International Journal of Public Health Research 2015; 3(5): 243-247 Published online August 20, 2015 (http://www.openscienceonline.com/journal/ijphr) Knowledge, Attitude and Practice of Family Planning Among Married Women Attending Primary Health Center in Sudan Siddig Omer Handady 1, Khalid Naseralla 2, Hajar Hassan Sakin 3, Awad Ali M. Alawad 4, * 1 Department of Obstetrical and Gynecology, Imperial Hospital, Khartoum, Sudan 2 Department of Obstetrical and Gynecology, University of Elribat, Khartoum, Sudan 3Department of Obstetrical and Gynecology, Royal Hayat Hospital, Kuwait, Elkwait 4 Department of Surgery, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan Email address awadali82@hotmail.com (A. A. M. Alawad) To cite this article Siddig Omer Handady, Khalid Naseralla, Hajar Hassan Sakin, Awad Ali M. Alawad. Knowledge, Attitude and Practice of Family Planning Among Married Women Attending Primary Health Center in Sudan. International Journal of Public Health Research. Vol. 3, No. 5, 2015, pp. 243-247. Abstract Background: To predict the need of family planning methods, family planning managers often rely on unmet need derived from measure of contraceptive demand. However women's intention and her background knowledge of family planning methods not received as much attention as a measure of family planning methods demand. Objectives: To assess the knowledge, attitude and practice (KAP) on family planning among women attending primary health center in Khartoum, Sudan. Methodology: It was cross-sectional and facility based study conducted in primary health center in Khartoum State, during one year (January\2014 December\2014). A total of 400 women of child bearing age were interviewed regarding their awareness, attitude and practices of contraception. Results: The mean ± SD of age was 30.7 + 7.2 years. The majority of women (87.0%) heard and had knowledge about family planning, while (13.0%) said did not know anything about family planning. One hundred and sixty women (40.0%) practiced family planning, while 240 women (60.0%) did not. Conclusion: The present study concludes that a significant proportion of respondents have good knowledge about family planning. But low practice of contraception and compliance is low. Keywords Knowledge, Attitude, Practice of Family Planning, Sudan 1. Introduction Family planning (FP) is an important strategy in promoting maternal and child health. It improves health through adequate spacing of birth, avoiding pregnancy at high-risk maternal age and high parity. It is often used as a synonym for birth control, however. It does have a wider view, dealing with birth control, reproductive health, as well as premarital and pre conception counseling (1). Despite the fact that contraceptive usage has increased over a period of time, there exists a Knowledge Attitude and Practice-gap regarding contraception (2, 3). The reasons for not using any family planning methods are lack of knowledge and education, religious belief and fear of side effects. Family planning has two main objectives; firstly, to have only the desired number of children and secondly, pro-per spacing of pregnancies (4). The widespread adoption of family planning represents one of the most dramatic changes of the 20th century. The growing use of contraception around the world has given couples the ability to choose the number and spacing of their children and has tremendous life saving benefits. Yet despite the impressive gains, contraceptive use is still low and the need for contraception is high in some of the world s poorest and most populous places (5) In Sudan, services were initiated in 1965 and in 1985 were integrated into the primary health care system (6). Utilization rates are among the lowest in the world. These low rates may have been due to the result of poor acceptance, inadequate knowledge, or inaccessibility of the services in a community that is large and of such diverse cultural backgrounds (1). The Contraceptive prevalence rate (CPR) is also very low,
244 Siddig Omer Handady et al.: Knowledge, Attitude and Practice of Family Planning Among Married Women Attending Primary Health Center in Sudan only 7.7% in Sudan, again reflected by the poor family planning service utilization. The present paper is an attempt to assess the knowledge, attitude and practice of family planning among child bearing women. 