Indian Journal of Obstetrics and Gynecology Research

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Indian Journal of Obstetrics and Gynecology Research (IJOGR) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific journals, research content, providing professional’s membership, and conducting conferences, seminars, and award more...

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Get Permission Thakur, Mohi, Pathak, and Jafra: A comprehensive analysis of contraceptive safety: Implications for gynecological health and education levels


Introduction

Contraception means using a method to lower the likelihood of getting pregnant after sexual intercourse.1 For instance, oral contraceptives not only prevent pregnancy but also lower the risks of endometrial and ovarian cancer while providing protection against pelvic inflammatory disease and ectopic pregnancies. However, they may increase the risk of cardiovascular disease. It's essential to be aware of these factors for informed decision-making.2

India, the second-most populous country globally, has a rapidly growing population increasing by approximately 16 million each year. India is still having trouble controlling the baby boom, even though it was the first nation to introduce a comprehensive population control program in 1952.3

In 2005, a study representing the entire nation revealed that India achieved 70% satisfaction in meeting the demand for family planning through modern contraceptive methods.4 Notably, there was a predominant dependence on female sterilization as opposed to reversible contraceptive methods.5 Historically, India's family planning policies prioritized population control over women's reproductive rights. The focus was primarily on promoting female sterilization. However, the 2014 Family Planning 2020 action plan signifies a shift, still endorsing sterilization with financial incentives but also incorporating reversible modern contraception methods.6

In the National Family Planning program, three new contraceptives were introduced: injectables, a non-hormonal weekly pill, and progesterone-only pills for breastfeeding mothers, all provided for free. Despite their long availability through public health services, the use of intrauterine devices (IUDs) remains low. Condom use increased after HIV prevention efforts. However, reversible contraceptives and male sterilization are still less common in India. Female sterilization remains the primary method, making up two-thirds of total contraceptive use.7, 8

Family planning reduces maternal ill-health and deaths by preventing unintended pregnancies. It benefits young girls and older women by reducing health risks. It also lowers the need for unsafe abortions and decreases HIV transmissions. Additionally, it promotes girls' education and women's participation in society. Therefore, this study aims to analyze contraceptive safety and its implications for gynecological health and education levels.

Materials and Methods

This observational study was conducted at the tertiary care center in Patiyala district of Punjab over a period of one year, from July 2021 to July 2022. In the present study, approximately 450 females of reproductive age between 18 and 45 years were included, and females outside this age group and who were not giving informed consent were excluded. Ethical approval of the study was obtained prior to the initiation of the study.

This was a questionnaire-based study in which predesigned questionnaires were asked to the patients about their knowledge and perception of the use of contraception and results were noted.

Results

Table 1

No of participant involved in the study group according to education level

Education Level

No. of cases

Percentage

Primary

242

53.78%

Higher secondary

133

29.56%

Graduate

75

16.67%

Total

450

100.00%

The study investigated how people's understanding and views on contraception varied based on their education levels. It included 450 participants, with the majority (53.78%) having completed only primary education. The next largest group (29.56%) had finished higher secondary education, while 16.67% were graduates.

Table 2

Demographic characteristics of the participant according to education level

Characteristics

Education Level (No. of Cases)

Primary

Higher Secondary

Graduate

Total

Percentage

Age

(18-26) Years

79

34

45

158

35.11%

(26-36) Years

111

51

20

182

40.44%

(>36) Years

52

48

10

110

24.44%

Total

242

133

75

450

100.00%

Address

Rural

206

100

45

349

77.56%

Urban

36

33

32

101

22.44%

Total

242

133

75

450

100.00%

Occupation

Homemaker

198

102

48

348

77.33%

Private Jobs

44

31

27

102

22.67%

Government Jobs

0

0

0

0

0.00%

Total

242

133

75

450

100.00%

Marriage duration

<5 Years

163

62

15

240

53.33%

>5 Years

79

71

60

210

46.67%

Total

242

133

75

450

100.00%

Marital status

Married

241

131

75

447

99.33%

Unmarried

0

0

0

0

0.00%

Divorce

1

1

0

2

0.44%

Widow

1

1

0.22%

Total

242

133

75

450

100.00%

The age distribution showed that the majority of participants fell within the age groups of 18-26 years (35.11%) and 26-36 years (40.44%) and above 36 years (24.44%). Most participants were from rural areas (77.56%), while a minority resided in urban areas (22.44%). In terms of occupation, the majority were homemakers (77.33%), while a smaller portion were private jobs (22.67%). Marriage duration was divided into less than five years (53.33%) and more than five years (46.67%). Majority of participants were married (99.33%), with very few are classified as unmarried, divorced, or widowed.

Table 3

Questionnaire based on awareness about contraception at education level

Awareness Statement

Responses according to Education Level

Primary

Higher Secondary

Graduate

Total

Percentage

Are you aware about Contraception?

