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\def\RunningAuthor{Asawari Deo et al.}
\firstPage{182}
\articleType{Original Article}
\receivedDate{13 Dec 2021}
\acceptedDate{17 Jan 2022}
\revisedDate{16 Jan 2022}
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\journalDoi{ijrps.v13i2.182}
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\title{Knowledge, Attitude, and Practice of Contraception in Rural Area of Vidarbha}
\author{Asawari~Deo\textsuperscript{*},  
            Deepti~Shrivastava, 
            Sonali~Chauhan~\\[5pt]{Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Sawangi [M], Wardha-442001, Maharashtra, India}}

\begin{abstract}
Knowledge of use of contraceptives is necessary to prevent unwanted pregnancies and for optimal spacing, especially when it comes to rural populace. It is essential to create awareness and educate them regarding the proper usage of contraceptives and facilitate their usage. Family planning has two main objectives; firstly, to have only the desired number of children and secondly, proper spacing of pregnancies. India has undergone fertility transition and important feature of this transition is the fact that contraceptive use has spread to even uneducated women. Family planning is widely discussed topic on the national stage, with lot of government machinery to help implement it, yet there exist lot of disparity in its execution. In our study, the knowledge of contraception was upto 60\%, while its acceptance was seen in 50\% of the population, knowledge of contraceptives was very much likened to the level of education the populace has received as well as due to efforts of mother and child health and family planning services in the rural area, lack of use contraceptives was mainly attributed to fear of side-effects, which were mainly due to hearsay. Our study highlights the fact that even though our study was based in rural area, it involved women belonging to all stratas of society, and women had more predilection towards temporary methods of contraception rather than going for permanent contraception. It is concluded from the present study that 60\% women had knowledge and were aware of the contraceptives but lacking information about their availability at health care centers.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Contraceptives,\newline Family Planning,\newline Knowledge,\newline Attitude,\newline Practice,\newline Awareness
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Asawari~Deo~\\ Phone:\ 7507647064~\\  Email:\ deoasawari94@gmail.com
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\section{Introduction}
The national family planning program, established in 1951, was the first state-sponsored family planning programme in the developing world. The program's main goals were to reduce fertility rates and restrict population increase in order to boost economic growth. Despite this, there remains a contraceptive knowledge, attitude, and practise gap. The reasons for not using any kind of family planning include a lack of awareness and education, religious beliefs, and a fear of adverse effects. India continues to experience population expansion despite exponential rise of contraceptives in the previous four decades, with the recent census showing a population of 1.21 billion people \unskip~\citep{1340329:24287546}.

Family planning has two basic goals: first, to have just the number of children wanted, and second, to space pregnancies properly.India has gone through a fertility shift, and one of the most notable aspects of this change is that contraceptive usage has expanded to even the most illiterate women \unskip~\citep{1340329:24287546}.

Such investigations have become increasingly significant in recent years. Because more detailed information regarding the factors that influence fertility and family acceptability may be obtained. This information may then be utilised to create a curriculum that is appropriate for them \unskip~\citep{1340329:24287596}.

The couple protection rate is the percentage of eligible couples who are adequately protected against childbirth using one or more approved methods of family planning, such as sterilisation, condoms, intrauterine devices, or oral tablets \unskip~\citep{1340329:24287546}.

The mismatch between reproductive goals and birth control behaviours is known as an unmet contraceptive demand.

The rate of pair protection is the most important element in lowering the net reproduction rate. Percentage of women who use any contraceptive method. Contraceptive Prevalence Rate (CPR) the current cpr is 54 percent among eligible couples aged 15 to 44 years old \unskip~\citep{1340329:24287623}. CPR must be more than 60\% to get an net reproduction rate of one. Promoting the adoption of the most effective contraceptive techniques necessitates a review of what women who want reversible contraception already know about the effectiveness of the options.

Fertility is a large counteracting factor to population attrition caused by death, and hence has a considerable influence on population dynamics as an expansionary force. Mortality, on the other hand, governs the distribution of people in various age groups and prevents population growth from becoming uncontrollable. It is commonly recognised that rising birth rates lead to a slew of socioeconomic issues, including a crisis of basic survival and subsistence needs, such as food and land shortages, poverty, unemployment, and illiteracy \unskip~\citep{1340329:24287623}.
    
\section{Material and Methods }
\textbf{Study Design}

Prospective, cross-sectional study.

\textbf{Inclusion Criteria}

Women belonging to reproductive age group, belonging to lower and lower upper socio-economic class, according to the modified kuppuswamy scale, attending the gynaecology opd of avbr hospital, sawangi.

