Socio-Biological Determinants of Contraceptive Practice in A District of West Bengal, India: An Appraisal

Introduction:

It is now universally accepted that family planning services are essential to promoting birth spacing to reduce maternal and infant mortality.¹It has been estimated that if family planning services were more widely available,up to 42% of maternal deaths could be averted in developing countries. In demographic transition, the two concepts namely “population stabilization or zero growth” and “replacement level fertility or low growth momentum” are important. Both concepts match if the annual growth (CBR-CDR) is below 1 percent and children ever born (CEB) to women in 15-49 ages is about 2.1.³ Although India has the distinction of initiating an official family planning programme way back in 1952,but most couples in India adopt a terminal method after they have had three or more children, and current family planning users are by and large, those who have achieved their desired family size and do not want any additional children. Further due to emphasis on sterilization, spacing methods have not been actively promoted nor are they easily available to those who are willing to adopt them.⁴Two thirds of French women used some of the contraception in 1994 but both male and female sterilization remain rare.⁵ The use of different contraceptive methods was studied in 5 western European countries, along with knowledge of fertility,motives for choice and perceptions held by women.⁶Studies in the Philippines showed perceptions of couples and practice were important for the fulfillment of desired family planning objectives.⁷The knowledge, attitude and practice (KAP)survey in a Mexican community revealed a wide gap between women’s fertility desires and their actual fertility pattern. Covert use of family planning methods was studied in Kenya⁹ which accounted for 6-20% of all contraceptive use and was more widespread if contraceptive use was low. So with the above perspective the present study was undertaken to assess the current status of contraceptive practice among the eligible couples and to determine the relevant factors influencing it,also to recommend suggestive measures for promotion of contraceptive acceptance.

Materials and Methods:

Community based cross-sectional observational study was carried out in 3 blocks and 2 Municipality areas of the Paschim Midnapur District in West Bengal in India.

The study was conducted for a period of 6 months .

Sampling technique: Stratified Multi stage random sampling.

Out of the total 19 districts in West Bengal, Paschim Midnapur District wasselected for the study purpose.

Out of total 29 blocks in the district, 3 blocks had been selected.

From each rural block 2 sub-centers and from each sub centre area, 2 villages had been selected randomly.

Out of total municipalities of the district, 2 municipality areas were selected. From each municipality, 2 wards had been selected randomly.

So total 12 villages (4 villages from each block) and 4 wards (2wards from one municipality) had been chosen for study purpose.

So total 16 areas had been selected throughout one district (3 blocks X 4 villages + 2 wards X 2 municipalities = 16).

Sample size: Based on present CPR (49.5%) of West Bengal, the minimum sample size comes to be 1735 (approx) considering allowable error 5%

Here, P = 49.5, Q = 51.5, Allowable error 5%

So, n = 4PQ/L² = 1735 (approx) Therefore, the sample size used in the study was 2000. From each village/ ward 125 eligible couples were selected to obtain a total sample size of 2,000.

Results:

The total study population was 2000 eligible couples. Outof total respondents, majority (1/3^rd) was in the age group of 24-29 years. Majority (46.9%) of the respondents belonged to illiterate and just literate group (Table-I).

Out of the total study population, 67.4% were practicing any method (modern or traditional) of contraception. Out of total contraceptive users, 38.8% had undergone ligation followed by Oral ContraceptivePill(19.4%) then 4.8%,3%, 1.3% used to practice traditional methods, Condom, CU-T respectively and only 0.1%adopted male sterilization (Fig-1).

Close

Fig 1:

Practicing of Different FP Methods by Study Population (N-2000)

Export to PPT

Table 2reflected the contribution of different modern methods in Couple protection rate. C.P.R (Couple protection rate) was 62.6% in the district of Paschim Midnapur. Out ofthe total modern method users, 62.1% had undergone ligation or vasectomy, 30.9%,4.9% and 2.1% of the respondents used to practice oral contraceptive pill, condom and Copper-T respectively.

The contraceptive practice was higher (77.5%) among higher age groups (36 and above) and lowest (30.4%) below 18 years age group and the difference was statistically significant. Contraceptive use was also more (71.1%) in nuclear families than joint families (27.7%) and the difference was also statistically significant (p<0.05). Contraceptive practice was highest (77.1%) among the couples who had two children followed by 76.1%, 71.6%, 53% and 37.4% among those who had 3, 4 +, one child and no child respectively.The significant difference also observed.

