Rajivgandhi Universityofhealth Science,Karnataka

RajivGandhi UniversityofHealth Science,Karnataka

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

A STUDY TO ASSESS KNOWLEDGE AND ATTITUDE OF ANTENATAL WOMEN REGARDING PERMANENT METHOD OF CONTRACEPTIONWITH A VIEW TO DEVELOP INFORMATION BOOKLETIN SELECTED PRIMARY HEALTH CENTRE, BANGALORE

SUBMITTED BY

MISS. SHELEEJA. S

I YEAR M.SC., NURSING,

ROYALCOLLEGE OF NURSING,

UTTARAHALLI,

BANGALORE – 61

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / Name of the Candidate and Address / Miss Sheleeja. S
1year M.Sc., Nursing,
RoyalCollege of Nursing,
RoyalCollege of Nursing,
7th Main, 1st Block, Uttarahalli,
Bangalore-560061
2 / Name of the Institution / RoyalCollege of Nursing, Bangalore.
3 / Course of Study and Subject / I year M.Sc., Nursing
Obstetrics and GynaecologicalNursing
4 / Date of Admission to Course / 01/06/2012
5 / Title of the Topic:
“A Study To Assess Knowledge And Attitude Of Antenatal Women Regarding Permanent Method Of ContraceptionWith A View To Develop Information Booklet In Selected Primary Health Centre, Bangalore”
6 / Brief Resume of the Intended Work
6.1. Need for the Study
6.2. Review of Literature
6.3. Objectives of the Study
6.4. Operational Definitions
6.5. Hypothesis of the Study
6.6. Assumptions
6.7. Delimitations of the Study
6.8. Pilot Study
6.9. Variables / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7 / Material and Methods:
7.1. Source of Data: Data will be collected from antenatal womenin selected primary health centre, Bangalore.
7.2. Method of Collection of Data;Structured Knowledge Questionnaire and
Check list
7.3. Does the study require any investigations or interventions to be conducted on clients or other human or animals? Yes
7.4. Has ethical clearance been obtained from your institution? Yes, Ethical committee’s report is enclosed here.
8 / List of References / Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

A small family is a Happy Family

It is rightly said ‘The greatest shortcoming of the human race is our inability to understand the exponential function’. For countries like Spain, Canada and Italy, where the population is decreasing, population explosion might be considered as a boon. But for developing country like India, population explosion is nothing but a curse which is damaging the development of the country and its society. With 16% of world’s population, India is the second most populated country in the world. A developing country already faces a lack in their resources and needs. With the rapidly escalating population, the resources available per person are further plummeting, leading to increased poverty, malnutrition and other large population related problems. Therefore, predicament is much more severe here in India because of the escalating pressure on the limited resources of the country.1

According to the provisional population count released within four weeks of completing the Census, India’s total population in 2011 was 1.21 billion, up from 1.03 billion in 2001, thus adding 181 million people in one decade.General’s office that projected that India is now expected to become the most populous country of the world by 2030 overtaking China sooner than earlier expected. But the horrible situation conveniently forgotten is that while China is the world’s third-largest country after Russia and Canada and is the second largest country by land area, India is about only a third of China’s size. In terms of population, China tops India at 1.35 billion people, India is just a step behind, with 1.21 billion.2

Even though in, the 2001-2011 decadal growth rate has reduced to 17.6 %, compared to 21.5 recorded during 1991-2001, suggests slowing down of growth, there is an urgent need for the XII Five Year Plan to further accelerate the stabilization of India’s population by repositioning family planning within the broader framework of reproductive health and primary health care.3

India has a long history of addressing the population question. Beginning with the launch of the largely clinic-based National Family Planning Programme in 1952, the latest National Population Policy (NPP) of 2000 is much more embedded in the framework of women’s empowerment and reproductiverights.4

India’s sustained efforts over the years to achieve population stabilization are finally beginning to yield the desired results. Preliminary results from the Census of India 2011 reveal several positive trends in India’s population growth. Despite the many achievements on the population front, many worry, somewhat unnecessarily, about the ‘serious problem of rising numbers’ and the lack of conviction to contain or stabilize India’s population exist. Ultimately it is only by repositioning family planning within a rights based framework can India ensure planned and healthier families, a positive outcome for every pregnancy, and most importantly, that every child is a wanted as well as a healthy child.3

Hence spreading the awareness for adopting one or the other method for family planning and encouraging for permanent method of contraception will contribute an immense role in improve maternal and child survival and stabilizing the population of India at large.

