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Table of Contents
ORIGINAL RESEARCH
Year : 2022  |  Volume : 15  |  Issue : 2  |  Page : 97-100

Contraception knowledge and practices among women in Peshawar


1 Department of Gynae Obs, Category-D Hospital, Peshawar, Pakistan
2 Department of Gynae Obs, DHQ Hospital, KPK, Pakistan

Date of Submission23-Jan-2022
Date of Decision05-Mar-2022
Date of Acceptance27-Mar-2022
Date of Web Publication04-Jul-2022

Correspondence Address:
Seema-Gul Salman
House No. 5, Street H, Danish Abad, Peshawar, KPK
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hmj.hmj_8_22

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  Abstract 


Background: Contraception is an integral component for addressing the population emergency faced by resource deprived third-world countries like Pakistan but studies in this regard are lacking. Aims and Objectives: This study was conducted to assess the knowledge and practice of contraception among women in Peshawar. Materials and Methods: This cross-sectional prospective observational study was carried out from March 2020 to November 2021. All women of reproductive age were included in the study. Biodata, socio-economic status (SES), reproductive data, knowledge and practice of contraception were collected from a total of 1260 women during the study period. Results: One thousand two hundred and sixty females of reproductive age visiting the hospital were studied. Regarding reproductive health and contraception 431 (34.2%) had no knowledge and 415 (32.9%) had wrong information. Only 387 (30.7%) patients had correct information about fertility window, 447 (35.5%) had erroneous knowledge about it and 426 (33.8%) were completely uninformed about it. 609 (48.3%) patients were of low SES. 617 (49%) patients were motivated for contraception while 643 (51%) rejected it. 377 (29.9%) patients used no method for contraception, 398 (31.6%) used injectables while the remaining methods included; 225 (17.9%) implants, 68 (5.4%) natural withdrawal and 67 (5.3%) intrauterine contraceptive device. Conclusions: The study population lacked or had inadequate knowledge about reproductive health and contraception. Further, studies should be carried out for a wider understanding of the lack of contraceptive knowledge and practices to control the ballooning population growth and the lack of reproductive and contraceptive health services and practices.

Keywords: Contraception, fertility, reproductive health


How to cite this article:
Salman SG, Rafiq M. Contraception knowledge and practices among women in Peshawar. Hamdan Med J 2022;15:97-100

How to cite this URL:
Salman SG, Rafiq M. Contraception knowledge and practices among women in Peshawar. Hamdan Med J [serial online] 2022 [cited 2022 Aug 10];15:97-100. Available from: http://www.hamdanjournal.org/text.asp?2022/15/2/97/349807




  Introduction Top


Pakistan with a total population of approximately 230 million people ranks as the 5th most populous country in the world after Indonesia.[1] Uncontrolled population growth has resulted in lack of reproductive and contraceptive health services. As a result, it has some of the worst fetomaternal and reproductive health indicators; 178/100,000 maternal mortality[2] and 3.5 fertility rate per woman.[3] The ballooning population is not matched with contraceptive practices and the modern contraception prevalence rate is an estimated 41% with the actual rate probably much lower than this.[4] It is recommended that knowledge about contraception should be imparted to all young mothers first seeking reproductive health services and in the immediate post-partum (PP) period.[5],[6] Contraception in the immediate PP, i.e., 12 months after delivery is defined as contraceptive practices to prevent and manage unplanned pregnancy and/or closely spaced pregnancy.