Contraceptive practice was highest (>70%) among higher educated groupand lowest among illiterate and just literate groups and the difference was statistically significant (Table-3)

Those who belonged to upper high and high socio economic status (S-E-S) group 90% used to practice contraceptive methods.76.1%, 71.1% and 66.8% practiced contraceptive methods by upper middle, lower and poor groups respectively(Fig-2).

Close

Fig 2:

Practice of F.P Methods according to S-E-S

Export to PPT

Figure-3 indicated area wise couple protection rate, in rural area, the average couple protection rate was 62.1%(76.4% in Chandrakona-II to 46% in Nayagram). But in urban areait was 64.2% (58.4% in Kharagpur to 70% in Midnapur Municipality).

Fig.3

Close

Fig 3:

Area Specific Couple protection rate

Export to PPT

Discussion:

The present Community based cross sectional study was conducted among 2000 eligible couplesin three rural blocks and two municipality areas in Paschim Midnapur district of West Bengal,India. The contraceptive prevalence rate (contraceptive practice by all methods) was found 67.4% in the present study which was less than NFHS-III of West Bengal (2005-06) where it was 71.2% but the rate of present study was higher than India figure(56.3%) of NFHS-III.¹²

The couple protection rate(contraceptive practice by modern methods) in the present study was higher (62.6%) than the NFHS-III of West Bengal findings of 49.5% and the National figure of 48.5%.^12,13

Out of all methods,ligation was on the top (38.8%), when considered only modern methods, its contribution was quite high (61.9%). It may be due to adoption of permanent method after completion of family size and also male dominant nature of Indian Society which also prevailed in the study area and corroborated with the finding of the previous study. ¹⁴

In the present study, acceptance of contraceptive methods was significantly higher among nuclear families, which did not corroborate with the findings of earlier study¹⁵ done in south Delhi by Singh et al. Contraceptive practice of the eligible couples increased to some extent with higher literacy level and higher socio-economic-status group. Similar observation also reported by the earlier studies^{15, 16}. The findings of the present study corroborated with the finding of the study done in Pakistan by Shah NM¹⁷ whereby it was reported that women’s education to be a significant variable,as the use increased from43% in the primary educated women to 70% in secondary and higher educated women.¹⁷

Kanoja also concluded that education was the main variable in the decision regarding family size and contraceptive awareness.¹⁸ The present study highlighted the area specific couple protection rate (46%- 76%).But oral pill users more (19.4%) andleast Cu-T adopters (1.3%) as spacing methods which did not corroborate with the findings of earlier study¹⁴ where Cu-T adopters were maximum(15.2%) and minimum(0.95 %) was Oral Contraceptive pill users.

In the present study, majority (38.9%) of couples had undergone ligation or vasectomy who had three and more children, these findings are against the small family norm (2 child norm) of India. Similar observations were noted by the earlier studies.¹⁴

The findings of the present study did not corroborate with the finding of the earlier study¹⁶ done at Nepal Medical College where permanent method adopters were only 8% but in the present study it was 38.9% quite higher than earlier on. This variation may be due to the fact that the earlier onewas clinic based study but the present study was community based.

In Pakistani study only 16% of married women had used modern method and proportion of female sterilization(4.0%) was higher than male sterilization(1%). ¹⁹ Trends in Family planning in Russia, (1994-2003) showed the use of traditional methods has remained steady²⁰and the similarity in prevalence across age groups that observed is consistent with findings from another study. ²¹

Prevalence of traditional methods was particularly high in the two main cities during the mid-1990s, consistent with a 1993 study from St Petersburg.²² Overall traditional methods continue to be used much more widely in Russia than in Western Europe.²³ But in the present study4.8% of the eligible couples used to practice traditional methods which was very less than West Bengal figure (21%) according to NFHS—III.¹² Another interesting fact that in India reversible forms of contraception(spacing methods) less used than permanent methods, regarding this issue findings of the present studycorroborated with the findings of a prospective study²⁴ done in Bihar showed only 6.8% of the women practiced spacing methods and tubal sterilization was the most popular method of contraception.

Conclusion:

Couple Protection rates as well as Contraceptive Prevalence rate are far greater in the district of Paschim Midnapur than national averages, but due to more emphasis on permanent methods, adoption of spacing method is neglected.So area specific intervention needed for promotionof spacing and permanent methods judiciously.

Behavior change Communication Campaigns to be strengthened for awareness generation among the beneficiaries for utilization of services in appropriate time to achieve small family norm for population stabilization.