Original Article Socio-demographic Factors affecting ...
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OriginalArticle
Socio-demographicFactorsaffectingFemaleSterilizationOperationamong
CouplesofAhmedabadCity:ARecordBasedStudy1 2 1 1 1VirajPanchal ,VaibhaviPatel ,AasthaNayak ,JayParikh ,BansariParikh
1 2MBBSStudent, AssistantProfessor,DepartmentofCommunityMedicine,Smt.NHLMunicipalMedicalCollege,
Ahmedabad,Gujarat,India
Correspondence:VirajPanchal,Email:[email protected]
Accessthisarticleonline
Website:
www.healthlinejournal.org
DOI:
10.51957/Healthline_206_2021
QuickResponseCode Howtocitethisarticle:
PanchalV,PatelV,NayakA,ParikhJ,ParikhB.Socio-
demographic Factors affecting Female Sterilization
Operation among Couples of Ahmedabad City: A
RecordBasedStudy.Healthline.2021;12(2):43-48.
Abstract:
Introduction:Unplannedpregnancymaybethereasonofmanyneonatalandmaternaladverse
effects. Many factors have been reported to be associated with acceptance of female sterilization.
Objective:Toidentifyvarioussocio-demographicfactorsaffectingthedecisionofchoiceofTubalLigation
(TL).Method: A recordbased studywasdoneusingdata from the registermaintained at the Family
PlanningUnitofObstetricsandGynaecologydepartment.AnalysisofdataofTLoperationsconducted
betweenApril2018toMarch2019wereperformed.Results:Atotalof675tuballigationoperationswere
conducted.ThemeanageoffemalesundergoingTLwas28.8±3.9yearsandtheirhusbandswas33.25±
4.38years.Outofthetotal,484(71.1%)coupleswereMuslims.Total74(10.8%)femaleswereilliterateand
39(5.8%)maleswereilliterate.Among440(65.1%)coupleswhohadunderwentTLhad3livingchildren.
Majorityi.e.,518(76.7%)hadtheageoftheirlastlivingchildlessthan1month.Ninetyonepercentof
coupleshadatleastonemalechild.Therewasasignificantrelationshipoffemaleeducationwithtotal
numberoflivingchildren.Relationshipoftotalnumberoflivingchildrenwithreligionwasalsosignificant
statistically.Conclusion:Thestudyconcludesthatfemaleeducationaswellasreligiousandculturalbeliefs
playsamajorroleindecidingthefemalesterilization.
Keywords:Femaleeducation,Femalesterilization,Religion,Tuballigation.
Introduction:
Unplannedpregnancymaybeamajorsocialand
publichealthissuewithadverseeffectsonneonatal
anddevelopmentaloutcomesandalsoonmaternal[1]
health and wellbeing. In India, the birth control
program was implemented in 1952, as a national
population policy to regulate the rapid rise of
population and reduce poverty. Initially, variety of
recent methods were focused and later shifted
toward male sterilization, but female sterilization
becametheprimefocusfromlate1970.However,the
persistent dominance of sterilization in the family
program is largely affected by the socioeconomic[2]
conditions. The use of contraceptive methods
among Indian women is related to several factors
such as personal, interpersonal, partner related,[3]
service related and/or method related. Various
factorslikeage,educationofboththeparents,ageof
the last livingchildwerereported tobeassociated
with acceptance of female sterilization in the[4]populationofruralAhmedabad,Gujarat. Itwasalso
seen that e i ther lack of in format ion or
misinformation regarding temporary methods and
less opportunity to prefer modern temporary
HealthlineJournalVolume12Issue2(April-June2021)
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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...
methodsduetoaffordabilityandaccessibilityissues
also affect women's choice of selecting female[5]sterilizationinruralpartsofIndia. Onequalitative
study from Mumbai showed that from a women
perspective, the choice to undergo sterilization
makesthemeffectivelycontroltheirfertilityleading
totheirimprovedsexualrelationshipsandemotional[6 ]health. However, a major determinant in
sterilizationwassonpreference,asitwasfoundthat
manywomenpreferredsterilizationevenwith two
sons than if they had two daughters, especially in
stateslikeGujarat,Punjab,Rajasthan,UttarPradesh[7]
andBihar. Due to scarce data onmultiple factors
affectingtheselectionofcontraceptive,itisworthto
analysetherecordbaseddataanduseittoidentify
thevarioussocio-demographic factorsaffectingthe
decisionofchoiceofTubalLigation(TL).
