+44 3308188785Research Article, J Womens Health Issues Care Vol: 7 Issue: 3
Knowledge, Attitude, and Practice of Family Planning Methods among Married Men and Women
Sonia Sultan1*, Mahvish Mansoor Ali2, Sana Sadruddin Bardai2, Muhammad Adnan Kanpurwala3 and Farahnaz Shoukat Ali Punjwani2
1Robert Morris University, Illinois, USA
2The Indus Hospital, Karachi, Pakistan
3Karachi Institute of Medical Sciences, Pakistan
*Corresponding Author : Sonia Sultan
Robert Morris University, Illinois, USA
Tel: 1-630-480-1530
E-mail: [email protected]
Received: April 17, 2018 Accepted: May 15, 2018 Published: May 21, 2018
Citation: Sultan S, Ali MM, Bardai SS, Kanpurwala MA, Punjwani FS (2018) Knowledge, Attitude, and Practice of Family Planning Methods among Married Men and Women. J Womens Health, Issues Care 7:3. doi: 10.4172/2325-9795.1000311
Abstract
Abstract Objective: The objective of this study was to assess the knowledge, attitude, and practice of family planning methods among the married men and women in Pakistan. Methodology: A quantitative study using a descriptive crosssectional design was conducted in a community located in one of the urban areas of Karachi, Pakistan from October 2014 to December 2014. Two hundred participants were recruited, including 72 men and 128 women who were interviewed regarding their knowledge, attitude, and practices of family planning methods through a predesigned questionnaire. A two-stage sampling technique was used including systematic and convenient sampling to collect the data. Women with infertility, non-reproductive age (49 and above), widows, and widowers, separated and divorced individuals were excluded from this study. Results: Mean age of the participants was 30 ± 3 years. Results of the study showed that majority of the participants had knowledge of few contraceptive methods, but they lack awareness about all the family planning methods. Among men (100%) and women (97.7%), the most common method known was a male condom. Private hospitals and internet appear to be the key sources of information related to family planning. Regarding the practice of family planning methods, 54% of men and women were using few contraceptive methods. 74% men and 71.3% women had positive attitudes regarding family planning methods. The most common reasons for not using family planning methods among men and women were fear of side effects and desire of a male child. Conclusion: The study concludes that most of the men and women have the comprehensive knowledge and assertive attitudes regarding the use of contraceptive methods, however, the practice of family planning methods is still low.
Keywords: Knowledge; Attitude; Practice; Family planning method
Introduction
Among the most populous countries in the world, Pakistan lies at seventh position with an approximate population of about 180 million [1]. Increase population growth has caused limitation of resources along with economic burden in the country. Family planning plays an imperative role in population dynamics that aids in economic stabilization of the country. Family planning has a significant role in improving the health of the mother and the child, thus reducing maternal and child mortality rate.
Family planning has two main purposes: firstly, proper spacing between two pregnancies and secondly, control birth of more children. The three main elements that contribute to achieving these purposes are knowledge, attitude, and practices and the disproportion between any of these elements affect family planning outcome.
Several studies have been carried out which shows the level of education is a key factor in influencing the knowledge, attitude, and practice of family planning [2]. Approximately, 97% of the people of Pakistan have knowledge of at least one of contraceptive methods but contraceptive prevalence rate (CPR) is only 29% [1]. Utilization of contraceptive methods varies according to the individual’s attitudes. Lack of awareness, religious beliefs, and fear of side effects are the barriers affecting contraceptive usage [1].
In Pakistan, men play an important role in family decision making. Many studies have been carried out on family planning which emphasis mainly on women [3]. This female-oriented approach excludes men’s opinion and perceptions regarding family planning, and therefore this study endeavor to participate both men and women.
In recent times, family planning is one of the major areas of interest which needs to be addressed and deal with. Since more explicit knowledge can be attained relating to the factors that determine the knowledge, attitude, and practice of family planning. Consecutively, this can be useful for organizing suitable programs for the society [2].
The objective of this study was to assess the knowledge, attitude, and practice of family planning methods among the married men and women.
Methodology
This quantitative study using a descriptive cross-sectional design was conducted in a community located in Federal B-Area block 14, Karachi, Pakistan from October 2014 to December 2014. The ethical requirements were fulfilled. The sample size was 200 including 72 men and 128 women. Two-stage sampling technique was used. The first stage was systemic sampling technique in which out of 1500 flats every 7th flat was selected and the second stage was convenient sampling technique in which data was collected from those who fall under study criteria from every 7th flat. Married men and women served as inclusion criteria, while infertile, non-reproductive age (49 and above), widows, and widowers, separated and divorced individuals were excluded from the study. The informed consent was taken. Data was collected through the interview. The participation was on a voluntary basis. Each interview lasts for 15-20 min. Data was documented in a predesigned questionnaire. Questions were close-ended and precoded. The questionnaire consisted of demographic characteristics including age, gender, ethnicity, religion, years of marriage, number of children, level of education and employment. Questions were asked regarding knowledge and sources of contraceptive methods, its usage and their attitude towards contraception. Attitude towards decision making by own, their spouse was also questioned. Questions regarding reasons for not using contraceptive methods were also asked.