\textbf{Exclusion Criteria}

Women belonging to reproductive age group, who have not undergone any permanent sterilization procedure or hysterectomy.

\textbf{Place of Study}

AVBR Hospital, Sawangi [M], Wardha.

\textbf{Duration of Study}

Period of six months from Oct 2019 to March 2020.

Women were evaluated for their knowledge and practices towards regular contraceptive methods, emergency contraception and medical abortion with the help of a structured questionnaire after taking informed, verbal consent. Women were then given the cafeteria choice of different contraception methods available and contraceptive method accepted by them was recorded and analysed statistically.
    
\section{Results and Discussion}
In the present study, women belonging to reproductive age group who have not undergone permanent sterilization were surveyed, with the help of pretested, verified set of questions to attest their knowledge, awareness and practices of contraceptive use. According to statistics as depicted in Table~\ref{tw-4e39dfdaa43c}, mean age of women in our study was 26.4 yrs, mostly women who opted for or were open to use contraceptive were after they had completed their family which for most was after having two children. Almost 50\% of women were literate, and had primary formal education. Socio-economic strata did not have much affect on use contraceptives although choice of contraceptive varied widely.


\begin{table*}[!htbp]
\caption{\boldmath {Demographic Characteristics} }
\label{tw-4e39dfdaa43c}
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\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.39510000000000005\linewidth-2\tabcolsep}p{\dimexpr.3299\linewidth-2\tabcolsep}p{\dimexpr.275\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack  & \cAlignHack Number of Women [n=2000] & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Age &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack Range 20-40 year  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack Mean age 26.4 years &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack Parity &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 1 &
  \cAlignHack 300 &
  \cAlignHack 15\%\\
\cAlignHack 2 &
  \cAlignHack 650 &
  \cAlignHack 32.5\%\\
\cAlignHack 3 &
  \cAlignHack 340 &
  \cAlignHack 17\%\\
\cAlignHack 4 &
  \cAlignHack 400 &
  \cAlignHack 20\%\\
\cAlignHack {\textgreater}4 &
  \cAlignHack 310 &
  \cAlignHack 15.5\%\\
\cAlignHack Education &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack Illiterate &
  \cAlignHack 500 &
  \cAlignHack 25\%\\
\cAlignHack 1 primary &
  \cAlignHack 1000 &
  \cAlignHack 50\%\\
\cAlignHack Secondary and above &
  \cAlignHack 500 &
  \cAlignHack 25\%\\
\cAlignHack Socio-economic status &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack Lower &
  \cAlignHack 600 &
  \cAlignHack 30\%\\
\cAlignHack Upper lower &
  \cAlignHack 400 &
  \cAlignHack 20\%\\
\cAlignHack Lower middle &
  \cAlignHack 500 &
  \cAlignHack 25\%\\
\cAlignHack Upper lower &
  \cAlignHack 300 &
  \cAlignHack 15\%\\
\cAlignHack Upper &
  \cAlignHack 200 &
  \cAlignHack 10\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Knowledge and Awareness, About Contraceptives} }
\label{tw-53e89ebf954b}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4084\linewidth-2\tabcolsep}p{\dimexpr.3098\linewidth-2\tabcolsep}p{\dimexpr.2818\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Method Known & \cAlignHack Number of Women & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Condom &
  \cAlignHack 140 &
  \cAlignHack 0.7\\
\cAlignHack Intrauterine devices &
  \cAlignHack 4 &
  \cAlignHack 0.002\\
\cAlignHack Oral contraceptive pills &
  \cAlignHack 250 &
  \cAlignHack 12.5\\
\cAlignHack Male sterilization &
  \cAlignHack 10 &
  \cAlignHack 0.5\\
\cAlignHack Injectable &
  \cAlignHack 5 &
  \cAlignHack 0.25\\
\cAlignHack Not aware of contraceptives &
  \cAlignHack 550 &
  \cAlignHack 27.5\\
\cAlignHack Emergency contraceptives &
  \cAlignHack 220 &
  \cAlignHack 11\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Attitude-Reason for Not Opting to Use Contraceptives} }
