Unmet Need of Family Planning Among Rural Women
Subject: Medical | Topics:

This report briefly explain to determine the unmet need of family planning among rural women. Report also focus on to estimate the prevalence of contraceptive use and explore the unmet need of family planning the rural women. Finally find out obstacles toward using family planning methods and to assess the socio-economic condition of the respondent.

 

Introduction

Population trend in Bangladesh, which can be traced from the beginning of the century from the population censuses conducted by the British, show that, at present Bangladesh is well into the third phase of demographic transition, having shifted from a high mortality-high fertility regime to a low mortality-low fertility one. The uniqueness of demographic transition in Bangladesh is evident from the fact that while worldwide low income country’s population grew at an average annual rate of 2.1% between 1990 and 1997, the population of Bangladesh grew only at the rate of 1.6%.

Unmet need is disconnection between woman’s fertility preference and what she does about them: She wants to avoid conceiving but fails to do what is needed to prevent pregnancy. Such women are defined as having an unmet need for family planning. Survey research in developing countries estimates that more than 150 million married women of reproductive age have an unmet need for contraception. India has about 31 million women, and the majority of African and Middle Eastern countries and in a large no. of countries in Asia, Latin America and the Caribbean at least 20% of married women of reproductive age has an unmet need of contraception. In Bangladesh also the unmet need is as higher as 24 %.

Unmet need does not necessarily mean that family planning services are not available, it may also mean that women lack information or that the quality of services on offer does not inspire the necessary confidence or that women themselves have little say in the matter.

If family planning programmes served most women with unmet need, the demographic impact would be substantial contraceptive prevalence would rise, reducing fertility and slowing population growth.

Current circumstances present a critical opportunity to reconsider the importance of family planning and to revisit and update programme strategies. In 2006, unmet need for family planning was added to the 5th millennium development goal (MDG) as an indicator for tracing process on improving maternal health. A recent analysis concluded that family planning among a handful of feasible, cost effective interventions that can make an immediate impact on maternal mortality in low resource settings.

Family planning can reduce maternal mortality by reducing the no. of pregnancies, the no. of abortions and the proportion of births at high risks. Family planning offers a host of additional health, social and economic benefits: it can help reduce infant mortality, slow the spread of HIV/AIDS, promote gender equality, reduce poverty, accelerate socio-economic development, women empowerment and promote the environment. Investigating in family planning takes on additional urgency because it can help to reduce global inequities in health-a fundamental element of the MDG agenda.

Unmet need is a valuable indicator for national family planning programmes because it shows how well they are achieving a key mission: meeting the population’s felt need for family planning. It is important to remember that low levels of unmet need may reflect the fact that the women want large families-not that contraceptions are widely available or used.

Researchers estimate that the lives of 150,000 women could be saved each year worldwide with access to sufficient family planning. In addition, by increasing birth intervals to at least 24 months, the deaths of 1 million or more children under the age of 5 could be averted. An estimated 150 million women worldwide want to delay or avoid pregnancy but are not using family planning. In 26 of 32 countries with a yearly population growth higher than 2%, only 17% of married women aged 15-49 on average or their partners are using contraceptives.

Most of the married women want to use the contraception methods but are unable to use because of lack of knowledge, economical problem, fear of side-effects, religious cause, insufficiency of FPW, uncooperative husband and limited supply and high cost. The choice of contraceptive methods, information given to clients, the technical competence of providers, interpersonal relations between providers and clients, follow-up and continuity of services, and the constellation of services offered are the six key dimensions of family planning services. Good quality services not only attract new client but can also help prevent contraceptive discontinuation.

At present various active programmes on family planning are running over the few decades but considerate number of people yet not motivated to adopt the family planning in their practical life. Analysis should be carried out to find out which group has the highest unmet need and why. To find out their motive is to be talked first.

 

Justification of the study

Among the developing countries, especially in countries of Southeast Asia, the growth rate is quite high for a long time. The scenario is not much different in our country, Bangladesh. The country, with an area of 1, 47, 570 square kilometres is now facing a burden of 143.91 million people which is increasing by a growth rate of 1.41%. It creates difficulties in every sphere of our life. The fundamental needs of people remain far behind their expectation.

