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ORIGINAL ARTICLE
Year : 2018  |  Volume : 59  |  Issue : 4  |  Page : 39-42  

Unmet need and nonacceptance of usage of contraceptive devices in a Rural Area of Delhi: An exploration of facts


1 Department of Community Medicine, HIMSR, Jamia Hamdard, New Delhi, India
2 Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication13-Jun-2019

Correspondence Address:
Meely Panda
Asst. Prof, Community Medicine, HIMSR, Jamia Hamdard, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nmj.NMJ_9_17

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   Abstract 

Background: An important cause of high fertility rates in Delhi is the low availability and use of family planning services. Fostering family planning practice alleviates poverty, accelerates socioeconomic development, increases child schooling, promotes gender equality, and decreases maternal and infant mortality. The study objective was to find out the perception of potential users, health workers, and health professionals on the reasons for nonusage of contraceptive services provided and to recognize possible solutions to the identified barriers. Methods: This cross-sectional study was done using qualitative methods among three groups of people by focus group discussion and in-depth interviews. The study was conducted in the rural health center of Madanpur Khaddar, Department of Community Medicine, Jamia Hamdard Institute of Medical Sciences and Research, from June to August 2016. Results: The median age group of the participants was 27 years, and the participants were majorily less educated and were homemakers. Description of key thematic issues found out that contraceptive nonusage was due to lack of accessibility, lack of availability, as well as issues with privacy and autonomy. Out of 25 women, 3 had never heard the term Copper-T (CuT). Twelve out of the rest 22 women had heard about CuT, but knew no more than that. Conclusion: The findings that have emerged from this study thus provide some recommendations to increase the demand for contraception. Effective information, education, and communication should be promoted continuously with the help of community health workers for better acceptance of CuT because it is believed that no single child should be born into the world unplanned.

Keywords: Contraception, family planning services, unmet need for contraception


How to cite this article:
Panda M, Pathak R, Rasheed N, Shaikh Z, Islam F. Unmet need and nonacceptance of usage of contraceptive devices in a Rural Area of Delhi: An exploration of facts. Niger Med J 2018;59:39-42

How to cite this URL:
Panda M, Pathak R, Rasheed N, Shaikh Z, Islam F. Unmet need and nonacceptance of usage of contraceptive devices in a Rural Area of Delhi: An exploration of facts. Niger Med J [serial online] 2018 [cited 2019 Dec 9];59:39-42. Available from: http://www.nigeriamedj.com/text.asp?2018/59/4/39/260369


   Introduction Top


Worldwide, there is a growing consensus that a good approach to family planning would help in achieving the Millennium Development Goals.[1],[2] Fostering family planning practice alleviates poverty, accelerates socioeconomic development, increases child schooling, promotes gender equality, and decreases maternal and infant mortality.[3]

The National Family Planning Program since its inception has been dominated by demographic goals. The program focused primarily on sterilization, largely obviating client choice and limiting availability to a narrow range of services. In October 1997, India reoriented the national program and radically shifted its approach to more broadly addressed health and family limitation needs.[4]

Globally, the prevalence of contraceptive use has been increasing, but the unmet need for contraception still remains a problem. According to the National Family Health Survey-3 (NFHS-3), the national figure for unmet need is 13%. According to the District Level Household and Facility Survey-3, the unmet need of contraception in India is 21.3%, with 7.9% for spacing and 13.4% for limiting births. The unmet need for contraception in Delhi is about 13.9%, out of which 3.8% is for spacing and 10.1% is for limiting family size.[5],[6]

The NFHS-2 reveals that 16% of women in the country have an unmet need for family planning.[5] Some of the reasons for unmet needs for family planning are lack of appropriate family planning and motivational services in the area, lack of knowledge, and disapproval by one of the partners or family members. Our interaction with women in the community revealed that, though people have understood the importance of small family size and have understood its repercussions on them and on the community as a whole, they are reluctant to accept and use certain contraceptives for their own benefit. This observation made during field experience by the author as a clinical practitioner has prompted the need to assess the factors underlying the nonacceptance of contraceptives among rural women. Besides the potential users, the perspectives of medical professionals and health workers were also reviewed in parallel to get a comparative overview of these perspectives on key thematic issues. This would provide a balanced feedback from all stakeholders on this subject.


