Knowledge, Attitude and Practices of Family Planning in Antenatal Women in a Tertiary Care Hospital during COVID-19 Pandemic: Indian Perspective

Introduction

COVID 19, the global pandemic with its first case notified on December 31, 2019 from Wuhan, Hubei Province of the People’s Republic of China. It was declared as a Public Health

emergency of International Concern on January 30, 2020.

WHO declared it to be a pandemic on 11 March, 2020 thereby requiring a need of various social restrictions, withdrawal of various services with availability of only emergency services following the lockdown.

It is a novel viral disease, developed across the world. A rapid population growth is an encumbrance on resources available of many developing countries. Even though various choices of contraceptive methods are available, still there are higher rates of unwanted pregnancies and population explosion as a result.

In particular, documented disruptions to voluntary family planning and reproductive health care due to competing health priorities, service disruptions, stock outs and lockdowns are significantly impacting reproductive, maternal, newborn, and child health.

A recent World Health Organization (WHO) survey discovered that across 105 countries, 90% have experienced health service interruptions as a result of the pandemic. One of the most commonly disrupted areas includes family planning (FP) services, with 68% of countries reporting service disruptions [1]. In particular, women heightened direct and indirect risks of unintended pregnancy as a result of lockdowns, service disruptions, stock outs, and financial adversities [2, 3].

Family planning is a way of thinking and living that is accepted voluntarily upon the bases of knowledge, attitude, and responsible decisions by couples and individuals [4]. Family planning refers to a mindful effort by a couple to limit or space the number of children they have through the use of contraceptive methods [5].

Family planning deals with reproductive health of the mother, having adequate birth spacing, avoiding undesired pregnancies and abortions, preventing sexually transmitted diseases, and refining the quality of life of mother, fetus, and family as a whole [6].

A woman can get pregnant if one of man’s sperm reaches her egg (ovum). Contraception attempts to stop this either by stopping egg production or by keeping the egg and the sperm apart or by stopping the implantation of the fertilized egg into the uterus. Contraception in the meekest terms is the prevention of pregnancy and contraceptive methods, by definition, are the preventive methods to help women avoid unwanted pregnancies [7].

WHO has developed recommendations on which types of health workers can safely and effectively provide specific family planning methods? WHO based these recommendations on the evidence that a wide variety of providers can safely and effectively provide contraception? Specific competency-based training and sustained educational support help all types of healthcare providers do a better job at providing family planning [8]. In India, the spacing methods of contraception, viz. IUCDs (intrauterine contraceptive devices), OCPs (oral contraceptive pills), and Condoms are available at the public health facilities beginning from the subcenter level. Since OCPs, Condoms, and emergency contraceptive pills are not skill-based services, they are made obtainable through trained ASHAs (accredited social health activists) and FMPHWs (female multipurpose health workers). Permanent methods of contraception viz. vasectomy and tubal ligation are generally accessible at primary health center level or above. They are provided by MBBS doctors or gynecologists who have been trained to provide the services [9].

If healthcare workers do not have an apt knowledge and a favorable attitude to practice family planning, the acceptance level and compliance of family planning services by their beneficiaries from those healthcare workers will be compromised. For primary healthcare physicians to understand the strategy that would be required to promote family planning services they need to know the level of knowledge, attitude of their team workers, and thus having an idea about their practice, ultimately their counseling drive and intent of incentive to beneficiaries.

Materials and Methods

A self-administered questionnaire was served to the 100 antenatal women attending the outpatient department of Obstetrics and Gyanecology at Grant Government Hospital, Mumbai from January 2021 to February 2021 (two months) with the help of Health Care Person. This questionnaire was designed to explore KAPs about the available forms of Family planning methods. The data was analysed with dependant variables to be knowledge, attitude and practices of contraceptive methods and the independent variables being age, residency, religion, educational status, occupation, number of pregnancies and socio-economic status.

Discussion

Increasing program coverage and access of family planning will not be adequate unless all eligible women have satisfactory awareness or favorable attitude, and correctly and consistently practicing as per their need. Snowballing awareness/knowledge and favorable attitude for practicing family planning activities at all levels of eligible women are The Antenatal women were counselled regarding the use of contraceptive methods available, imparted the knowledge about the availability, benefits and side effects of the aforesaid methods, following which the women were ready to accept the methods. The women showed acceptance to barrier methods and female sterilization. The women were also counselled for the emerging new contraception and emergency contraceptives.

The awareness of MTP Act and impact of legalizing the abortion is increasing the society and the increasing number of service rendered through the government establishment underlines the increasing faith in the system. The chief reason of MTP is failure of contraception. This fact highlights the huge unmet need of contraception and counselling. The permanent method of contraception in the form of Tubal ligation is increasing as a choice of contraception after MTP. Still the religious differences are apparent in availing the MTP services and needs to be addressed tactfully [12].

These women were asked about their knowledge and awareness of contraception and pacing and their wishes regarding further childbearing. After ascertaining their wish, they were counseled regarding the various methods available (cafeteria approach), and the most suitable one for each one were individualised. Primiparas were counseled to rather insert an IUD or injectable contraceptives for birth spacing as it is not patient compliance dependent. Increased emphasis was laid on permanent methods of contraception (tubal ligation and vasectomy) for multiparous women (para 2 and above). Those multiparous women refusing sterilization operations were then counseled regarding the other temporary methods of contraception.

The demographic, socioeconomic, and educational/ professional background of the women and their partners were recorded. Parity and number of antenatal visits of these women, their knowledge/awareness of contraception, their responses to contraceptive counseling, and the reasons for refusal were also charted. A prepared data sheet that included all these information was used to analyze each woman’s data and response [13].

Women’s empowerment is a key factor in promoting contraceptive choice. This empowerment should not only be addressed at the education/employment level but more so at the family/community/religious levels. Involvement of community leaders is essential to overcome the hurdles. Efforts should also be directed at improving male education/ employment and, especially, male awareness [13]. The pandemic that lead to a major national lockdown with availability of only emergency services further limited the percentage of contraceptive methods available.

The National Family Planning Programmes have made available numerous contraception to the population and is encouraging more use of such contraceptive methods.

However still family planning is an important challenge with COVID 19 pandemic, because of the restrictions imposed by the administration.

Conclusion

The results highlight the importance of social awareness, women education and women empowerment in order to increase the use of contraceptive methods available. The use of emergency contraceptives should be encouraged so that the number of unplanned pregnancy thereby leading to increased rates of unsafe abortions can be controlled. Although there are various programs that highlight the importance of family planning, still COVID 19 pandemic with the major challenge of lockdown and restrictions imposed for the containment of the infection and hence the survival of current population is a dilemma situation. Hence the general population in addition to the counselling of the family planning methods, need education like wearing of masks, hand sanitization and social distancing to combat this difficult and challenging pandemic. In order to control one infectious pandemic, we cannot overlook the hidden pandemic of population explosion that waits to further impose threat in our future. A proper mitigation of family planning is of utmost demand, although restraining of COVID 19 pandemic is also important.