Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 59, Num. 4, 2005, pp. 143-149

Indian Journal of Medical Sciences, Vol. 59, No. 4, April, 2005, pp. 143-149

Original Article

Contraceptive practices and awareness of emergency contraception in educated working women

Takkar N., Goel P., Saha P.K., Dua D.

Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India

Correspondence Address:Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Sector 32-B, Chandigarh - 160023, India. E-mail: navneet@doctor.com

Code Number: ms05021

Abstract

Keywords: Contraception; educated women; emergency contraception

The success of contraceptive practice lies in the acceptance of a regular contraceptive to prevent future pregnancies. Emphasis needs to be placed on informing and educating women that every unprotected intercourse implies a risk of pregnancy. An ICMR study evaluating contraceptive choices revealed that the majority of women after receiving balanced information could make an informed choice overriding a provider's bias.[1] After the birth of their first child, 80% of educated couples used spacing methods whereas even after the birth of their third child more than 50% of the uneducated did not.[2] Hence, education plays a key role in contraceptive use. Emergency contraception or postcoital contraception provides an additional support whenever there is a breach in the regular contraceptive use. A number of studies are available from the west regarding the use of emergency or postcoital contraception.[3-5] The main reasons for needing emergency or postcoital contraception are the nonuse of condoms, condom breakage and missing an oral contraceptive pill.[6] The department of Family Welfare, Ministry of Health and Family Welfare, has introduced emergency contraceptive pills in the Family Welfare Program, as a contribution to achieving the National Population Policy goals.[7] It is also a very critical option for preventing an unwanted pregnancy in case of sexual assault. In this survey educated working women were selected to study knowledge and use of contraceptive methods, most popular contraceptive method, source of knowledge about contraception and awareness of emergency contraception.

Material and methods

A cross-sectional study was conducted during January-April 2003. The study was carried out among women belonging to the following categories:

1. Staff nurses.
2. Ministerial staff, i.e., clerks, stenos and assistants.
3. Others, viz . laboratory technicians, physiotherapists, speech therapists, psychologist and medical social workers.

These three categories are the educated women working in this medical college. All of them have done some vocational course after finishing basic education. All the female employees from this medical college alone were invited to participate. Married as well as unmarried employees in the reproductive age group were interviewed for the study purpose. Of the 284 employees 258 women consented for the interview while 26 (9.2%) refused.

Instrument

A mixed questionnaire containing open as well as closed ended questions which covered socio-demographic information concerning age, education, professional status, marital status, type of family, parity and number of spontaneous as well as induced abortions. Participants did not disclose their names. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception. Knowledge about contraceptive methods was assessed by following questions, awareness of contraceptive methods, type of contraceptive methods, source of knowledge and advantages and disadvantages of the method. Sources in awareness about contraceptive methods included media, medical literature, friends, partner and family members. Awareness of emergency contraception was assessed by asking two questions: (1) if a woman had unprotected intercourse, is there anything she can do within 3 days to prevent pregnancy and (2) awareness of methods of postcoital contraception. The questionnaire was pilot tested in 20 persons and was subsequently modified. A total of 36 questions were asked which took approximately 30-40 min. Regular user was defined as one who was having contraceptive use for every act of coitus. Joint family was defined as family consisting of more than one married couple and their children living together in the same household and the men being related by blood with a common family income from which all family expenditures are met.[8]

Procedure

Medical social worker (MSW) informed the staff personally, no participation information form was given. The staff was approached in their respective areas of work between 9 a.m. and 5 p.m. and the questionnaire was collected by MSW after getting it filled. Informed consent was taken. Study was approved by the departmental ethics committee.

On the basis of information collected, data were analyzed. Statistical analysis was done using SPSS 10 software (SPSS Inc., Chicago, IL, USA).

Results

Demographic characteristics

The main characteristics of the demographic profile are shown in Table 1. Mean age of the study group and mean age at marriage was 28.2 ± 6.9 and 24.6 ± 4.9 years, respectively. All the women in the study population were literate, of whom 81 (31.3%) were graduates and 24 (9.3%) were postgraduates. Majority of the women 251 (97.2%) were of urban background, 169 subjects (65.5%) belonged to nuclear family and 89 (34.4%) belonged to joint family. None of the subjects had more than two children. Only married women had undergone induced abortions. Thirty-four women who underwent induced abortions 28 had one induced abortion while six underwent abortion twice.

