Survey of the Attitude to, the Knowledge and the Practice of Contraception and Medical Abortion in Women Who Attended a Family Planning Clinic

Objective: To assess the attitude to, the knowledge and practice of contraception and medical abortion in women attending the family planning clinic at the mvj medical college , hosakote , Bangalore, India.

Materials and Methods: Between 1^st of August, 2011 and 31st of July, 2012 200 women attending family planning clinic of the mvj medical college, hosakote, Bangalore India of which 105 requested for medical termination of pregnancy (mtp), 95 for family planning advice, were interrogated on a structured questionnaire. The age of women ranged in between 20-45 years, 71 (35.5%) were illiterate, 30 (15%) had primary school education and 99 (49.5%) had diplomas from high school and above. Patients were grouped into low and high socio-economic status according to modified kuppuswamy socio-economic status scale: (i). upper class, (ii). Upper middle class, (iii). Middle class, (iv). Lower middle class, (v). lower class.consent of both husband and wife was taken. They were counseled about the various contraceptives available and allowed to choose whichever suited them best.

Results: Among the 200 women 85 (42%) did not use contraception; 51 (25.5 %) were on the barrier method; 49 (18.31%) used intrauterine devices (iud); 12 (6%) used oral pills and and 3 (1.5%) used other methods. the request for mtp was on grounds of unplanned pregnancy in 55.25% cases or failure of contraception in 44.7%. there was no eugenic indication of the women, 3 (1.5%) had heard about emergency contraceptives, however none had used them; 20 (10%) had heard of medical abortion and 12 (6%) had previously undergone mtp with satisfaction. the various methods of contraception accepted by the women post abortion were ocps by 11 (10.47%), iuds by 54 (51.5%) and female sterilization by 26 (24.71%). in the other group, 23 (24.2%) had iuds removed and reinserted; 37.8% had iuds inserted; 26 (27.36%) women underwent sterilization operation; and 6 (6.31%) had iuds removed opting for pregnancy. statistical analysis was done using spss software (Chicago) with χ² test taking p value of 0.05 as significant.

Conclusion: There is lack of awareness of emergency contraception and medical abortion in the women community under study.

About one third pregnancies are unplanned and 20% pregnancies end in abortion, inspite of the increased contraceptive usage. There exist knowledge, attitude and practice with regards to contraception. The reasons why women do not use family planning methods are lack of knowledge and education, religious beliefs and fear of side effects.. There is a definite need of giving utmost importance to various family planning methods, especially regular contraception and emergency contraception [1].

MATATERIALS AND METHODS

Two hundred women who attended the family planning clinic at the MVJ medical college in Bangalore, India for MTP or family planning advice between 1^st of August 2011 and 31^st of July 2012, were interrogated by using a structured questionnaire about family planning, as their attitude to, knowledge and practice of contraception, emergency contraception and medical abortions.

RESULTS

Among the 200 women who attended the family planning clinic, 105 (52.5%) came for MTP and 95 (47.5%) came for advice on Ramadevifamily planning. The data which was acquired on the history and the demographics of the women, have been shown in [Table/Fig-1].

[Table/Fig-1]:

Gynecological and demographic characteristics of the women studied

Sll. No.	Characteristics	No. of women (n=200)	Percentage (%)
1.	(i) Medical termination of pregnancy cases	105	52.5
	(ii) Family planning advice	95	47.5
2.	Age
	Range	20-45 yrs
	Meanage	30.5 yrs
3.	Parity
	0	00
	1	70
	2	80
	3	21
	4	16
	≥4	13
4.	Education
	Illiterate	71	35.5
	Primary School	30	15
	High School and above	99	49.5
5.	Socio-economic status
	Upper class	18	4
	Upper middle class	62	31
	Middle class	85	42.5
	Lower middle class	16	8
	Lower class	19	9.5

[Table/Fig-2] shows the knowledge and the practice of contraception, medical abortion and the indication for MTP in these women. 85(42.5%) were not on contraception and 51 (25.5%) were using the barrier method. The more reliable methods like intrauterine devices and oral pills were used by 18.3% and 6% women, respectively. A total of 10% had heard of medical abortion, but only 6% of them had used it. The knowledge on emergency contraceptives was even poorer, only 3 (1.5%) women having heard of it, while none of them had ever used it. The indications for MTP were unplanned pregnancies in 55.25% women and failure of contraception in 44.7% women.