6.1 NEED FORTHE STUDY

The rapid growth of the world's population over the past one hundred years results from a difference between the rate of birth and the rate of death. It took the entire history of humankind for the population to reach 1 billion around 1810. Today the world has a population of 6 billion and the population of India stands at over 1.2 billion. This only means that more people are now being added each day than at any other time in human history which poses as a major problem.5

Thus India has more than a sixth of the world's population.Already containing 17.5% of the world's population, India is projectedto be the world's most populous country by 2025, surpassing China,its population exceeding 1.6 billion people by 2050.6

The general thinking at the time of Independence of India was that the massive population of the country and its unchecked growth was detrimental to accelerated social and economic progress and, therefore, efforts should be made to check population growth through curtailing fertility.7

An important answer for controlling this problem of increasing population lie in a principles adopted by almost all the world’s nations at a 1994 UN conference held in Cairo. An operating assumption of this program is that when women have access to the information and means that allow them to choose the timing of pregnancy, the intervals between births lengthen, average family size shrinks, and teen births become less frequent. All of these improve maternal and child survival and slow population growth.8

A descriptive cross sectional study was carried out among the eligible couples residing in Rajshahi City Corporation for three months with a view to collect information about the acceptance of contraceptive methods from 366 respondents with 50 male and 316 female. In this study 93.67% of female respondents & 20% of male respondents were currently using contraceptive methods. The modern methods were oral pill 21.6% IUCDs 14.9%, injection 35.14%, Norplant 12.16%, condom 16.0%, safe period 6.76%, Tubectomy 9.46%, Vasectomy 4.0% and 6.13% were non acceptors of contraceptives. Permanent methods were adopted by 9.5% female and by 4% male only. Study shown that percentage of the contraceptive method users increased with the level of education. The major causes for not accepting contraceptive methods were fear of complications (46.7% among female and 23% among male), opposition of the elderly (13% among female and 6.4% among male) and 55% male said about female partner's preference as user, so they did not use methods by them. Major causes for not accepting permanent methods were fear of operation (43% among female and 55.6% among male), religious barrier (31.9% among female and 42.2% among male), fear for decreased physical ability (12.5% among female and 2.2% among male) and lastly familial pressure (among 12.5% female).9

A cross sectional study was carried out in 10 villages of a rural area of Ludhiana, Punjab among 2465 married females. There were 12.9% non-users, 49.5% were using spacing methods and 37.6% had accepted permanent method. A highly statistical significant association was observed between parity and contraceptive usage. Education of husband and education of study subjects significantly effects the choice of family planning method. The acceptance for permanent methods of family planning was higher in subjects having 1or 2 male children. Only 1.2% couples accepted sterilization without having a male child while the acceptance of sterilization was 52.9% among subjects having two living sons.10

A study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. A total of 204 married women of reproductive age were interviewed by a registrar to record their knowledge about contraceptive methods, attitudes and practices of contraception. Of the women, 67% were para 2 – 5; 68% had some sort of awareness regarding contraception. The majority knew about the pill (68%) and IUCD (55%). Only 47% were using some sort of contraception. The most common method chosen was the barrier method (15%), followed by IUCD (10%) and the pill (10%). The least common methods were sterilisation (2%) and the rhythm method (2%); 85% of the women and 74% of the men in the study group had a positive attitude toward contraception.11

A study was done to enhance contraceptive acceptance among currently-married women through empowerment training of female community health volunteers. Seventeen FCHVs, who were working in Kakani Village Development Committee in the hills of central Nepal, attended an empowerment training that used participatory action research and reinforcement mechanisms. Following the training, the FCHVs were expected to empower the currently-married women to increase their contraceptive use. The impact of the intervention was assessed in a sample of 241 who were neither pregnant nor using contraceptives at the time of selection, by interviewing them before and six months after the intervention. The implementation of the intervention significantly increased the proportion of currently-married women knowing at least one contraceptive method. The use of modern contraceptives among the currently-married women from none before the intervention increased to 52.3%six months following the intervention.12

The above studies clearly indicate that in order to improve contraceptive use there is need to educate couples regarding contraceptive services also to recommend family planning and to create awareness among women to have their rights and opinions about the size of family. The concept of differentiation between sons and daughters should be discouraged. It is high time to control our growth rate for economic stabilization of the country and to raise the living standards of our people.Hence the researcher felt that a study determining the knowledge and attitude of antenatal women, in order to develop an information booklet would be useful in bringing more awareness and motivate the antenatal women to adopt permanent methods of contraception.

6.2. REVIEW OF LITERATURE

The review of literature is a broad, comprehensive, in depth, systematic and critical review of scholarly publication, unpublished scholarly print materials, audio-visual materials and personal communications. A literature review is a written summary of the state of existing knowledge on a research problem. The task of reviewing research literature involves the identification, relation, critical analysis and written description of existing information on a topic.13

Review of Literature is mainly divided into two headings.

Review related to contraceptive methods

Review related to knowledge of contraceptive methods

Review related to attitude of contraceptive methods

Review related to contraceptive methods

A study assessed the family planning methods adopted among 540 the married women of reproductive age (15- 45yrs) residing in urban slums of, Lucknow. The study revealed that acceptance of family planning methods both temporary and permanent methods increased with level of literacy of women. About 53.40 % adopted I.U.C.D, 38.83% O.C pills & only 7.77% of their partners used condoms. 66.6% have undergone laparoscopic & 33.4% mini-lap sterilization. Vasectomy was not done for even a single partner. More number of illiterate and primary educated accepted permanent method after 3 or more children than higher educated who accepted it after 1 or 2 children. The study concluded that acceptance in family planning is associated with increasing age, nuclear family & level of literacy. This study highlights the necessity to inform and motivate married women to adopt permanent method of contraception earlier.14

Across-sectional study was conducted in rural and urban areas of Allahabad district in Uttar Pradesh to find out the knowledge, attitude, and practices of contraceptives among the currently married women (15-45 years) and the number of children after which permanent method was used. This study included 1,063 and 1,082 eligible women in rural and urban areas, respectively. No significant difference was found in the awareness level of women regarding contraception in rural (71.9%) and urban areas (92.9%). Only 13 per cent of rural women were using some method of contraception as compared to 47.1 per cent urban women. The most commonly used contraception method was permanent method (tubectomy) in both the areas (57.2% and 52% in rural and urban areas, respectively). The study concluded thatpermanent method of contraception method was used after one or two children only by 11.3 per cent and 18.3per cent of women in rural and urban areas, respectively, therebydefeating the purpose of family planning to control population. Malesterilization accounted for only around 2 per cent of permanent methods.15

A study determined prevalence of unmet need for family planning in an urban resettlement colony of East Delhi and the factors associated with it are investigated in this study, using a sample size of 1051 married females aged 15- 49 years who were fecund and sexually active. The findings reveal that (i) Amongthe subjects, 562 (53.5%) were currently using contraceptives, 130 (12.4%) were pregnant and 359 (34.1%) were not using any contraception; (ii) The overall unmet need for family planning was 25.4 per cent, of which 6.7 per cent was need for spacing and 18.7 per cent was need for limiting the family. Unmet need was highest among the illiterate group.16

A cross sectional study determined the prevalence of contraceptive acceptance, the type of contraceptive used and the reasons for not accepting contraceptive methods at village Chanai, Ambajogai,Maharashtra Dt., India. Data was collected by house to house survey using predesigned and pretested questionnaire inall the married women between 15-49 years. Out of 512 married women 48.63% were contraceptive acceptors; 64.66%women were accepted permanent method of contraception. Among the temporary methods most commonly accepted was IUD by 19.28% women. Commonest reason for not accepting contraceptives was desire of

children in 25.85% women followed by fear of side effects in 16.34% women.17

Review related to knowledge of contraceptive methods

A 2-weeks cross-sectional survey was carried out to identify women’s level of knowledge toward FP and identify possible barriers to using FP. At all maternity units in Butembo of post-partum women, 572 women were interviewed. FP knowledge was high (76%), perception good (80%). Majority used traditional methods (65%), mostly Calendar method (72%). Barriers to using modern FP included lack of knowledge, fear of side effects, religious considerations and husband opposition. Unmet need for spacing and limiting was high (21 & 31%). Promotion of FP was poor (42%). The study recommended training of health workers, advocating modern contraception, improving FP services in all public health facilities and promoting FP on each contact of women.18

A quasi-experimental study provided group training of contraceptive methods to 53 women, and then evaluated the effect of training on the dependent variable of husbands’ participation in family planning. The data was gathered using a questionnaire and a checklist and then was analyzed.The results indicated that the mean score of knowledge level of the case group members and their husbands changed significantly after the training program (p < 0.001). Also, it was found that 51% of the participants and their husbands used contraceptive methods after the training program. Considering the results, providing training for couples to increase the participation rate of men in family planning programs will be beneficial.19

A cross-sectional observational study assessed the knowledge, attitude regarding family planning and the practice of contraceptives among 100 rural women between the ages 15-45, living with their husbands and coming from rural area were interviewed. The mean age of 29.7 years, 81(81%) had some knowledge about family planningmethods. Regarding the usage ofcontraceptive methods, only 53 (53%) of the respondents were using some sort of contraception. Barrier method(condoms) was in practice by 18 (33.9%) and 12 (22.6%) of women had already undergone tubal ligation. The womenusinginjectables and intrauterine contraceptive devices were 10 (18.8%) and 7 (13.2%) respectively. Six were using oralcontraceptive pills (11.3%). Positive attitude towards contraception was shown by 76 (76%) of them, while 41(41%) statedtheir husbands’ positive attitude towards contraception.20

Review related to attitude of contraceptive methods

A prospective study was conducted to know the attitude of women regarding use of family planning methods and to find out the factors that restricts its use.

Using convenient sample method, families were selected starting from a point in the selected block (Block G). 40 women of childbearing age group (15- 49 years) were enrolled. All women were followed for a period of one year. More than 70% women told that irregular menstruation from Oral Contraceptive pills and ill health from tubectomy as the other side effects. Demands for more children and for son preferences were the leading reason for not using any methods followed by afraid of side effects and health problems. The study concluded that effective family planning methods use should be advocated through adequate counseling about the correct use, side effects and their proper management and their benefit in the back ground of custom and belief.21