Contraceptive use in Pakistan. Knowledge, attitude and family planning practices among rural married women of Ali Raza Abad, Lahore

List of contents

Abstract

Chapter 01 Introduction and Background knowledge:
Knowledge, Attitude and Practices of contraception:
Purpose Of The Study
Objective
Significance Of The Study
Research Question:

Chapter 02 Literature Review
Key definitions:

Chapter 03 Material and Methodology

Chapter 04 Analysis

Chapter 05 Discussion

Chapter 06 Conclusion
Recommendations
Limitation of the study:

Questionnaire

Refrences

ACKNOWLEDGEMENTS

I thank the never changing God, my Creator for granting me the strength and the divine health during the period of this study, and courage to complete this thesis. I pay my sincere gratitude to honorable my Principal Mr. Afzal, “Lahore school of Nursing” The University of Lahore

- My promoter, Mr. Muhammad Shahid Riaz, for his wise counsel, valuable guidance, constructive evaluation and sustained support and encouragement during this research
- My joint promoter, Sir Ali Waqas, for his guidance and continuous support.

I addition, I would like to acknowledge with gratitude the contribution of the following:

- My husband, Yasir Ali for his unconditional love, constant support, forbearance and patience.
- My colleagues and friends, for their support and encouragement during difficult times.

DEDICATION

I dedicate this thesis to:

My dear mom Mrs. Farhat Yasmin and late dad, Mr. Muhammad Bashir

who did not live to witness the completion of this thesis.

Their interests and enthusiasm in the education of all their children is greatly cherished and appreciated.

My loving husband, Yasir Ali

with thanx.

Abstract

Objective: To determine the awareness level, attitude about family planning practices in community women of Ali Raza bad Lahore.

Background: Pakistan is facing a vast challenge of poverty. About 45% of its inhabitants has limited approach to health services both public and private, particularly in rural areas where 65% of its population lives. Pakistan was included in between the six countries having more than half of the maternal deaths happening worldwide in 2008. Maternal and neonatal wellbeing is firmly included. Modern family planning method, are much effective in enhancing maternal wellbeing by preventing unplanned pregnancies in order to confirm healthy timing and spacing of births

Material and methodology: A cross sectional study was design to assess the knowledge, attitude and family planning practices among rural married women of Ali Raza Abad Lahore. A total of 200 women were selected from the married women who have children and an active in reproductive age life. Data was collected through questionnaire, 200 results were used to analyze.

Results: The study reveals the findings and showed that about more than half of the married women (56%) were had the knowledge about family planning methods. But only few (25%) respondents in the community were active in using family planning techniques.

Conclusion: The study shows the good knowledge and positive attitude of women regarding family planning; while negative response about practices.

KEY WORDS:

Contraception, knowledge, attitude, practice

Chapter 01 Introduction and Background knowledge:

Contraception is characterized as the utilization of strategies wanted to evade or space coming pregnancy (Indongo, 2007). “According to the World Health Organization family planning allows individuals and couples to attain willingly, number of children, on the basis of their choices so that advance the wellbeing and advantage of family gathering and after that offer effectively to the social change of a nation" (Pegu, Gaur, Sharma, & Singh, 2014).

Family arranging has two primary purposes; firstly, to have just the most loved number of youngsters and furthermore, suitable spaces of pregnancies (Sajid & Malik, 2010).

The population rate of Pakistan was 32.5 million in 1951, that time it was the fourteenth most packed nation on the world. Pakistan was the 6th most crowded nation in the world in 2013 (Epstein & Kronstadt, 2013). The existing population development rate is 2 percent. As indicated by estimations, Pakistan will turn into the fifth most populated nation in 2050 at its recent rate of population development (Epstein & Kronstadt, 2013).