Objectives:
• Tostudythesocio-demographicprofileofvarious
couplesundergoingTubalLigation
• To correlate the various socio-demographic
factors affecting thedecisionof choiceofTubal
Ligation.
Method:
A record based study carried out at the Family
planningunitofObstetricsandGynaecology,atoneof
thetertiarycarehospitalofAhmedabadcity.Dataof
theCouplesundergoingTuballigation(TL)operation
attheabovehospitalduringtheoneyearperiodfrom
April 2018 to March 2019 was collected with
permission. The data included the variables like
education of couple, their age, and number of
children, occupation and age of last child, religion,
andtimeofselectionofTL.
Results:
Atotalof675coupleshadoptedTLoperationsat
the Family Planning Unit of Obstetrics and
GynaecologyDepartmentfromApril2018toMarch
2019. Out of the total, 486 (72%) couples were
Muslim, one was Sikh and rest 188(27.9%) were
Hindu.Itmaybeduetomajorityofthepopulationin
thenearbyareaofthehospitalisMuslim.Meanageof
femalesundergoingTLwas28.8±3.9yearsandtheir
husbandwas 33.25 ± 4.38 years.Maximum age in
femaleswasfoundtobe41yearsandinmalesitwas
50years,while theminimumage found in females
was 20 years and in males was 23 years. Most
commonagegroupatthetimeofTLoperationamong
femalewasof21-30yearsandamongmaleswas31-
40years.Majority(75%)ofthefemaleand65%ofthe
malehadcompletededucationuptoprimary level.
(Table1)
Themeannumberofchildreninthefamilywas
3.09±0.72.Themeannumberoffemalechildrenwas
1.53±1andthemeannumberofmalechildrenwas
1.56±0.8.Therewere92(13.6%) coupleswithout
anyfemalechildinthefamilyand59(8.7%)couples
withoutanymalechildindicating91%ofthecouple
hadatleastonemalechild. Only15%ofthecouples
underwentpermanentmethodofcontraceptionafter
2livingchildrenwhilemajority(65%)ofthecouples
decideditafterhaving3livingchildren.Only1couple
underwentTLoperationeveniftheydidn'thaveany
childandthereasonforthesamewasnotmentioned
intherecords.
Agegroup(years)
11-20
21-30
31-40
41-50
Educationalstatus
Illiterate
Primaryeducation
Secondaryeducation
Graduate
Religionofcouple
Hindu
Muslim
Sikh
Notmentionedinrecord
1(0.1)
502(74.4)
171(25.3)
1(0.1)
No.ofwomen(%)
74(10.8)
509(75.5)
88(13.05)
4(0.6)
No
187
484
1
3
0(0)
246(36.4)
403(59.7)
26(3.9)
39(5.8)
441(65.3)
188(27.9)
7(1)
Percent
27.7
71.7
0.1
0.4
No.ofmen(%)
No.ofmen(%)No.ofwomen(%)
Table1:Socio-demographicinformationofcouplesselectingTubalLigation(n=675)
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Majorityi.e.,518(76.7%)ofthecouplespreferred
thesterilizationoperationwhentheageoflastliving
child was less than one month. Out of total 675
couples,thelastlivingchildwasmalein375(55.6%)
andfemalein300(44.4%)couples.(Table2)
Majority (62.7%) of couples selected TL along
withLowersectioncaesarean,94(13.9%)ofcouples
preferred TL after normal vaginal delivery while
114(16.9%) females underwent sterilization after
MedicallyTerminatedPregnancy (MTP)procedure.
(Figure1)
Outof675,74(11%)wereilliterateandamong
these 71(96%) had more than 2 children while
among literate females, 501(83%) out of 601 had
more than 2 children and this difference was also
statisticallysignificant(pvalue0.003andOddsRatio
(OR)4.72).Outof675males,39(5.8%)wereilliterate
Table2:Totalnumberoflivingchildren,genderandageoflastlivingchildincouplesatthetimeofdoingTubalLigation(n=675)
Numberoflivingchildren
0
1
2
3
Morethan3
Numberofchildren
0
1
2
Morethan2
Ageoflastlivingchild
<1month
1monthto12months
1yearto5years
5yearsto10years
Morethan10years
Genderofthelastlivingchild
Female
Male
No.ofcouples
1
1
101
440
132
No.ofcouples
(malechildren)
59(8.7%)
275(40.7%)
253(37.5%)
88(13.1%)
No.ofcouples
518
10
97
41
9
No.
