alexa Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda District, West Bengal | OMICS International
ISSN: 2161-0711
Journal of Community Medicine & Health Education

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Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda District, West Bengal

Nazmul Hussain*

Research Scholar, Department of Geography, Aligarh Muslim University, Aligarh-202002

*Corresponding Author:
Nazmul Hussain
Research Scholar, Department of Geography
Aligarh Muslim University, Aligarh-202002
Tel: +91-9410060741
Email: [email protected]

Received date: September 09, 2011; Accepted date: November 16, 2011; Published date: November 18, 2011

Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda District, West Bengal. J Community Med Health Edu 1:102. doi: 10.4172/jcmhe.1000102

Copyright: © 2011 Hussain N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

The demographic profile of India is characterized by one of the high levels of fertility, low ages at marriage and relatively low contraceptive prevalence. The present paper aims at analyzing the level of awareness and adoption of family welfare methods, assessing the source of information and ascertaining the reasons of non-acceptance. Our study was planned to know the contraceptive practices among females in the reproductive age groups in rural area of Malda, West Bengal. The study used data collected from 2587 married women (age 15 to 44) were selected through systematic random sampling techniques. Data were analyzed by simple percentage for easy understanding of the problem. The findings of the study Revealed that the level of knowledge of family planning were high, 98.69 per cent. However, the actual practice of family planning methods was found to be low where only 55.28 per cent were using any family planning method in their life span. The substantial variations in awareness as well as in adoption of contraceptive methods have been observed across the various societies, castes and religious groups in this study. On an average awareness level accounts for 78.18 per cent and adoption rate 68.73 per cent. The concerted effort is needed from Governmental, Non- governmental and Multimedia organizations for enhancing the awareness about the family welfare programme so that it could lead automatic enhancement in adoption rate. The behaviour related to reproduction is determined by cultural and religious values in some communities. No significant association of contraceptive usages was observed with age of marriage and literacy. A statistically significant association of contraceptive usage was seen with number of living children, religion and the age of female.

Keywords

Adoption; Contraceptive; Family Welfare; Family; Joint; Knowledge; Methods and Nuclear.

Introduction

One out of six people on this globe live in India. It occupies second place after China. More so, the population of India expected to exceed of that of China by year 2045. The country has steady population growth has put tremendous pressure on the land and natural resources and has strained them. As the population of the developing countries increase day after day, most of the people residing in the developing countries like India face economic and social unfairness which leads to poverty [1]. Population explosion has been India’s major problem since Independence due to its high fertility. Government has been taking various steps to combat this problem. Adoption of family planning methods is one of the best solutions to tackle the problem of high fertility and ultimately lead to population explosion. Modern contraception has been one of the several paths for people to control the high fertility and large size of the family. India is the first country in the world officially adopted the Family Planning Programme in 1952. Rao [2] argued that in spite of political commitment for the Central Government funded National Family Planning Programme, the birth rate has not come down as desired. A lot of changes have been made to this programme to make it more acceptable and accessible to the larger section of the society. Government goes to the extent of monitory benefits for those keeping their family size small. However, fifty years later this has not prevented the population touching the one billion mark. It is obvious that despite good intentions and concerted efforts the state has failed in controlling our population. Considering the seriousness of the situation it is appropriate to introspect and ascertain as to what went wrong. The National Family Welfare Programme was launched to promote responsible and planned parenthood through voluntary family planning methods. Couples have the choice of adopting temporary or preventive measures. Facilities for medical termination of pregnancies in certain circumstances are also available. The use of contraceptives has increased in recent period. Family planning programs have been the centerpiece of government efforts to reduce fertility. These programs, which provide access to contraceptive information and services, make it easier for couples to plan the number of children that they would like to have. In an effort to lower the desired family size, they also help to spread the idea that birth control is within the realm of human choice and they provide information about the benefits of small families [3]. Family planning could prevent as many as one in every three maternal deaths by allowing women to delay motherhood, space birth, avoid unintended pregnancies and abortion and stop childbearing when they reached their desired family size [4]. A WHO expert committee has defined five methods in 1975 to evaluate the success of Family Planning Programme. One of them is the evaluation of knowledge, attitude, motivation and behavior among people. The knowledge and attitude of people towards Family Planning methods are important determinants in the adoption of Family Planning methods [5]. Much is known about womens’ role in the adoption of Family Planning methods. Females have often been neglected in both Family Planning programme and in surveys used to design and evaluate such programmes. But the reproductive and child health programme of the Government of India has felt the need for involving women in Family Planning Programme. Since women are not the dominant decision makers in India family system as Indian society is patriarchal, it is prudent to discover the knowledge, perception, attitudes and contraceptive adoption of women and improve their involvement in reproductive health needs of family.

