INTRODUCTION
“Women have the right to know about the potential health benefits of birth spacing," says --JEFF SPIELER.
Becoming Mother, every woman’s fulfillment of life. This gives her a feeling of caring, loving and compassion. Old days in India every women were treated as high positions as we can knew about from our histories. The act of child bearing has its own importance. Now a day’s couple can make decisions about the timing and number of child they want actually. This helps every one to plan for the parenthood as well as to welcome the new life in an ever memorable manner. Yet all pregnancies are not welcomed by the couple, there arise the need of family planning measures, for to avoid unwanted pregnancies and to bring about wanted pregnancies.1
Both mother and child includes the vulnerable group in the society, and its comprising three fourth of the population of our country. The government had developed lot of programmes and plans for the betterment of mother and child. Even though they are not getting this in its root level, the needed rural community. The sensitive index of the quality of the health care delivery system of a country as a whole in part, is reflected by its maternal and perinatal mortality rates. Unregulated fertility, unsafe abortion, inadequate antenatal care is some of the factors that contribute to maternal and perinatal deaths. 2
Couples who space their births 3 to 5 years apart increase their children’s chances of survival, and mothers are more likely to survive, too, according to new research. Many women want to space births longer than they currently do. Programs can do more to help them achieve the birth intervals they want. Over the years research has consistently demonstrated that, when mother’s space births at least 2 years apart, their children are more likely to survive and to be healthy. Many programs have recommended 2-year intervals, and the message is widely known: In surveys most women say that a birth interval of 2 years is best.3
For many years, family planning experts have generally agreed that a twenty-four month or two-year birth interval is important for infant, child and maternal health. Studies have shown that birth intervals less than two years are associated with adverse perinatal and maternal outcomes. Despite this knowledge, few governments, or international health organizations have birth spacing policies or programs. Although birth spacing is at the heart of reproductive health/family planning, it is rarely addressed directly. In short, the two-year recommendation for birth spacing is an "invisible norm"4
Family planning is one of the most basic and essential health-care services. The ability to choose the number and spacing of their children promotes healthier mothers and children, as well as smaller families that are better able to meet their household’s economic needs. At least 200 million women in need lack access to modern methods of family planning. The combination of an increase in population and low contraceptive use has increased the annual number of unintended pregnancies to 80 million in the developing countries. Family planning is an effective means to reduce maternal mortality by preventing unwanted pregnancy and unsafe abortion and by promoting healthy pregnancies4
6.1 NEED FOR THE STUDY.
“ Pregnancy is by choice, not by chance -WHO
Access to contraceptives empowers women and can save their lives. Contraception can prevent 2.7 million infant deaths a year. It can reduce poverty, slow population growth, ease the pressure on the environment and make for a more stable world. Being able to plan how many children to have and when to have them is a recognized human right. But this right is not yet realized, especially among the poor5.
Some 200 million women worldwide, especially in the poorest countries, still have an unmet need for effective contraception. Meeting their needs would cost about US$3.9 billion a year, and could prevent 23 million unplanned births, 22 million induced abortions, and 142,000 pregnancy-related deaths (including 53,000 from unsafe abortions) and1.4 million infant deaths.6
A study to assess the knowledge, attitude and practice of family planning among Igbo women in Nigeria conducted by Ikechebelu J.I. et.al. , a total of 200 Nigerian women visiting antenatal clinic in Azikiwe university teaching hospital was selected as samples. About 90% were literate, their knowledge of family planning was high (80%) but the practice of family palnni9ng methods was low. (25%) their attitude and practice in family planning measures were low because of partner objection. This study reveals that both partner education and awareness camp, needs to implement especially in rural area7.
Surveys and other in depth research from the 1990s reveal a range of obstacles and constraints that can undermine a woman’s ability to act on her childbearing preferences. For example, many women fear the side effects of contraceptive methods, having heard rumors or experienced some side effects themselves. Others fear their husband’s disapproval or retribution if they use family planning, or oppose family planning themselves because of religious or personal reasons. Some women are uncertain about whether they are likely to become pregnant, or they may feel ambivalent about whether they want a pregnancy. Finally, some women lack knowledge about contraceptive methods or where to get them, or they may not have access to the methods they want because of weaknesses in services and supplies8.