2. Material and Methods It was descriptive, cross-sectional and facility -based study in primary health center in Khartoum State during one year (January 2014 December 2014). Four hundred women of child bearing age were selected by systematic random sampling technique form the target population of the primary health care center. Women interviewed regarding their awareness, attitude and practices of contraception. The inquiries were recorded by predesigned questionnaire. Questions regarding methods of contraception known and source of knowledge and their practices were recorded. The source of knowledge and the women s attitude towards the contraception in the form of motivation, involvement of spouse and acceptability of contraception were recorded. The Arabic version was used to collect data. Statistical analysis was performed via SPSS software (SPSS, Chicago, IL, USA). Continuous variables were compared using student s t test (for paired data) or Mann Whitney U test for non-parametric data. For categorical data, comparison was done using Chi-square test (X2) or Fisher s exact test when appropriate. A P value of <0.05 was considered statistically significant. Ethical clearance and approval for conducting this research was obtained from the general manager of the health center and informed written consent was obtained from every respondent who agreed to participate in the study. Of course, the respondents informed that the study is not associated with experimental or therapeutic intervention while information was collected from her Table 1. Family planning knowledge significance and the p value among respondents. Knowledge about family planning Yes No P value Awareness about family planning 384(87%) 52(13%) 0.00* Age <20 years 29 (7.25%) 7 (1.75%) 20-25 years 42 (10.50%) 10 (2.5%) 26-30 years 88 (22.0%) 12 (3.0%) 31-35 years 120(30.0%) 16 (4.0%) 0.62 36-40 years 40 (10.0%) 4 (1.0%) 41-45 years 29(7.25%) 3(0.75%) Residence Rural 102(25.5%) 40(10.0%) Arabian 246(61.5%) 12(3.0%) 000* Socioeconomic status below average 119(29.75%) 15(3.75%) average 138(34.5%) 19(4.75%) 0.04* above average 91(22.75%) 18(4.5%) Education level No education 31(7.75%) 34(8.5%) Primary 72(18.0%) 12(3.0%) secondary 162(40.5%) 6(1.5%) University 78 (19.5%) 0(0.0%) 0.03* Post graduate 5(1.25%) 0(0.0%) Number of children 1-2 70 (17.5%) 7(1.75%) 3-4 112(28.0%) 10 (2.5%) 5-6 72 (18.0%) 13(3.25%) 7-8 68(17.0%) 12 (3.0%) 0.00* 9 and above 26(6.5%) 10 (2.5%) Accessibility of FP Yes 102(25.5%) 9(2.25%) No 246(61.5%) 43(10.75%) 0.03* Total (87.0%) 348 (13.0%)52 Parity <3 57 (14.25%) 9 (2.25%) 3--5 88(22.0%) 20(5.0%) >5 203(50.75%) 23 (5.75%) 0.00* *Statistically significant at 0.05 level 3. Results The mean ± SD of age was 30.7 + 7.2 years. Two hundred and three women (56.5%) were having more than five children. Majority of respondents (42.0%) completed their secondary level of education, 64.5% were from Arabian area and 38% of the respondents were in average social status (Table 1). The majority of participants (87.0%) heard and had knowledge of family planning, while 13.0% were not. The majority of participants (35.0%, their source of information about FP was media, there were (25.5%) were from health personnel, relatives and friends were (8.0%) and husband was (9.0%). Concerning methods known, majority of them
International Journal of Public Health Research 2015; 3(5): 243-247 245 (83.0%) heard about oral pills, 66.8% were aware about IUCD, 52.8% knew condom and 50.2% heard about injection (Table 2). Table 2. Knowledge, methods known and source of knowledge of contraception among respondents. Item Frequency Percent Heard about contraceptives Yes 348 87.0 No 052 13.0 Oral pill Yes 332 83.0 No 068 17.0 IUCD Yes 267 66.8 Yes 133 33.2 Condom Yes 211 52.8 No 189 47.2 Injection Yes 199 49.8 No 201 50.2 Breastfeeding Yes 164 41.0 No 236 59.0 Implants Yes 159 39.8 No 241 60.2 Tubal ligation Yes 150 37.5 No 250 62.5 Withdrawal Yes 132 33.0 No 268 67.0 Vasectomy Yes 091 22.8 No 309 77.2 Source of information Health personnel 102 25.5 Radio/TV 080 20.0 Family planning centers 038 09.5 Husband 036 09.0 Relatives and friends 032 08.0 Local news, newspaper and magazines 060 15.0 Not heard 052 13.0 (290 subjects, 72.5%) were had positive attitudes towards FP, while there were 58 subjects (14.5%) were negative and there were 52 women (13.0%) who do not know. (160 subjects, 40.0% practiced family planning, while 240 women (60.0%) were not. Regarding causes of uses of FP, 52 subjects (13.0%) were due to husband pressure, there were 44 subjects (11.0%) were due to financial problem, participants due to health condition were 22 (5.5%), and 240 (60%) were not used FP (Table 3). Concerning causes of rejection of FP, the majority of participants (88 subjects, 22.0%) were due to fear of side effect, 56 (14.0%) were due to want more children and only 4(1.0%) were for religious beliefs (Table 3). Regarding current practice of FP 90 (22.5%) of respondents were used pills, 16 (4.0%) were used injections, 8 (2.0%) were used implants and 12 (3.0%) were insert intrauterine contraceptive device (IUCD) (Table 4). The study revealed that there was a highly statistical significant relationship between level of education of the studied sample, gender and number of children, availability and accessibility of contraceptive, distance from the center, husband supporting family planning and their practice of contraceptives as evidence by P. <0.005. Table 3. Causes of uses and rejection of family planning among respondents. Causes of uses and rejection of FP Frequency Percent Causes of uses of FP Husband approval 52 (13.0%). Financial problem 44 (11.0%) Health condition 22 (05.5%) Child spacing 20 (05.0%) Delay due to education 18 (04.5%) Any other reasons 04 (01.0%) Not used FP 240 (60.0%) Causes of rejection of FP Fear of side effect 88 (22.0%) Want more children 56 (14.0%) Health conditions 38 (09.5%) Financial problem 32 (08.0%) Husband disapproval 22 (05.5%) Religious beliefs 04 (01.0%) Not reject FP 160 (40.0%) Table 4. Distribution of the respondents according to their methods of current practice of family planning. Current practice of (FP) Count Percent Pills 90 22.5% Injection 16 4.0% Implant 08 2.0% Intra uterine device 12 3.0% Male condom 10 2.5% Female condom 0 0.0% Safety period 08 2.0% Breast feeding 16 4.0% Not used FP 240 60.0% Total 400 100.0% 4. Discussion Family planning services in our country are still developing and parallel to this, there are some advances in the health indicators, but the need for family planning which cannot be met still stands out as an important health problem. The present study showed that, the awareness of contraceptive use is (87%), as compared with the study of Sara Barer et al (7) who carried out study on Barriers to family planning service utilization among Sudanese women in Khartoum locality, the awareness of contraceptive use is (87%) which is same and comparable with our study. High level of awareness 99% has also been reported at Lahore study (Pakistan) (8) and Indian study revealed knowledge rate of 82.2% (9). The most methods of contraception that mothers
246 Siddig Omer Handady et al.: Knowledge, Attitude and Practice of Family Planning Among Married Women Attending Primary Health Center in Sudan knew were the, contraceptive pills, IUCD and breast feeding. These are the methods most used by females and most available in Sudan (10). Attitudes are not gained by birth, they are learned and adopted by experiences and culturally gained during socialization. Attitudes of women towards family planning are influenced by education and experiences such as pregnancy. It was observed that there was significance association between practice of contraceptives and level of education in our study. This result is consistent with Sudanese Household Health Survey (SHHS) 2010 (6) where only 22% of women with no education were using modern methods of contraception as compared to 52% of women with at least some secondary education. This is also supported by other studies which concluded that knowledge and practice of family planning is strongly related to higher level of education (2, 11). Media consider being other important factor responsible for knowledge of family planning. in our study 35% of women got family planning information from the media and health care providers 25.5%, unlike Sara Barer et al (7) who reported only 22% of women their source of information were media Similarly to our result, study from rural Nepal also reported an exposure to electronic media messages as the main factor for use of family planning methods among women (12). Importantly, it was found that (40.0%) of women practice family planning. Although this figure has increased from other studies done in the past which quoted utilization rate as 24% ever use (13). This percentage might have increased, especially in Khartoum Locality, due to the wide publicity which has been undertaken by both the State and the Federal Ministry of Health regarding contraception. One the same point of view, the results of this study were high than recent observations in Darfur, Western Sudan (14). In Darfur, the use of family planning services was 34.2%, contraceptive pills was the most frequently used method (74.4%), in Qatar contraceptive prevalence rate was (47.8%) (15) and in India 45% (16), which is comparable to the prevalence rate obtained in this study. Overall, more than two third 72.5% of our respondents had a positive attitude towards family planning, but 60% of the women reported having ever used any type of contraception. Other studies have already described similar findings, i.e. high awareness but low utilization of contraceptives, making this situation a serious challenge in developing countries (17-18). In the present study the reason for not using contraceptives, 22% women were worried about side effects, 14% wanted more children, 5.5% opposed to family planning because of their husbands influence in choosing contraceptive method. Previous studies in Khartoum States and Darfur, Western Sudan pointed out that many users experienced side effects from different methods, and that side effects are the common causes for either ceasing contraception altogether, or changing the type of contraceptive to a more traditional method which is less effective (7,14-19). Our finding had been supported by other studies conducted in Ethiopia and Bangladesh (20-21). 5. Conclusion The study concludes that a significant proportion of respondents have good knowledge and favorable attitude towards family planning, but, practice of using contraception was poor. Fear of side effects of contraception and women wanted more children are significant reasons for poor practice. 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