Data analysis
The statistical analysis was done by SPSS version 16. Quantitative variables were presented as a mean and standard deviation and qualitative variables were presented as frequencies and percentages using the descriptive statistical method. To analyze the data, the inferential statistical method was used since the variables were qualitative; chi-square was applied to examine the significance of the association between two or more categorical variables.
Results
Table 1 shows the demographic and social characteristics of the participants. The mean age among the 200 participants including men and women was 30 ± 3 years. Among the participants, majority (58.3%) men were postgraduate and (48.4%) women were graduates. Among men, 54.2% were Sindhi speaking while 66.4% women were Urdu speaking. All participants were Muslims.
| Characteristics | Men (n=72) | Women (n=128) |
|---|---|---|
| Age of the Participants | ||
| In between 21-25 years | 0 | 15 (11.7%) |
| In between 26-30 years | 41 (56.9%) | 83 (64.8%) |
| In between 31-35 years | 29 (40.3%) | 18 (14.1%) |
| Above 35 years | 2 (2.8%) | 12 (99.4%) |
| Education Level | ||
| Primary | 0 | 1 (0.8%) |
| Intermediate | 1 (1.4%) | 13 (10.2%) |
| Graduation | 29 (40.3%) | 62 (48.4%) |
| Masters/ Post graduation | 42 (58.3%) | 52 (40.6%) |
| Ethnicity | ||
| Urdu | 23 (31.9%) | 85 (66.4%) |
| Sindhi | 39 (54.2%) | 22 (17.2%) |
| Gujarati | 10 (13.9%) | 19 (14.8%) |
| Punjabi | 0 | 2 (1.6%) |
Table 1: Demographic characteristics.
The awareness regarding at least one family planning method was 100% among married men and women. A question was asked to the participants that what methods of family planning they were aware of? Table 2a shows that out of 72 men, 100% and out of 128 women, 97.7% were aware of the use of male condom as a protective tool for family planning. Table 2b shows that among men and women the best sources of information are private hospital (men= 100%, women=83.6%) followed by Internet (men=62.5%, women=47.7%) and the best persons of information among men and women were general practitioner (men=76.4%, women=73.4%) followed by spouse (men= 50%, women=44.5%).
| Methods | Men (n=72) | Women (n=128) | p-Value |
|---|---|---|---|
| Pills | 53 (73.6%) | 116 (90.6%) | 0.001* |
| Injection | 45 (62.5%) | 109(85.2%) | 0.000* |
| Male Condom | 72 (100%) | 126 (98.4%) | 0.286 |
| Female Condom | 34 (47.2%) | 46 (35.9%) | 0.118 |
| IUCD/Coil | 34 (47.2%) | 89 (69.5%) | 0.002* |
| Spermicide | 8 (11.10%) | 5 (3.90%) | 0.047 |
| Tubal-ligation | 34 (47.2%) | 68 (53.10%) | 0.423 |
| Vasectomy | 28 (38.9%) | 52 (40.60%) | 0.81 |
| Withdrawal method | 53 (73.6%) | 74 (57.80%) | 0.026* |
| Rhythm method | 42 (58.3%) | 54 (42.2%) | 0.028* |
Table 2a: Knowledge of contraception methods.
| Sources* | men (n=72) | Women (n=128) | p-Value |
|---|---|---|---|
| Home | 10 (13.9%) | 27 (21.1%) | 0.208 |
| Academic institution | 7 (9.7%) | 20 (15.6%) | 0.241 |
| Private hospital/clinic | 72 (100%) | 107 (83.6%) | 0.000* |
| Television | 0 | 33 (25.8%) | 0.000* |
| Radio | 0 | 13 (10.2%) | 0.005* |
| Printed material | 10 (13.9%) | 22 (17.2%) | 0.541 |
| Internet | 45 (62.5%) | 61 (47.7%) | 0.043* |
| Persons* | |||
| Mother/father | 10 (13.9%) | 33 (25.8%) | 0.049* |
| Teachers | 17 (23.6%) | 20 (15.6%) | 0.163 |
| Spouse | 36 (50%) | 57 (44.5%) | 0.457 |
| General practitioner | 55 (76.4%) | 94 (73.4%) | 0.646 |
| Friend | 23 (31.9%) | 43 (33.6%) | 0.812 |
| Relative/neighbor | 11 (15.3%) | 17 (13.3%) | 0.696 |
Table 2b: Sources/persons of information.