Women attitude is much more important in the adoption of temporary methods of contraception and also in limiting the family size. Many rural women are reportedly reluctant to accept any method of contraception. Several studies also revealed that rural women who were unwilling to accept family planning methods were concerned about child survival and viewed children as a source of support in old age [6]. The perceptions and the behaviour related to reproduction are strongly, even predominantly, determined by prevailing cultural and religious values [7]. Ntozi and Kabera [8] found that the low use of modern methods of contraception was caused by the lack of knowledge of supply sources, low education, low levels of employment outside the home, unavailability of supplies and cultures. The focus of this study is to analyze the demographic and socio-economic factors influencing contraceptive knowledge and use. Understanding the pattern of contraceptive use among married women is very important in relation to designing programs and policies to control fertility in order to maintain a low fertility level.

In view of the above narrated facts, it was decided to study the knowledge, attitude and adoption of married women regarding the adoption of Family Planning methods. As India is a country of great diversities of religion, culture, socio-economic status and literacy so there is a varied range of attitude and perception of the people towards the family planning. These diversities exist even within the region, states and even district also. Various studies have been done to know the contraceptive practices in different regions of the states and country. During the last few years, studies have documented that family planning service is influenced by various factors which includes demographic characteristics, psychological, knowledge and attitudinal factors and the like [9]. Above all the religion is one of the important factor influence the decision of adopting the family planning programme. The present study attempts to know the contraceptive practices among currently married women (CMW) in the reproductive age groups (15-44 years) in rural area of Malda district, West Bengal. To be specific, the paper aims at answering the question: the status of determines factors the family planning decision to the family and women in a particular.

This paper attempts to know the level of awareness and prevalence of methods of family planning among the female of the rural areas of Malda district, West Bengal. Researchers have found that many factors affect contraceptive use. The efforts have also been made to study the relationship of socio-economic determinants various factors i.e. age, education, total family income, occupation, religion, caste, and number of children and sons on to the level of knowledge and use of contraceptive practices. On the basis of above discussion the following questions will be attempted, what the factors are related to the contraceptive usage of reproductive age in Malda district of West Bengal, how far married women are informed about the methods of contraception.

The study was conducted in Malda district of West Bengal. Malda district is a centrally located district of West Bengal. Geographically, Malda district is extended between 24°40’20” and 25°32’8” North latitudes, and 87°45’50” and 88°28’10” East longitudes, according to the 2001 census the district is covering an area of about 3733 sq. km (4.2 per cent of the total geographical area of the state) and supporting 3.29 millions of people (4.1 per cent of the state population). Out of total district population 1.63 million are Muslim and 1.62 million Hindu. There is small number of others religious group’s people (Christians 8388, Sikhs 283, Buddhists 164, Jains 293 and others 23701). The district records about 92.68 per cent of the population is rural living over 1642 villages (including 44 uninhabited). The district is socio-culturally and economically one of the lagged behind districts in West Bengal. The district is inflicted with dire socio-economic and cultural disparities across the region and human groups as well. Malda district stands at bottom having lowest index of Human Development in the state [10].

Material and Methods

The study was carried out in rural area of Malda district, West Bengal. It was a cross sectional and descriptive study. The main data for this study has come from primary data source. The information for the present study has been collected from 2390 households, selected from 80 villages at 5 per cent from rural area of Malda district, West Bengal. Study was interview based one respondent from one household. A total of 2587 currently married women (CMW) who were in the reproductive age group of 15-44 years from the selected household of 2390.

For the purpose of collection of data a pre-coded structured interview schedule was prepared and then required data were collected from the women by direct interview method. The survey was conducted during January-March 2010. On an average, one interview lasted for about 45-50 minutes. All the selected households were interviewed, based upon a semi-structured pre-designed and pre-tested interview scheduled after taking consent from the subject. The study area is characterized by all castes and communities. The information pertaining to demographic and socio-economic characteristics of households, and attitudes of spouse regarding family planning acceptance, has been collected through in depth interviews with structured questionnaire. The respondents were categorized on the basis of their age, caste, occupation, education and income, etc. The data collected was analyzed by using percentages.

After the collection of data from the field, for some of the un coded information contained in the interview schedule, coding was done and then they were entered in the computer using the SPSS 12 for windows.

Results and Discussion

The following section gives a brief demographic and socio economic profile of the sample household and women of Malda district selected for the present study/survey.

