RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs. KalaiSelvi.SSri Lakshmi College of Nursing,
# 127/ 1, Sri gandadakaval,
Magadi Main Road,
Vishwaneedam Poat,
Sunkadakatte,
Bangalore – 91
2. / NAME OF THE INSTITUTION / Sri Lakshmi College of Nursing,
# 127/ 1, Sri gandadakaval,
Magadi Main Road,
Vishwaneedam Poat,
Sunkadakatte,
Bangalore – 91
3. / COURSE OF STUDY AND SUBJECT / M.sc Nursing I Year Community Health Nursing
4. / DATE OF ADMISSION TO COURSE / 11.06.2009
5. / TITLE OF THE TOPIC / A descriptive Study to assess the knowledge of child Spacing among mothers of Single child in a Selected rural area with a view to prepare information Booklet.
6. A BRIEF RESUME OF INTENDED WORK
“ACCEPT THE FIRST
POSTPONE THE SECOND
FOR ATLEAST THREE YEARS”
6.1 NEED FOR STUDY
Birth Spacing is important in child growth and development. The child is likely to receive his full share of love, care including nutrition he needs, when the Family size is small & births are properly spaced. Infants and mothers are extremely important part of the society as it lays the foundation for good nation. To achieve this it is necessary to improve the knowledge regarding child spacing.1
Child spacing is a way of thinking and living that is adopted voluntarily upon the basis of knowledge, attitude and responsible decisions by individual and couples in order to promote the health and welfare of the family group and thus contribute effectively to the Social development of the country (WHO 1971).1
It is recognized as a basic human right to decide freely and responsibly on the number and spacing of their children
A typical Ugandan women will give birth to 7 children in her life time, Making Uganda’s fertility rate as one of the highest in the world. The growth rate is equally impressive, Uganda’s Population increase by about one million people a year. More than 70% of women have a child before 20 years of age and only one in four Ugandans uses a family Planning method.The lack of knowledge and access to reproductive health services and family planning methods directly contribute to Uganda’s high fertility rate and also Significantly increase the already high rate of disease and death among mother’s and children.2
According to the Survey conducted in the year 1994 among North Americans they noted that maternal mortality, 21 per 1000 births was not bad as in the third world, but not good as in the west. 9% of infants born were underweight and 25% of children below the age of five were malnourished.
They conducted that the main Problem was that mothers were becoming pregnant every year and that there should be a program of child spacing.3
India has the highest under five mortality with over 2 million children dying before their fifth birthday – that’s one death every 15 seconds. About 90% can be prevented around 3 quarters of these children dies with malnourishment. The causes of this malnutritions is having another child within a year and poor economic status.3
World fertility Survey (1974) Suggests that infant Mortality is directly influenced by the proceeding birth interval. A longer birth interval increase the odds of an infants Survival by 25% whereas the death of the preceding child decreases the odds by 45%.4
According to the Survey conducted on 2007. Proper Spacing between the births reduces Mortality and Morbidity and improves the health of both mother and the child.5
Family Welfare Program in India Says That Birth Spacing is important in child growth and development. The child is likely to receive her full share of love and care including nutrition he or she needs, when the family size is small and births are properly spaced.6
According to the data collected on 2003 the total fertility rate in Karnataka was 2.3 and crude birth rate was 20.9 in the year 2004. Then the adoption of family planning was 56.3%. For spacing the birth family Planning was adopted by Urban was 6.7 and by rural it was about 8.9.7
In district level that is in Bangalore the knowledge about child spacing was widely spreaded in Urban areas. The birth rate in urban area was 1.4whereas in rural area it is about 2.3 And the Spacing between the birth was less than 2 among the illiterate.8
Research at colorado State University has found that the first born , having a Younger Sibling born 2 or more years later the older child a blow to its self Esteem while having a Sibling born less than 2 years later did not have the effect.7
The Colorado group proposes that this may be so because a child raised alone is privy to all his parents nurturance and affection. The longer a child has to get used to this relationship the more negativity he will experience the birth of younger Sibling.8
Researchers conducted observational studies on mothers and infants have found that if four years or more have passed since the birth of the last child a mother is more likely to treat a new infant with the special care and attention. She lavished on his first born. Children born about 2 years apart are likely to have the more intense competition for parental attention throughout their lives.9
According to study reports child spacing helps the mother to gets more time to participate in other fruitful activities like education , vocational training and community projects etc., The child gets proper nutrition, parental care and love.9
In a review of more than 200 studies, the evidence Strongly suggests that spacing of siblings strongly linked to success in life. Siblings born with intervals more than 3 years or more, tends to be more intelligent in childhood, show more autonomy and Psychological maturity by college age and attain higher incomes and more occupational prestige in adulthood.6
Research conducted on optimal birth spacing indicates that the lowest risk for fetal death
Pre – term delivery, small for gestational age neonatal death and low birth weight occur when births are spaced from 3 – 5 years.8
According to studies on the effects of birth order, has also proposed an original, though highly, speculative, explanation for the superior achievement of first born and only children. In his view it is related to a biological difference found in primates and other mammals, which suggests that the first born is prepared by nature for a more difficult birth and a less experienced mother than a subsequent Siblings.5
Information Booklet is issued to the mothers of single child with the purpose of giving information to gain knowledge about the importance and need for child spacing and to teach about the various methods of family planning to practice child spacing.10
The healthy future of society depends on the health of the children of today and their mothers, who are guardians of that future. However despite much good work over the years, 10.6 million children and 529000 mothers are still dying each year. So it is necessary for all community health nurse and midwives to extend their best to build a healthy nation.11
7.0 REVIEW OF LITERATURE:
Review of literature is an essential activity of Scientific Research Project stated that literature review involves the systematic identification, location, scrutiny and summary of written material that contain information on a research problem.