300
375
percentage
0.1
0.1
15
65.1
19.7
No.ofcouples
(femalechildren)
92(13.6%)
261(38.7%)
215(31.9%)
107(15.8%)
percentage
76.7
1.5
14.4
6.1
1.3
percentage
44.4
55.6
Figure1:SelectionoftimingforTL
and among these couples, 95%were havingmore
than 2 living children. However, male educational
statuswasnotsignificantlyassociatedwiththetotal
number of living children in family(p value0.1134
and Odds Ratio (OR) 3.49). Out of 484 Muslims
couples,429(88%)hadmorethan2childrenwhile
amongHinducouples139(74%)outof187hadmore
than2 childrenand thisdifferencewasalsohighly
significant(pvalue0.0001andOddsRatio(OR)2.69).
Genderof last livingchildwhethermaleor female,
wasnotsignificantlyrelatedtothetotalnumberof
livingchildren(pvalue0.9618andOddsRatio(OR)
0.98).Outof a total 675 couples, 59(8.7%)hadno
male child, andamong these couples53(90%)had
more than two living children. However, this
association was insignificant(p value 0.3428 and
OddsRatio(OR)1.65).(Table3)
Discussion:
The study was conducted at Vadilal Sarabhai
GeneralHospitalwhichissituatedinthewestzoneof
Ahmedabadcity.Themeanageoffemalesundergoing
TLwas 28 years and their husbandwas 33 years.
Puwaretal.,hadalsoreported28yearsasmedianage[4]infemalesand31yearsasmedianageinmales. This
showsthatcouplesarechoosingpermanentmethod
ofcontraceptionatayoungerage.74.4%femaleswho
underwentTLinourstudywereintheagegroupof
21-30 years. While a study by Benjamin et al.,
reported that 40.1% of female who underwent
sterilizationoperationwereintheagegroupof30-35
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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...
Table3:Associationbetweensociodemographicvariableandtotallivingchildren(n=675)
[8]years. Wefoundinourstudythat75%femalesand
65%ofmaleshadcompletededucationuptoprimary
level,whereasinastudybyAthavaleAetal.,showed
that 23% of women were illiterate, 11% were
educateduptoprimaryleveland66%hadcompleted[9]educationbeyondprimarylevel. Amongstilliterate
females,96%hadmorethan2childreninourstudy.It
was seen in an ICMR studybyRBaveja et al., that
illiterate women in their study had more children[10]
compared to literate women. A significant
relationship was seen between female education
withnumberoflivingchildren(Oddsratio4.72andP
value0.003) inourstudy.Educationof femalewas
alsofoundsignificantlyrelatedtothetotalnumberof
children (chi square22.4, p=0.001) in a studyby[4]
PuwarBetal. Thisshowsthatfemaleeducationplay
a major role in limiting the family size. Male
education had no significant relationship with the
number of living children (p value 0.1134) in our
study.AstudybyPalamuleniMEetal.,showedthat
with higherwomen empowerment the use of long[11]
actingcontraceptiveshasincreased. Whileastudy
conducted from thedataofNationalFamilyHealth
Survey(NFHS) inUttarPradeshin1992–1993by
Totalnumberoflivingchildren
Morethan2(%) Upto2(%)Total
Oddsratioand95%Confidence
Intervalp-valueVariable
FemaleEducation
Illiterate 71(95.95) 3(4.05) 74
Literate 501(83.36) 100(16.64) 601
Total 572(84.7) 103(15.2) 675
4.72(1.46to5.301) 0.0030
MaleEducation
Illiterate
Literate
Total
Religion
Muslims
Hindu
Total
Genderoflastlivingchild
Female
Male
Total
Atleastonemalechild
No
Yes
Total
37(94.8)
535(84.1)
572(84.7)
429(88.6)
139(74.3)
568(84.6)
254(84.6)
318(84.8)
572(84.7)
53(89.8)
519(84.2)
572(84.7)
2(5.1)
101(15.8)
103(15.2)
55(11.3)
48(25.6)
103(15.3)
46(15.3)
57(15.2)
103(15.2)
6(10.2)
97(15.7)
103(15.2)
39
636
675
484
187
671
300
375
675
59
616
675
3.49(0.82to14.72)
2.69(1.74to4.14)
0.98(0.64to1.51)
1.65(0.69to3.94)
0.1134
0.0001
0.9618
0.3428
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HealthlineJournalVolume12Issue2(April-June2021)
DwivediSNetal.,showedthatwhosehusband'swere
literateweremorelikelytoadoptcontraception(OR=[12]1.7, 95% CI : 1.4-2.1). Thus, improving the
educationallevelmayprovebeneficialincontrolling
thepopulationgrowth.Themeannumberofchildren
inthefamilywas3inourstudy.Similarly,PuwarBet[4]
al.,reported2.84asthemeannumberofchildren.