Background characteristics of Household and women

Before going to discuss the family planning and its factor it is worthwhile to discuss the background characteristic of the survey households and the women under the survey. The study covered 2390 households from the rural areas of Malda district of West Bengal and it includes in total of 2587 currently married women (CMW) within 15-44 years age group. Among the sample households 9.69 per cent were from female-headed households. There 25.95 per cent of the households are complex family and the rest (74.05 per cent) are simple family. Majority (74.05 per cent) of women belonged to a simple family. Out of the total sample households (2390), 50.20 per cent (1200) household are Muslims while 1190 households (49.80 per cent) are drawn from non-Muslims. Table 1 shows that 69.34 per cent households belong to general castes 14.59 per cent people are OBC and remaining 16.06 per cent households are SC/ST. The average household size is 5.72 persons. The average monthly family income of the family ranges from rupees below 2000. Most of the respondents are farmer (46 per cent) as they are engaged in agriculture and allied activities, and 46 per cent respondents are labourers employed in primary sector. Only 8 per cent respondents are engaged in secondary and tertiary sectors. The percentage distribution of ever-married women by background characteristics is given in Table 1.

Households Per cent Currently Married Women
(15-44 Years)
Per cent
Household headship Age
Male 90.08 15-24 22.61
Female 9.92 25-34 44.80
Nature of the Households   35-44 32.59
Simple 74.05 Education
Complex 25.95 Illiterate 44.87
Religion Below Primary 9.34
Non-Muslim 49.80 Primary 20.36
Muslim 50.20 Middle 9.66
Castes High School 11.09
Gen 69.34 Intermediate 2.50
OBC 14.59 Graduation and Above 2.18
ST/SC 16.06 Occupations
Habitation Type Farmer 1.82
Kaccha 43.05 Agricultural Labours 9.30
Pucca 27.14 Non-Agricultural Laboures 7.01
Mixed 26.56 Business 0.86
Jhopri 3.24 HHBW 15.60
Average Household Size 5.72 Service 4.08
    Marginal Workers 30.30
Sex Ratio 925 Unemployed/ House Wives 31.02
Household Income Mean age Marriage 20.09
Below 2 000 13.93 Mean Age of Pregnancy
2001-5000 36.90 Below 18 25.09
5001-10000 35.40 18-21 48.51
10000-15000 9.08 22-25 18.32
Above 15000 4.69 Above 25 8.08

Table 1: Background Characteristics of Survey Household and Currently Married Women in Rural Malda, West Bengal.

  Knowledge Adaptation
No. Per cent No Per cent
Yes 2553 98.69 1430 55.28
No 34 1.31 1157 44.72
Total 2587 100.00 2587 100.00

Table 2: Knowledge and Adoption about Family Planning Methods in Rural Areas of Malda District, 2010.

Source of Knowledge YES
No. Per cent
Radio 965 67.48
TV 996 69.65
Paper 312 21.82
Film 84 5.87
Family 261 18.25
Gov. Employees 397 27.76
NGO 213 14.90
Other 965 67.48

Table 3: Sources of Knowledge about Family Welfare Methods in Rural Areas of Malda District, West Bengal (2010).

The age wise distribution of currently married women (CMW) shows that slightly more than a fifth (22.61 per cent) of women are belongs to the age group of 15-24 years, 44.80 per cent and 32.59 per cent are belongs to the age of 25-34 and 35-44 years of age respectively. Most women were illiterate (44.87 per cent) and only 2.18 per cent of them are educated up to graduation and above.

About the occupation of the CMW 1.82 per cent are farmer, 16.31 per cent work as labourers 15.60 per cent are household based workers and 0.86 per cent and 4.08 per cent are fall in the category of business and services respectively. While 31.02 per cent of them are housewives which are the general trend in the district and other parts of the country. The computed mean are at first marriage for the CMW is 20.09 years and by age below 18, 25 per cent of the women are got their first pregnancy, by age 18-21 and 22-25, 48.51 per cent and 18.32 per cent get their first pregnancy while rest of the women are have their first pregnancy after 25 years of age.

Knowledge and Use of Contraceptive/Family Planning Methods

The provision of contraceptive information is fundamental to the ability of women to make informed choices about reproductive health decisions. The awareness about family planning methods is widespread among the women with 98.69 per cent of currently married women reporting the knowledge of at least one method of family planning. Knowledge about contraceptive methods among the women is generally high as 98.69 per cent currently married women know at least one method (Table 1). However the latest National family Health Survey (2005-06/NFHS-3) provides that the knowledge of family planning methods among currently married in rural Malda district is slightly low when it compare to the state of West Bengal (99.3 per cent) and country level (99.1 per cent). The current contraceptive use rate among married women age 15-44 is 55.28 per cent, while 44.72 per cent did not use the contraceptive. However according to the NFHS-3 the contraceptive prevalence in the state of West Bengal is 61.62 per cent and the national 56.31 per cent. Thus the rate of contraceptive use in study sample is found to be much lower than the state and national figures when it compared with NFHS-3. Even after four years (2005-06/ NFHS-3) the district show lower rate of the knowledge and current use of family planning methods of currently married women, it may due to the domination of SC, ST and Muslim population which also shows the backwardness of the district.