Above circumstance demonstrates that it could be disturbing for the economy of nation, having already inadequate national resources. Currently, the population mass in Pakistan is 231 persons for each square kilometer (Epstein & Kronstadt, 2013). While birth and death rates have fallen in Pakistan in the course of the last various periods, the reduction in the death rate is much more speedy than the decrease in the birth rate (Smith, Ashford, Gribble, & Clifton, 2009). Subsequently, in 1981, life suspense at birth has increased from 63.4 years and in 2013 66.5 years for females and for males from 62.4 years to 64.6 years respectively. (Epstein & Kronstadt, 2013)

Pakistan is facing a vast challenge of poverty. About 45% of its inhabitants has limited approach to health services both public and private, particularly in rural areas where 65% of its population lives (Nalwadda, 2012). The country gaps faraway last on nearly all progress indicators, mainly with respect to maternal and child health. Stated in Pakistan that nearly 30000 women die yearly because of pregnancy and childbirth disorder (Mustafa et al., 2015).

Pakistan was included in between the six countries having more than half of the maternal deaths happening worldwide in 2008. Maternal and neonatal wellbeing is firmly included. Similarly, about 33% of neonates die because of maternal diseases and different issues in Pakistan associated with pregnancy and delivery (Azmat et al., 2015).

Modern family planning methods, are much effective in enhancing maternal wellbeing by preventing unplanned pregnancies in order to confirm healthy timing and spacing of births, only in form of 26% of contraception in Pakistan (Smith et al., 2009). Furthermore, the overall levels of family planning use in rural areas continue to stay very low (around 31%), as compared to 45% in urban areas (CHIDINMA & CAMPUS, 2014). Likewise, women from the poorest families and those having no education have the lowest contraceptive prevalence rate (CPR) (CHAUDHRY et al., 2015).

The growing development of population has become a vital widespread issue. Family planning plays a vital general wellbeing parts in managing fertility (population development) and decreasing mortality, especially maternal death (CHIDINMA & CAMPUS, 2014). In developing nations, there is still continue to increasing population growth and high death rates. In these same countries, contraception is still very low (Hogan et al., 2010).

Family planning has been measured an effective approach to enhance the health of the mother and the child and reducing mother and child death. Despite the fact that the reality of the matter is that contraception has expanded over a period of time, there is a Knowledge Attitude and Practice gap with respect to contraception (CHAUDHRY et al., 2015). The key reason of the study is to build the data of family planning techniques and improve among the people an attitude acceptable for application of contraceptive method.

Pakistan is a cultivated country, and about 64 percent of its inhabitants live in rural zones. Agriculture is crucial to the country’s economic progress and development (Azmat et al., 2015). In urban areas the consciousness of contraception is 60% (Sajid & Malik, 2010). The reason is that these ranges are sufficiently served by different family planning administration. There is a need of evaluation in our rural population so that our growth rate can be reduced to the objective level that is 2 / per year (Sajid & Malik, 2010).

Usually, distance between reproductive health facility in rural areas is greater than urban regions which makes access to services for rural ladies without transportation or finances much difficult (Mustafa et al., 2015).

According to Pegu ” about half of the population in the world of seven billion people is in or arriving their regenerative years, as a result there is great requirement for contraceptive use” (Pegu et al., 2014).

Contraceptive prevalence rate has been raised slowly from in 1990, 54 per cent to 70 for each penny in 2010 (Jabeen, Gul, Wazir, & Javed, 2012). Women who are existing in urban regions are 66% who are used modern contraceptive methods as compare to rural regions. So, focused struggles are necessary to operate all available resources in the public, private, and nongovernment regions (Azmat et al., 2015).

Knowledge, Attitude and Practices of contraception:

Knowledge and practice of family planning is intensely linked with larger volume of training, to work power commitment, to fruitfulness. Lady's knowledge and confidence concerning family planning is a major issue of contraception (Zhang et al., 2009). Family planning has significant effects in population changing aspects as unregulated fertility rate act the monetary upkeep of Pakistan (CHAUDHRY et al., 2015).