The aim of this study was to identify the current contraception knowledge and practices of women in Peshawar. This included women of all reproductive ages to better assess the subject matter and identify reasons due to which women cannot follow contraception even after 12 months of delivery.[7] A lack of contraceptive measures also causes additional fetomaternal complications including malnutrition, anaemia, restriction of foetal growth and below low weight at birth.[8] These factors lead to babies with poor milestones and stunting of growth.[9]

Implementation and use of contraceptive health services are also impeded by a complete lack of awareness about the fertile window and recommended use of contraception measures.[10] In Pakistan, such services and treatments are also ineffective simply because of unavailability in remote areas.[11] This study will provide further data for accurately responding to the population emergency faced by resource-deprived third-world countries like Pakistan.[12]


  Subjects and Methods Top


A prospective cross-sectional observational study was carried out from March 2020 to November 2021 after the hospital's ethical and research committee's approval and in accordance with the ethical principles mentioned in the Helsinki Declaration 2013. A total of 1260 women who consented to participate were studied during this period. These included all women of reproductive age. Since breastfeeding is a natural method of contraception that mothers in the study population were aware of and for most an important concern was if contraception will affect their breastfeeding thus they were divided into two groups, i.e., Non-PP (NPP) and PP.

Data were collected on a printed pro forma. Biodata, i.e., age (years), age at marriage (years), socio-economic and educational status were collected. Obstetrical information including parity and knowledge about the fertility window was noted. The main variables for this study included knowledge about contraception, information source, motivation for contraception, a preferred method for contraception and preference reason. Statistical analysis was completed with SPSS 23 (IBM Corporation, New York, USA).


  Results Top


A total of 1260 patients were studied. Of these, 627 (49.8%) were NPP and 633 (50.2%) were PP. The overall average age of patients and age at marriage was 29.72 ± 7.95 and 24.91 ± 5.55 years, respectively. The average age in years and age at marriage of NPP and PP groups was 29.36 ± 7.93 and 25.08 ± 5.51 years versus 30.07 ± 7.97 and 24.74 ± 5.60 years, respectively. Both were statistically insignificant; P = 0.8 and 0.2, respectively. The majority of patients in both groups were of low or middle socio-economic status (SES); 301 (23.9%) and 324 (25.7%) versus 308 (24.4%) and 322 (25.6%), respectively. SES was also statistically insignificant (P = 0.8). In educational status, literacy of the majority of patients in NPP and PP was at least matric and above; 230 (18.3%) versus 223 (17.7%), respectively with a P = 0.8. Details of educational status and other data are given in [Table 1].
Table 1: Contraception knowledge and practices among women in Peshawar

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Parity vise, most patients in NPP and PP had at least five children or less; 224 (17.8%) versus 217 (17.2%), respectively, P = 0.4. In both groups, most patients had wrong knowledge about the fertility window 220 (17.5%) versus 227 (18%), P = 0.6. Most NPP patients had no knowledge about contraception 221 (17.5%) whereas most PP patients had wrong knowledge about it; 215 (17.1%), P = 0.6. The source of information for this knowledge in most NPP patients was none or other; 230 (18.3%) whereas the majority of PP patients had used media or booklets as their source; 214 (17%), P = 0.4. The majority of patients in both groups were not motivated for contraception; 325 (25.8%) versus 318 (25.2%), respectively, P = 0.5. There was no preferred method of contraception in the NPP group; 201 (16%) versus 204 (16.2%) patients in the PP group whose preferred method was injectables, P = 0.3. This was because most NPP patients believed the reason for preference should be convenience or availability; 264 (21%) versus 264 (21%) PP patients who believed their preference was based on the effectiveness of the method of contraception, P = 0.5.


  Discussion Top


Pakistan is a resource-poor third-world country. Scarce resources require proper planning and allocation for the present and future needs. In this regard, contraception is a valuable tool.[13] Properly applied and used it has been shown of great benefit to developing countries.[14],[15] It has been recommended that contraception should be applied as a population programme for all reproductive ages.[16],[17] However, for many, the most practical time is the immediate PP.[18] It has been defined as the first 6 weeks after childbirth.[19]

In Pakistan, contraceptive practices are influenced by cultural, religious and socio-economic factors with a higher practice usually associated with a high SES.[20] However, motivation for contraception is still low.[21] This was also shown by our study where only 315 (25%) of the PP patients were motivated for contraception. However, in a local study by Abid et al., 368 (73.8%) of the patients wanted to use contraception which is high for Pakistan for religious and cultural factors hinder this. A probable reason is the difference in province with Abid et al.'s study conducted in Punjab. A comparison of our findings with other local studies revealed regional differences even within the country which is an important finding.