In addition to, the reasons is the illiteracy among the married women. As data reports large portion of the married women are illiterate they are unaware of the use of the contraception. At one time, all the religions of the world except Buddhism, are pro-natalist or ‘populationist’. It may, however, argued that all these religions like Judaism and Christianity, Islam and Hinduism have their origin in the distant past, which was a period of high mortality. As such the emphasis on prolific fertility was a functional adjustment to high mortality in order to ensure the continuation of the group. In contrary, though mortality has been tackled by the advance medical technology, old age perception of massage of populationist theory still persists and practiced among larger section of the people across all [11]. Of 2587 currently married women, 55.28 per cent were found to be ever users of contraception. Thus, it is seen that knowledge about the family planning method is much higher even the acceptance/use level is low. The gap between the knowledge and the use of the contraceptive methods is associated with religion, caste, age, education, occupations, etc.

In a country like India, where a large number of women are illiterate and have attained little or no formal school education, informal channels such as mass media plays an important role in bringing about modernization and thereby influencing and motivating women about their reproductive rights and choice. There are differentials in knowledge and use of contraceptive by different variables was observed. It is found that women in fact are aware of certain methods. The source of knowledge is interesting. Majority of women knew more than one source to obtain information about contraceptives. The major source of information about family planning is through both electronic media and government employees. As expected TV was the best source of knowledge following by radio and government workers. The radio which once upon a time used to be the main source of communication had losing its role to play in this matter. Watching television substantially increased the odds of women seeking knowledge of contraceptive. Among different sources of knowledge on contraception, health professional viz. Doctors, paramedical staff, Anganwadi workers PHC/ ASHAs and friends seem to be the main source for acquiring knowledge on family planning methods about 47.45 per cent of the respondents came to know about these methods through such government employees. It is followed by other sources i.e. relatives, husbands and friends with 16 per cent and NGOs initiatives with 40 per cent respectively.

Majority of the couples do not discuss matters related to family planning information, the use of spacing methods and sexual matters. The reasons for not discussing are that these issues are not as relevant and pertinent as financial matters, purchase of household items and education of children etc. [12]. The poor role of mass media among the unaware and non-acceptor female population could be due to the nonavailability of electronic media such as T.V. and radio and also, due to the poor literacy status they could not get much information from family welfare programme. Many rural women are reportedly reluctant to accept any method of contraception. Several studies also revealed that rural women who were unwilling to accept family planning methods were concerned about child survival and viewed children as a source of support in old age [6].

Education level of the women has a highly significant effect on the contraceptive use and it is expected that the better educated women may delay to marry and freely discuss about family planning with their partners or spouses. Meanwhile, a husband’s education had no significant effect on his wife’s current contraceptive use [13]. Women’s education also played an important role in relation to contraceptive use, as literate women were more likely to use contraceptives than illiterate women [14,15].They have more awareness and opportunities to have information about the contraception in order to have birth control. Increase in the education raised the likelihood to use contraception than did those without education [16], because low education level associate with lack of awareness and acceptability of family planning and these affects on the usage of contraceptives [17]. The level of education is positively and significantly associated with knowledge and adoption of family planning methods. Literacy, particularly female literacy is seen to influence awareness level and acceptance of family planning method in this study.

The study showed that a lack of formal education was identified as a key factor in use contraceptives. Out of the (2587) total women of the present study, 1224 (47.31per cent) was illiterate. Among the women who are illiterate, 97.71 per cent are aware of family planning methods as against 29.33 per cent users. Similarly, among the literate female respondents, more than 90 per cent are aware in comparison to only 72 per cent users (Table 4). The proportion of users is significantly higher among the literates as compared to illiterate respondents. The study demonstrates the positive relationship between education level of women and use of spacing methods. Other study/investigators [18,19] have also reported similar findings and NFHS-2 results are of similar tune. This indicates that not only the literacy but economic affordability of contraception may be a more important factor than knowledge. Reversible family planning methods like tubal ligation are heavily subsidized under the National Population Control Program in India which makes them much more affordable for women across economic groups.

  Educational Status Knowledge Using Not using Total
Women
No Per cent No Per cent No Per cent
Illiterate 1196 97.71 359 29.33 865 70.67 1224
Below Primary 234 98.73 139 58.65 98 41.35 237
Primary 516 98.85 411 78.74 111 21.26 522
Middle 249 99.20 207 82.47 44 17.53 251
High School 263 100.00 231 87.83 32 12.17 263
Intermediate 48 100.00 44 91.67 4 8.33 48
Graduation and Above 42 100.00 39 92.86 3 7.14 42
Total 2548 98.49 1430 55.28 1157 44.72 2587

Table 4: Education wise Response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

There is a clear-cut relationship between economic conditions and knowledge and adoption of family planning methods. Higher monthly income is consistently associated with higher knowledge and adoption of family welfare methods among the females of this study. The respondents having monthly income below Rs. 2000 have only 98.06 per cent have knowledge and 47.92 per cent acceptance whereas those having income Rs.2000-5000 per month showed 98.53 per cent knowledge and 50.26 per cent acceptance rate (Table 5). The acceptance of family welfare methods is observed to be directly proportional to the monthly family income of the acceptors in the study area. The highest rate of acceptance of family planning observed among highest income group (above 15000). The finding is supported by another study where the acceptance rate was highest in the higher income groups [20]. Socio-economic status is thus seen to have a definite impact on acceptance of methods of contraception.