More than 100 million women in less developed countries, or about 17 percent of all married women, would prefer to avoid a pregnancy but are not using any form of family planning.

Demographers and health specialists refer to these women as having an “unmet need” for family planning—a concept that has influenced the development of family planning programs for more than 20 years. Over the past decade, rising rates of contraceptive use have reduced unmet need for family planning in most countries. In some countries, however, unmet need remains persistently high (more than one-fifth of married women) or is increasing, indicating that greater efforts are needed to understand and address the causes of unmet need.

Numerous studies reveal that, a range of obstacles other than physical access to services prevents women from using family planning. Policymakers and program managers can strengthen family planning programs by understanding and using data on unmet need, considering the characteristics of women and couples who have unmet need, and are working to remove obstacles that prevent individuals from choosing and using a family planning method.

Unmet need for contraception can lead to unintended pregnancies, which pose risks for women, their families, and societies. In less developed countries, about one-fourth of pregnancies are unintended—that is, either unwanted or mistimed (wanted later).

One particularly harmful consequence of unintended pregnancies is unsafe abortion: An estimated 18 million unsafe abortions take place each year in less developed regions, contributing to high rates of maternal death and injury in these regions.

In addition, unwanted births pose risks for children’s health and wellbeing and contribute to rapid population growth in resource-strapped countries.

For more than 30 years, surveys in less developed countries have been conducted in which women were asked about their childbearing intentions and use of family planning. These surveys have showed an inconsistency in women’s responses: A significant number of women say that they do not want another child but are not using any method of contraception. This gap between women’s preferences and actions inspired many governments to initiate or expand family planning programs in order to reduce unintended pregnancies and lower their countries’ fertility rates.

The unmet need for FP should be addressed sincerely. Analysis should be carried out to find out which group has the highest unmet need and why. At the same time, massive programmes should be taken up to address the issue with special emphasis.

 

Research question

What is the extent of unmet need of family planning among the rural women?

Objectives

General Objective:

To determine the unmet need of family planning among rural women .

Specific Objectives:

  1. To estimate the prevalence of contraceptive use
  2. To explore the unmet need of family planning the rural women
  3. To find out obstacles toward using family planning methods
  4. To assess the socio-economic condition of the respondent .

 

Variables

Socio-demographic variable:

    1. Age of the respondents in year
    2. Religion of the respondents
    3. Educational status of the respondents
    4. Educational status of the respondent’s husband
    5. Occupation of the respondents
    6. Occupation of the  husband of the respondents
    7. Monthly family income
    8. Family type
    9. Family size

    Obstetrical variable:

      1. Duration of married life
      2. Having experience of pregnancy
      3. Number of delivery
      4. Number of living child
      5. Age of last child in month

      Variable regarding family planning:

        1. Knowledge about contraceptive method
        2. Source of information
        3. Current user of contraceptive
        4. Method being used currently
        5. Best preferred method
        6. Eagerness to use contraceptive method

         

        Operational definitions

        Contraceptive method

        It is the preventive method to help women to avoid unwanted pregnancy which include oral contraceptive pill, injection, Norplant, permanent method, i.e. vasectomy and tubectomy, safe period and others.

        Unmet need of family planning

        Women of reproductive age who prefer to avoid becoming pregnant but are not using any contraceptive method (including use by their partner) are considered to have unmet need of family planning.

        Monthly family income

        Income generated by both husband and wife during a period of month.

        Duration of married life

        Time since the date of marriage upto the time of data collection.

        Having experience of pregnancy

        Woman who has conceived at least one time in her life is considered as ever conceived.

        Number of living child

        Number of child alive during the time of data collection.

        Knowledge about contraceptive method

        Woman who can mention few contraceptive methods is considered as she has knowledge about contraceptive method.

        Source of information

        The person or media from which a woman has got the information about contraceptive method, like Doctor, Family planning worker, Relative, Husband, Mass media e.g. Television, Radio etc.

        Current user

        Woman who is practising any type of contraceptive method during the time of data collection.

        Method being used

        The contraceptive method that is being used by the woman during the time of data collection.

        Eagerness to use contraceptives

        Woman who is willing to use contraceptive method but not using any method due to any reason during the time of data collection.


