RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address (in block letters) / NAVYA
UNITY COLLEGE OF NURSING, SHEDIGURI
DAMBEL ROAD
ASHOK NAGAR POST
MANGALORE-575006
2. / Name of the Institution / UNITY ACADEMY OF EDUCTION
COLLEGE OF NURSING, SHEDIGURI
DAMBEL ROAD
ASHOK NAGAR POST
MANGALORE-575006
3. / Course of Study and Subject / M. Sc. NURSING
COMMUNITY HEALTH NURSING
4. / Date of Admission to the Course / 28.06.2011
5. / Title of the study
A STUDY TO COMPARE THE LEVEL OF KNOWLEDGE AND PERCEIVED BARRIERS RELATED TO INTRAUTERINE DEVICES (IUDs) USAGE AMONG WOMEN AGED 20-40 YEARS RESIDING AT SELECTED URBAN AND RURAL AREAS OF MANGALORE WITH A VIEW TO PREPARE PAMPHLET.
6. / Brief resume of the intended work
6.1 Introduction
Population in India was not growing rapidly till the early twenties of the last century. It was nearly static, with a relatively safe and acceptable rate of annual growth, since both birth and death rates were relatively high .With advances in technology, expansion of health services death rate started declining in the following decades. Mean while the birth rate continued to persist at the same level .This caused a severe demographic gap between the birth and death rate, and resulted in growth of population at an alarming rate1.
Inadequate attention to alarmingly rising population and its deleterious effect on developmental effort and food situation, has led us to a disastrous situation. Many women who are sexually active would prefer to avoid becoming pregnant but not using any method of contraception2.
According to the 2006 National Family Health Survey (NFHS) report, the vast majority of Indians do not use modern methods of birth control until the desired number of children is achieved. Out of the 3 spacing methods currently promoted by the Indian government (oral contraceptives, condoms, and IUDs), IUDs is the most effective, longest lasting, and easiest to use, since it only requires 3 medical visits during 5 years of use. As a long-term method, the IUDs is also highly cost-effective for both patients and the medical system3.
The extent of acceptance of contraceptive methods still varies within societies and also among different castes and religious groups. The factors responsible for such varied picture operate at the individual, family and community level with their root in the socioeconomic and cultural milieu of Indian society. Women need the ability to decide when to start and finish child bearing, how long to wait after the birth of one child before becoming pregnant with the next and how many children to have4
6.2 Need for the study
“No woman can call herself free who does not own a control over her body; No woman can call herself free until she can choose consciously whether she will or will not be mother”.
- Margaret Sanger
India is the first country to initiate the family planning programme in 1952. The Programme suffered a setback on 1976 due to the element of coercion introduced in the programme and because of its political fallout; the political support for the programme was lost .Undue emphasis on terminal method of contraception in the programme resulted in the neglect of the need of young couples for spacing method, use of which not only decrease total fertility but also improve the health of the mother by delaying the next birth5.
Current population of India in 2011 is 1.21 billion. Current population in Karnataka is 61,130,704. In India total fertility rate in India is 2.62 children born \ women. Total fertility rate in rural area is 2.9% and urban area is 2%6
Survey research in developing countries estimates that more than 150 million married women of reproductive age have an unmet need for contraception. India has the highest number at among them with about 31 million women (20 percent)7. NFHS-2 survey (1998-99) shows that unmet need is highest (27%) among women below age 20, the need is almost entirely for spacing rather than for limiting, the need get reducing with the advancement of age2
In the state of Karnataka the trend of Women in the reproductive age group ( 20-24) who have completed their family (with two or more children ) is still high, i.e., 61.5% rural and 54.2% in urban area.8
The IUDs is underused among the rural and urban woman (1.1% vs 3.4%). IUDs increases choice for long acting and safe contraceptive to achieve optimal birth interval (3-5 years). With the copper T-380, women can protect herself against for pregnancy for up to 12 years. This is particularly attractive for those couples who have achieved their desired family size but do not want to adopt a permanent method like sterilization. The IUDs is a highly
effective contraceptive method and does not require (pregnancy rate< 1%) constant attention9 .IUDs many advantages also makes it a very alternative for reducing the unmet need for long term contraception around the world.10
A study to assess the knowledge and use of contraception among currently married adolescent women (CMAW) was conducted in rural India. Sample size consists of 89,199 ever married women. Result showed that IUD is still unpopular followed by condom. A huge urban- rural differential is noted in knowledge of all the methods of contraception, except sterilization .Only 71.1% of urban women and 54.2% of rural women were aware of IUD. Among the CMAW who are not having any son, about 7% of the couple are contracepting, it increases to 17% when they have one son, and it further increases to 26% when they have two or more sons. Researcher concluded that in India due to strong son preference, contraceptive practice depends not mainly on number of living children, but heavily on the number of living son11.
A study to assess the unmet need for family planning among women of reproductive age group was conducted in Kolkata. Sample consists of 240 mothers. Result showed that contraceptive use rate increases significantly higher in the age group below 30. Major reason for unmet need is opposition from husband, family and community (32%),lake of knowledge is (24%), health concern about side effects of the methods2.