Yes

242

133

75

450

100.00%

No

0

0

0

0

0.00%

Source of information

Social circle

114

62

36

212

47.11%

Health Worker

45

17

10

72

16.00%

Media

78

46

28

152

33.78%

Educational Institute

5

8

1

14

3.11%

Total

242

133

75

450

100.00%

Do you use any contraception?

Yes

242

133

75

450

100.00%

Which contraception do you use?

Barrier

62

33

29

124

27.56%

OCP

49

29

23

101

22.44%

RHYTM

43

13

1

57

12.67%

IUCD

29

23

10

62

13.78%

Injection

7

2

0

9

2.00%

Withdrawal

52

33

12

97

21.56%

Implant

0

0

0

0

0.00%

Total

242

133

75

450

100.00%

All participants across education categories indicated awareness of contraception, with no reported cases of unawareness. Social circles (47.11%) being the most common source of information followed by media (33.78%), health workers (16.00%), and educational institutions (3.11%). Regarding contraception usage, all participants affirmed its use. Barrier methods were the most prevalent (27.56%), followed by OCP (22.44%), and rhythm methods (12.67%). (IUCD) and withdrawal were also commonly used (13.78% and 21.56% respectively), while injections were less common (2.00%). No participants reported using implants.

Table 4

Knowledge and awareness of contraception in at education level

Awareness Statements

Responses according to education level

Primary

Higher Secondary

Graduate

Total

Percentage

Would you opt for Tubal Ligation?

Yes

108

59

30

197

43.78%

No

134

74

45

253

56.22%

Total

242

133

75

450

100.00%

Would you opt for vasectomy?

No

194

95

52

341

75.78%

Yes

48

38

24

110

24.44%

Total

242

133

75

450

100.00%

Do you think hysterectomy can be used as a method of contraception?

Yes

1

0

4

5

1.11%

No

241

133

71

445

98.89%

Total

242

133

75

450

100.00%

Which barrier contraception you know about?

Male condom

241

133

74

448

99.56%

Female condom

1

0

1

2

0.44%

Total

242

133

75

450

100.00%

What do you do if spillage/rupture of condom

Takes pill

132

67

58

257

57.11%

do nothing

110

66

17

193

42.89%

Total

242

133

75

450

100.00%

Do you know it’s side effects

Yes

153

73

43

269

59.78%

No

89

60

32

181

40.22%

Total

242

133

75

450

100.00%

Would you use condom

Yes

129

61

29

219

48.67%

No

113

72

46

231

51.33%

Total

242

133

75

450

100.00%

Table 4 showed that (43.78%) of participants across all education levels expressed willingness to opt for Tubal Ligation while a majority were inclined against vasectomy (75.78%). (1.11%) considered hysterectomy as a contraceptive method. As barrier methods, particularly condoms, (99.56%) of participants were aware of male condoms with fewer knowing about female condoms (0.44%). In case of condom spillage or rupture, participants predominantly reported taking emergency contraceptive pills (57.11%) or doing nothing (42.89%). (59.78%) portion was aware about side effects.

Table 5

Knowledge and awareness about contraception at education level

Awareness Statements

Responses according to education level

Primary

Higher Secondary

Graduate

Total

Percentage

Which OCP you know?

Mala D

206

107

63

376

83.56%

Mala N

36

26

12

74

16.44%

Total

242

133

75

450

100.00%

Do you know side effect of OCP?

Yes

82

51

36

169

37.56%

No

160

82

39

281

62.44%

Total

242

133

75

450

100.00%

Which side effect do you know of OCP?

Irregular period

4

4

8

1.78%

Headache

4

7

1

12

2.67%

Nausea

8

8

4

20

4.44%

Weight gain

47

19

17

83

18.44%

Acne

4

1

2

7

1.56%

Total

67

39

24

130

28.89%

Would you opt for OCP?

Yes

98

55

14

167

37.11%

No

144

78

61

283

62.89%

Total

242

133

75

450

100.00%

Which IUCD do you know of?

CuT

242

133

75

450

100.00%

Multiload

2

1

0

3

0.67%

Total

244

134

75

453

100.67%

Do you know side effect of IUCD?

Yes

58

38

23

119

26.44%

No

184

95

52

331

73.56%

Total

242

133

75

450

100.00%

Would like to go for IUCD?

Yes

70

33

6

109

24.22%

No

172

100

69

341

75.78%

Total

242

133

75

450

100.00%

Regarding oral contraceptive pills (OCP), (83.56%) of participants were aware of Mala D while fewer knew about Mala N (16.44%) but were unaware about the side effects of OCP (62.44%). (37.11%) participant expressed interest willingness to opt for OCP while a majority refused (62.89%). Participants were largely aware of IUCD; CuT (100.00%), while (0.67%) knew about Multiload. Only (73.56%) were aware the side effects of IUCD and only few wanted to opt for it.