[Table/Fig-2]:

Knowledge and practice of contraception, medical abortion and indication for medical termination of pregnancies (MTP) (n=200)

Sll. No.	Characteristics	No. of women (n=200)	Percentage (%)
1.	Use of contraception
	i) No contraception	85	42.5
	(ii) Barrier method	51	25.5
	iii) Intra uterine device	49	24.5
	iv) Oral pills	12	6
	v) Others
2.	Knowledge of medical abortion
	i) Heard of medical abortion	20	10
	ii) Used medical abortion	12	6
3.	Knowledge of emergency contraception
	I) Heard of emergency contraception	3	1.5
	ii) Used emergency contraception	0	0
4.	Indication for medical termination of pregnancy (n=105)
	I) Unplanned pregnancy	58	55.25
	ii) Failure of contraception	47	44.75
	iii) Eugenic indication	0	0
5.	Socio-economic status
	i) Upper class	18	4
	ii) Upper middle class	62	31
	iii) Middle class	85	42.5
	iv) Lower middle class	16	8
	v) Lower class	19	9.5

[Table/Fig-3], [Table/Fig-4] shows the methods of contraception which were accepted by the women. Of the 105 MTP cases, (51.5%) accepted intrauterine devices and 24.7% preferred permanent sterilization, while oral pills and barrier methods were used by only 10.47% and 13.3% of the women, respectively. Among the 95 women who sought family planning advice, a change of IUDs and insertion of IUDs were accepted by 24.2% and 37.8% women respectively, while female sterilization was accepted by 26 (27.36%) women; 4 (4.21%) opted for oral contraceptive pills. 6 (6.31%) had the IUD removed for a trial of pregnancy.

[Table/Fig-3]:

Forms of contraception accepted by the women

Sll. No.	Characteristics	No. of women (n=200)	Percentage (%)
1.	Group I MTP cases (n=105) 105
	Oralpills	11	10.47
	Intra uterine device	54	51.5
	Female sterilization	26	24.7
	Barrier method	14	13.3
2.	Group II Family planning seekers (n=95) 95
	Change of intrauterine device	23	24.2
	Insertion of intrauterine device	36	37.8
	Removal of IUD fortrial of pregnancy	6	6.31
	Femalesterilization	26	27.36
	OCPs	4	4.21

[Table/Fig-4]:

Forms of Contraception Accepted by the Women

DISCUSSION

There are a variety of methods of regular contraception which are available for the individual choice of a woman, which include 494natural methods, barrier methods, oral pills, intrauterine devices, progestogen injections and permanent methods in the form of female and male sterilizations [1–3]. India was the first country in the world to formulate a National Family Planning Programme in 1589 and it gave due importance to it by taking up subsequent Five Year Plannings [4]. Recently, The Tenth Five-Year Plan has also aimed at achieving demographic targets by focusing on eligible couples, to achieve their reproductive goals [5,6]. In spite of the availability of safe and effective contraception, the need for it has not been met, mainly due to the ignorance amongst women, especially in the rural and tribal areas [4]. Despite the availability of MTP, many women in the rural and tribal areas go to unqualified practitioners for unsafe abortions and they face life-threatening complications [7]. Medical abortions with the use of mifepristone and misoprostol are now available in India and they can be safely used in early pregnancy [8, 9]. There is a lack of awareness amongst many women about the availability of regular contraception and emergency contraception. This makes them more prone to unintended pregnancies and their complications [9,10]. The present study clearly showed that a very high percentage of women (42.5%) had not made use of any contraceptive method, while many (25.5%) had used less effective methods. The reliable and the most effective method of using oral pills was used by only 6% of the women. Only 10% of the women had heard of medical abortions and only 6% had used it. The knowledge on emergency contraceptives was even poorer; only 1.5% women had heard of it and none had used it.

Amongst the 105 women who had requested termination of their pregnancies, 55.25% had unplanned pregnancies and 44.7% of them had pregnancies due to the failure of contraceptives. After MTP, 51.5% of them had an intra-uterine device inserted and 24.7% had undergone sterilization. Among the family planning seekers, a majority of the women opted for IUDs or permanent tubal sterilizations [12–14]. In the present study, a very high prevalence of unwanted pregnancies were due to a lack of the use of regular contraception, lack of knowledge and the use of emergency contraception.

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