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Table of Contents
STUDENT SECTION
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 96-100

Assessment of knowledge regarding birth spacing method among married women visiting outpatient department in selected hospital at Mangaluru


1 Final year BSc Nursing Students, Department of OBG Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
2 Assistant Professor, Department of OBG Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India

Date of Submission09-Dec-2019
Date of Decision13-Oct-2020
Date of Acceptance31-Oct-2020
Date of Web Publication07-Jul-2021

Correspondence Address:
Mrs. Pramila D'Souza
Department of OBG Nursing, Father Muller College of Nursing, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_34_21

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  Abstract 


Decisions regarding family planning cannot be forced but need to adopted willingly. Countries with many customs and traditions prefer interval method than sterilisation as a method of family planning. Awareness on benefits and ways of family planning will help to control overpopulation, increase life expectancy and reduce the maternal and neonatal mortality. The aim of the study was to identify the knowledge of married women on birth spacing methods visiting the outpatient department of tertiary hospital at Mangaluru. Non-probability sampling technique was used to select 323 married women. The baseline characteristics showed that 36.6% of subjects were in the age group of 32–38 years, 41.9% were Hindus and 65.6% were educated up to SSLC. About 42.9% of the subjects were multigravida and 37.5% subjects were married for <5 years. The findings also revealed that majority of the subjects (78%) were not using birth spacing method at the time the data collection was done for this study and 59.4% did not have previous information on birth spacing methods. About 22% of the subjects had an average knowledge, whereas 78% had good knowledge about birth spacing method. Although many subjects had good knowledge on birth spacing, majority were not using any birth spacing methods. Spreading awareness on birth spacing as well as encouraging them to choose any one method prevents unplanned and untimely as well as high-risk pregnancies.

Keywords: Birth spacing method, knowledge, women


How to cite this article:
Agaya S P, Philip A, Joy A, Tom A, Babu A, D'Souza P. Assessment of knowledge regarding birth spacing method among married women visiting outpatient department in selected hospital at Mangaluru. Indian J Cont Nsg Edn 2021;22:96-100

How to cite this URL:
Agaya S P, Philip A, Joy A, Tom A, Babu A, D'Souza P. Assessment of knowledge regarding birth spacing method among married women visiting outpatient department in selected hospital at Mangaluru. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Dec 1];22:96-100. Available from: https://www.ijcne.org/text.asp?2021/22/1/96/320822




  Introduction Top


Birth spacing is defined as the time interval between two births. Birth spacing between pregnancies is an essential factor in the reproductive life as it promotes health and well-being of the mother and child. Family planning allows people to attain their desired number of children and determine the spacing between pregnancies.[1] In India, National Family Planning Programme was introduced in the year 1952, sponsored centrally with the aim to reduce the birth rate and to stabilise the population at a level consistent with the requirements of national economy.[2] Although the rate of population growth is declining in recent years due to effective family planning and welfare programs, the population number is still increasing. Globally, the use of modern contraceptive methods increased slightly, from 54% in 1990 to 57.4% in 2015[3] revealing an increase in awareness and acceptance to contraception. However, the increase is very minimal. Easy and affordable contraceptive methods for women and couples secure the well-being and autonomy of women, in return support the health and development of communities.

The WHO 2018 fact sheet reads that the unmet need for contraception is a strong reason in developing countries in avoiding unwanted pregnancies among 214 million women of reproductive age.[4] The community education modalities such as mass media, print/mail, web-based, text messaging and interpersonal interventions are the power tools to promote a positive impact on reducing teen and unintended pregnancies. Client satisfaction with family service delivery is very important.[5] Challenging situations in low economic countries lead to low utilisation rates of contraceptives in spite of having the highest knowledge.[6] Bringing up a family is a responsibility of both husband and wife. Husbands play an influential role in women's access to family welfare services. A research study from Ethiopia has revealed that husbands' involvement and knowledge towards the use of family planning methods were only 42%. Cultural dominance and hierarchical decision is one of the reasons for not using family planning methods.[7]

A community-based cross-sectional study among 500 women identified that the spousal (husband) opposition, religious beliefs, concern, fear of side effects, distance of family planning services facility, incomplete family size and negative perceptions were the reasons for not using contraceptive methods.[8] Another community survey conducted in India depicted that the average age of marriage is 23 years in females and the permanent methods of sterilisation are widely used by women with an education level of plus two or below. Male sterilisation was less adopted because of beliefs such as 'vasectomy reduces sexual desire' and 'it makes a man physically weak' and has led to disapproval of vasectomy as a contraceptive method.[9] Mass media was the major source of information for many and in some places, information about different contraceptive methods was not available.[8]

There are marked mental disturbances among mothers who had unwanted pregnancies. Maternal and neonatal health is strongly interlinked. Birth spacing reduces the maternal and neonatal mortality and morbidity rate. In the community-based study among 500 women in rural Haryana, 70% of women had a good knowledge as well as interest in opting to follow the birth spacing method.[8] Sufficient knowledge motivates the couple to make right choices to practice the desired method for birth spacing.[10] There is also evidence of higher incidence of mental disturbances among mothers who have had unwanted pregnancies.[4]

The health impact of family planning occurs primarily through the avoidance of unwanted pregnancies, limiting the number of births and proper birth spacing. We conducted this study to identify the knowledge on birth spacing methods among married women attending the outpatient department of tertiary hospitals at Mangaluru.