Outofall,91%of thecouplehadat leastonemale
childand55%oftotalcoupleshadthelastlivingchild
asmaleindicatingthathavingatleastonemalechild
inthefamilybeforeundergoingpermanentmethodof
contraception does have an influence. Similarly,
AthavaleAetal.,reportedthat89%ofthecoupleshad[9]
atleastonemalechild. PuwarBetal.,alsoobserved
that98.9%coupleshadatleastonemalechildinthe[4]
family before selecting permanent method.
EdmeadesJetal.,alsoshowedthat29%womendid[13]sterilizationiftheyhadatleastoneson. Agooddeal
ofdocumentedresearchhadshownthesameresults[7,14-17]
forsexpreference.
Whenanalyzed,thegenderoflastlivingchildwith
the total number of living children, no significant
relationshipwasseen(P=0.9618).Instead,anequal
distributionwasnoted.Alsohavingatleastonemale
childdidnot showasignificant relationship inour
studywithtotalnumberofchildren(P=0.3428).We
alsonotedthat62%ofthecouplespreferredTLsoon
after Lower section caesarean delivery and 76%
couplespreferredTLwhentheageoftheirlastchild
waslessthanamonth.Puwaretal.,statedthat28%
femalespreferredtoundergosterilizationwhenthe[4]ageof last living childwas less than1month. TL
afterlowersectioncaesareandeliverymakesitacost-
effectivestrategy.Itwasalsoseenthatabout16.9%
couplesdidsterilizationafterundergoingMedically
Terminatedpregnancy,indicatinganunmetneedfor
contraception.
ItwasseenthatoutofMuslimscouples,88%had
more than 2 children before selecting TL while in
Hindusitwas74%ofcoupleswhohadmorethat2
children,thisrelationshipwasalsofoundtobehighly
significant(P=0.0001).AstudydonebyHayatHetal.,
in rural Kashmir valley particularly Muslim
dominatedalsoshowed17%ofcouplesdidnotuse
[18]contraceptionduetoreligiousreasons. Inastudy
byKansalAetal.,theystatedthatthemostcommon
reasonfornotusingcontraceptionwasthedesirefor
more children in21%couplesorparticularlymale
child (5.4%) followed by religious reasons also[19]
(5.8%). SimilarlyinastudybyPatraSetal.,in2015,
about 9% Muslim women in India do not use
contraception due to religious reasons, and non-
Muslim women were more likely to use a family[20]planningmethodinthefuturethanMuslimwomen,
thus religious and cultural beliefs regarding the
familysizeplayadefiniteroleinlimitingthesizeof
thefamily.
Limitations:
Thiswasarecordbasedstudyso,onlythefactors
mentionedintherecordscouldbestudied.Moresuch
studiesarerequiredhavingalargersamplesizeanda
populationconsistingofdifferentethnicgroupsand
religion.
Conclusion:
Inpresentstudy,womendidsterilizationat the
ageof28yearsafterhavingapproximately3children.
Majorityofthefamilieshadatleastonemalechild.
Educationofmotherwassignificantlyrelatedtothe
totalnumberofchildren,indicatingwomen'srolein
deciding the time of sterilization. Religion of the
couple also showed a significant association with
totalnumberofchildreninthefamily.Mostcommon
time selected for TLwas soon after Lower section
caesarean delivery and majority of the couples
preferredTLwhentheageoftheirlastchildwasless
than amonth. So wewould like to recommend to
increaseliteracyamongfemales.
Declaration:
Funding:Nil
Conflictsofinterest:Nil
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Panchaletal Socio-demographicFactorsaffectingFemaleSterilization...