Contraceptive use has been measured a dynamic approach to build up the wellbeing of the mother and the kid and diminishing maternal and perinatal death (Zhang et al., 2009). Generally around 97%, of Pakistani ladies distinguish no less than one strategy for family arranging (Jabeen et al., 2012). The total contraceptive prevalence rate (CPR) of Pakistan is 29%. Therefore a wide gap is perceived between information of contraception and its usage (Pegu et al., 2014). The ladies who finished secondary school having no training, just 19 percent of them are utilizing preventative techniques. (Azmat et al., 2015).

In developing countries there is a solid and clear connection in the middle of larger amounts of training amongst ladies and littler family measure. It has been found that each year of young ladies' training has been diminished fruitfulness rates by 0.3 to 0.5 kids for every lady. This is a mainly observable association for Pakistan, where for the mostly ladies have no training, around 65 percent in DHS review (Sajid & Malik, 2010).

Presently, one in third married ladies in Pakistan are utilizing minimum a single contraceptive strategy, that is a five percent increase from 2006 to 2007. Mostly women who are using contraceptive methods select a modern method (26% of currently married women) and 9 percent use traditional tecniques. Though, in Pakistan, an a portion of ladies in the generative age group (15 – 49 years) have unmet requirements for family planning (CHAUDHRY et al., 2015).

Family arranging has vast impact on wellbeing of the ladies. Prophylactic use includes in lessening maternal demise and increments maternal wellbeing by counteracting undesirable and high danger pregnancies and staying away from unstable premature births. Some family arranging strategies likewise enhance ladies' wellbeing by protective against certain cancers and health problems (Pegu et al., 2014).

In Pakistan in the course of the most recent fifty years, family arranging use has been expanded. However, the expansion condition has been moderate, almost 0.5% every year in the course of the most recent fifty years (Hogmark, Klingberg-Allvin, Gemzell-Danielsson, Ohlsson, & Essén, 2013).

The reasons behind not using any family orchestrating methodologies are lack of data and education, religious conviction and worry of responses (Prachi, Das, Ankur, Shipra, & Binita, 2008). Prophylactic organizations, which consolidate managing, information, preparing, system movement and follow up, should be available to both men and women (Azmat et al., 2015).

Purpose Of The Study

The main purpose of the study was to assess Knowledge, Attitude and family planning practices among rural married women of Lahore

Objective

The objective of the study was to:

- To determine the awareness level, attitude about family planning practices in community women of Ali Raza bad Lahore.

Significance Of The Study

The significance of this was clear and beneficial for everyone, because Pakistan is the most populous country in the world, she has the poorest inhibitants, she has poor reproductive health indicator. The purpose of the study was to health and made awareness among women in the rural areas of the country about family planning. The people are aware of about the family planning especially women which has been ignored in the rural areas. Over population unemployment, poverty, illiteracy and much more elements like these are directly contribute to birth rate. Promotion of family planning is one of the best options to reduced the above mentioned factors which has been solved by determining the awareness and attitude in the existing rural community.

Research Question:

What is the level of knowledge, attitude and family planning practices among rural married women of Lahore?

Chapter 02 Literature Review

Different studies have identified the rates and use of contraceptives from different perspectives. According to Azmat et al 2015 “use of modern contraceptive method among currently married women is 22%; whereas the use of contraception is even lower among rural residents (17.7%) and among women of lower levels of education”.

Pakistan remains a dominatingly rustic nation with an unevenly disseminated populace. As per a study in 2006-07 DHS 33% of the ladies lived in urban areas, while 66% are rural residents. WHO research demonstrates that every year, more than a large portion of a million ladies overall passed away due to pregnancy related complications (Azmat et al., 2015).

Most studies uncovered training is the most affecting component. It could have direct impact on fertility, since it influences the state of mind and conduct examples of the people (Prachi et al., 2008). A few Knowledge, Attitude and Practice Surveys have been completed including involving different population groups (Hogmark et al., 2013).