Income Group Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
Below 2000 353 97.78 173 47.92 188 52.08 361
2000-5000 937 98.32 479 50.26 474 49.74 953
5001-10000 905 98.69 531 57.91 386 42.09 917
10000-15000 241 98.77 166 68.03 78 31.97 244
Above 15000 112 100.00 81 72.32 31 27.68 112
Total 2548 98.49 1430 55.28 1157 44.72 2587

Table 5: Income wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

Occupational Status Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
Farmer 47 97.92 32 66.67 16 33.33 48
Agri. Labour 252 96.92 159 61.15 101 38.85 260
Non-Agri Labour 168 97.67 118 68.60 54 31.40 172
Business 18 100.00 15 83.33 3 16.67 18
HHBW 404 99.26 271 66.58 136 33.42 407
Service 98 100.00 88 89.80 10 10.20 98
Marginal Worker 799 99.01 449 55.64 358 44.36 807
House Wives 762 98.07 298 38.35 479 61.65 777
Total 2548 98.49 1430 55.28 1157 44.72 2587

Table 6: Occupation wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

Occupation often influences the decision making for practicing contraceptives among women [21]. The employment factor increased the status of women and gives them a higher sense of freedom in the decision making process in the family. Women who were working exhibit a higher probability of using modern contraceptives than women with no work [17]. The Table 7 shows that the women from the service and business class adopt family planning more vigorously than the other sectors like agriculture and allied activities and labourers. The knowledge of family planning methods has been found highest in government sector while highest adoption rate is recorded in private service and business class.

  Age Group Knowledge Using Not using Total
Women
No Per cent No Per cent No Per cent
15-24 571 97.61 307 52.48 278 47.52 585
25-34 1143 98.62 647 55.82 512 44.18 1159
35-44 834 98.93 476 56.47 367 43.53 843
Total 2548 98.49 1430 55.28 1157 44.72 2587

Table 7: Age group wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

It is observed that the knowledge and acceptance of family planning methods increases systematically with an increase in age. Women’s age was a significant variable to contribute positively to contraceptive use [22]. From Table 7 results show that the knowledge of family planning methods increases constantly with the increase in age of the women. The overall contraceptive use rate was 55.28 per cent; this rate is 52.48 per cent were in the age group of 15-24 years, 55.82 per cent were among 25-34 years, which is the most crucial period in the reproductive span and 66.47 per cent of the age group of 35-44 years used contraceptive. In the present study, contraceptive acceptors are maximum in the higher age group (35-44 years) of CMW. For instance, the highest percentage of awareness (98.93 per cent) and use of contraception (56.47 per cent) have been found in the age group of 35-44 years. The proportion of users declined slightly among the lower age group (15- 24 years). It appears that adoption of methods for spacing between children increase with age, but as the respondents reach at the age of 35 years or above, they achieve their desired family size and a large number of them adopt the terminal methods or decide to adopt other methods of family planning. Low acceptance of contraception in the age group of 15-24 years might be due to the desire of newly married couples to prove their fertility first since contraceptive use is associated with side effects.

An analysis of the family type shows that about 74 per cent respondents are of simple families and remaining 26 per cent belong to complex families. Level of knowledge and adoption of the family planning methods is higher among the nuclear families as compared to those who come from the complex families. Almost 98.80 per cent female respondents from simple families as compared to 97.62 per cent females from complex families had the knowledge of family planning methods and 55.64 per cent of the women from the simple families and 54.24 per cent from complex families are the acceptors of family planning practices (Table 8). It has been observed that the respondents of simple families had higher percentage of family planning acceptance than that of complex families, this may probably due to the greater freedom and privacy. The use is higher in nuclear families than in joint families. The structures of joint Indian family constitute of more members and as the parents are hardly bothered about the responsibility of their children. It is the joint responsibility of head of the family and this is one of the reasons that use of contraception is low.