The objectives of the study were to

  1. Assess the knowledge regarding birth spacing methods among married women
  2. Determine the association between baseline variables and the knowledge of married women regarding birth spacing methods.



  Materials and Methods Top


This descriptive survey was conducted in the outpatient departments of a tertiary hospital at Mangaluru. Non-probability sampling technique was used to select 323 married women aged between 18 and 45 years. Women who were able to read and write and visited the outpatient department were included in the study.

Instruments

Tool 1: Baseline pro forma

It consisted of 12 items including age, religion, educational status, type of family, socio-economic status of family, occupation, number of children, family income, duration of the marriage, use of birth spacing methods and previous information on birth spacing methods.

Tool II: Structured knowledge questionnaire

The structured knowledge questionnaire was developed with 27 multiple-choice questions on methods of birth spacing. The score ranged from 0 to 27 and was interpreted as poor (0–9), average (10–18) and good (19–27). The blueprint covered six areas such as the concept of family planning, intrauterine contraceptive device, condoms, diaphragms, natural methods, pills and injections. The tool was translated to Kannada and Malayalam languages and validated before administering. The prepared tool was submitted to nine experts for content validation. Hundred per cent agreements from the experts over the items were retained in the final tool. Split-half method was used to measure the internal consistency of the tool. Karl-Pearson's correlation depicted that the tool is reliable (r = 0.8).

Data collection process

After obtaining the ethical clearance from the ethical committee of the institution, permission was sought from the hospital administrator to collect data from the patients. The investigator explained about the study and also assured the confidentiality of the collected information. Informed written consent was obtained from the participants. First, the baseline information was collected and then the participants were asked to fill the structured questionnaire. The data collection was done in the outpatient department of the hospital.


  Results Top


The baseline characteristics of the participants shows that majority of the women (36.6%) were between 32 and 38 years, 41.9% were Hindus, 65.6% were educated up to SSLC, 54.8% from the nuclear family, 56% were from above poverty line and 45.7% were unemployed. About 42.9% of the study women were multigravida, 37.5% were married for 5 years or less. Among the total women, 78.9% were not using any birth spacing method and 59.4% did not have previous information on birth spacing methods.

The data presented in [Table 1] show that 22% of the subjects had an average knowledge on birth spacing method, whereas 78% had good knowledge about birth spacing method.
Table 1: Frequency and percentage distribution of subjects according to the category of the knowledge score

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The data presented in [Table 2] show that the mean and standard deviation of knowledge score is 20.78 ± 3.09 and the mean percentage is 76.9. Knowledge level based on domain is presented in [Table 3].
Table 2: Mean, standard deviation and mean percentage of knowledge score on birth spacing method

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Table 3: Knowledge level according to domain

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There was a significant association between the socioeconomic level, use of family planning methods and knowledge regarding birth spacing. [Table 4] also depicts that 247 (78.9%) did not adopt any birth spacing methods but had a knowledge score above a median of 13. In the present study, majority of subjects were not using the spacing method during data collection period. However, many had used spacing methods initially under the guidance of healthcare personnel to maintain short-term spacing and once their family was complete, some of them had undergone permanent method sterilisation. Few of them were with secondary infertility.
Table 4: Association of knowledge score and baseline variables of married women

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  Discussion Top


The study addressed the current knowledge, among 323 participants. The major findings of the study revealed that majority of the subjects (78%) had good level of knowledge and 22% of women had average knowledge regarding birth spacing method. One of the supporting study results showed that almost all the women knew about family planning; around 53.3% were aware of birth spacing.[11] In another study, 86.4% knew about methods of birth spacing.[8] These results are corresponding with the present study findings and reveal that most women had good knowledge about birth spacing methods.