        Barriers in using contraceptive method

        The obstacle that keeps woman away from using contraceptive method. Some of the barriers in using contraceptive method are:

        1. Ignorance about contraceptive method: Woman not having sufficient knowledge regarding the type, choice, method and duration of use and other related information about contraceptive method.
        2. Unavailability: Failure to get the constant supply of contraceptive method.
        3. Economical constraints: Problem regarding the purchase of contraceptive method due to economical problem.
        4. Non-cooperation of husband: Lack of support or help from the husband to his wife regarding the use of contraceptive method.
        5. In fear of side effects: Women who were not using contraceptive method due to its unwanted side effects.
        6. Religious bar: Women who were not interested in using contraceptive method from religious reason.
        7. Eager to conceive: Women, who were not using contraceptive methods, as she had a desire to become pregnant.

         

        Literature review

        The concept that eventually became unmet need for family planning was first explored in 1960s, when data from surveys of contraceptive knowledge, attitude and practices (KAP) showed a gap between some women’s reproductive intention and their contraceptive behaviour. The term that came to popular use describing this group was “KAP-gap”. One of the first published use of the term “unmet need” appeared in 1977. Millions of couples however want to delay or avoid pregnancy but are not using contraception.

        Research reveals many factors contribute to this unmet need for contraception, including lack of knowledge about contraception, fear of side effects, opposition from husbands, ambiguous feelings about contraception, dissatisfaction with methods and poor access to, or a limited range of contraceptive choices.

        In a study in Ghana showed that only about a third of women with unmet need felt comfortable discussing contraception with their husband compared to about two-thirds of contraceptive users. Concerns also include side effects and unfounded fear about side effects or health consequences based on lack of information or false information. Fear of gaining weight or developing sterility is most common among women in our country towards using pills.

        Lacking a range of contraceptive choices can result in unmet need. Research in Vietnam found that expanding the mix of available methods should reduce unmet need substantially. The country has relied almost exclusively on IUD.

        The Pakistan study found that nearly nine of every 10 women perceived men’s disapproval of contraceptive use as an obstacle to meeting of contraceptive needs. Pilot programs have sought to involve men in Pakistan, but sustaining that effort has been challenging.

        Little is known about men’s role in the adoption of family planning. Recent studies suggest that men may be a barrier to women’s use of family planning. However, it is not clear whether represent a true or perceived barrier; this can be determined by studying –

        1. Whether men and women report concordant fertility desires, discussions and contraceptive use
        2. The accuracy of women’s perception of their husbands is a barrier to women’s family planning use.

        In recent years, programs in Colombia, Ghana, India, Kenya, Mexico and other countries have begun efforts to involve men in reproductive health programs. In Philippines, for example, Dr. Cesar Malaya, a former FHI research fellow, has begun a male clinic at Dr. Jose’ Flabella Memorial Hospital in Manila, providing no scalpel vasectomy to husbands of postpartum mothers.

        In a study, Huq et al. in 1992 found that almost half of the respondents (50%) adopted family planning method for birth spacing and the 34% wanted to limit their family size. However, a few were concerned about the methods were quite aware of what they were doing. When the reasons for discontinuation were analyzed many reasons were found. Among them were: want of child (30%), physical illness (26%), and side effect: dizziness (8%), weakness (7%), menstrual irregularities (3.5%) etc. About 45% of the respondents of that survey who did not adopt family planning method, were not isolated clients who have never been contacted, rather majority of them (60%) indicated that they had been in touch with family planning workers.

        In a study done through Bangladesh Demographic and Health Survey and the urban surveillance system in both Dhaka and rural areas, the main reasons for not accepting contraception among the non-user women of child bearing age groups were related to past, current or future pregnancy. Three main reasons for non-use in all areas were the desire for additional children, menstruation not returned after child birth and being currently pregnant. Infrequent sex or husbands living away from home were cited as reasons for non-use of contraceptives among a substantial proportion i.e. 17% of women in Dhaka. The main reasons for not using contraceptive in Dhaka slums are similar to those for all other urban groups. These reasons were –

        1. Menstruation not returned after delivery (22.3%)
        2. Desire for additional children (18.4%)
        3. No need (17.5%)

        By Schuler SR. et al in Nepal in a study, 5 couples out of 8 were former users of contraception. Of these four quit because of side effect and failed to find an acceptable alternative method. The fifth, a woman with four daughters and an infant son, said she had wanted to stop after having 2 or 3 children but had been preserved by her husband to keep trying for a son and was discouraged from using contraceptive by family planning workers.