\label{tw-b4a175a9cfef}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.404\linewidth-2\tabcolsep}p{\dimexpr.37260000000000005\linewidth-2\tabcolsep}p{\dimexpr.2234\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Reason & \cAlignHack Number of Women [n=2000] & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Worried of side effects &
  \cAlignHack 500 &
  \cAlignHack 25\\
\cAlignHack Opposition from family members/spouse &
  \cAlignHack 300 &
  \cAlignHack 15\\
\cAlignHack Wanted male child &
  \cAlignHack 150 &
  \cAlignHack 7.5\\
\cAlignHack Wanted conception &
  \cAlignHack 200 &
  \cAlignHack 10\\
\cAlignHack Inconvenience/lack of privacy &
  \cAlignHack 350 &
  \cAlignHack 17.5\\
\cAlignHack No access to family planning service &
  \cAlignHack 500 &
  \cAlignHack 25\\
\cAlignHack Inconvinence &
  \cAlignHack 400 &
  \cAlignHack 20\\
\cAlignHack Too much cost &
  \cAlignHack 500 &
  \cAlignHack 25\\
\cAlignHack Think mtp is method of contraception &
  \cAlignHack 150 &
  \cAlignHack 7.5\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Number of Women Actually Practicing any Contraceptives} }
\label{tw-3a3ea17ea144}
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\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Method of Contraceptive & \cAlignHack Number of Women [n=2000] & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Natural [withdrawal] &
  \cAlignHack 550 &
  \cAlignHack 27.5\\
\cAlignHack Barrier [condom] &
  \cAlignHack 950 &
  \cAlignHack 47.5\\
\cAlignHack Oral contraceptive pills &
  \cAlignHack 880 &
  \cAlignHack 44\\
\cAlignHack Intrauterine devices &
  \cAlignHack 11 &
  \cAlignHack 0.55\\
\cAlignHack B/l tubal ligation &
  \cAlignHack 118 &
  \cAlignHack 5.9\\
\cAlignHack 1. Puerperal tubal ligation &
  \cAlignHack 80 &
  \cAlignHack 4\\
\cAlignHack 2. Interval tubal ligation &
  \cAlignHack 38 &
  \cAlignHack 1.9\\
\cAlignHack No contraceptive used &
  \cAlignHack 440 &
  \cAlignHack 22\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparative Analysis of Data from Various Similar Studies Regarding Awareness of Various Contraceptives} }
\label{tw-93428ba7ecc2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1503\linewidth-2\tabcolsep}p{\dimexpr.1297\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.12459999999999999\linewidth-2\tabcolsep}p{\dimexpr.16700000000000003\linewidth-2\tabcolsep}p{\dimexpr.14379999999999999\linewidth-2\tabcolsep}p{\dimexpr.1446\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{6}{p{\dimexpr(.8553999999999999\linewidth-2\tabcolsep)}}{\cAlignHack Contraceptive Method Used} & \cAlignHack Present Study\\
\tblmidrule 
\cAlignHack  &
  \cAlignHack \unskip~\citep{1340329:24287596} &
  \cAlignHack \unskip~\citep{1340329:24287726} &
  \cAlignHack \unskip~\citep{1340329:24287727} &
  \cAlignHack \unskip~\citep{1340329:24287658} &
  \cAlignHack \unskip~\citep{1340329:24287758} &
  \cAlignHack \\
\cAlignHack Condoms &
  \cAlignHack 10\% &
  \cAlignHack 41.6\% &
  \cAlignHack 6.2\% &
  \cAlignHack 96.67\% &
  \cAlignHack 64\% &
  \cAlignHack 47.5\%\\
\cAlignHack Oral contraceptive pills &
  \cAlignHack 6.1\% &
  \cAlignHack 10.2\% &
  \cAlignHack 2.4\% &
  \cAlignHack 84.67\% &
  \cAlignHack 62\% &
  \cAlignHack 44\%\\
\cAlignHack Intrauterine devices &
  \cAlignHack 13\% &
  \cAlignHack 31.2\% &
  \cAlignHack 3\% &
  \cAlignHack 87.33\% &
  \cAlignHack 74\% &
  \cAlignHack 0.55\%\\
\cAlignHack B/l tubal ligation &
  \cAlignHack 20\% &
  \cAlignHack 9.6\% &
  \cAlignHack 51.1\% &
  \cAlignHack 96.67\% &
  \cAlignHack 80.6\% &
  \cAlignHack 5.9\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
Table~\ref{tw-53e89ebf954b} depicts that, more than a quarter of study population was unaware of the need to use contraception, which was striking considering widespread campaigns and awareness drives conducted by government and local authorities, yet women were barely open to use of intra uterine contraceptive devices or injectable contraceptives. Male sterilization was again a non-starter, considering the stigma attached to it, and unwilling of male partners. Condoms and oral contraceptive pills were most widely accepted methods of contraception. While, a lot of population believed in use of emergency contraceptive even for regular contraceptive purposes.