Type of Family Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
Simple Family 1893 98.80 1066 55.64 850 44.36 1916
Complex Family 655 97.62 364 54.25 307 45.75 671
Total 2548 98.49 1430 55.28 1157 44.72 2587

Table 8: Family type wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

 Religion Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
Non-Muslim 1228 98.16 743 59.39 508 40.61 1251
Muslim 1325 99.18 687 51.42 649 48.58 1336
Total 2553 98.69 1430 55.28 1157 44.72 2587

Table 9: Religion wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

Castes Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
General 1795 99.06 1028 56.73 784 43.27 1812
OBC 350 98.87 195 55.08 159 44.92 354
SC/ST 408 96.91 207 49.17 214 50.83 421
Total 2553 98.69 1430 55.28 1157 44.72 2587

Table 10: Caste wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

As India is a country of great diversities of religion. Various studies have been conducted to know the contraceptive practices in different regions of the states and country also. Social development levelsnotably educational levels and health patterns along with different familial systems and gender hierarchies have been argued to explain differences in reproductive behaviour [23-26]. It is also argued that reproductive behaviour is strongly influenced by the insecurities associated with minority-group status [7]. Religion is one of the most important factors responsible for determining the social and personal behaviour of the individual within the family. The association of religion with contraceptive behaviour had been documented in various other studies [27-29]. Religious groups in Malda district are not against the principle of family planning, as it can be seen from Table 8. Data shows that percentage of women knowing the any methods of contraception is higher among non-Muslims compared to Muslim women. However, from this result it cannot be firmly confirmed that non-Muslim CMW have higher knowledge, because here other factors are not taken into consideration. The main reason behind this difference is more involvement of non-Muslim women as family planning workers such as ASHA and Aganvadi workers that are more familiar to their own society, that’s why they successfully spread more awareness in their own community. This study is confirmed to previous studies which have indicated that Hindus have higher awareness and adoption level than Muslims [30,31]. Also, the prevalence of illiteracy among Muslim women is only aggravated their condition of not using the contraception.

Differential use of contraception also prevails across castes groups. The female of general castes showed higher knowledge and adoption of family welfare methods than the respondents of other castes. It is found that highest percentages of women (56.73 per cent) from general/forward caste are current users of family planning, followed by OBC (55.08 per cent) and SC/ST (49.17 per cent) women. It is because women from forward castes are mostly better educated, have desire for lesser number of children etc. Among SCs 96.91 per cent, among OBCs 98.87 per cent and among general caste 99.06 per cent have knowledge of contraception. Compared with various castes, percentage of tribal women having knowledge of contraception is quite low, and very low level of use of contraceptives which indicates that the message of family planning methods even after about five decades of its advocacy could not reach tribal population in India. Therefore, planners and policy makers should scrutinize earlier programs, and rectify and modify accordingly so that tribal women could have full choice of contraception.

Jayaraman [21] and Ojakaa [32] found that the number of living children is important factor affecting the current use of contraception. It has been observed from Table 11 that among the CMW when they do not have any child, about 5 percent uses contraception, when they have one child its use is 13 per cent, it increases to 22 per cent when they have two children and further increases to 27 percent when they have three or more children. Close observation into the result reveals that there is a huge difference in contraceptive use between women who knows all modern methods of contraception and those who knows only some of them. Among the women who knows all the modern methods of contraception, even if they do not have child, 7 per cent are using contraception, it increases to 19 per cent when they have one living child, it rises to 24 per cent when they have two living children and goes as high as to 48 per cent when they have three or more living children. On the other hand, among CMAW who do not know all the modern methods of contraception, when they have no living child, contraceptive use is about 4 percent, 7 per cent when they have one living child, 20 per cent when they have two living children, and increases to 22 per cent when they have three or more living children.

No. of living
Children
Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
0 0 167 96.53 81 46.82 92 53.18
1 1 360 98.90 188 51.65 176 48.35
2 2 732 99.19 419 56.78 319 43.22
3 3 568 98.27 328 56.75 250 43.25
4 4 378 98.69 217 56.66 166 43.34
5 5 224 97.82 128 55.90 101 44.10
5+ 5+ 119 97.54 69 56.56 53 43.44
Total Total 2548 98.49 1430 55.28 1157 44.72

Table 11: Living children wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

The results clearly indicates that there is constant increase in contraceptive use with the increase in number of living children, but its increase is much faster when they have knowledge of contraception. However, we also need to examine this fact from other angle. As, son preference in India is well established fact, so only having the larger number of children is not sufficient ground for contraceptive use. Hence we shall examine the relationship between number of living sons and knowledge of contraception with its use. Women who did not desire additional children were more likely to use contraception than those who desired additional children. Interestingly, those who wanted more children were more likely to use but were less likely to use a long-term method than those who did not want more children. As far as living children wise knowledge and adoption is concerned, it is found that the percentage of acceptance increases with an increase in number of living children, especially an increase in number of male children, thus showing a strong son preference. Table 12 shows that the acceptance rate is higher among women having 2 or more children. But it is surprising to note that both knowledge and acceptance rate decreases rapidly with increase in number of children above five. The reason attributable to this fact may be no requirement of contraceptive methods after achieving a target for desired number of children.