Contraceptive practices

All women had knowledge about contraceptive methods. Of 190 married women, 154 (81.1%) practiced contraception among which 113 women (73.3%) were regular users and 41 women (26.6%) were irregular users. All the 68 unmarried subjects were aware of the contraceptive methods but none of them was sexually active. Spacing methods or reversible methods like condoms, Copper T, rhythm and withdrawal method were more popular and only three (1.9%) opted for female sterilization. The most commonly used contraceptive method was condom (57.8%) followed by Copper T 38 (24.6%) (Table 2)

Both print and electronic media were an important source of public awareness in (57.7%). Print media such as newspapers, charts outside clinics, leaflets distributed by health care workers and electronic media mainly comprised of television and radio. A large majority (82.4%) was aware of advantages and disadvantages of method used and were satisfied (74%) with the use of contraceptive method.

In 54.5% cases both the husband and wife took the decision regarding the choice of contraceptive use.

Awareness of emergency contraception

Only 29 women (11.2%) of the 258-study population were aware of emergency contraception. All knew only about Yuzpe′s regimen. Of the 29 women who were aware of emergency contraception 19 were nursing staff. Only three (10.3%) women had practiced emergency contraception. All these women used the Yuzpe′s regimen. Once aware of emergency contraception 81% were willing to use it (Table 3). There was no difference in the awareness about emergency contraception in nursing staff vs others as compared by chi-squared analysis (P=0.29).

Discussion

Contraceptive practices and awareness of emergency or postcoital contraception was studied in three categories of educated workingwomen viz.: professionally qualified like nursing staff, psychologist, physiotherapist, etc., women with vocational training and the ministerial staff. This study group is a fair representation of the educated workingwomen in our society; it cannot however represent all the strata of workingwomen. The study showed that 81.1% of educated married women practiced contraception, which is quite high in comparison to the contraceptive prevalence rate of 48.2% indicated in the National Family Health Survey 1998-1999.[9] The contraceptive methods used were spacing methods in 98% of women and permanent method in only 1.9% of women. This is in accordance with the study by Kanojia et al. that spacing methods were more popular among educated urban population.[2] Steroidal contraception was used by 2.6% of women in contrast to United States where oral pills are the most popular reversible method of contraception.[10] In ICMR task force study on evaluating contraceptive choice through method mix approach showed that only 6% of women opted for oral contraceptive use.[1] In another Indian study after the birth of first and second child the use of oral contraceptives was 4 and 5%, respectively.[2] The chief source of knowledge of contraceptive methods was both electronic and print media, indicating that dissipation of information by these means helped the couples. As per ICMR Task Force Study 68% of the couples took decision by themselves regarding contraceptive use.[11] Our study reveals that in about half of the women, the couples took the decision themselves regarding contraceptive use. Both husband and wife participated equally in the choice of contraceptive method. This was couples decision not that of friend, family member or health care provider.

Another incidental finding of this study was that none of the subjects had more than two children. This depicts the acceptance of the two-child norm and attitude of the working women to go in for a small family.

In India awareness about emergency contraception in general population and paramedical workers is practically nonexistent.[12] In comparison, a survey in United States showed that 36% of respondents realized that anything could be done to prevent pregnancy after unprotected sex.[13] A Swedish study by Aneblom et al.[14] and a survey in Melbourne Health Clinic[15] showed that awareness about emergency contraception was 83 and 80%, respectively. In the present study the awareness about emergency contraception was 11.2%, which was higher than that reported by Tripathi et al.[12] This could be because the study population included only educated and working women in a hospital setting. There was no difference in the awareness about emergency contraception in nursing staff vs others; however, the number of those who were aware is too small to come to a definitive conclusion.

Another encouraging observation of the study was that 81% of women were willing to use emergency contraception if educated about it. A three-year program of training for health care providers and multifaceted information campaign for general public from 1997 to 2000 in Mexico City showed that emergency contraception awareness increased significantly from 13 to 32%.[16]

To summarize, a high percentage of females in this literate working-women population used contraception. Spacing methods of contraception were more commonly practiced, among those condom was the most popular method. Electronic and print media were important sources of public awareness. Awareness of emergency contraception was low and there is an urgent need to promote it.

References

Copyright 2005 - Indian Journal of Medical Sciences

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