Family Planning Knowledge and Practices among Women in a District Hospital

Introduction: Family planning services have the potential to improve the quality of the lives of people. The study was done to assess the family planning practice and methods among the married women of reproductive age attending female clinic of district hospital of Nepal.


INTRODUCTION
Reproductive Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infi rmity, in all matters relating to the reproductive system and to its functions and processes.This implies that given peoples capability to reproduce they have the freedom to decide it, when and how to do so.Women and men therefore have the right to be informed and have access to safe, affordable and effective methods of family planning of their choice as well as other methods of fertility regulation.
Family planning services can be an important and effective fi rst step to reduce maternal deaths in developing countries.Fewer unwanted pregnancies mean fewer pregnancy related deaths, making family planning a vital way to improve maternal health. 1 The Total Fertility Rate (TFR) decreased from 6.3 in 1976 to 3.1 in 2006.In the same period, the contraceptive prevalence rate increased from 2.9% to 48%.In addition the maternal mortality rate declined from 539 in 1996 to 281 in 2006, and much of this decline was attributed to increase use of family planning, information, education and communication campaigns have successfully increased knowledge of family planning methods. 2 The study of Mustafa R. et al conducted among rural women of Pakistan found that there was low contra-ceptive use among women of rural origin despite good knowledge.In the study the main source of awareness for family planning was from media.Only 53% of interviewed women were practicing family planning methods. 3A study from Kathmandu showed that 93% of participants were aware of at least one family planning methods but only 65% had ever used it and contraceptive prevalence rate was 33.5%. 1 The most commonly known method was depo provera followed by oral contraceptive pills. 1

METHODS
This is a cross sectional descriptive study carried out in collecting quantitative data from married women of reproductive age group of 15-49 years visiting Lamjung District Hospital female clinic.The duration of study was from October 2011 till December 2011.
An ever married woman of 15-49 years who had at least one child were the subjects of study and were randomly selected among the women attending the outpatient clinic of the hospital.A structured questionnaire was composed on knowledge, practice and methods of use of contraception.The questionnaire was then used to conduct structured interviews with women in the clinic at Lamjung District Hospital.
The study was approved by the Internal Management Committee of the hospital and verbal consent was taken from each participants.The participants were informed that the participation in the study will be voluntary and that they could end at anytime.The data thus collected was compiled, analyzed in Microsoft excel software.

RESULTS
There were total of 100 participants in the study.It is encouraging to know that the level of knowledge among the women about family planning practice was 94%.Sixty eight percentage of women were using a modern method of contraception and thirty two percent were not using any method of contraception (Figure . 1).

Using contraceptive
Not Using contraceptive

Distribution of use of contraception
The age in years of the participants varied from 16 to 42.In the study group 32% of women belonged to 20-24 years age group, followed by 30% in the age group of 25-29 years (Figure 2).More than half 34 (54%) of women were using injectable contraceptives.Oral pills were used by 18 (28%) of women.Permanent female sterilization was done by 8 (12.5%) of women (Table 1).In distribution of reason for not using any contraception one third 10 (33.3%) opined that they wish to extend their family.Sixty percentage of women did not use any contraception because of their husbands being abroad (Table 2).

DISCUSSION
Family Planning is defi ned by WHO as "a way of think-ing and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of family groups and thus contribute effectively to the social development of a country.
Acceptance of family planning largely depends on knowledge and awareness of family planning methods.Knowledge of contraception methods is an important precursor to their use.The fi ve year development programme of Nepal has aim towards a decentralised reproductive health programme that will increase the utilisation of quality reproductive health services by women, men and adolescents whilst also increasing awareness of reproductive health risks and benefi ts.This latter initiative has the goal of brining about behavioural changes regarding safer sex and reproductive practices. 4e present study aimed to assess the knowledge and practice of family planning methods among the women of rural district of Nepal.Results showed that knowledge of contraception was 94% as compared to 93% in study conducted at Kathmandu. 1 In a study conducted in Pakistan and India, knowledge of contraception was 81% and 82.2% respectively. 3,5A study from rural part of our country has reported an exposure to electronic media messages as main factor for use of family planning methods among women. 6 the present study only 68% of the interviwed women were practicing family planning methods, the result was high then the study conducted in rural part of Pakistan were only 53% were practicing any one fam-ily planning methods.In study of Kumar et al 66.5% were using a method of contraception among women of urban slums of Lucknow city. 7Regarding the usage of family planning methods, an important dimension is the type of contraceptive used.Temporary method of contraception was more commonly preferred.Injectable contraceptive was used by 54% of women followed by oral pilles by 18% and IUCD by 6.2% and 12.5% of women were sterlised.The result was similar on preferance of using temporary method of choice by the women of kathmandu.Injectable contraceptive was practiced by 78% and folowed by oral pills by 74%. 1 The study of Kumar et al showed 36.6% of women preferred oral pills followed by sterilization by 24.3%. 7he study of Mustafa R. et al conducted among rural women of Pakistan, the most common chosen method used by 33.9% followed by 11.3%. 3men not practicing contraception in our study was 32%, other studies of Srivastava R et al and Prachi R et al showed that non use of contraception was 55% and 44.6%. 5,8The most common reason for not using contraception was husband being abroad followed by wish to extend family.

CONCLUSION
The study reveals good knowledge and practice of rural women towards contraception but still needs improvement.Continuous effort is needed from the government and local community to educate the public about the safety and convenience of modern, long term and reversible methods of contraception.

Figure 2 .
Figure 2. Distribution of participants as per age group