No. of living
son(s)
Knowledge Using Not using Total
No Per cent No Per cent No Per cent Women
0 511 97.15 104 19.77 422 80.23 526
1 654 98.49 333 50.15 331 49.85 664
2 798 98.76 525 64.98 283 35.02 808
2+ 585 99.32 469 79.63 120 20.37 589
  2548 98.49 1431 55.32 1156 44.68 2587

Table 12: Living Son (s) wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

In the study area, due to strong son preference, contraceptive practice depends not mainly on number of living children, but heavily on the number of living son(s). Here results (Table 11 and Table 12) show that among the CMW who are not having any son, about 20 per cent of the couple are contraception, it increases to 48.64 per cent when they have one son and it further increases to 66.09 per cent when they have two finally it further increases to 80 per cent when they have two or more sons. However, despite having desired number son(s), knowledge of wide range of contraception is must for its use. From the results it is quite clear that even if CMW do not have any son, if they know any methods of contraception, its use is 19.77 per cent, whereas among others it is above 50 per cent. If the CMW have one son and knowledge of contraception increase to 98.49 per cent of women, its use is as high as 79.63 per cent, however, when CMW have two or more sons. The knowledge and use of contraception is sharply increased among the women when they have one son. Of course this result may be due to the very small cell count. However, from this result it can be inferred that along with number of living sons, knowledge of contraception has a great role in its practice. Hence, women without son(s) should be motivated to use contraception for their better reproductive health, not from fertility reduction per se. Because decision regarding fertility is personal matter and everyone has the right to decide how many children (sons) to have, provided they are not eliminating daughters.

The women were asked whether they have ever used family planning methods or not, of 2587 currently married couples, the level of knowledge and approval of family planning were high, 98.69 per cent and 55.28 per cent respectively. Although 55.28 per cent of women have ever practiced one form of family planning methods and 44.72 per cent have never practiced family planning methods during their life. However, the actual practice of family planning methods was found to be low where only 38.3 were using any family planning method at the time of the survey.

As shown in Table 13, for the women who used contraception, the most popular means of birth control is the sterilization operation, which was used by 25.41 of all women and another 1.97 per cent who have husbands who are sterilized. This predominance of the female sterilization method is similar to findings from Karnataka and other Indian states. Because sterilization is irreversible, only women who are certain that they do not want any more children are likely to use it. Sterilized women tend to be substantially older than other women, but age alone does not account for their large family size. In every age group, sterilized women have substantially more children than women who use temporary methods. The difference is particularly pronounced among young women. or in other words out of total married couples 27.37 per cent have adopted a permanent method whereas remaining 27.51 per cent are using temporary contraceptive methods (Table 13). Use of temporary methods is very low in India, both in absolute and relative terms. The second most popular method of family planning was birth control pills, which was used by 13.41 per cent of women. Thus 27.51 per cent females are effectively protected against conception by one or the other family planning methods. The adoption percentage by each method is 9.63 per cent (condoms), 13.41 per cent (i-pill), 1.78 per cent (loop) and 4.36 per cent (for both safe period and self restrain method).

Methods of Contraceptive Knowledge Using
No Per cent No Per cent
Not Using 34 1.31 1157 44.72
Male Sterilization 1457 57.18 51 1.97
Female Sterilization 1969 77.28 657 25.40
Oral 1861 73.04 347 13.41
Condom 1842 72.29 249 9.63
Loop 1354 53.14 46 1.78
Safe Period 1792 70.33 32 1.24
Withdrawal 907 35.60 22 0.85
Other 872 34.22 26 1.01
Total   2587 100.00

Table 13: Methods wise use of family welfare methods in Rural Areas of Malda District, West Bengal (2010).

The present study reveals that the majority of the females of the study area are adopting terminal methods such as sterilization. But in the case of temporary methods, oral pill and condom is the more common than other methods. This study suggests that the favorable attitude towards permanent family planning methods among the women is a welcome trend towards the promotion of family planning programme. Besides the permanent methods, temporary family planning methods are also given due weightage in order to strengthen the programme. Lack of complete knowledge and some side effects thereof about the temporary family planning methods are the reasons for their less propagation and use among the women. This clearly shows the close association between knowledge and attitude formation towards behavioural change.

Reasons for non-acceptance of family planning methods

For non-users, reasons were asked for non-utilization. The reasons for the non-utilization of family planning methods among women varies by the CMW for those families having less than or equal to three and more than five living children in their families. Significantly high proportion (21.5 per cent) of the families who are having more than four living children in their families have expressed old age as one of the reasons and are confident that they won’t get children. About 16.4 per cent respondents account for health hazards, side effects and fear of operation as potent reasons for their non-acceptance of sterilization compared to the families which are having less than or equal to three living children. The desire for son and daughter is an important reason for non acceptance revealed by the majority of the females who are having less than or equal to three living children in their families. This clearly reflects various reasons expressed by the non-acceptors of less than or equal to three living children as well as more than four living children in their families.

