Determinants of Contraceptive Utilization among Married Women

Review of Literature

Arbab et al., used a sample of 1130 Qatari married women aged 18-49 years [1]. They studied their viewpoint and practice of contraception and its related socio demographic factors to found the awareness of contraception among them. Questionnaire was used for the data collection. The average age of woman was 32.5 years with SD 7.6. They found that a large majority (94.6%) had the knowledge of contraception but of these only (64.9%) were in favour of it. Education played a significant role (P<0.001) as the level of education increased the knowledge of contraception increased but decreased the household income (p=0.002). Almost half of the women were using the contraceptives, which were significantly related with age, husband’s age, education level, income level, years of marriage and attitude to the family planning. Intrauterine device and pills were commonly used contraceptives. They also found that friends were biggest source of information about family planning methods (80%).

Minhas and Sekhon conducted a cross sectional community based descriptive study [2]. They used a sample of 206 women with the age interval of 15-49 and they found the anticipated prevalence of contraception was 50%. They considered an error margin of 10% with finite correction and non-response of 10% and also 95% CI. The sample of 90 married women of reproductive age group was calculated. The study was conducted after drawing the sample of women residing at the village with simple random sampling method. They found the result that only 55 (61.11%) were practiced contraception. In this case only three (3.33) couples were used condom while in remaining case 52 (57.58), wife had undergone tubectomy. Hence, they concluded with their study that most commonly used method of contraception was tubectomy and psychosocial factors played a significant role in decision making.

Ali et al. conducted a survey to estimate the association of prevalence and factors with the practice of present contraceptive methods among recently married women of age group (15-49) years [3]. The area of response was District Naushahro Feroze. The conducted survey was a community based cross sectional survey from May to June 2000. The data was collected regarding socio-demographic factors and economic condition through interview of 420 women which was recently married and belonged to reproductive age group. They also studied the source of information and the purpose of using modern contraceptive techniques. The result showed that the prevalence of the method of contraceptive was 27.9%. Finally, they applied multiple logistic regression and found that with husband agreement (OR, 5.4; 95% CI 2.2-13.2). They also found a significantly association of the women employment status (OR, 2.5; 95% CI 1.2-5.2) and the women went alone to a health care provider (OR, 1.4; 95% CI 1.1-2.4) with the practice of latest contraceptive methods. Husband education also played a significant role for the use of modern contraceptive. Similarly, women who had 2 or less children were less likely in favor of family planning as compared to who had 3 or more children. Finally, they reached to a conclusion that the use of latest discovered contraceptive was very low. Similarly there were also significant association between socio-demographic factors of women and modern contraceptive methods. Couples education and small group discussions related to awareness of family planning and the use of the practice of modern contraceptive methods may be helpful for creating awareness in the district.

Globally, round about 350,000 women die each year while almost 50 million suffer disability and illness due to the complications of childbirth and pregnancy. Ethiopia is one of the top six countries that almost contribute 50% of the maternal deaths. It is widely believed that due to the advancement in technology, modern contraceptive methods influence fertility reduction. Lakew et al., conducted a secondary survey of a sample of 10,204 women of reproductive age included in Ethiopia Demographic and Health survey (DHS) conducted in 2011 [4]. The sample was selected by using a two-stage stratified sampling technique to estimate the national, regional rural and urban representative estimates for demographic indicators and key health. They used bivariate and multivariate logistic regression to determine the associated factors in Ethiopia and also to measure the prevalence of the latest contraceptive use. They found the result that being in monogamous relationship, wealthy, employed; more educated and visited by health worker intensely predicted the modern contraceptive use. While on the other hand, being in polygamous relationship, older age, living in rural areas were found negatively influenced on modern contraceptive use. It was also revealed by the analyses that eastern and western parts of the country had lower prevalence of latest contraceptive use than central and southwestern parts of the country. They also concluded that women education and community conservation program should be given topmost priority.