Table~\ref{tw-b4a175a9cfef} depicts the attitude of women towards contraceptives, as low adoption of family planning methods among eligible couples was mostly due to the husband's opposition, which he believed would lead to family discord, religious restriction, and fear of negative consequences \unskip~\citep{1340329:24287641}. 

Their attitude, education, and employment were also major linked variables. Women's educational levels, sex preferences, marital duration, infant death, and media exposure all have an impact on contraceptive use. As a result, these considerations should be taken into account when developing a family planning programme, and efforts should be made to raise public awareness of the benefits of the small family norm.

Table~\ref{tw-3a3ea17ea144} depicts the usage of contraceptives as temporary contraceptive methods such as barrier or oral contraceptive were widely accepted and routine practiced by most women. Women who were more open to a fail-safe method went for permanent tubal ligation. Participants were quite likely to get it done while in puerperium rather than as interval tl method. Also, nearly half the populace believed in withdrawal method or in using no contraception whatsoever.

Family planning is widely discussed topic on the national stage, with lot of government machinery to help implement it, yet there exist lot of disparity in its execution.

In our study, the knowledge of contraception was upto 60\%, while its acceptance was seen in 50\% of the population, knowledge of contraceptives was very much likened to the level of education the populace has received as well as due to efforts of mch and family planning services in the rural area, lack of use contraceptives was mainly attributed to fear of side-effects, which were mainly due to hearsay.

According to nfhs-4, 2015-2016, current use of family planning methods (currently married women age 15{\textendash}49 years), was female sterilization was 51.1\%, intrauterine devices was 3\%, oc pill use 2.4\%, condom 6.2\%, which was comparable with our study \unskip~\citep{1340329:24287658}.

When it comes to family planning, the main problem for india is putting information into practise. Barrier (96.67 percent) and female sterilisation (96.67 percent) had the highest levels of knowledge, followed by intrauterine devices (87.33 percent), oral pills, and injectable contraceptives (84.67 percent) in the research by Ramesh et al. (1996) \unskip~\cite{1340329:24287658}, which are consistent with findings from other developing nations.

In our study, it was evident that even though the study was conducted in a rural setting, the number of barrier contraception users and oral contraceptive pills users was on the higher side, as compared to use intrauterine devices or undergoing permanent sterilization which was strikingly in contrast with other similar studies. This particular phenomenon could be attributed to various outreach and awareness campaigns that are conducted by the hospital and local obstetrics and gynaecological society, exponential increase in the number oral contraceptive pills users could also be due to availability or various newer oral contraceptive pills with lesser side-effects.

It is imperative to mention that medical abortions or dilatation and evacuation procedures were considered as standard form of contraception or regular spacing method, by 7.5\% of study participants, which is a quite significant number. It also brings to light, the knowledge gap present amongst certain participants.

Table~\ref{tw-93428ba7ecc2}  depicts the percentage of usage of various methods of contraceptives as assessed various studies conducted along the similar of assessing the knowledge, attitude and practice of various methods of contraception mainly male condoms, oral contraceptive pills, intrauterine contraceptive devices and bilateral tubal ligation. As our study was based in rural setup there was a wider gap in usage as compared to various studies conducted elsewhere, most commonly use contraceptive was barrier as male condoms in our study at 47.5\% which was comparable to study by Pandey et al. (2014) \unskip~\cite{1340329:24287726}. Yet much higher than state average of 6.7\% \unskip~\citep{1340329:24287727}. While bilateral tubal ligation as permanent female sterilization for females was given less preference in our study population, which was in paradox to other similar studies, secondary only to intrauterine devices.
    
\section{Conclusion}
Our study highlights the fact that even though our study was based in rural area, it involved women belonging to all stratas of society, and women had more predilection towards temporary methods of contraception rather than going for permanent contraception. It is concluded from the present study that 60\% women had knowledge and were aware of the contraceptives but lacking information about their availability at health care centers. Most common fear about practising contraception was health hazards and side effects along with some inconvenience to use them positive attitude about contraception. Govt. Could popularize and spread information regarding availability and accessibility of contraceptives at all peripheral centres through various awareness campaigns and mass media propaganda. It also showed there were still a wide number of women who still did not practice contraception even though they were aware of their accessibility. It shows that quite simply that accessibility is not an hurdle in use of contraceptives, willingness to proper use them is quite the reason. Especially in the low socioeconomic class, there is still a distance between contraceptive awareness and practise that needs to be bridged. Family planning advice should be made available in all prenatal and postnatal clinics.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.
    

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