Fertility related reasons were the most reported reasons that affected the family planning services utilization among participants. Among fertility related reasons, abstinence was the highest husbands/partners. Religious opposition has also appeared to be important barrier to nonuse of family planning methods which accounted for 7.6 per cent of the non-users. Sometimes potential family planning users prefer not to use more reliable methods due to misperceptions and concerns about their health. Method related reasons like health concerns, fear of side effects and lack of access/too far, too much costs and health care provider bias accounted for 32.4 per cent of non-utilizations of family planning services. The method related reasons were mainly health (17.9 per cent) followed by fear of side effects (6.7 per cent), lack of access (3.5 per cent), health provider bias (2.4 per cent) and cost of contraceptives (1.8 per cent). The knowledge and sources of family planning methods were other important factors for non-utilization of family planning. This was mainly due to respondents lack of knowledge on the type of method or they did not know the source of family planning methods. Lack of knowledge of family planning methods accounted 6.5 Per cent while lack of sources of family planning method was also reported by 4.4Per cent of non-users.

Conclusion

This study has examined the pattern of contraceptive use and choice of methods among 2587 married women of reproductive age in rural areas of Malda district of West Bengal with a particular focus on the extent to which demographic and socio-economic characteristics influenced the practice of contraceptive use. The results show that there are significant relationships with contraceptive use. Considerable differences in Knowledge and Use of Contraception according to women’s literacy and educational status, income and occupation, age, family type, religion and caste, mass media exposure and living children and son(s) experience by mothers were found in the study. The study revealed the knowledge and favourable attitude of rural women towards contraception. In the study area even after about five decades of family planning programme, only 1.51 per cent of CMW do not have any knowledge of any methods of contraception. This high knowledge with low utilization rate is mainly because of different barriers to decision on use of contraceptives. Therefore, there is a need to impart knowledge about the family planning methods among the CMW so that it will help women to choose suitable and affordable method, enable them to lead a burden and danger free and healthy reproductive life, enable couples to decide when to and whether to have child, and thereby facilitate fertility decline in the study area. May be with increasing education, the women understand their contraceptive better and practice it more intensely. As level of education is significantly associated with the contraceptive usage among women. Religious communities show differential use of contraceptives. Among the religious communities the use of contraception is low among Muslims and lower castes women. A couple’s working status also had a significant effect on contraceptive use. The improving employment opportunities for women will increase the prevalence of contraception thus, hopefully, lower the birth rate [21]. Electronic media, government employees and organizations can play a positive role to impart knowledge and overcome the gaps arising thereof between knowledge and practice. Regarding methods of contraception, female sterilization is the most popular permanent method and is used by majority of females.

Throughout the world, mass media have influenced knowledge, attitudes, and behavior regarding the use of contraception [33]. Our study also found that mass media exposure (Radio/TV) has an important effect on reproductive behavior. It could be because radio and television programs and the values they disseminate are transmitted directly into the home, they have the potential to directly affect every member of the household, even those with little or no schooling [34,35]. The role of mass media in changing both patterns of contraceptive use and notions of ideal family size could be another reason for low fertility among those exposed to mass media [36].

The evidence in support of the religiosity hypothesis is also modest. While Muslim women are less likely to be currently using contraception, the percentage using modern contraceptive methods are much higher than that of Christians. In addition, a very small percentage of Muslim women cited religious prohibition or husband’s objection as reasons for their non-use of contraception.

Despite the legal restrictions against marrying at a young age, early marriage is common in the country in general and in the study area in particular. Therefore, programs should focus on creating awareness of the marriage law and the disadvantages of early marriage and large family size. Similarly, more emphasis needs to be place on messages conveyed via the mass media, addressing the advantages of small family size and family planning. Mass media can present a wider range of knowledge and lead to adopting contraception. Furthermore, longrunning programs focusing on increasing literacy status and wealth status are essential to improve the reproductive health status of women.

Above all, period of emergency proves that force full implementation of Family Planning Programme (FPP) will not be possible in a country like India. In India people’s relation with the state, i.e. at the order of law, in these arenas comes only next to society. The state norms are appreciated as long as they assist the masses into which the reproductive and familial domains function. The state need to bring more amendment in the FPP keeping in mind all the cultural complexities of gender and reproductive political economy dimensions. Then only the desire of the state to progress in the economic frontier by achieving small family size norm which is the only hidden agenda of FPP could be achieved as our study suggest.

Acknowledgements

This research work was sponsored by UGC DRS-II Programme. The authors thus, would like to express his heart felt gratitude to Prof. Farasat Ali Siddiqui, Chairman, Department of Geography, Aligarh Muslim University, for his Constructive support.

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