According to population Ethiopia is at second place in Africa, it also has highest fertility rate and fast population growth rate. So Mohammed et al., conducted a community based survey [5]. It was a cross-sectional study conducted from 15 of August to September 1, 2010. A sample of 851 married women aged from 18-45 years was selected. Area of response was Debre Birhan District and they used multistage sampling technique to select the sample. The data was collected by using a pre-tested structured questionnaire. SPSS (16.0) was used to perform bivariate and multivariate logistic regression. They found that contraceptive prevalence rate was 46.9% among the currently married women. Result showed that the injectable method was most frequently used to stop the pregnancy with a 62.9% ratio while only 0.8% was in the favor of female sterilization method. 16.8% people were used intrauterine devices. Followed by pills 14%, norplant 4.3% and male condom 1.2%. Multiple logistic regressions exhibited that there was a significant association of number of living children and family planning with use of contraceptive methods. Hence the conducted survey reached to a conclusion that in the district the use of modern contraceptive methods was very high. Similarly husband approval for contraceptive and couple’s discussion both were significantly associated with contraceptive use. People should give attention to family planning.

A large proportion of girls in India gets married at their adolescent age, so they experience the risk of childbirth before the legal age. According to Jejeebhoy research 34 percent girls in India got married at adolescent age and apparently sexually active. Kamla-Raj conducted a survey in India to study the knowledge of women who currently married at their teenage. The data of National Family Health Survey 1998-99 have been used for this survey. A sample of 6,888 married women belonged to 15-19 years old, who was currently living with their husband was selected. Cross tabulation, percentage distribution and logistic regression was used to find the required results. They found that even in the modern world 12 percent of currently married adolescent women (CMAW) do not know about the contraceptive methods. Age, standard of living, place of residence and husband’s education was the factors which played an important role for those women who have knowledge about all the modern contraceptive methods. There were only 10% CMAW who were using currently all the contraceptive methods and this ratio was increasing constantly as the number of living children was increasing. But with the awareness of women about all the contraceptive methods this ratio was increased much faster than before. Hence the living children and the women awareness about contraception was the most significant factors which played an important role for the use of contraception. Moreover, communication between the couple about the family planning and exposure to mass media was also played a significant role. Hence it was concluded that there was a need declared all the knowledge among the CMAW about the family planning methods, so the women can decide the most affordable and suitable method which will helpful for the fertility decline in the country.

Khan et al., conducted a survey to observe various demographic and socio-economic factors related with the use of contraception among the juvenile of Bangladesh [6]. There were multifarious factors that impact on the contraceptive use. Therefore, greater attention was given to find the more influencing factors for the use of contraceptive methods as well as the growth of population. The data used for the study was derived from the 2007 Bangladesh Demographic and Health Survey (National Institute of Population Research and Training (NIPORT), 2009) the period of data collected was 24 March to 11 August 2007. To find the affected factors to the use of contraception cross tabulation and logistic regression analysis was used. Both the cross-tabulation and logistic regression analysis declared that respondent age, age at first marriage and type of place of response was the factors which had significant effect on the use of contraception. The survey also showed that adolescents who have no living child tended to less use of contraceptive methods than those who have at least one living child.

Today the world population is nearly around 7 billion and according to expectation it will reach to 8 billion till 2025. India shelters 1.2 billion and it is predicted to reach 1.53 billion till the year 2015. There are multifarious reasons for this uncontrolled population growth, but the unregulated fertility is at top. The reason is that numerous times this unregulated fertility leads to unintended pregnancies due to the lack of knowledge about currently contraceptive methods, such pregnancies are leading to unwanted births. Walvekar conducted a survey to find the determinants of contraceptive methods used by the married women inhabited in rural areas of Belgaum [7]. It was a cross sectional study conducted from a one-year interval May 2008 to May 2009. A sample of 2106 married women was selected by using systematic random sampling from the rural areas of Belgaum. He applied the method of chi-square and found that the prevalence of the use of contraceptive was 59.92% among which temporary methods was used by 14.25%. the study showed that the significant determinants of contraceptive use were socio- economic status, age of married women, duration of married life, age at first pregnancy, type of family and the total number of children with p value less than 0.05. The unassociated factors with the use of contraceptive methods were religion, education of both men and women and the age at marriage (p>0.05). Hence, he concluded that the number of children were the main reason behind the decision of the use of contraceptive methods.