74% men and 71.3% women had a positive attitude towards family planning. Table 3 shows reasons for not using family planning methods. 75% men believed that couples don’t prefer to use contraceptive methods because of fear of side effects while a 49.2% women believed that couples don’t know how to use contraceptive methods.
| Reasons* | Men (n=72) | Women (n=128) | p-Value |
|---|---|---|---|
| To have more children | 2 (2.8%) | 18 (14.1%) | 0.011* |
| To have a male child | 11 (15.3%) | 49 (38.3%) | 0.001* |
| To have a female child | 0 | 13 (10.2%) | 0.005* |
| Cannot afford contraceptives | 0 | 19 (14.8%) | 0.001* |
| Do not know how to use contraceptives | 19 (26.4%) | 63 (49.2%) | 0.002* |
| Do not know where to get contraceptives | 19 (26.4%) | 44 (34.4%) | 0.243 |
| Spouse does not allow them | 0 | 28 (34.4%) | 0 |
| Do not use for health reasons | 10 (13.9%) | 12 (9.4%) | 0.327 |
| Do not use due to religious reasons | 0 | 9 (7%) | 0.021* |
| Fear of side effects | 54 (75%) | 58 (45.3%) | 0.000* |
| Adopt natural methods | 29 (40.3%) | 15 (11.7%) | 0.000* |
| Women are breast feeding | 10 (13.9%) | 6(4.7%) | 0.021* |
Table 3: Reasons for not using family planning methods.
The pie chart shows the practice of family planning methods by the married men and women. 75% men and 67.2% women responded that they have used family planning methods (Figure 1). Table 4 shows out of 72 men, 75% men were practicing male condom with their partner whereas 53.1% out of 128 women were practicing withdrawal methods with their partner.
Figure 1: Practice of family planning methods.
| Methods | Men (n=72) | Women (n=128) | p-Value |
|---|---|---|---|
| Pills | 8 (11.1%) | 13 (10.2%) | 0.511 |
| Injection | 0 | 15 (11.7%) | 0.002* |
| Male Condom | 54 (75%) | 54 (42.2%) | 0.000* |
| Female Condom | 0 | 4 (3.1%) | 0.135 |
| IUCD/Coil | 0 | 6 (4.7%) | 0.068 |
| Spermicide | 0 | 0 | 0 |
| Tubal-ligation | 0 | 0 | 0 |
| Vasectomy | 0 | 0 | 0 |
| Withdrawal method | 51 (70.8%) | 68 (53.1%) | 0.022* |
| Rhythm method | 15 (20.8%) | 50 (39.1%) | 0.001* |
Table 4: Practice of family planning methods.
Discussion
The mean age of the participants in this study was 30 ± 3 years in comparison with the study of Sajid et al who carried out the study on Knowledge, Attitude and Practice of Contraception among Multiparous Women at Lady Aitchison Hospital, Lahore, the mean age was 33.03 ± 4.55 years [3]. In this study, the knowledge of at least one contraceptive methods among women was 100% as compared to the other study at Liaquat national hospital in which 81% women had knowledge of some contraception methods [1]. The awareness regarding male condoms (97.7%), pills (90.6%) and withdrawal method (57.8%) among women, in comparison with study of Khan et al. the awareness of male condom was (95%), pills (69%) and withdrawal (25%) [1] among women. In our study, the major sources of information for men was a private hospital (100%) and internet (62.5%) in comparison with the study from Punjab, Pakistan, the major sources of information was a television (20.7%) [4-7]. The major sources of information for women were private hospitals (83.6%) and internet (47.7%), in contrast to another study reported that media (64.5%) was the major sources of information [3].
Our finding revealed that 71.8% women and 73.6% men had the positive attitude towards family planning, as compared to the study of Mustafa et al. 84.9% women and 58.4% men had a positive attitude towards family planning [6]. The reasons for not using family planning methods among women were fear of side effects (45%) and desire of a male child (38.3%). In contrast to the study of Naqvi et al. [1] 57% of the women believe that use of family planning methods affects health [1]. 99.2% of the women and 86.1% of the men believe that women alone are not responsible for family planning as compared to the study of Naqvi et al. [1] where the majority of the men and women believes that it is only women’s primary responsibility [1].
Our study findings showed that the practice of contraceptive methods among men were 75% among which the most common method used was male condom (75%) followed by withdrawal method (70.8%), in comparison with the study conducted at Punjab, where 40% of the men were using family planning method among which the most common method used was male condom (27.3%) [8-11]. Besides this, the study also showed that 67.2% of the women practiced contraceptive method among which the most common method used was withdrawal method (53.1%) followed by the use of a male condom (42.2%). In comparison with another study, 49% of women were using family planning method among which the most common method used was male condom (48.9%) followed by pills (19.3%) [3].
The study has few limitations. The sample size was small and there was an inadequate ratio between men and women’s sample size (72:128). In addition, questions were answered according to the participant’s perception which could influence the results even though all potential efforts were made to obtain accurate data.
Conclusion
The study concludes that most of the men and women have the comprehensive knowledge and assertive attitudes regarding the use of contraceptive methods, however, the practice of family planning methods is still low.
At the government level, policies for population control and family planning can be proposed. Efforts should be made to provide easy accessibility to family planning services. At the community level, family planning programs can be organized to provide awareness to both men and women. Moreover, nowadays mass media is the main source of information, therefore; it can be utilized for the promotion of family planning issues. To encourage spousal relation and communication, counseling of couples can be promoted, emphasize couples to have a joint decision about the adoption of family planning services.
Acknowledgement
The authors are thankful to the authorities of Health and Hospital Management Department at Institute of Business Management (IoBM), the nonprofit organization “Aahung” that works for the promotion of reproductive health, for providing the questionnaire on family planning, and to the participants who have shown interest to be the part of the study.
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