In terms of contraception, 98% of women had overall knowledge about temporary family planning methods. This might be due to the reason that the awareness is given to the mothers during pregnancy in the outpatient department and after delivery during discharge from the hospital. Besides, the qualification, status of living also contributed the mother to gain knowledge on contraception. Several studies on similar aspects have highlighted that women have good knowledge in one or the other method of temporary contraception.[11],[12],[13],[14] In the present study, women were well aware of the use of oral contraceptive pills, intrauterine device and condoms but had less knowledge about the use of diaphragms. These results are matching with the study done by Nidhi, Sunder, Mohan and Jasleen where 92.3% knew about oral contraceptives, 89.7% were knew about condom, 71.9% were aware of the intrauterine device and 62.8% had an idea about other traditional methods such as abstinence, coitus interruptus, safe period and lactation amenorrhoea, emergency contraception and injectables.[15] It is important to note that in spite of having good knowledge majority did not continue to practice birth spacing methods. This result has to be cautiously interpreted as many women in this study were older and multigravid. The findings also suggested that some women had practiced any one of the family planning methods earlier in their life. Further in-depth exploration is needed to understand the factors influencing adoption and continuation of birth spacing methods. Such knowledge is needed to tailor educational and support interventions to encourage women in decisions related to birth spacing.

Population explosion is a major obstacle to the overall progress of our nation. Awareness and adoption of birth spacing methods are one of the best solutions to tackle this problem. In the present study, there was an association with the socio-economic status and knowledge on use of different types of contraceptives. The current reviews support the findings. The outcomes of the study carried out in Nepal by Thapa depict that the level of education had greater influence over the awareness of contraception.[16]

Undoubtedly, the well and timely information on birth spacing methods protects the women to prevent unwanted pregnancies; nevertheless, it also plays a major role by contributing to the reduced maternal morbidity and mortality rate. Although several studies contribute to the present findings, modern society especially women in the rural remote areas and the urban slums require more attention and motivation to adopt the currently available birth spacing methods.


  Conclusion Top


India is the second-most populous country in the world, after China. India is expected to overtake China as the world's most populous nation by 2027. The prosperity of the nation is dependent on the synchronisation of residents' health with the country's wealth. Nurses are the primary care providers in the health sector. One of the primary goals of nursing profession is to promote health. Adequate information on birth spacing methods and use of family planning methods can be fostered through the health education. Further studies can be conducted among young couples and primipara mothers on large samples in the rural areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Baksh L, Davis K, Davis T, Bloebaum L, Streeter N, Galloway K, Rolfs B. Unintended pregnancy in Utah. Prams Perspectives: A pregnancy risk assessment monitoring system quarterly report. 1999. Available at: http://health.utah.gov/mihp/prams/Unintended.pdf. [Last accessed on 2020 Oct 06].  Back to cited text no. 3
    
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World Health Organisation. Family Planning-Contraception. 2018 February 8. Available from: https://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception. [Last accessed on 2020 Feb 20].  Back to cited text no. 4
    
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Chekole MK, Kahsay ZH, Medhanyie AA, Gebreslassie MA, Bezabh AM. Husbands' involvement in family planning use and its associated factors in pastoralist communities of Afar, Ethiopia. Reprod Health 2019;16:33.  Back to cited text no. 7
    
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Yadav B, Pandey S. Study of knowledge, attitude, and practice regarding birth spacing and methods available for birth spacing in rural Haryana, India. Int J Reproduct Contracept Obstet Gynecol 2017;7:1390.  Back to cited text no. 8
    
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Anjum S, Durgawale PM, Shinde M. Epidemiological correlates of use of contraceptives methods and appraisal of health education on status of knowledge and practices among married woman. Int J Sci Res 2014;3:203-10.  Back to cited text no. 9
    
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Takkar N, Goel P, Saha PK, Dua D. Contraceptive practices and awareness of emergency contraception in educated working women. Indian J Med Sci 2005;59:143-9.  Back to cited text no. 10
[PUBMED]  [Full text]  
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Tuladhar H, Marahatta R. Awareness and practice of family planning methods in women attending gyne OPD at Nepal Medical College Teaching Hospital. Nepal Med Coll J 2008;10:184-91.  Back to cited text no. 11
    
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Anjum S, Durgawale PM, Shinde M. Knowledge of contraceptives methods and appraisal of health education among married woman. Int J Sci Res 2014;3:584-90.  Back to cited text no. 12
    
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Pegu B, Gaur BP, Sharma N, Singh AS. Knowledge, attitude and practices of contraception among married women. Int J Reprod Contracept Obstet Gynecol 2014;3:385-8.  Back to cited text no. 13
    
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Lincoln J, Mohammadnezhad M, Khan S. Knowledge, Attitudes, and Practices of Family Planning Among Women of Reproductive Age in Suva, Fiji in 2017. J WOMENS Health Care 2018;7:431.  Back to cited text no. 14
    
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Nidhi S, Sunder DS, Mohan L, Jasleen K. Knowledge and practice of family planning among married women of reproductive age group in urban slums of Amritsar city. Int J Health Sci Res 2015;5:42-8.  Back to cited text no. 15
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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