RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE I
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MS. GREEMA PAVITHRA1ST YEAR, M.Sc. NURSING,
ROOHI COLLEGE OF NURSING,
NEAR KANNUR, HENNUR MAIN ROAD,
KADUSONA PANAHALLI CROSS
BANGALORE
2. / NAME OF THE INSTITUTION / ROOHI COLLEGE OF NURSING,
BANGALORE
3. / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER OF SCIENCE IN NURSING, OBSTETRIC AND GYNOCOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE
5. / TITLE OF THE TOPIC / “A study to assess the knowledge and attitude regarding spacing method among post natal mothers admiited in maternity wards of selected hospitals in Bangalore city”.
INTRODUCTION
“Delay the first, postpone the second, and prevent the third”
The capacity to enjoy and control sexual and reproductive behaviour is a key element of sexual health.
There is real pleasure in finding oneself functionally capable of becoming pregnant. There is pleasure in learning that other is pleased with the promise of having, and being given, a child.
Reproduction of species is one of the primary factor in nature .it is essential for the survival of all higher forms of life. Pregnancy and childbirth are natural phenomena that exist since the draw of humanity in all the parts of the world, and child birth occurs almost every minute somewhere in the world. Even through the man and women both have their role in process; it is the woman who takes the major and active part in it. Any women associates all that is beautiful in her life with series of events, namely out, marriage, early married life and finally the motherhood.
The concept of reproductive health is relatively new, but has gained momentum since mid-1990s. While it mainly addresses issues on reproduction for both men and women, it also deals with women's health issues as a whole, since these issues are closely related to the reproductive process.1 As women play an important role in caring for family members, especially children, their illness or deaths has an immediate effect on the well being of the family as a whole, and may impact the entire population.
World health organization defined “Reproductive health as a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this are the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.” (2)
“All Couples and individuals have the basic human right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so” (3)
Control of their own fertility is the largest single factor affecting the independence of women.4
· Population dynamics is the largest important factor for use preventive and community medicine as well as appropriate and safe spacing methods.
· Spacing method is an important factor in many women’s lives with need varying according to the particular stage of life and viewed in the wider context of sexual and reproductive health.
India is the second most populous country and as per growth continuous updated the projected population in 2025 ,363 millions for these reason many family planning programmes is running and present approach in these programme is to provide a “cafeteria choice”.5
The Scenario os estimâtes Target and eligible couple in India as on May, 2008 is as show in figure
Target couples for spacing
Couples Sterl
Target Group for sterilization
ESTIMATED ELIGIBLE COUPLES AND TARGET COUPLES IN INDIA
High fertility levels are of major concern to planners and policy makers in most countries in the developing world. The analysis of birth intervals is of interest in this context since it can provide further insight into the mechanisms underlying changes in fertility.(6)
BACKGROUND OF THE STUDY:-
The Census of India has found that the population of India had crossed 1.21 billion as of April 2011 and with the current schedule of fertility and mortality the country is adding about 18 million people to its population every year. This growth of population is considered to be the main impediment to our socio economic development. Among various factors, the low female literacy, low age at marriage, strong son preference and low acceptance of family planning methods are recognized as the main causes of high population growth.7
It was in recognition of the need to control population growth that the official family planning programme was initiated in 1952. The programme has undergone major changes in the last 50 years both in its approach and in its emphasis. As a result, the current use of contraceptives among married women had increased from a low of 13 percent in 1970 to 48 percent in 1998. However, overemphasis on female sterilization, high unmet need for spacing methods and low quality of services are some of the problems faced by the family planning programme.8
According to the National Family Health Survey (NFHS), while the use of any method of family planning among currently married women in the age group 15-49 had increased from 41 percent in 1992-93 to 48 percent in 1998-99, the use of modern methods had only increased from 37 percent to 43 percent during this period. The use of spacing methods (condom, pill and IUD) had only increased marginally from six percent in 1992-93 to seven percent in 1998-99 and this finding is in conformity with the official statistics of the Ministry of Health and Family Welfare. The couple protection rate is on a continuous increase and had doubled from 22 percent in 1980 to 45 percent in 1998. On the contrary, the use of spacing methods has continued to be low over the decades.9
Almost 34 percent of India's population now below 15 years of age, it will become difficult to protect 60 percent of India’s couples in the coming years by continuing to focus only on contraceptive methods that require permanent medical intervention. The number of Indian couples who choose to use "spacing methods" — condoms, IUD, and pills (official spacing methods) — must expand significantly. Regarding the preferred method for family planning, a question was asked in the NFHS to the married women in the age group 15-49 who are not currently using any method of family planning, about the future preferred method in the next 12 months. It was reported that 25 percent of the respondents preferred the use of pills and only six percent each preferred the IUD and condoms. Thus, there is a potential demand for spacing methods in the country and its use can be expanded.10
Another reason for the low use of spacing methods is the high unmet need for such methods. As found in NFHS 2, the unmet need for family planning methods is estimated to be 16 percent. The unmet need for spacing is eight percent and for limiting also eight percent with interstate variations. Any reduction in unmet need will increase the contraceptive prevalence and help to further reduce the fertility level. Understanding the implication, the recent National Population Policy, 2000 has aimed at meeting the unmet need for family planning and health infrastructure as its immediate objective. To fulfill the unmet need for spacing, it is necessary to promote the temporary and reversible methods such as pill, Condoms and IUD.10
The CDC Advanced Data from Vital and Health Statistics in 2004 reported:11
· 8.7% of women 15-44 years of age are pregnant or postpartum and therefore not using contraception
· 46% of women 15-44 who had zero births are using a method of contraception
· 59.9% of women 15-44 who had one birth are currently using a method of contraception
· 77.7% of women 15-44 who had two births are currently using a method on contraception.