The level of wellbeing among Pakistani ladies is alarmingly poor and adds to both maternal and youngster morbidity and mortality (Mustafa et al., 2015). A few appraisals from late studies recommend that the lifetime danger of maternal death for Pakistani ladies is one in 93. Just 50% of the deliveries in Pakistan happen in the presence of skilled health provider (Mustafa et al., 2015). Besides, the PDHS 2012-13 records a huge unmet requirement for contraception at 20%. As per an appraisal, 890,000 affected premature births happen yearly in Pakistan whereby one in seven pregnancies is ended by induced abortion performed in clandestine conditions and abortion are used as a source to control fertility and as a result of failed contraceptive use (Mustafa et al., 2015).

Pakistan is associated with the International Conference on Population and Development (ICPD). To accomplish the nation's dedication to the worldwide MDGs to bring down the fruitfulness rate, moderate the quick populace development, and decrease maternal, neonatal, and kid dreariness and mortality, the administration of Pakistan promised to expand the prophylactic commonness rate to 55% by 2015 (Azmat et al., 2015).

Nonetheless, with the prevailing situation, it is faulty that this objective will be accomplished, in spite of the fact that the legislature of Pakistan is still the major family planning supplier in Pakistan (47%) while 23% of the need is satisfied by the private part. Critically, 53% is supplied by the general population area, however their commitment in the present day contraceptive prevalence rate (CPR) is only 2.3% (Azmat et al., 2015).

According to Pegu et al., “Legitimate guiding of number of childe arranging essential in light of the fact that 27% of ladies are at danger of spontaneous pregnancy (Pegu et al., 2014).

Therefore according to CHAUDHRY et al., “knowledge, Attitude and Practice gap with respect to contraception is exceptionally apparent. The explanation behind not utilizing family arranging strategies are absence of knowledge and instruction and religious conviction (CHAUDHRY et al., 2015).

Key definitions:

- Knowledge: Consciousness of the nearness of family planning, its significance and value (Barclay & Murray, 1997)

- Attitude: Intention of utilizing family arranging techniques when a need emerges. Expecting to utilize or prescribe is measured as an positive disposition, and no reason as a negative attitude.

- Practice: Any earlier history of Contraceptive use utilization

Chapter 03 Material and Methodology

I was used cross-sectional design in research to assess knowledge, attitude and family planning practices among rural married women of Lahore . This study design was help me to assess the knowledge of married women in rural area Ali Raza bad about contraception. The target population was all married women (400) in Ali Raza bad Lahore. Only those married women who have children and an active reproductive life from the selected rural area Ali Raza bad Lahore was included in my research. Women who were unmarried, having no children and those who were not active in their reproductive life was excluded in my research. My sample size was 200 females was taken from rural area Ali Raza bad Lahore. The data was collected with convenient sampling technique. The following criteria was set to select the sample according to the demographic data of the participants was age, education, occupation, family income, duration of marriage life and number of children.

First of all I was get permission from ethical review committee Lahore school of nursing, The University of Lahore through a permission letter. Later, the community permission of Ali Raza bad was taken for conducting the research study. The participants was informed require information for the objective of my research project and their data confidentially is secure. Data was collected by set of 15 questions which was self administered questionnaire on likert scale adapted on 5 point likert-type scale ( from 1, strongly disagree to 5, strongly agree). Software Package statistical analysis SPSS version 21 was used for data analysis by Chi squre test.

According to formula my sample size was:

n=N/1+N (E) 2

n= sample size

N= Total population

E= Margin of error=0.05

N/1+400 (0.05)2

N/1+400 (0.0025)

400/1+1= 400/2

400/2 = 200 (sample size)

Chapter 04 Analysis

Two hundred copies of questionnaires were distributed to married women of reproductive age in Ali Raza bad community. The responses were collected and presented in frequency tables and percentages according to research questions. Data were analysed using descriptive statistics such as percentages, frequency, means and standard deviation for answering research questions and inferential statistics such as chi square analysis was used for testing hypothesis.

Socio demographic characteristics of the respondents:

n = 200

Frequency Table

Distribution of age

illustration not visible in this excerpt

Table 1.1

According to Table 1 shows that 48 (24%) of the respondents were within 18- 26 years; this was followed by the age group 27- 34 years 59 (29.5%); while 93 (46.5%) women were distributed in 35-42 years and above age groups.

[...]