Low literacy is a major causative factor of the uncontrolled population. This directly impacts knowledge about reproductive health. In a study by Ali et al., 46% of correspondents knew about the window of fertility which is not supported by our study where 426 (33.8%) patients had no knowledge of it and 447 (35.5%) had the erroneous or wrong knowledge about it.[22] According to Khawaja et al. 97% of correspondents were aware of some form of contraception or the term alone but this is not supported by our study where 431 (34.2%) patients had no knowledge of it and 415 (33%) had the erroneous or wrong information about it.[23]

Societal factors are also responsible for poor reproductive and contraceptive markers. Some of the reasons include an early age of marriage which according to Nasrullah et al. is as high as 50% of all women aged 20–24 years.[24] This is supported by our study where the overall age of marriage was 24.91 ± 5.55 years. Early marriage contributes directly to a long span of reproduction ability.

Religious factors are also important in determining contraception due to related edicts and problems arising from their interpretation.[25] Including and expanding upon these and sociocultural factors would have taken the study farther from its original goal, i.e., contraception knowledge and practice but it should be considered in similar studies carried out in the future.

In contrast to popular belief, most women in Pakistan do not rely on media for contraceptive knowledge. This was shown by Mahmood and Ringheim. and is also supported by our study where the majority of 443 (35.2%) patients had none or other sources as their source of contraceptive knowledge compared to 425 (33.7%) patients who used media and/or booklets.[26]

Methods of contraception have changed over time in Pakistan. For the past 20 years, the most commonly used methods included natural withdrawal and condoms.[27] Atif et al. showed that in most patients, 51.2% did not use any method but among the most preferred method used was hormones; oral or injectables at 22.3% followed by intrauterine contraceptive devices in 13.4%.[28] In our study, as well the majority of patients, 377 (30%) did not use any contraception but among the methods most preferred was injectables at 398 (31.6%) patients followed by implants at 225 (17.8%) patients.


  Conclusion Top


Contraceptive knowledge and practice among women in Peshawar which is a reflection of the region, i.e., Khyber-Pakhtunkhwa or Pashtun belt not only differ from the remainder of Pakistan but is also well below the desired level nationally and internationally. Religious and sociocultural factors have an important significant part in this and need to be explored in the future studies.

Ethical clearance

The study was approved by the institutional Ethics Committee of Category-D Hospital, Peshawar, via approval No. 01/2019.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Contraceptive Performance Report 2017-2018. 1st ed. Islamabad: Pakistan Bureau of Statistics, Government of Pakistan; 2018. p. 14. Available from: http://www.pbs.gov.pk/sites/default/files//social_statistics/Contraceptive%20Performance%20Report%202017-18.pdf. [Last accessed on 2020 Nov 17].  Back to cited text no. 4
    
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23.
Khawaja NP, Tayyeb R, Malik N. Awareness and practices of contraception among Pakistani women attending a tertiary care hospital. J Obstet Gynaecol 2004;24:564-7.  Back to cited text no. 23
    
24.
Nasrullah M, Muazzam S, Bhutta ZA, Raj A. Girl child marriage and its effect on fertility in Pakistan: Findings from Pakistan Demographic and Health Survey, 2006-2007. Matern Child Health J 2014;18:534-43.  Back to cited text no. 24
    
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Nasir JA, Hinde A. Factors associated with contraceptive approval among religious leaders in Pakistan. J Biosoc Sci 2011;43:587-96.  Back to cited text no. 25
    
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27.
Azmat SK, Shaikh BT, Hameed W, Mustafa G, Hussain W, Asghar J, et al. Impact of social franchising on contraceptive use when complemented by vouchers: A quasi-experimental study in rural Pakistan. PLoS One 2013;8:e74260.  Back to cited text no. 27
    
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