A study was conducted by Schwarz EB et.al.to know the Interest in intrauterine contraception among seekers of emergency contraception and pregnancy testing in Center for Research on Health Care, Pittsburgh, the main objective is to estimate the interest in using intrauterine contraception among women and adolescent girls seeking emergency contraception or walk-in pregnancy they surveyed 412 women and adolescent girls who requested emergency contraception or pregnancy testing at four family planning clinics in Pittsburgh, Pennsylvania. The 41-item survey assessed knowledge of, attitudes toward, and interest in using an intrauterine device (IUD). Data were analyzed the response rate was 85%9.
There is renewed programmatic interest in the effects of birth spacing on infant, child, and maternal health and survival because family planning programs have thePotential to affect the timing of pregnancies. For example, in response to recent researchthat suggests that birth intervals of at least three years may be associated with betterhealth outcomes for mothers and children, communication campaigns in several countrieshave already begun using a 3-year spacing message. USAID is currently supporting theOptimal Birth Spacing Initiative, which seeks to provide advice on how programs canbest promote optimal spacing. Understanding the size of the effects of birth spacing andreasons for them and identifying the groups for whom they are greatest will provideuseful information for guiding the formulation of the most effective policies to improvebirth spacing. IUD insertion may be a reasonable way to increase the use of highly-effective contraception among women and adolescent girls seeking emergency contraception10.
Investigator find evidence that childhood mortality risk is influenced by the pattern of childbearing, that is, by the timing and spacing of birth and that birth-spacing and fertility are, in turn, a function of realized mortality. The investigator also has observed that the women from the rural areas are most prone to develop complications associated with pregnancy and child birth due to fewer intervals between pregnancies and due to multiparity.They are also sufferings from nutritional deficiencies. So in this study the investigator wants to compare the situations in both urban and rural areas of Mangalore to rule out the effect of knowledge about family planning and birth spacing.Results of several studies clearly demonstrate that there is a considerable lack of knowledge among married women regarding birth spacing and use of copper –T. They are unaware of various temporary methods of family planning; furthermore, they have limited knowledge of benefits of birth spacing. The investigator felt that it is necessary of all health care professionals should engage health care activities related to birth spacing in all health care settings. So the investigator wants to assess the knowledge of both urban and rural married women about birth spacing and copper-T insertion.
6.2 REVIEW OF LITERATURE
Review of literature is one of the most important steps in the research process. It is an account of what is already known about a particular phenomenon. The main purpose of literature review is to convey to the readers about the work already done and the ideas that have been already established on a particular topic of research11.
In this study it includes the literature related to
1. The knowledge and attitude of birth spacing and copper-T insertion.
2. The reasons for early discontinuation of copper-T
3.The comparison of copper-T
Literature related to knowledge and attitude.
A study was conducted to assess the knowledge and acceptability of the IUD in the family planning services in South Africa by van zijl. S. et.al., a descriptive cross-sectional survey was conducted at eight family planning clinics, a total of 216 clients and 30 providers were interviewed using structured questionnaire, and result was awareness of IUD among client was low, 41% ( n= 88 ) women had ever used IUD was very low, only 4% ( n=9) in which 3 were still using, lack of knowledge was an obstacle to use IUD. Among providers also lack of knowledge is there 47% ( n=14) and conclude the study that IUD is available free of charge in our public sector, it is not being utilized due to lack of knowledge, and ongoing education and knowledge assessment is essential to improve acceptance and accessibility12.