Table 6

Knowledge and awareness about contraception at education level

Awareness Statements

Responses according to education level

Primary

Higher Secondary

Graduate

Total

Percentage

Have you heard of injectable?

Yes

6

3

5

14

3.11%

No

236

130

70

436

96.89%

Total

242

133

75

450

100.00%

Which injectable have you heard of?

DBMA

6

3

5

14

3.11%

NTEN

0

0

0

0

0.00%

Total

242

133

75

450

100.00%

Have you heard of Implant?

Yes

0

0

0

0

0.00%

No

242

133

75

450

100.00%

Total

242

133

75

450

100.00%

Have you heard of I pill (emergency pill)?

Yes

50

35

20

105

23.33%

No

195

97

53

345

76.67%

Total

245

132

73

450

100.00%

Did you ever had unintended pregnancy?

Yes

50

35

20

105

23.33%

No

195

97

53

345

76.67%

Total

245

132

73

450

100.00%

Any prior MTP?

Yes

49

37

21

107

23.78%

No

191

99

53

343

76.22%

Total

240

136

74

450

100.00%

How did you deal with unintended pregnancy?

Medical Method

49

35

20

104

23.11%

Surgical Method

0

0

0

0

0.00%

A majority of respondents had not heard of injectable (96.89%) or implants. Similarly, awareness of specific injectable options was low, with only a small percentage having heard of DBMA (3.11%). None of the participant reported being aware of NTEN. Less proportion of participants had heard of I pill (23.33%). Similar percentage of participant had experienced unintended pregnancies. (23.78%) had prior MTP. 23.11% of the respondents reported opting for medical termination method, while none for surgical method.

Discussion

Using contraception lowers the chance of health problems during pregnancy for women, especially teenagers. Babies born within 2 years after their older sibling have a 60% higher risk of dying as infants. Babies born within 2-3 years after their sibling have a 10% higher risk. It's safer for babies when there's a 3-year gap or longer between births.

The present study investigated 450 participants based on their education levels, including those with primary education (53.78%), higher secondary education (29.56%), and graduate education (16.67%). The participants were aged between 18-26 years (35.11%), 26-36 years (40.44%), with fewer above 36 years (24.44%). Most participants lived in rural areas (77.56%) and very few in urban areas (22.44%). The majority were homemakers (77.33%), followed by those in private jobs (22.67%). In terms of marital duration, 53.33% were married for fewer than five years and 46.67% for more than five years, indicating a about equal split. Almost all participants (99.33%) were married, with only a few people single, divorced, or widowed.

All participants, irrespective of education level, were aware about contraception. The key sources of information included social circles (47.11%), media (33.78%), health workers (16.00%), and educational institutions (3.11%).

According to the study of Seidu et al.,9 they included 691 participants in their study. More than half (56.73%) had not received sexual and reproductive health education, yet most (77.28%) had used contraceptives. Women without sex education had lower odds of using contraception (OR = 0.641, 95% CI 0.443, 0.928), even after adjusting for demographic factors (AOR = 0.652, 95% CI 0.436, 0.975). Non-married women and those exposed to media were more likely to use contraceptives. They concluded that, the need for improved education using local media and social networks in urban slums.

Participants used various contraceptives such as barrier methods (27.56%), oral contraceptive pills (22.44%), rhythm methods (12.67%), IUD (13.78%), withdrawal (21.56%), and injections (2.00%). No one used implants. These findings underscore the importance of diverse contraceptive options for promoting reproductive health.

The knowledge and awareness was varied according to the education level of the participants. Many people were willing to undergo tubal ligation, while they opposed to vasectomy and very few considered hysterectomy as contraception. Male condoms were known by most of the participants and very less people known about the female condoms 99.56% and 0.44% respectively. These results were in concordance with the results of the NFHS-4 results for NCT Delhi and India10 and Gore et al.11 the most common method of contraception used was male condoms.

According to the study of Haldar A et al.12 in West Bengal (58.4%) Consistent contraceptive use is essential to achieve the effectiveness of a particular contraceptive method, which can further influence the choice, and decision of eligible couples to continue or discontinue the used contraceptive method in the future.

In present study, side effect of the OCP was not known to a considerable population 62.44% and those who were aware they only know the common side effects such as irregular periods, headache, nausea, weight gain, and acne. The participants who were interested in opting for OCP were 37.11% while a notable portion decline for it (62.89%). Peoples are largly aware about the ICUD and CuT, while only few knew about the Multiload. A considerable percentage of individuals (73.56%) were uninformed of the negative effects of IUCD. Despite this, a small fraction (24.22%) indicated interest in IUCD, while the bulk (75.78%) was against. In a study conducted by Khatri et al.,13 nearly half (48.25%) participants who were aware about IUCD as a modern contraceptive but not willing to use it.