        Strong and significant effect of gender preference on contraceptive use are observed by Rahman et al. in the study at Motlab, Bangladesh. Preference, particularly a preference for son represents a significant barrier to fertility regulation in rural Bangladesh.

        In BDHS surveys, current use of contraception is overall 56 percent in Bangladesh. Almost half (48%) use a modern method and 8 percent use a traditional method. The pill is by far the most widely used method (29%), followed by injectables (7%), female sterilization (5%), periodic abstinence (5%), male condoms (5%), and withdrawal (3%).

        The contraceptive prevalence rate for married women in Bangladesh has increased from 8% in 1975 to 56% in 2007, a sevenfold increase over more than three decades. Overall, current contraceptive use has declined by two percentage points in the past three years, from 58% in 2004 to 56% in 2007, but use of modern methods has remained unchanged.

        Study reveals that, twenty years ago, Bangladesh and Pakistan were similar in women’s stated reproductive preferences, levels of unmet need, and contraceptive prevalence. Before 1971, in fact, the two comprised one country, with a common population policy and a single family planning program. By the early 1990’s, however the level of unmet need in Bangladesh was 18%, while in Pakistan the level was 32%. Contraceptive prevalence in Bangladesh was 45% compared with 12% in Pakistan.

         

        Methodology

        Type of study

        This was a cross-sectional type of descriptive study.

        Place of study

        The study was done at Sripur village of Sripur union at Sripur upazila under Gazipur district.

        Period of study

        The duration of study was from  June 2009 to  December of 2009.

        Study population

        All the married women of reproductive age, residing in Sripur village, were included as study population.

        Selection criteria

        Inclusive criteria:

        1. Who were permanent resident of the study area
        2. Who were physically and mentally sound
        3. Who were present during the period of data collection
        4. Who were willing to take part in the interview

        Exclusion criteria:

        1. Respondents whose husbands were living abroad
        2. Who were pregnant
        3. Who were not willing to give interview

         

        Research instrument

        Data was collected by questionnaire consisting of both open and close ended questions, considering the objectives of the study. It was duly pre-tested among the married women of reproductive age at Gynaecology outpatient department of DMCH. The questionnaire contained 22 questions which included the reproductive health condition of the respondents regarding contraceptive practice as well as problems related to unmet need of family planning.

        Data collection procedure

        Data was collected by 28 students of batch K-63 of Dhaka Medical College. The students of this group were divided into fourteen Groups. Each group consisted of a male and a female students. They were guided by health assistant. The overall supervision was done by the batch teachers.

        Data quality control

        Data was checked and verified everyday by data collectors for any discrepancy, error or lack of information. If any error was found, it was corrected on the next day.

        Data analysis

        The collected data were analyzed by using statistical programme in computer. The descriptive analysis includes frequency distribution, mean, median and standard deviation. Specific test of significance was used to explore relationship, wherever necessary and possible.

         

        Results

        The study was carried out among 277 married women of reproductive age at Sripur village of  Sripur union at Sripur upzilla. Information was collected by  face to face interview.

        This chapter presents results of the study, which was collected, compiled, edited, analyzed and presented according to the specific objectives. During compilation five data were excluded as they did not fulfil our criteria. Data are presented through tables, graphs and  diagrams.

        Figure 1: Age of the respondents

        About half of the respondents(51.8%) were in the age group of 20 – 30 years. Below 19 years and above 45 years were only a few (6.3% and 2.2% respectively).Mean age of the respondents was 28.65 with SD + 7.02 years.

        Table 1: Religion of the respondents

        Among 272 married women of reproductive age most (97.8%) were Muslim and a few (2.2%) were Hindu.

        Figure 2: Educational status of the respondents

        About a quarter (26.5%) of the respondents completed primary education. 9.9% of them were illiterate.

        Table 2: Educational status of the husbands of the respondents

        Here also, 9.2% of them are illiterate. About one quarter (27.6%) attended Secondary School Certificate examination.

        Table 3: Occupation of the respondents

        Most (94.1%) of them were housewives. Among others, some (3.3%) were service holders and a few (0.7%) were garments workers.