A study was conducted by Mustafa R, Afreen U, Hashmi HA in the department of gynecology and obstetrics, Fatima Hospital, Karachi, about contraceptives knowledge, attitude and practice among rural women, they conduct a cross sectional study and sample was 100 women between the ages 15-45 coming from rural area , assessed with the help of questionnaire found that 81% of women had some knowledge about contraceptives ,41% of the husbands have positive attitude towards the contraception, and this study shows there was a low contraceptive use of women despite of good knowledge in the rural areas due to negative attitude towards contraception by women’s as well as their husbands13.
A study was conducted by Espey.E, Ogburn.T,Espey.D,Etsitty.V,about IUD related knowledge, attitudes and practices among Navajo area Indian health service providers, and sample size was 107 Navajo area health service providers , among them conducted a mailed survey using the Cochran-Mantel-Haenszel method,results was overall 69-78 % of providers had good knowledge ,69%providers and 44%women are not recommending IUD due to low knowledge and fear about side effects, needs further study, assessment and training in rural areas14.
Literature related to early discontinuation of copper-T
A study was conducted to investigate change in contraceptive use and the effect of education on fertility and contraceptive attitude by Baksu A. et.al. at Turkey, a retrospective review of medical charts were used for 2514 women in 1997 and 2268 women in 2002 ,during the 6 years period studied significant decreases occurred in the number of births, elective abortion, gravidity and number of living children (p<0.001) In contraceptive method use of IUD and coitus interrupts diminished, where as pill and condom was increased significantly (p<0.001) they suggests socio cultural and education of women affect their contraceptive use15.
A study was conducted by Tripathi V, Nandan D, Salhan S, in the department of obstetrics and gynecology , V. M Medical college , New Delhi, India, the study was to assess the determinants of early discontinuation of IUCD use in rural northern districts , a multivariate analysis was done for 100 samples and found that there are several reasons for the early discontinuation , in which menstrual irregularity, low motivation, less knowledge about benefits of contraception, and lack of health centers are the main problems16.
Literature related to comparison.
A comparative study was conducted on contraceptive efficiency and clinical performance of the copper/ low density polyethylene nanocomposite IUD and the copper T220c IUD by Yu J , and et,al. in Wuhan , china, 100 females were randomly divided in to two groups ( experimental and control group.) n = 50 in each group. Clinical observation and comparative study were performed on the two groups for 12 months, found that the cumulative continuation rate wee both 92.0/ 100 women at 12 months that there was no significant difference between them (p> .05 ) the pregnancy rate, removal rate and expulsion rate were low with the difference being not statistically significant (p> .05 ) the rate of side effect were lower in experimental group than control group with the difference being statistically significant (p< .05 ) the study suggested new design low density polyethylene nanocomposite IUD had high contraceptive effect , and low side effect17
6.3 STATEMENT OF THE PROBLEM
A STUDY TO COMPARE THE KNOWLEDGE AND ATTITUDE OF BIRTH SPACING AND USE OF COPPER-T AS A TEMPORARY FAMILY PLANNING METHOD AMONG MARRIED WOMEN IN SELECTED URBAN AND RURAL AREAS OF MANGALORE,WITH A VEIW TO PREPARE AN INFORMATION BOOKLET.
6.4 OBJECTIVES
The objectives of the study are to:
- To assess the knowledge of urban and rural married women about birth spacing and copper-T insertion.
- To assess the attitude of married women in the urban and rural area about birth spacing and copper-T insertion.
- To compare the knowledge of the married women in the rural and urban areas about birth spacing and copper-T insertion
- To compare the attitude of the married women in the rural and urban areas about birth spacing and copper-T insertion.
- To find out the association between
B. knowledge of rural married women about birth spacing with selected demographic variables (age, education and employment).
- To find out the association between
B. attitude of rural married women about copper-T insertion with selected demographic variables(age, education and employment)
7. To prepare an information booklet about proper birth spacing and copper-T insertion.
6.5 OPERATIONAL DEFINITIONS
Knowledge : In this study refers to the awareness or familiarity regarding birth spacing among married women's as measured in terms of structured questionnaire
Attitude : Married women beliefs and feelings towards copper-T as a temporary contraceptive method, which can be measured by an attitude scale.