   Methods Top


This was a cross-sectional study using qualitative methods among three groups of people who were recruited using a convenient sampling technique. The rural health center in Madanpur Khadar attached to the Department of Community Medicine, Jamia Hamdard Institute of Medical Sciences and Research, was chosen for conducting the survey. It caters to a population of 120,000. The first group in the study comprised women of reproductive age (WRA), who were conveniently chosen from the village for focus group discussion (FGD) and in-depth interviews (IDIs). The second group comprised community-level health workers, including medical social workers, health educators, Anganwadi workers, and health inspectors attached to the community or working in collaboration with a nongovernmental organization in the rural health training center. There were a total of ten community health workers during the survey, and they all gave consent to participate in the group discussion. The third group was selected by a closed fish bowl technique with a total of thirty participants; six participants were drawn each time from the center by rotation. This comprised 22 students from MBBS; nursing and paramedics were chosen by a purposive sampling with uniform representation from all batches and grades as depicted in [Table 1]. The rest of the eight participants were drawn from the Department of Community Medicine.
Table 1: Description of the study participants and study objectives

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Data collection was followed by analysis for which the grounded theory was used to sum up the collected data.  Atlas More Details Ti software was used, and ultimately representation was done using the thematic framework approach. Privacy was ensured while conducting interviews. Confidentiality and anonymity was maintained during the procedure. Informed consent was obtained from the participants. Participation was purely voluntary. Necessary ethical approval was collected, and there was no conflict of interest.


   Results Top


The participants were largely less educated and were homemakers, with a median age of 27 years this is depicted under the sociodemographic details in [Table 2].
Table 2: Sociodemographic profile of the study participants

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Metric level is education up to class 10.

Findings of IDIs of WRA group and FGDs among WRA, health workers, and professionals were summed up as depicted in [Table 3]. We chose certain common key thematic issues and noted down the summarized views of different stakeholders as follows:
Table 3: Summary of focus group discussion and in-depth interviews, based on key thematic issues

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Quotes:

  • Respondent no. 5: “My husband does not recommend CuT, so I cannot use it”
  • Respondent no. 8: “I feel shy and bad to talk about this secret issue with someone else other than my husband”
  • Respondent no. 15: “I don't know whether other women are using it or not, so I do not discuss it with anyone else”
  • Respondent no. 19: “I thought that it was an operative procedure and as health worker is senior to me in age, I felt shy to ask her in detail about CuT.”



   Discussion Top


This study was conducted to explore the perception of women about contraceptive device usage, why they prefer certain type of contraceptives, whether the low acceptance is due to unavoidable encroachment on women's privacy, what are the barriers they face, and what challenges and hindrance are faced by health-care workers in delivering contraceptive services.

In rural areas, few women were not aware of certain contraceptive methods, so they never demand this service from health-care providers. Most of the women thought that contraception means usage of pills. Out of 25 women, 3 had never heard the term Copper-T (CuT). Twelve out of the rest of the 22 women had heard about CuT but knew no more than that. This indicates a gap in the required knowledge and reason they fail to demand, as well as nonacceptance of the method. There are no information, education and communication (IEC) programs to increase awareness about the various types of contraceptive methods in the community as noted by the health-care workers in FGDs. An operational research study done in Gujarat by frontiers in Reproductive Health Programme of the Population Council using a pre- and post-intervention design stressed the importance of IEC, which improved clients' performance after the intervention.[7],[8]

From among the few women who knew about intrauterine contraceptive devices in detail, all had the fear of side effects. They had less perceived benefits of CuT and more perceived benefits of oral pills. This might be due to the differential dissemination of information by health-care providers. Moreover, the women narrated that the health-care workers motivated them more about sterilization methods and contraceptive pills. Insertion of intrauterine devices (IUDs) requires skill, expertise, and confidence; the lack of such skills by the health-care workers might be one of the reasons they are less motivated to counsel clients on its use. A study by Rati et al. and Murarkar et al. mentioned that inadequate knowledge of women regarding contraceptives leads to myths and misconceptions, resulting in the nonacceptance of IUD as a spacing method.[9],[10]