        Table 4: Occupation of the husbands of the respondents

        Table 4 gives a picture of the occupation of their husbands where 42.6% were service holders and 40.1% businessmen whereas some (1.1%) remained unemployed.

        Figure 3: Types of family

        According to Figure 3,  about three quarter families were nuclear and the rest were joint families.

        Table 5: Monthly income of the respondents

        Of the total respondents, 65.4% had an income below Tk. 10,000. Very few (0.7%) of them earned above Taka 50,000. Mean income was Tk. 11,194.85 with a standard deviation of Tk.  8867.03.

        Figure 4: Having experience of pregnancy

        Figure 4 states that, of the 272 respondents, majority (87.5%) experienced pregnancy at least once during data collection period.

        Table 6: Distribution of the respondents by number of living child.

        Among 234 respondents, about three quarter had 1 to 2 children while rest of them had 3 to 5 children in their families. Only Four women though having experience of pregnancy but have no living children. Mean number of living child was 2.21 with SD + 1.19.

        Table 7:  Respondent’s knowledge about contraceptives

        According to table 7, most (96.7%) of the respondents had knowledge about contraceptives.

        Table 8: Current user of contraceptives

        Nearly three quarter (72.1%) of the respondents were using contraceptive methods while remaining (27.9%) were not

         Table 9: Contraceptive methods used by the respondents

        Of the 272 respondents, about half (44.5%) used oral contraceptive pills and about one-sixth respondents used condom. Most importantly, about a quarter (27.9%) did not use any contraceptive method.

        Table 10: Eagerness of the respondents to use contraceptives

        According to that, about two-third of them (68.4%) were not eager to use any contraceptive method while remaining one-third (31.6%) were willing to use.

        Table 11: Barriers to use contraceptives

        About half (46.05%) of the respondents kept aside from using contraceptive method in fear of the side effects. Some (18.42%) were eager to conceive. Other reasons stated by the respondents were as follows  husband’s non-cooperation(13.15%), religious prohibition(11.84%), ignorance about method (9.21%), not informed by family planning worker (3.95%), economical constraint(2.63%) and other(6.57%).

        Table 12: Relationship between monthly family income and number of          living children

        Though the test is not statistically significant, there is relationship between parity and income. It was found that parity was declining with increase level of income.

        Table 13: Relationship between respondents having experienced pregnancy and current user of contraceptives

        Table 13 shows that, use of contraceptive is higher among the respondents who experienced pregnancy once or more.

        Table 14: Education of the respondents and parity

        Table showed that increase level of education has effect on parity. Parity declines with increase level of education.

         

        Tables

        Table 1: Religion of the respondents

        ReligionFrequencyPercentage
        Islam26697.8
        Hindu62.2
        Total272100.0

         

        Table 2: Educational status of husbands of the respondents

        Educational status of the respondentsFrequencyPercent
        Illiterate259.2
        Primary3412.5
        Secondary3613.2
        S.S.C7527.6
        H.S.C3914.3
        Degree or above5921.7
        Others41.5
        Total272100.0

         

        Table 3: Occupation of the respondents

        Occupation of the respondentsFrequencyPercent
        House wife25694.1
        Garments worker20.7
        Service holder93.3
        Business10.4
        Others41.5
        Total272100.0

         

        Table 4: Occupation of the husbands of the respondents

        Occupation of husbandsFrequencyPercent
        Farmer259.2
        Business10940.1
        Day labourer124.4
        Service holder11642.6
        Unemployed31.1
        Others72.6
        Total272100.0

         

        Table 5: Monthly family income of the respondents

        Monthly income

         ( in Taka)

        FrequencyPercent
        <1000017865.4
        10001-200007627.9
        20001-3000093.3
        30001-4000051.8
        40001-5000020.7
        >5000020.7
        Total272100.0

        Mean: Tk. 11,194.85

        Median: Tk. 10000

        SD:  Tk. 8867.032

        Number of living childFrequencyPercent
        1 to 217775.6
        3 to 55724.4
        Total234100.0

         

        Table 6: Distribution of respondents by number of living child 

        Respondent’s knowledge about contraceptivesFrequencyPercent
        Yes26396.7
        No93.3
        Total272100.0

         

