiterate 30(11.1 ) 12(6 ) Primary 110( 40.7) 92( 46) Secondary 77( 28.6) 60( 30) High 53( 19.6) 36( 18) 104
Table (2): Distribution of women knowledge according to methods of contraception. s Knowledge No. % IUCD 42 15.5 Oral 34 12.6 Injection 10 3.7 Condom 14 5.2 Sterilization 14 5.2 Safe period 18 6.7 Coitus interrupts 30 11.1 Total 162 60 Figure (1): Frequency distribution of contraception methods among current users. Doctor Advice 35% Advice by others 15% Safe & easy 20% Husband preferred 30% Figure (2): Reason for choosing specific contraception method. 105
Table (3): Frequency distribution of contraception according to women age. Age IUCD Oral Injection Condom Sterilization Coit.int. Safe period No. % No. % No. % No. % No. % No. % No. % No. % 19 0 0 0 0 4 50 4 50 0 0 0 0 0 0 8 4 20-24 16 36.4 8 18.2 0 0 12 27.2 0 0 4 9.1 4 9.1 44 22 25-29 12 25 12 25 0 0 4 8.4 0 0 8 16.6 12 25 48 24 30-34 16 57.2 8 28.6 0 0 0 0 0 0 4 14.3 0 0 28 14 35 24 33.3 24 33.3 4 5.6 0 0 8 11.1 4 5.6 8 11.1 72 36 Total 68 34 52 26 8 4 20 10 8 4 20 10 24 12 200 100 Total Table (4): Frequency distribution of contraception according to parity. Parity IUCD Oral Injection Condom Sterilization Coit.int. Safe period No. % No. % No. % No. % No. % No. % No. % No. % Para 1 0 0 4 20 4 20 4 20 0 0 4 20 4 20 20 10 Para 2 20 41.7 12 25 0 0 8 16.7 0 0 0 0 8 16.7 48 24 Para 3 8 33.3 12 50 0 0 4 16.7 0 0 0 0 0 0 24 12 Para 4 28 58.3 4 8.3 0 0 4 8.3 0 0 4 8.3 8 16.7 48 24 5 12 20 20 33.3 4 6.7 0 0 8 13.3 12 20 4 6.7 60 30 Total 68 34 52 26 8 4 20 10 8 4 20 10 24 12 200 100 Total Table (5): Frequency distribution of contraception according to educational level. Ed. Level Not read or write Safe Total IUCD Oral Injection Condom Sterilization Coit.int. period No. % No. % No. % No. % No. % No. % No. % No. % 0 0 4 33.3 4 33.3 0 0 0 0 4 33.4 0 0 12 6 Primary 40 43.5 20 21.8 0 0 8 8.7 4 4.3 12 13.1 8 8.7 92 46 Secondary 8 13.3 28 46.7 4 6.6 4 6.6 4 6.6 4 6.6 8 13.3 60 30 High 20 55.6 0 0 0 0 8 22.2 0 0 0 0 8 22.2 36 18 Total 68 34 52 26 8 4 20 10 8 4 20 10 24 12 200 100 Table (6): Frequency distribution of contraception according to residency. Residence Rural Urban No. % No. % Total IUCD 8 18.2 60 38.5 68 Oral 16 36.3 36 23.2 52 Injection 0 0 8 5.1 8 Condom 4 9.1 16 10.2 20 Sterilization 0 0 8 5.1 8 Coitus int. 8 18.2 12 7.7 20 Safe period 8 18.2 16 10.2 24 Total 44 100 156 100 200 106