Birth spacing : In this study birth spacing refers to the time period or gap between births and the minimum period is two years.
Copper-T Copper-T is a device made up of plastic material and the copper wire is wrapped around the stem of the device, used as a temporary contraceptive.
Temporary contraceptive method: Measures which would prevent pregnancy for a desired time.
Married women: In this study married women refers to the women after marriage have one child living with husband.
Urban area: In this study it refers to a place of small geographical area with 5000 – 15,000 population of different age groups constituting a city or town.
Rural area: In this study it refers to a place of area where high density of populations is seen, consists of villages and slums.
Information booklet: It is written information about the topic that includes the benefits of birth spacing and the advantages of copper-T as a temporary method of family planning.
6.6ASSUMPTIONS
The study assumes that
All women in the rural and urban areas have less knowledge of birth spacing and temporary contraceptive techniques.
Adoption of copper-T insertion prevents unwanted pregnancies and provides proper spacing.
Birth spacing promotes maternal and child health.
Birth spacing contributes to prevent maternal and infant mortality.
6.7DELIMITATIONS
The study will be delimited to:
- Only married women have one child and living with husband.
Hypotheses will be tested at 0.05 level of significance
H1: There will be a significant difference between the knowledge levels of urban married women than the knowledge level of rural married women.
H2: There will be a significant difference between the attitude score of urban married women than the attitude score of rural married women.
H3: There will be significant association between knowledge of urban and rural married women about birth spacing and copper-T insertion and selected demographic variables as measured by a semi-structured questionnaire at 0.05 level of significance.
H4: There will be significant association between attitude of urban and rural married women about birth spacing and copper-T insertion and selected demographic variables as measured by Modified Likert attitude scale at 0.05 level of significance.
7. MATERIALS AND METHODS
7.1SOURCES OF DATA
The source of data will be collected from married women in the selected urban and rural area of Mangalore..
7.1.1 RESEARCH DESIGN
The present study was aimed at comparison of knowledge about birth spacing and attitude towards copper-T insertion among urban and rural married women. Descriptive approach has been adopted for this study. This approach has been used to gather accurate information regarding birth spacing and attitude towards copper-T insertion. The design used for the present study is comparative descriptive survey.
7.1.2 SETTING
The study will be conducted in the selected urban and rural community at Mangalore, Karnataka within 10 kilometer from the institution.
7.1.3 POPULATION
The population consists of married women of selected urban and rural community at Mangalore.
7.2 METHODS OF THE DATA COLLECTION
7.2.1 SAMPLING PROCEDURE
A non probability convenient sampling technique will be used in this study.
7.2.2 SAMPLE SIZE
In this study the investigator planned 50 married women from an urban area and 50 married women from rural area as samples. (Total 100 samples.)
INCLUSION CRITERIA
Married woman who:
- Are willing to participate in the study.
- Are available at the time of data collection.
- Knows to read and write Kannada language or English .
The married woman who adopted permanent methods of family planning .
7.2.5 INSTRUMENTS INTENDED TO BE USED
- Structured questionnaire is used for assessing knowledge
7.2.6 DATA COLLECTION METHOD
After getting permission from the concerned authorities of selected urban and rural areas at Mangalore, the data will be collected. The objectives of the study will be explained and their permission will be taken. The researcher will introduce himself to the participants. The researcher himself will collect the data. Data will be collected by giving questionnaire to all participants and attitudes are assessed by using modified Likert type attitude scale.
7.2.7 DATA ANALYSIS
The data will be analyzed using descriptive and inferential statistics.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
No
7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF THE ABOVE PROCEDURE?
Permission to conduct the study is obtained from the institution. Permission will be obtained from the concerned authority at the time of data collection.
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13. Musthafa R , Afreen V, Hashmi H A. A study of contraceptive knowledge, attitude and practice among rural women, Karachi. Journal of collective Physician2008; 18(9): 542-545.
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