        Table 7: Respondent’s knowledge about contraceptives

        Currently using contraceptiveFrequencyPercent
        Yes19672.1
        No7627.9
        Total272100.0

         

         

        Table 9: Contraceptive method used by the respondents

        Contraceptive usedFrequencyPercent
        OCP12144.5
        Norplant41.5
        Condom4215.4
        Injection217.7
        Permanent method72.6
        Others10.4
        None7627.9
        Total272100.0

         

        Table 10: Eagerness of the respondents to use contraceptives

        Eagerness of the respondents to use contraceptivesFrequencyPercent
        Yes2431.6
        No5268.4
        Total76100.0

         

        Table 11: Barriers to use contraceptives

        BarriersFrequencyPercent
        Fear of side effect3546.1
        Eager to conceive1418.4
        Religious bar911.8
        Husband’s non cooperation1013.2
        Ignorance about method79.2
        Not informed by FP worker33.9
        Economical constraint22.6
        Others56.6

        Note: Multiple responses


        Table 12: Relationship between monthly family income and number of living children

        Income (in taka)No of living childrenTotalTest statistic
        1 – 23 – 5
        120

        (67.8%)

        36

        (63.2%)

        156

        (66.7%)

        2 = 3.31

        P = 0.652

        df = 5

        11000 – 2000046

        (26.0%)

        18

        (31.6%)

        64

        (27.4%)

        21000 – 300005

        (2.8%)

        3

        (5.3%)

        8

        (3.4%)

        31000 – 400002

        (1.1%)

        0

        (0.0%)

        2

        (0.9%)

        41000 – 500002

        (1.1%)

        0

        (0.0%)

        2

        (0.9%)

        2

        (1.1%)

        0

        (0.0%)

        2

        (0.9%)

        Total177

        (75.6%)

        57

        (24.4%)

        234

        (100.0%)

         

        Table 13: Relationship between respondents having experience of pregnancy    and  current users of contraceptives

        Having experience of pregnancyCurrent user of contraceptiveTotalTest statistic
        YesNo
        Yes176

        (89.8%)

        62

        (81.6%)

        238

        (87.5%)

        2 = 3.38

        P = 0.06

        df = 1

        No20

        (10.2%)

        14

        (18.4%)

        34

        (12.5%)

        Total196

        (72.1%)

        76

        (27.9%)

        272

        (100.0%)

         


        Table 14: Relationship between educational status of the respondents and parity

        Educational status of the respondentsNumber of living childTotalTest statistic
        1 – 2 3 – 5
        Illiterate11

        (6.2%)

        15

        (26.3%)

        26

        (11.1)

        2 = 26.80

        P = 0.08

        Primary47

        (26.6%)

        20

        (35.1%)

        67

        (28.6)

        Secondary38

        (21.5%)

        16

        (28.1%)

        54

        (23.1)

        S.S.C.52

        (29.4%)

        3

        (5.3%)

        55

        (23.5)

        H.S.C.22

        (12.4%)

        1

        (1.8%)

        23

        (9.8)

        Degree or above6

        (3.4%)

        1

        (1.8%)

        7

        (3.0)

        Other1

        (0.6%)

        1

        (1.8%)

        2

        (0.9)

         

         

        Discussion

        The study entitled “Unmet need of family planning among rural women” was a cross sectional study.

        The study was carried out from May to December 2009. A total of 272 respondents were interviewed. The data were collected from respondents by face to face interview.

        The objective of the study was to explore the proportion of unmet need of family planning among the married woman of reproductive age. The study also explores the CPR, reason for not using contraceptives, the choice of contraceptive by the respondents.

        Most of the respondents who participated in the study were muslim (97.8%), as the village is predominantly muslim resided. About one tenth of the respondents were illiterate (9.9%), 26.5% had primary schooling and 62.4% had secondary & higher education. In BDHS 2007, it was found that in rural areas of Bangladesh 48.5% woman of age group 15-49 year age group were illiterate, 18.7% had primary education and 32.8% had secondary & higher education13.  The higher educational status may be because Sripur is more developed area than other rural areas of Bangladesh with higher educational facilities.