· 81.2% of women 15-44 who had three or more births are currently using a method of contraception.
· The leading method of contraception in the United States in 2002 was the oral contraception pill; the second leading method was female sterilization. These have been the leading methods of contraception in the United States since 1982.
· 56% of women 15-44 years of age received family planning or medical services from a private doctor, private group practice, or HMO (Health Maintenance Organization)..
· 22% of women 15-44 years of age received their family planning or medical services from a public clinic
The CDC survey provided no data regarding repeat unintended pregnancy postpartum or usage of contraception postpartum.
The National Population Policy provides a framework for achieving the twin objectives of population stabilization and promoting reproductive health within the wider context of sustainable development. The Tenth Five Year Plan (2002-2007) outlines efforts in three broad areas:12
1. Meeting the unmet need for contraception;
2. Reducing infant and maternal mortality; and
3. Enabling families to achieve their reproductive goals.
Clinicians and women’s main concern regarding postpartum contraception is the effects of hormonal contraception on breastfeeding, breast milk, infant growth and development and maternal health (Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit, 2004)13. Contraception for women who are breastfeeding is a public health issue of global importance. For women who are breastfeeding, the choice and timing of hormonal contraception may influence both lactation and infant growth (Truit et al., 2003)14.
NEED OF THE STUDY:-
“Unintended pregnancies can have long lasting effects on the quality of life of parents and children’s”
Currently, India’s annual population growth rate is 1.74%. India is the second most populous country in the world, contributing about 20% of births worldwide.
Unintended pregnancy is still a major concern within both Developed and developing countries. Various studies recommend the importance of postpartum contraception education. Although this is started prenatally, some studies concluded this education may not be helpful during the antenatal period. Therefore, postpartum contraception can be incorporated during the postpartum period within a clinic setting. With such a wide range of contraception options available today, clinicians might not be completely familiar with the appropriate contraceptive options for women postpartum based on each female’s needs: breastfeeding (and how much), as well as other factors that can affect their decision.15
Unintended pregnancies have long-lasting effects on the quality of life of parents and children’s. Globally it is estimated that approximately 38% unintended pregnancy of all pregnancies. In the U.K, the government white paper “Health of the nation” heralded the rising numbers of unintended pregnancies, highlighting the need to improve access to family planning services for all womens.4
Children born as a result of unintended pregnancy experience increased adverse outcomes including premature birth, low birth weight, and small-for-gestational age. Other factors that are associated with unintended pregnancy include adverse maternal behaviors, morbidity including depression, mortality, as well as physical/sexual abuse.
Terminations
Outcome Terminations; Spontaneous (4 million/year)
Terminations; Induced (42million/year)
Births (unintended) 34 million/Year.
If Contraceptives services, were provided to 201 million women at risk of unintended pregnancies worldwide:-
ü Unintended pregnancies prevented:-52 million, globally.
ü Reduced abortions:- 64% ,globally.
ü Maternal and child death prevented: 1.5 million,glabally.
ü Pregnancy related illness reduced and healthy life years preserved; 2.7 million.
CUBBIN, BRAVEMAN, MARCHI, SANTELLI AND GILLBERT, 2002)
In 2000 the contraceptive prevalence rate (CPR) among married women was 48.3%. Contraceptive use in India is characterized by:
• The predominance of non-reversible methods, particularly female sterilization;
• Limited use of male-/couple-dependent methods;
• High discontinuation rates; and negligible use of contraceptives among both married and unmarried adolescents.
“It is estimated that if all unwanted births were prevented, India’s TFR would drop to replacement level fertility”
Less than 7% of currently married women use the officially sponsored spacing methods (pills, IUD and condoms). The reported use of traditional contraceptive methods and male/ couple dependent methods is low.
COMPARATIVE FIGURES OF NATIONAL FAMILY HEATH SURVEY
With regard to addressing the unmet need for contraception, the government is focusing particularly in areas where fertility declines have been lagging. Issues such as adolescent reproductive health, unintended pregnancy and access to safe abortion are addressed. Counseling, access to and provision of good quality services and follow-up care are emphasized.
On situational analysis of unmet need of contraception in India, many factors like inadequate knowledge regarding methods, dependent on public sector, son preference, early marriages and limited options, high unmet need for spacing methods and low quality of services are some of the problems faced by the family planning programme.19
The figures that will be obtained are essential for any planning of mother and child health interventions. Health team members need to know this information and the variables related to them in order to advise mothers. The figures are also essential in planning measures to reduce infant and child morbidity and mortality.