Theme 3: Access to and utilization of quality maternal

health care

Frequency of contraceptive use and its association with couple’s education and income status in Rawalpindi, Islamabad

(Pakistan)

Presented by,

Dr. Farwa Rizvi,

Assistant Professor, Community Medicine Dept., IMDC (Islamabad Medical and Dental College), Bahria University,

Islamabad, Pakistan.Email: farwa.riz@gmail.com

Background

• WHO (World Health Organization) definition of reproductive health establishes reproductive rights for men and women. This includes the capability to reproduce and the freedom to decide if, when and how often to do so.

(Evangelische HF, Bugginger Str , Freiburgi Br. Reproductive health of women:Family planning and reproductive rights in Germany Feb 2013;56(2) :192-8)

Background

• Family Planning is an emerging issue in the developing countries especially in the south East Asian region. Well documented link between female education and use of contraception plays a key role in devising family planning policies in developing or lower income countries.

• (Evangelische HF, Bugginger Str , Freiburgi Br. Reproductive health of women:Family planning and reproductive rights in Germany Feb 2013;56(2) :192-8)

Background

• Contraception is a major component of reproductive health. Assessing the awareness regarding contraception and the gaps and barriers related to implementation of Family Planning practices and use helps to point towards potential areas of intervention.

• (Shaikh BT. Marching toward the millennium development goals: what about health system, health seeking behaviors and health service utilization in Pakistan? World Health Popul 2008; 10(2): 44-52)

Background

• In another study conducted by collecting data from the demographic and health surveys for 26 countries, it has been confirmed that higher education is consistently associated with lower fertility.9

• (Teresa CM. Studies in family planning 1995;Vol 26,no 4:187-202)

ABSTRACT

• Background: The decision autonomy of women and couples

regarding contraceptive use is one of the dependent variables affected by education and income in developing countries, like Pakistan.

• Objective: To determine the frequency of contraception use and

its association with couples education and income status in Rawalpindi, and Islamabad, Pakistan.

• Design: Cross section study • Place and Duration of Study: Gynecology and Obstetrics Unit, PIMS (Islamabad)

and PESSI (Rawalpindi), from February, 2013 to July, 2013.

• Patients and Methods: Patients (420) were selected by consecutive

sampling after informed written consent and acquiring Hospital ethical committee Permission.

The survey interview tool was a semi structured questionnaire. The FP methods used included Condoms, IUCDs, Oral contraceptive hormonal pills or injections.

Results: • Majority of women (75%) belonged to the Punjab

province and federal area (12%). In this cohort (68%) belonged to urban area and (32%) were from rural area. The mean age of these women were 29.43 with standard deviation of 5.384 years. The minimum age was 18 years and maximum was 50 years.

Results:

• In these women 4% were illiterate, maximum women had primary education (42.5%), (28.8%) women had done SSC (matric), 11% were HSSC (intermediate), 12% were graduate and only 1.4% women had higher education (Postgraduation). In this cohort only 38% women were doing any job and rest were house wives.

Results:

• The educational level of their husbands showed that 10% were illiterate, 16% had done primary and majority (50%) of them had an education level till SSC (matric) and 21% were graduates with only 2.1% postgraduates.

Results:

• Husband’s educational status was significantly associated with the couple’s current use of Family Planning methods (p=0.049). Wife’s educational status was significantly associated with the couple’s current use of Family Planning method (p=0.01). Husband’s income was highly significantly associated with the couple’s current use of contraceptives (p=0.007).

Conclusion:

• Higher educational levels of both men and women have strong influence on the use of contraceptive methods in a family unit.

Methodology:

• A cross sectional survey was carried out for the patients coming to PIMS Hospital and PESSI for patients coming from Rawalpindi, District Punjab and district Mansehra KPK (Khayber Pakhtun Khwa).

• Consecutive sampling• Informed written consent

Tables

• Table No 1:• Association of Husband Education with

Current Use of any Family Planning Method • p value is significant 0.049 (Husband’s educational status was

significantly associated with the couple’s current use of FP method)

Husband Education

Are you currently using any Family Planning

methodTotal P-value

Yes No

Illiterate 20 17 37

0.049

Primary 24 28 52

SSC (Matric) 111 74 185

HSSC (intermediate) 1 0 1

Graduation 57 25 82

Post graduation 9 2 11

Total 222 146 368

• Table No 2: Association of Woman Education with Current Use of any Family Planning Method

• p value is significant 0.01 (Wife’s educational status was significantly associated with the couple’s current use of FP method)

Woman Education

Are you currently using any Family Planning method

Total P-value

Yes No

Illiterate 40 47 87

0.01

Primary 68 45 113

SSC (Matric) 82 38 120

HSSC (intermediate) 1 0 1

Graduation 28 10 38

Post graduation 3 4 7

Total 222 144 366

TABLES

• Table No 3: Association of Husband’s education with Current Use of any Family Planning Method

• p value 0.007 (very highly significant)

Husband Income

Are you currently using any Family Planning method

Total P-value

Yes No

7,000- 10,000 112 96 208

***0.00710,000 - 25,000 84 43 127

> 25,000 21 5 26

Total 217 144 361

Discussion

• The reason for tending to maintain smaller family size by the couples can be increased urbanization as well as economic constraints, as it seems to have a strong influence on people’s knowledge and use of contraception. Economic constraints appear to be leading influencing factor for limiting the number of children.

• (Cebeci SD, Erbaydar T, KalacaS,Harmanci H,Cali S, Karavus M. Resistance against contraception or medical contraception method Eur J Contracept Reprod Health Care 2004;9(2):94-101)

Discussion

• Moreover education appears to have a strong impact on fertility, as it promotes a later age at marriage and reduces lifetime exposure to the risk of childbearing, induces women to marry men with higher income, thus widening the horizon for family planning and contraceptive use. Also educated women tend to start jobs; this too reduces demand for children.

• (Sathar ZA, Mason KO. How female education affects reproductive behaviour in urban Pakistan. Asian Pac Popul Forum 1993;6(4):93;103)

• (Mikolajczyk RT, Stanford JB, Rauchfuss M. Factors influencing the choice to use modern natural family planning. Contraception. 2003 Apr;67(4):253–258. doi: 10.1016/S0010-7824(02)00490-0.)

Thank you