        In our study among of husbands of respondents, only 9.2% were illiterate, 21.1% had primary education, 76.8% had secondary or higher education.  BDHS 2007 found that among male (age group 15-54 years) of rural areas of Bangladesh, 46.2% were illiterate, 21.1% had primary education and 37.2%had secondary & higher education13. The study by Sarkar in rural area of Dhamrai, Dhaka about 57% respondents were illiterate and the rest were experienced with some level of education31.  The higher educational status may be again because Sripur is more developed with higher educational facilities than other rural areas of Bangladesh.

        Among the respondents of our study, 94.1% were housewife, 3.3% were service holders and only 0.3% had business. Another study also found that at rural area of Dhamrai, all of the respondents were housewives31. So Sarkar study and this study had similar occupation of rural women.  In BDSH 2007, among ever married woman of 15-49 years age group, most (50%) were engaged in poultry and cattle raising, 14.3 were service holder (both technicals & labours), 5.5% had businessbd. The high rate of housewife among respondents of this study may be because, Sripur was near town and most women did not had enough scope for poultry and cattle raising.

        In our study, the occupation of husbands of respondents were 40.1% businessman , 42.6% service holders, 4.4% day labor & only 9.2% farmers. In BDHS 2007, occupation of men (age group 15-49 years) was found in rural areas of Bangladesh as 40.7% farmers, 15.5% unskilled labour & 19.9% service holder13. Our project area Sripur war near town & developed in industry and business than others rural areas of Bangladesh. In our study educational status of respondent husbands was much higher than BDHS. These factors may explain the difference in occupation in two studies.

        Among the respondents of our study, 87.5% have conceived at least once in their life, the rest married women (12.5%) never conceived. The study  in 2007 found in urban slums of Dhaka city, found about one-tenth (8.3%) had never experienced pregnancy. Rest of the respondents (91.7%) had experienced one or more pregnancies32. The BDHS  found that among currently married woman of age group 15-49 years, 9.9% had never born any child13. So, in this regard finding of our study is consistent with the other two studies in family planning.

        In our study we found number of living children 0 in 13.9%, 1-2 in 65% and 3-5 in 20.9%. According to BDHS 2007, number of children among currently married woman was- 0 in 9.9%, 1-2 in 42.3%. 3-5 in 37.5%13. The difference may be due to higher contraceptive use rate in our study (72%) than BDHS (55.8%).

        Almost all (96.7%) the respondents of this study had some knowledge about modern contraceptive methods. Khuda and Howladers study in 1988 found that knowledge of contraceptive is almost universal among both adolescents and adults in Bangladesh33. BDHS 2007 also revealed that almost all (99.8%) woman of reproductive age of Bangladesh knew about family planning methods13. So, it is obvious from the studies that, nearly all married woman of our country has knowledge about contraceptive methods.

        Contraceptive use rate was 72.1% in present study. According to BDHS 2007 use of contraceptive was overall 55.8% in Bangladesh13. In a ICDDRB study in 2001 in a low performing rural area of Bangladesh they found that only 21.07% of the total eligible couples were practicing family planning method34. As these two data included remote places, so the use rate might be low. In a study at Dhamrai thana the contraceptive acceptance rate was 69% which is nearer to our study finding31. As the two places are nearer to UH&FWC & got all facilities & proper services given by the family planning workers. Islam and mahmud demonstrated that among woman with a educational level of secondary and higher were found to be 2.5 times as likely to practice contraception as those who had no education35. The level of education was good in this study, so it might influence their contraceptive use rate.

        In our study, most widely used method was OCP 44.5%, Injection 7.7%, permanent method 2.6%, male condom 15.4%, norplant 1.5%. In a study in a  rural area found oral pill as the most common method followed by injectables, female sterilization, IUD and condom34. According to BDHS 2007, most widely used method of family planning was- OCP 28.5%, Injection 7%, condom 4.5%, female sterilization 5%, periodic abstinence 4.9%, withdrawal 2.9% of the respondents13. So, in these studies most prevalent method was OCP followed by injectables, condom. These methods are most prevalent methods of contraception in our country. This may be because easy availability and popularity of these methods. In these studies, permanent method was not so widely used method.