Large participants were not heard about the injectable and implants. This shows the potential literature gap regarding to these contraception. Awareness of specific injectable options was low, with only a less percentage having heard of DBMA (3.11%) and none of the participant reported being aware of NTEN. Response for awareness about emergency contraception, showed less proportion of participants had heard of I pill (23.33%), indicating some awareness of this option for preventing unintended pregnancies.

Mogan et al.,14 more than half of eligible couples had used contraception in the previous six months, with 54.7% using it regularly. Gordon et al.15 in their study, they concluded that, Women with more education tend to like the idea of family planning, know more about contraceptives, and visit clinics more often, leading them to use contraceptives more.

Also, according to the WHO, between 2000 and 2020, the number of women using a modern contraceptive method increased from 663 million to 851 million. An additional 70 million women are projected to be added by 2030. During the same period, the contraceptive prevalence rate (percentage of women aged 15–49 who use any contraceptive method) increased from 47.7% to 49.0%.16

In this study none of the respondents reported using surgical termination procedures. These findings emphasized the necessity of focused educational initiatives to raise awareness and comprehension of various contraceptive choices, especially among people with poor expertise.

Conclusion

According to this study, education is the key factor for the family planning. All the participants were aware about the traditional contraception but only few of them were aware about the modern contraception. In order to encourage continuous use of contraceptives, it is important to investigate social and cultural aspects as well as knowledge levels. Identifying obstacles to the adoption of contemporary contraception can be aided by qualitative and implementation studies.

Sources of Funding

None.

Conflict of Interest

None.

References

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S Teal A Edelman Contraception Selection, Effectiveness, and Adverse Effects: A ReviewJAMA202132624250718

2 

National Research Council (US) Committee on Population Contraceptive Benefits and RisksContraception and Reproduction: Health Consequences for Women and Children in the Developing WorlNational Academies PressWashington (DC)1989https://www.ncbi.nlm.nih.gov/books/NBK235069/

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D Tejaswini J C Spandana S Bai attitude and practices about contraception among married reproductive womenInt J Reprod Contracept Obstet Gynecol20187414314

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F Ewerling CG Victora A Raj CVN Coll F Hellwig AJD Barros Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind?Reprod Health201815142

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P Singh KK Singh P Singh Factors explaining the dominion status of female sterilization in India over the past two decades (1992-2016): A multilevel studyPLoS One2021163e0246530

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Government of India India’s Vision FP 2020 [Internet]2014Ministry of Health & Family WelfareNew Delhihttps://advancefamilyplanning.org/sites/default/files/resources/FP2020-Vision-Document%20India.pdf

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World Health Organization World Health Organization. Primary Health Care on the Road to Universal Health Coverage2019WHOGeneva

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AL Altshuler ME Gaffield JN Kiarie The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidanceCurr Opin Obstet Gynecol20152764519

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AA Seidu EK Ameyaw BO Ahinkorah L Baatiema S Dery A Ankomah Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, AccraReprod Health20221917

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Ministry of Health and Family Welfare National Family Health Survey 2015-16. State fact sheet, NCT Delhi. Ministry of Health and Family Welfare, Government of IndiaState fact sheet, NCT Delhi. Ministry of Health and Family Welfare, Government of India. International Institute for Population Sciences2017International Institute for Population SciencesMaharashtra, Indiahttps://dhsprogram.com/pubs/pdf/FR339/FR339.pdfLast accessed on 2021 Oct 17

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S Gore S Katkuri A study to assess contraceptive use among married women in urban and rural areas: a comparative studyInt J Reprod Contracept Obstet Gynecol201659297882

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A Haldar B Baur P Das R Misra R Pal PR Roy Contraceptive practices and associated social covariates: an experience from two districts of West Bengal, IndiaNepal J Epidemiol20122421925

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B Khatri A Khadka A Amatya SM Shrestha R Paudel Perception And Use Of Intrauterine Contraceptive Devices (IUCD) Among Married Women Of Reproductive Age In Bhaktapur, NepalOpen Access J Contracept2019106977

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KA Mogan P Sharma A Khokhar P Tiwari Contraceptive use and its consistency among eligible couples in a peri-urban area of Delhi, India: A secondary data analysisJ Family Med Prim Care2022114138894

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C Gordon R Sabates R Bond T Wubshet Women's education and modern contraceptive use in EthiopiaInt J Educ2011311

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Family planning/contraception methods5 September 2023World health organizationGenevahttps://www.who.int/news-room/fact-sheets/detail/family-planning-contraception



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Article type

Original Article


Article page

472-478


Authors Details

Srishti Thakur*, Manjit Kaur Mohi, Nayana Pathak, Pooja Jafra


Article History

Received : 24-04-2024

Accepted : 11-05-2024


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