Review of literature provides a basis for future investigation, justifies the need for replication. throws light on the feasibility of the study initiate ways to improve the efficiency of data collection and obtain useful advice to increase the effectiveness of data analysis.
7.1 Studies related to Knowledge about child spacing
7.2 Studies related to Factors influencing child Spacing
7.3 Studies related to effects of child spacing
7.1 STUDIES RELATED TO KNOWLEDGE REGARDING CHILD SPACING
1999, The Cairo international Conference on population and development in Sep 1994 contributed to a paradigm shift in child spacing in rural South India. The Survey was conducted in the period of Jan – April 1997 among 951 women. The respondents were selected from an earlier census and lived in eleven villages in Dharwad taluk. The reports presents actual child spacing behavior that is the duration of birth intervals and the constitutive proximate determinants of Postpartum amenorrhoea and the sue of contraceptives. Also perceptions and beliefs of women themselves regarding child spacing behavior which is influenced by the desired family size, the desired number of childrens and perceptions regarding the proximate determinants especially the use of tewmporary spacing methods.11
A Study was conducted to analysis the child spacing and two child policy in practice in rural Vietnam. A cross sectional survey was done among 1132 women who had at least one child under 5 years of age in April1992, in Tien Hai, a district in Red river Delta area. The result was the mean age at first birth was 22.2 years. The average Spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers and women belonging to the catholic religion had shorter spacing between the first and the second child and also a higher probability of having a third child. In addition women who had no Sons or who had lost a previous child were more likely to have a third child I short duration. Based on these data most families do not adhere to the official family planning policy, which was introduces in 1988, Stipulating that each couples should have a maximum of two children with 3 – 5 years spacing n between. More Consideration should be given to family planning needs and perceptions of the population, supporting the women to be in control of her fertility.11
7.2 STUDIES RELATED TO FACTORS INFLUENCING CHILD SPACING
A Cross Sectional Study was conducted in Al – Oyaynah, a village of 2000 inhabitants, during the month of April and May 1995.the sample consisted of 332 women 16.6% of total population . The questionnaire including items on demographics characteriscs of the mether , her fertility history information on the birth interval preceding the last infant and their infant breast feeding habits. They examines thew effects of Sociodemographic factors and nutritional habilts on child spacing in this rural community. They found the mean birth interval of 251 women, after excluding the 48 primipara and 32 who had no children was 31.2 monts. Ages of the mother and education were found significantly associated with birth interval. The results also showed that parity and type of infant feeding, although associated with birth interval did not reach the 5 % level of Significance. One – way analysis of variance also revealed a Significant increase in birth interval with age and level of education women of 30 – 34 years old had about an eightfold likelihood of increased birth interval compared to those in the younger age group ( 20 – 24 years) Older women , 35 years and over were 19 times more likely to have a long birth interval ( 1977)12
A research was conducted on child spacing in tropical Africa. from Jan 1, 1977 – Dec 31, 1979. Collaboration is called for between and researchers because of the interrelated facts of Society involved in birth Spacing. Other information that are collected includes variables affecting marriage, contraceptive practices and achieved fertility. Age, education , occupation , religion and partner relations are proposed to be examined . The project published its results which included the role and functioning of child spacing in traditional societies and the changes in child spacing. Then the demographic impact of traditional and changing child spacing practices on birth intervals and fertility levels.12
A Cross Sectional Study was conducted in Eastern SaudiArabia to determine the patterns of Child Spacing / Birth intervals and the Socio – economic factors related to them .The Study Sample comprised of 9 – 10 year old Saudi School children randomly selected from 14 schools I Khobar, Thoghba and Dhahran in eastern province of Saudi Arabia. The total Sample was 536. The mean Preceding and Succeding birth intervals of children in the study were 26.2 + 13.7 and 28.2 + 12 month respectively. The figures are essential for any planning mother and child health intervention .Health team members need to know this information and the variables related to them in order to advice mothers. The figures are also essential in planning measures to reduce infant and child morbidity and mortality. The most important variables that were found to be significantly correlated with the birth intervals in the study were maternal age, level of education , family size and breast feeding.13
A Study was conducted to know the effects of characteristics current at the beginning of the birth interval on the time relapsing before the next birth are examined. In the model on which Empirical research is based sociological and economic antecedents are used. The Study was based on data from 2 panels of the Bicol multipurpose survey collected in1978 and 1983. Detailed information on services communities also assessed. The Research results clearly shows that current characteristics at the individuals , household and community levels have significant and interpretable effects on the length of birth intervals. Because of the large rural development program introduced in various Sub Areas of the Bicol – region, Substantial changes in the rural infrastructure and in availability of health and family planning facilities and services occurred between 1976 and 1980, the period on which the analysis was focused. It gave a dear result that current characteristics at the individual, household and community level have significant and interpretable effects on the length of birth intervals.13