        Out of 76 respondents who were not using any method of contraception, the principal barrier to use contraceptive was fear of side effect in 46.05% cases. In another study in rural area of Bangladesh it was 12%34. In urban slum of Dhaka 19.2% woman mentioned side effect as the barrier to use contraception32. In Huq study in 1992 in 18.5% respondents side effect was the reason24.In a study in Nepal 5 couples out of 8 were former user of contraceptive. Of these 5, four quit because of side effects and failed to find an acceptable alternative method27. So side effect is a major barrier to contraceptive use. A number of both perceived and real risks associated with some forms of contraception continue to prevent use of contraceptives. The higher rate of fear of side effects in our study may be due to increased health consciousness and misconception about methods of family planning.

        18.2% were not using contraception because they were eager to conceive. In BDHS 2007 wanting more children was the reason in 12% cases13, in study carried out by Mitra it was found 13%36. So, our finding was nearer to BDHS & Mitra study. The main reason of not using contraceptive was desire for more children was 34.4% in ICDDRB study34 and 30.9% in another (Sarkar) study31. High educational status may influence them to keep family size small. This may be the reason behind low rate of wanting more children.

        Third barrier to barrier to use contraceptive in our study was husband’s non-cooperation (13.15%).It has been found that involving husband into FP affairs has the highest significant effect on current use of contraceptive among adolescent35. Study in urban slum revealed 11% women mentioned non-cooperation of family members as barrier to contraception32. So, our study finding is consistent with this study. In ICDDRB study 6% did not have approval of their husbands34. The difference may be due to difference in social custom.

        In our study 11.84% women were not using contraceptive because of religious prohibition. Religious prohibition was also found as a barrier in Mitra study (11%)36 & ICDDRB study (17.7%)34. So our study is consistent with Mitra study. ICDDRB study was done at a remote area, where educational status was low which may be the cause of higher rate of religious prohibition.

        Unmet need of family planning in our study was 22.4%. In Bangladesh, in 1999-2000 unmet need of family planning services was 15%, in 2004 it was 11% and in 2007 it was 18%6,7,13.  So, unmet need had increased by 7% in 3 years from 2004 to 2007. This finding is consistent with our study. From BDHS 2007 to our study in 2009 unmet need has increased by 3% in 2 years. The reason behind the increasing rate might be the shortage of manpower in the family planning programme, especially the Family Welfare Assistant (FWA). It urban slum of Dhaka city, unmet need was 41.1% in 200732. Our project area was more developed with better health facilities than urban slums, which might be the cause of higher unmet need in urban slum.

        Education increases receptivity to new technology including awareness and use of contraception. In a study it was found that educated women had desire for fewer children than their less educated counterparts because of incompatibility between formal sector employment and child care. In present study it was also found parity decline with increased level of education37.

        Contraceptive use rate also vary according to number of living children. As expected, fewer women use contraception before having their first delivery and after the first child birth, contraceptive use increases sharply.( source book:HNPS P:402) We also found association  between having experience of pregnancy with contraceptive use.

         

        Conclusion

        This cross –sectional study was designed to assess the unmet need of Family planning among the rural women of Sripur village of Sripur Upazilla under Gazipur District. Study was conducted among married women of reproductive age (15-49 years); Total respondents were 272.

        From this Study, it appeared that 22.4% women has unmet need of family planning. About 3% of the respondent had no knowledge about contraceptive methods. Contraceptive prevalence rate was found about 72%. Those who were not using any methods (n=76), one third of them were eager to use any method and two third were not eager to use any method. Reasons behind their not using any method were in fear of side effects (46%), eager to conceive(18%), husbands non cooperation (13%), religious bar(12%), ignorance about method 9%, not informed by family planning worker (4%) etc.

        Appropriate health information and health education is essential in overcoming these barriers which will minimize the unmet need of Family Planning to an acceptable level.

         

        Recommendations

        1. Extensive study should be performed at national level by the health service provider.
        2. Proper education and information should be directed towards the rural women by the health workers.
        3. Not only women but also their husbands should be motivated regarding family planning through regular home visits by FWA.
        4. Increase use of Mass media should be attempted to provide information about family planning by the ministry of health & family welfare.
        5. Proper supply & availability of contraceptive material should be ensured & must be cost effective.
        6. Social / community leaders including Imams should be included in awareness raising program so that religions misbelieve about family planning can be removed.
        7. Large scale community based study should be carried out to address the current situation with more importance.

        Related Medical Paper: