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An Assessment of the Knowledge and Attitude Towards Family Planning among Educated Married Men of Urban Islamabad, Pakistan.

Byline: Sumera Naz and Muhammad Arif Nadeem Saqib

Abstract

Background: Pakistan is the 6th most populous country of the world and also among one of the first Asian countries to begin family planning program yet the current contraceptive prevalence rates (CPR) stand at 35%. Men are the critically missing client as focus is always on women.

Objectives: To assess the knowledge and attitude towards family planning by educated married men of Islamabad.

Study design, settings and duration: Cross sectional study was conducted in twelve public and private sector organizations of Islamabad for duration of 12 months in 2014.

Subjects and Methods: Total 300 educated married men age 20 to 60 years who had completed at least 12 years of formal education were enrolled after taking the informed written consent. Data was collected using a structured pre-tested questionnaire through an anonymous interview. Grading scale was used for knowledge and attitude evaluation. 10 marks were given to correct answer and agreement with positive statement. Score less than 70% is categorized as poor, 71-80% fair, 81-90% good and above 90% as very good.

Results: Mean age of the study participants was 36 + 7 years. About 177 (59%) of the study participants were graduate.

Nearly all (99%) participants had heard at least one family planning method while 141 (47%) had poor knowledge. Regarding male contraceptive methods, only 33 (11%) of the study participants know about the permanent birth control methods for men with a misconception that vasectomy decreases male's sexual desire in 267 (89%) of participants. Meanwhile only 18 (6%) study participants are aware that condoms are available both for male and female use. About 193 (64%) study participants were currently using at least one family planning method in an order of with drawl (24%), male condom (13%), and injectables (9%) while 10% don't know that their wives were currently using contraceptive methods or not. Only 3% of the males had poor attitude score. Among the positive attitude males, 99 (33%) had fair score. While 186 (62%) had good score while only 06 (2%) had very good score indicating that generally educated males have positive attitude towards family planning. Overall non response rate was very i.e. 32%.

Conclusion: The study reveals positive attitude and poor knowledge of family planning methods among almost half of the study participants who are educated and are resident of urban Islamabad. High non response rate reflects that even educated men are very reluctant to talk and share information's on this topic. Increased use of traditional and temporary family planning methods highlights that positive attitude does not always lead to use to contraceptives.

Key words: Family planning, contraceptives, knowledge.

Introduction

The persistent high fertility and fast population growth rate has made Pakistan the 6th populous country with the present population surpassing 200 million. The current growth rate will double by 2050, making Pakistan the 3rd most populous country, after India and China.1 Pakistan was among the initial countries which supported and started family planning activities in 1950s. Later on all 5 year development plans have incorporated strategies and plans to decrease population growth rate and rise contraceptive prevalence rate but till now family planning programs are not successful to achieve desired targets. Although awareness is raised but contraceptives prevalence rate (CPR) is still less than 30 % and the population growth rate and the total fertility rate still persists round 4.77, which means on an average a Pakistani women is still giving birth to 4 to 5 children.1

Contribution of family planning in reproductive health is in two ways, firstly by allowing couple to decide with freedom the time and number of children they want to have and secondly by decreasing the number of times a woman is exposed to the threat of unsafe pregnancy and delivery.2

According to United Nations the involvement of the males is defined as the means by which men relate to reproductive behavior and reproductive health.4 Men involvement in family planning has two aspects, firstly whether the men understand and support their partner's need and preference regarding fertility, second is the sexual behavior of men and his choice and frequency of use of contraceptives. Globally it's a fact that husbands disapproval leads to discontinuation in contraceptives use and this reason is even more valid in the context of an Islamic society. In Pakistan high population growth rate of 3.5% with high mortality, illiteracy, poverty, beliefs, low women empowerment and poor health services create great challenge to promote the contraceptives use and practice of family planning. When compared with the neighboring countries, Pakistani couples are slow to adopt family planning practices.5

Studies on family planning in Pakistan have mainly focused on women. Very little work has been done on men. The biological and social dependence of the couple on each other regarding their authority to decide family size, choice and frequency of use of contraceptive method makes it important to include men in this research area. It is now realized that improvements in reproductive health outcomes in general and maternal health in particular along with rise in contraceptive prevalence rate (CPR) could only be achieved when there is active participation of men. In countries like Pakistan where women have relatively limited control over their lives and are dependent on their husbands for many decisions, exploring the role of men and contraceptive practices of their spouse is very important. Keeping in view the importance of the topic this project was designed with an aim to evaluate the knowledge and attitude towards family planning by educated married males of Islamabad.

Subjects and Methods

Cross sectional descriptive study of 1 year duration was conducted on 300 ever married educated males of age 20-60 years who had completed at least 12 years of formal education and were resident of urban areas of Islamabad. While unmarried males of any age group and also those married males who were more than 60 years or less than 20 years of age were excluded from the study.

Institutes were randomly selected from the urban areas of Islamabad. Before proceeding for data collection only those organizations were finally selected whose competent authority has given the permission. Fifty percent of the total sample i.e. 150 questionnaires were filled from the respondents who meet our inclusion criteria and were working in public sector organizations and remaining 50% from respondents working in the private sector organizations. There were three phases of the study. In first phase KAP study was done and data was collected with a four-page questionnaire to assess the knowledge, attitude and use of family planning methods, household composition and education level of the respondents followed by educational counseling which was done by distributing printed reference material on different family planning methods. Post interventional knowledge evaluation was done only from those participants who scored less than 70% in knowledge evaluation.

Questionnaires and consent forms were developed in English. Written consent was taken from those who agreed to participate. Data was collected using a structured pre-tested questionnaire through an anonymous interview. No proxy respondent was used. Grading scale was used for knowledge and attitude evaluation. 10 marks were given to correct answer and agreement with positive statement. Score less than 70% is categorized as poor, 71-80% fair, 81-90% good and above 90% as very good.

Ethical approval was obtained from the Ethical Review Committee of Pakistan Medical Research Council.

Percentages and frequencies for different variables were determined. There were 10 questions in each of knowledge and attitude evaluation section. For knowledge evaluation each correct answer was given 10 marks and wrong answer 0. For attitude evaluation for agreeing with a positive statement 10 marks were given and 0 for approving a negative statement. Both for the knowledge and attitude evaluation, score less than 70% was considered as poor. 71% to 80% fair, 81-90% as good and above 90% very good.

Results

The study was conducted in twelve public and private organizations of education, health and banking sector. Non response rate was 32%.

It was seen that 147 (49%) enrolled men were in the age group 30-39 years and only 54 (18%) were in the age group 20-29 years. Mean age of the study participants was 36 + 7 year. About 177 (59%) were graduate and only 42 (14%) were with post graduate qualification. Most study participants 189 (63%) were married at age 20-29 years and only 06 (3%) married at age 40 years and above. About 183 (61%) study participants had 3-4 living children and 72 (24%) respondent's had more than 05 living children.

Table 1: Knowledge of the participants about family planning methods.

###Questions###Correct answer###Wrong answer

###n###%###n###%

Which one of the following is the birth control method of men:###189###63###111###37

a)tubal ligation b) pills c)with drawl d)injections

One condom can be used:###198###66###102###34

a) once b)more than

Which one is the permanent birth control method for men:###33###11###267###89

a) tubal ligation b) pills c)vasectomy d)injections

Condoms are available for:###18###6###282###94

a) only for male use b) only for female use c)both for male and female

Which one is the permanent contraceptive method for female:###57###19###243###91

a) tubal ligation b) injections c)vasectomy d) pills e) don't know

Family planning means spacing the birth of children:###207###69###93###31

a) Yes b) No c) don't know

Family planning kill babies:###192###64###108###36

a) Yes b) No c) don't know

Vasectomy decreases a man's sexual satisfaction:###18###6###282###94

a) Yes b) No c) don't know

Natural family planning method is a way of preventing pregnancy without the use of###189###63###111###37

drugs or devices:

a) Yes b) No c) don't know

Knowledge of 141 (47%) enrolled men regarding different family planning methods was poor ( 90%) (Figure-1).

Only 33 (11%) study participants know about the permanent birth control methods for men with a misconception among 267 (89%) participants that vasectomy decreases male's sexual desire. Meanwhile only 18 (6%) of the study participants were aware that condoms are available both for male and female use (Table-1).

Regarding attitude only 10 (03%) of the men had poor attitude score. Among the positive attitude males 99 (33%) had fair score. While 186 (62%) had good score and only 06 (02%) had very good score indicating that generally Pakistani men have positive attitude towards family planning (Figure-2).

Almost 81% participants wants to know more about family planning and 291 (97%) are with the opinion that bringing up the family is combined responsibility of both husband and wife and 264 (88%) agree that family planning improves both mother and child health (Table-2).

Regarding current use of family planning methods 36% of the men were not using any method and 33% were using traditional methods, mainly with drawl by 72 (24%) and safe periods by 26 (9%). Modern family planning methods were used by 95 (31%) study participants and within this group condoms were frequently used by 39 (13%) study participants and 40 (18%) of the participants were using modern female contraceptive methods (Table-3).

Table 2: Attitude of the study participants towards family planning.

Statements###Response###n###%

Do you want to know more about family###Agree###243###81

planning

###Disagree###57###19

Are you willing to practice family###Agree###213###71

planning

###Disagree###87###29

###Agree###213###71

Family planning is only for young couples

###Disagree###87###29

Bringing up the family is the shared###Agree###291###97

responsibility of both husband and wife###Disagree###07###03

Family planning improves mother and###Agree###264###88

child health###Disagree###66###22

###Agree###48###16

Family planning is harmful

###Disagree###252###84

Husbands should be the only decision###Agree###57###19

maker regarding family planning matter###Disagree###243###81

Condoms can prevent sexually###Agree###129###43

transmitted diseases.###Disagree###171###57

Table 3: Current use of family planning methods.

Method###n###%###Total %

Modern Methods

Condoms###39###13

Oral pills###09###03

IUDs###27###09###31

Injections###06###02

Vasectomy###01###0.3

Tubectomy###13###04

Any traditional method

Safe period###26###9

###33

Withdrawl###72###24

Not using any method###107###36###36

The most common source of information regarding family planning methods was community i.e. friends, colleagues or relatives in 117 (39%) followed by mass media i.e. TV, radio, internet, newspapers in 81 (27%) participants. Only 6 (2%) of the enrolled men got the family planning information from health care staff.

Table 4: Post interventional knowledge evaluation. (n-106)

Variables###n###%

Poor knowledge###25###24

Fair knowledge###28###26

Good knowledge###43###41

V. good Knowledge###10###09

After distributing the reference material of population welfare department focusing on different modern family planning methods among the study participants, post interventional knowledge evaluation was done only from those participants who had poor score less than 70% in first knowledge evaluation. Total 141 participants scored poor score but for post interventional knowledge evaluation only 106 participants agreed to participate. In second knowledge evaluation among 106 participants 43 (41%) had good score but still 25 (24%) enrolled participants had poor score (Table-4).

Discussion

Nearly all respondents knew about at least single method of contraception and this finding is in an agreement with the findings of Pakistan Demographic and Health survey 2012-13.6 Data of PDHS is more focused on women while men were not interviewed. Therefore in current study we focused on educated married males of capital and found that knowledge of 141 (47%) study participants about family planning methods was poor (< 70%) and only 33 (11%) of the study participants know about the permanent birth control methods for men with a misconception that vasectomy decreases male's sexual desire in 267 (89%) of participants. This low score in knowledge evaluation is an alarming finding that if 47% of the educated males are so poorly aware of family planning methods than awareness level of illiterate men would be even lower.

In present study use of modern family planning methods was 31% which a bit higher from the findings of PDHS 2012-13 where 26% of women were using these methods again survey is silent about data taken from male respondents. Despite prediction of Government of Pakistan, population control is a dream to come true. In present study it was found that 40 (13.3%) of the males were using modern male contraceptive methods while as per results of PDHS 2012-13 use of modern male contraceptive methods is 9.1% this difference is due to the fact that in our study data is taken from the educated males who are residing in capital city Islamabad. Within this group 13% men were using condoms while in PDHS 2012-13 only 8.8% men are using condoms. This is most likely due to commencement of condom social marketing programme by the government, affordable prices and door step accessibility.7

Meanwhile rise of condom use imply positive male attitude towards family planning, who are usually dominant in decision making regarding women's fertility and birth spacing in Pakistan.8

In present study use of traditional methods i.e. withdrawal was 26% and is even high from the report of Pakistan Bureau of Statistics Islamabad (2011) in which 17% of the men opt for withdrawal method.9 While in PDHS 2006-07 it is reported that 4% currently married women used withdrawal10 and in PDHS 2012-13 it is almost doubled to 9% in currently married women. These findings again reflect incremental rise to adapt traditional methods of family planning. There was only a single man in our study who went for vasectomy and was a health professional. This finding again reflects the attitude of male to opt temporary and traditional methods of family planning. In present study inclination of the male regarding use of male contraceptive methods is very low this finding again indicates that men are with the opinion that only those family planning methods should be opted which are of female use. Here again men play a significant role in influencing the use of contraceptive.

They should be involved through different strategies to promote and improve healthy practices regarding use of family planning methods.

In this study use of modern family planning methods was 33% and traditional methods was 31% this is probably due to the enrolment of educated males and results are in agreement with the findings of the secondary analysis of national reproductive health and family planning survey 2000, in which they concluded that education plays a key role in improving family planning practices.11 In PDHS 2012-13 in Pakistan contraceptive prevalence rate (CPR) is 35% 12 which is very discouraging if compared with CPR of neighbouring countries as 48% in India, 58% in Bangladesh and 70% in Srilanka.13 One of the Millennium Development Goal is to increase the CPR to 55% by 2015 (planning commission 2010) which could not be achieved.

In this study main source of information regarding family planning was community and these findings are differing with the findings of a study conducted in Pakistan, India and Bangladesh in which mass media campaigns were the main source of information.14

Attitude regarding age at marriage for boys and for girls is important and has impact on fertility. Early marriage of girls is very common in Pakistan and in present study 36% respondents agreed that for girls ideal age for marriage is 18-20 years. Our results are in line with a study carried out by National Institute of Population Studies (NIPS), where majority of the respondents were of the view that age for marriage for boys should be 20-24 years and for girls it should be 15-19 years. Unfortunately in Pakistan use of contraceptives in teenagers is low when compared with developed countries.15 Thus if educated males of urban Islamabad are of the view that girls should be ideally married at 18-20 years than there is need to endorse and accelerate the use of family planning measures in young couples so as to reduce the birth rate.

A positive co-relation was observed between use of contraceptives, rise in parity and number of living children and findings are in agreement with other studies conducted in Pakistan.16

Regarding attitude, our findings are in agreement to a study conducted in Yemen, in present study most of the respondents (97%) showed positive attitudes towards family planning and (71%) agreed to practice family planning. A study conducted in a district of Sindh, Pakistan, revealed that family planning programs are influenced by religious and cultural pressures.17

It is suggested that men should be actively involved in family planning and to achieve this goal government and nongovernmental organizations should ensure that in future along with women family planning information at community level should also be given to men.

Conflict of interest: Sumra Naz is the Assistant Editor and Muhammad Arif Nadeem Saqib is the Managing Editor of the journal.

References

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2. Ministry of Population Welfare. Consultative Seminar on "Public-Private partnership vis-a-vis future challenges for reproductive health". World Population Foundation and Ministry of Population Welfare, Government of Pakistan; 2003.

3. Bongaarts J, Bruce J. The causes of unmet need for contraception and social content of services., Stud Fam Plann 1995;26(2): 57-75.

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10. Pakistan Daemographic and Health Survey of Pakistan 2006-07. (Accessed on 08th September 2015) Available from URL: https://dhsprogram.com/pubs/pdf/FR200/FR200.pdf

11. Saleem S, Bobak M. Women's autonomy, education and contraception use in Pakistan: a national study. Reprod Health 2005;2: 8-11.

12. Population Association of Pakistan, Pakistan's Population: Statistical Profile 2002, Islamabad, Pakistan; 2002. (Accessed on 08th September 2015) Available from URL: http://www.pap.org.pk/files/sp.pdf

13. Population Reference Bureau 2006, World Population Data sheet. (Accessed on 08th September 2015) Available from URL: https://www.prb.org/pdf06/06WorldDataSheet

14. Olenick I. Women's exposure to mass media is linked to attitudes towards contraception in Pakistan, India and Bangladesh. Int Fam Plann Perspect 2000;26: 48-50.

15. Sexna S, Oakeshott P, Hilton S. Contraceptive use among South Asian Women attending general practices in Southwest London. Br J Gen Prac 2001;52: 392-4.

16. Ali S, Rozi S, Mahmood MA. Prevalence and factors associated with practice of modern contraceptive methods among currently married women in District Naushero Feroze. J Pak Med Assoc 2004;54: 461-5.

17. Bibi S, Memon A, Memon Z, Bibi M. Contraceptive knowledge and practices in two districts of Sindh, Pakistan: A hospital based study. J Pak Med Assoc 2008;58: 254-8.
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Publication:Pakistan Journal of Medical Research
Article Type:Report
Geographic Code:9PAKI
Date:Sep 30, 2017
Words:3896
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