A cross sectional study was conducted in surendra nagar district to find out the knowledge, attitude, and practice regarding spacing methods among married women of the reproductive age group. Sample consists of 329 married women .Result showed that 25.6% women were using spacing methods. The maximum users of spacing method were in age group of 26-30 years is (31%) followed by 31-35 years (15.80%). In this study 26.44% of women not aware of IUDs and (14%) women using IUD .Most common reasons for not using IUDs were fear of wearing(22.5%) and increased menstrual bleeding (15.5%)12
However, the acceptance of family planning is influenced by many socio-cultural and demographical factors at levels of individual, family and society. Among this different factor, education is considered to exert most profound effect on Family planning acceptance and fertility. The large urban-rural gap in educational attainment exposure and opportunities, is thus the major impediment and obstacle in the success of family planning.13 Studies in
Turkey shown that better educated women have somewhat less unmet need than women do with little or no education 2
Many a times women shy away from using contraceptives mainly because they lack knowledge and are afraid of sterilization; Copper-T or pills does not suit them; or injection is not available etc; thereby have to carry the burden of unwanted pregnancies or go for abortion which is mainly unsafe, having knowledge of wide range of contraceptive methods helps women to overcome such difficulties. Further, it enable couples to decide when to and whether to have child11
During the community posting, in urban and rural area of Mangalore, researcher found acceptance of family planning is influenced by many socio cultural demographical factor such as ignorance, lack of scientific outlook, blindly following irrational beliefs, baseless psychological fear, traditional myth acceptance and fertility And also large urban rural gap in education attainment. So researcher felt need to research on this aspect.
6.3 Review of literature
A study to assess the extent of knowledge, attitude, and practice of eligible couples regarding family planning in rural area of Sreekaryam. Sample consists of 60 reproductive age group couples recruited by random sampling technique. Structured questionnaire were used for data collection .The result showed that, the total knowledge score was 52% and average score was taken 20%, almost 52% of the couple have attitude score above the average and rest fall in below average category .73% of couples are not practicing family planning just because they don’t like these methods .Among those using temporary methods 46.2% users copper T while 30.8% use condom and 23% are practicing safe period14
A community based cross sectional study was conducted in urban Delhi to find out the users and non users of contraceptive and factors associated with the nonusage of contraceptives. Sample consist of a 243 married women. Pre-tested questionnaire and knowledge index were used for data collection .The result showed that among the current acceptors of contraception, tubectomy accounted for 58.3%., 11.9% were using oral contraceptive, 8.3% intrauterine devices, 14.3% condom .In majority of the women, opposition from husbands families and male child preference (19.8%) was cited as the main
reason for non acceptance of any contraception .In case of 18.2% of mother, health concern about contraception and side effects were responsible for unmet needs. In case of 9.1% mother little perceived risk of pregnancy, 3.3% mothers wanted to complete the family15
A retrospective cross sectional study was conducted in Bangladesh to find out quality outcome of IUD use 12 months after insertion and to examine the factors associated with discontinuation of IUD. Sample consists of 375 respondents who had accepted an IUD. Result showed that one in five acceptors of these former, discontinued within one year although 15% had used IUD for more than five years. Four of the five acceptors (79%) reported that they were aware of some bodily changes as a result of the IUD, before the insertion itself and they have been educated about the possible side effect of IUDs.16
A cross sectional descriptive study was conducted in Dehradun district to find out the reason for not practicing contraception among ever married women in rural population .The Sample consist of 2,278 ever married women recruited by multistage stratified random sampling . The result showed that the created (fear of )side effects 19.5%, perceived infertility is 4.0%, want more children 21.5% , religious regions 5.8%, health region 2.0%, husband and family member objects 3.3%.17
A study was conducted in rural areas of India. 50 village were randomly selected. A sample consists of 500 women. Questionnaire were used for data collection. Result revealed that most of the mothers 78.8% had knowledge of one or more modern methods of contraception; Knowledge level were higher for condom 55.6% followed closely by sterilization method 55.4%, knowledge of oral pill 36.6%; knowledge of IUDs 33.2%. Obstacles to their adaptation of contraceptive method were hesitation 59.6%, non availability of a service provider 43.2% ,fear of side effects 36.6% ,custom , disbelief , or external pressure 22%18
6.4 Statement of the problem
“A study to compare the level of knowledge and perceived barriers related to intrauterine devices (IUDS) usage among women aged 20-40 years residing at selected urban and rural areas of Mangalore with a view to prepare pamphlet.”
6.5 Objectives of the study
Objectives of the study are to:
·  assess the level of knowledge and perceived barriers related to IUDs usage among women aged 20-40 years residing at selected urban and rural areas of Mangalore.
·  compare the level of knowledge and perceived barriers related to IUDs usage among women aged 20-40 years residing at selected urban and rural areas of Mangalore.
·  find association between level of knowledge and perceived barriers to IUDs usage among women aged 20-40 years residing at selected urban area with selected baseline variables
·  find association between level of knowledge and perceived barriers related to IUDs usage among women aged 20-40 years residing at selected rural area with selected baseline variables.
·  to prepare an educational pamphlet based on the findings of the study.
6.6 Operational definitions
Knowledge: In this study knowledge refers to awareness and understanding about effectiveness, advantage, contraindication, timing of insertion, side effect, follow up visit of IUDs.
Perceived barrier: In this Study perceived barrier refers to expression of women about obstacles to adoption of IUDs
IUD:IUD refers a device inserted intra uterinely which gives the contraceptive effect such as TCu-380A, TCu-200B, copper 7, TCu-380S, TCu 220c, CuNova T200, multiload 250 and 375, progestasert, levonorgestrel IUD.
IUDs usage : In this study IUDs usage refers to act or manner of using IUDs intra uterinely.
Urban area: it refers to a place of large geographical area with 10,000 or more population of different age groups residing in city or town .in this study urban refers to Kuloor area.
Rural area: It refers to population of small geographical area with 500-5000 population of different age group residing in village or outskirts of a city or town .In this study rural refers to surathkal area.