Despite availability of the family planning about 30% of couples do not prefer to use any method of contraception. Many demographic issues have major effect on the use of contraceptive methods such as education, age, number of living children and residential region also health concern, failure of the method and health concern effects on the use of contraceptive methods. Tehrani et al., conducted a survey to find the influenced factors on the contraceptive use [8]. Date was collected by using a questionnaire from university hospitals of Tehran. The questionnaire was included different questions about socio-demographic factors. A total sample of 4177 women of reproductive age was selected. Only those women were selected who just gave birth in hospitals of Tehran and at least enrolled one living child for the present study. With the use of logistic regression model most significant factors in Tehran was founded. Results declared that age, husband’s level of education, women’s level of education and previous awareness with contraceptive methods was most significant factors for the contraceptive use. Finally, it was recommended that government should pay more attention to the family planning services by giving more attention and providing more professional clinics.

Due to the fast increase in population of Bangladesh, different organizations paid attention to control this fast- growing population. For such purpose, they developed different family planning programs. Most of the programs was developed to motivate the females to use female methods of contraception to stop this fastly increasing population. Both men and women shared the decision equally, but such organization have not paid attention on the role of men as a decision maker. In the modern world the role of male involvement for the decision of contraceptive use is becoming very important. For such purpose Mosiur, et al., conducted a survey to inspect the contribution of men for both as a contraceptive user or as a supportive partner of women for the use of contraceptive methods in Rajshahi, a district of Bangladesh [9]. The data was collected through a field survey in both rural and urban areas of Rajshahi district. A sample of 500 married male aged 15-64 years was collected by interview method. Three villages were selected for selection of data from rural areas and urban area data was selected from Rajpara Thana of Metropolitan City Corporation of Rajshahi district. The method of graphical representation, percentage distribution and logistic regression were used for analysis of the survey. The results depicted that in the response area the knowledge and use of contraception methods were very low. The results exhibit that the user rate of female contraceptive methods (pill at 33.8%) is still much higher as compare to all male contraceptive user (e.g. condom at 17%). Hence the results of this study cleared that men liked to thrust the responsibilities of contraceptive use on women. To measure the response of demographic and socio-economic factors the technique of logistic regression was used. The results clarified that different significant factors such as education, fertility preference, residence, knowledge about AIDS and mass media facility influenced on the contraceptive use among men. The men’s opposition to use contraceptive methods was also one of the biggest reasons of not using the contraceptive method.

From more than five decades India has been giving to much importance to family planning programs. Both governmental and non-governmental activities are rising to promote the activities of family planning. Family planning programs directed to the use of contraceptive methods and helps not only to couples, but also to each individual to avoid from the unwanted births. It also helps to regulate the duration between pregnancies, to control the relation between the age of parents and the time at which birth occur and also to decide the total number of children. Kamla-Raj conducted a demographic survey to assess the knowledge of family planning program among the Hindu Gujjars of Delhi. Because the majority of Gujjar’s lives in rural areas so five Gujjar predominated villages were selected randomly for the response area. A total sample of 558 ever-married Gujjar women aged from 15-49 years was selected through scheduled interviews. The knowledge of family planning methods among Gujjars was predominant. It was exhibited that the majority of the women was in favour of the contraceptive use. However, a gap was founded between the knowledge and the use of contraceptive methods. The most significant contraceptive method among Gujjars was female sterilization.

According to the Uganda Demographic and Health Survey (UDHS) of 2011, the total fertility rate (TFR) is very high at 6.2 children per women. The reason of the high (TFR) is because Uganda has a very large young population (52% are less than 15 years and 17% are of age 15-24). According to the last survey, the contraceptive prevalence rate (CPR) is also very low in Uganda as compared to her neighbor countries. According to Blanc et al., there was a lot of experimentation for contraceptive use among both married and unmarried young women in developing countries [10]. The use of contraception is also inconsistent for the young women in developing countries because women of adolescent age face many hurdles for using the services of family planning due to embarrassment, cost, fear and lack of knowledge. Even in Uganda only 14% of married women under age 15-24 and over all 10% Ugandan women used contraceptive methods. Asiimwe et al., conducted a survey to measure the difference of socio-demographic factors related with contraceptive use between the young women and older women in Uganda. They developed a hypothesis that all the socio-demographic factors associated with the use of contraceptive methods have different impact on married women of two different age groups 15-24 years and 25-34 years. To test this hypothesis data was selected from Uganda Demographic and Health Survey (UDHS) of 2006 and 2011. The response population was non-pregnant married women of age 15-34. One year before the survey the respondent women were sexually active. A sample of 2,802 women and 2,814 women was selected simultaneously from 2006 and 2011. The logistic regression was applied to measure association of contraception use for each group of women in each year. The results depicted that for the younger married women age 15-24 year the significant factors associated factors with the use of modern contraceptive method were residence and desire for children for both the years. While on the other hand, significant factors related with contraceptive use for the older age group were household health, desire for children and education level for both rounds. Hence the results suggested that secondary education for women and livelihood of population should be improved. Similarly, family planning programs should be boosted to increase the knowledge of young married women and to meet their needs in the rural areas of Uganda.

Family planning played a vital role to protecting women not only from gestation (pregnancy) and its associated complications, but it also became the reason of child, infant and maternal morbidity and mortality. It also played big role to reduce the abortion cases by preventing women from mistimed and unwanted pregnancies. Despite of the huge investment on family planning to reduce the infant mortality rate, number of deaths increasing in many developing countries. According to survey each year almost 47000 deaths occurred in developing countries just because of 22 million unsafe abortions. It has been also estimated that almost one third of these maternal deaths can be reduced by using proper contraceptive method through ceasing the unwanted pregnancy. In many developing countries about 222 million women thought that they have poor facilities of family planning and lack of knowledge for the selection of proper contraceptive method. Ali et al., conducted a survey to develop a global research agenda for the guidance of women to invest money and to satisfy the large unmet quality for the modern method of contraception [11]. For such survey a team of experts on contraception were called and they were asked to rank the needed types of research and the knowledge gaps that required to be filled. In next step experts were then asked to score the given topics of research according to likelihood. Highest score given to topics were 15.

At the end the experts reached to a conclusion and gave top ranking to research on making the implementation and integration of health services better. They also gave priority to improving the health system that will support family planning services. The results of this exercise may help the women for taking better decision for the selection of contraceptive method. It will also help the funding agencies to focus on the exact needed requirements to make the family planning services better.

In modern era, the facilities to restrict the fertility have become more authentic and much safer. With the advancement women have more easily access to the contraceptive methods and also, they are more motivated to limit the fertility. According to the survey, total fertility declined to 2.55 in 2005-10 which was at 5.0 in 1950-55. But in sub- Saharan women have less access and less motivation than other countries of the world. From a very high total fertility 6.5 in the sub continentals in 1950 it only declined to 5.2 by 2010. Despite of the fast-growing practice of contraceptive use worldwide it remains very low in subcontinent of Africa. Lauro conduct research to measure the abortion and the use of contraceptive in Sub-Saharan Africa [12]. The reason behind the study was to check their motivation and planning about their families. Based on the available evidence the use of abortion in sub-Saharan Africa was used as a substitute of the contraceptive methods [13, 14].

Even in some regions the use of abortion surpasses the contraceptive use. Some surveys and data sets indicated that not only adolescent women practiced the abortion, but it also occurred in older age. In multifarious cities of sub-Saharan especially where access to clinical abortion was easily available and use of contraceptive methods was very low, the method of abortion was used as a method to limit the births. Particularly in rural areas, instead of using the contraception women were regularly resorted to abortion where the risk of deaths was very high due to the poor facilities. Hence it was concluded that that abortion was the mostly used source for the family planning and it will remain likely to continue within sub-Saharan Africa.