Rural women are less concerned about the hygiene of their genital tract, and most of them have pelvic inflammatory diseases (PIDs), which makes them unfit as candidates for IUDs.[11] Moreover, follow-up is seen as an additional burden by females because of time constraints and family engagements. Some women quoted that health workers could not ascertain the time of their last deliveries because of long intervals. Variation of autonomy in selection arises due to the ignorance of homemakers, dominant nature of husbands and mothers-in-law in the society, fear of being exposed, and lack of privacy. Similar result was seen in the study by Yadav et al. which was regarding the reproductive intentions and contraception between husbands and wives in rural Ballabgarh, India.[11]

Almost all health workers admitted that the women did not trust them, so they never took their advice serious. Women of low income and low literacy status often feel that it is a credit to them to manage spacing between pregnancies on their own without using any contraception. These women either use calendar method or withdrawal method. Muslim women do not like to use contraceptive methods except some who use withdrawal technique and oral pills. They confidently declare that their religion does not allow them to do so. Few adverse experiences from peer groups serve as a source of propaganda such that community health workers are unable to persuade them to use such contraceptive methods.


   Conclusion Top


Because of the demotivating facts, the demand from the acceptors' side dwindles and becomes less. The success stories become less than the failure stories, and hence, propagandas take the troll. The findings that have emerged from this study thus provide some recommendations to increase the demand. Effective IEC should be promoted continuously with the help of community health-care workers for better acceptance of IUDs. Because the most important constraint as regards to beneficiaries is their time and family workload, the best practical solution for checking eligibility of the candidate to be fit for CuT insertion is to do a house-to-house visit, report finding of any PID symptoms if any, get it treated, and then call her up for the intervention, rather than blindly calling everyone every time and then returning few because they were not fit for it. A team effort with collaboration and cooperation of various sectors and departments will help us in defining the vision and mission more accurately.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Population Reference Bureau. Integrating Family Planning and Maternal and Child Health Care: Saving Lives, Money, and Time. Available from: http://www.prb.org/pdf11/familyplanning-maternal-child-health.pdf. [Last assessed on 2017 Dec].  Back to cited text no. 1
    
2.
Abrejo FG, Shaikh BT, Saleem S. ICPD to MDGs: Missing links and common grounds. Reprod Health 2008;5:4.  Back to cited text no. 2
    
3.
UNFPA and PATH. Reducing Unmet Need for Family Planning: Evidence-Based Strategies and Approaches. Available from: https://www.unfpa.org/sites/default/files/resource-pdf/EOL_nov08.pdf ov08.pdf. [Last assessed on 2017 Dec].  Back to cited text no. 3
    
4.
Visaria L, Jejeebhoy S, Merrick T. From Family Planning to Reproductive Health: Challenges Facing India. International Family Planning Perspectives; 1999. p. 25.  Back to cited text no. 4
    
5.
International Institute for Population Studies. National Family Health Survey (NFHS-3), 2005-06. Mumbai: International Institute for Population Studies; 2007. Available from: http://www.mohfw.nic.in/nfhs3/index.htm. [Last assessed on 2017 Dec].  Back to cited text no. 5
    
6.
District Level Household and Facility Survey III 2007- 08 (DLHS III). Ministry of Health and Family Welfare, Government of India. Available from: http://www.rchiips.org/pdf/INDIA_REPORT_DLHS-3.pdf. [Last assessed on 2017 Dec].  Back to cited text no. 6
    
7.
Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun 2010;25:661-9.  Back to cited text no. 7
    
8.
Khan ME, Kar SS, Desai VK, Patel P, Itare BP. The model works! Interim findings from an OR project on repositioning of IUD in Gujarat. Research Update No. 12, December 2007. New Delhi: Population Council/FRONTIERS; 2007.  Back to cited text no. 8
    
9.
Rati SA, Jawadagi S, Pujari J. A study to assess the factors affecting acceptance of intrauterine devices among rural women of Hirebagewadi, Belgaum. IOSR J Nurs Health Sci 2014;3:37-52.  Back to cited text no. 9
    
10.
Murarkar SK, Soundale SG, Lakade RN. Study of contraceptive practices and reasons for not accepting contraceptive in rural India. Indian J Sci Technol 2011;4:8.  Back to cited text no. 10
    
11.
Yadav K, Singh B, Goswami K. Agreement and concordance regarding reproductive intentions and contraception between husbands and wives in rural Ballabgarh, India. Indian J Community Med 2010;35:19-23.  Back to cited text no. 11
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