European Journal of Cardiovascular Medicine

Contraceptive access and awareness are foundational to advancing reproductive rights, improving maternal and child health, and achieving sustainable development goals in low- and middle-income countries. In India, despite national family planning initiatives and growing availability of contraceptive services, uptake remains uneven—particularly in rural areas where social norms, limited education, and poor health infrastructure continue to constrain reproductive autonomy.

Multiple studies from rural India have reported gaps in both knowledge and continued usage of modern contraception. An ICMR Task Force study identified significant disparities in awareness and service utilization in rural communities, highlighting the need for more tailored, culturally sensitive outreach strategies [1]. Similarly, Gupta et al. reported that despite modest gains in contraceptive awareness, actual use remained suboptimal due to misconceptions, low male involvement, and fears about side effects [2]. Ghike et al. found that women often relied on anecdotal or incomplete information, leading to sporadic use or overdependence on traditional methods [3].

Recent trends show a concerning rise in reliance on withdrawal or periodic abstinence in certain regions, including Uttar Pradesh, reflecting a broader shift away from modern, more reliable contraceptive methods [4]. Other research from comparable rural contexts in South Asia underscores that even when women are aware of options such as IUCDs or injectables, continued use is often undermined by systemic and social barriers [5,6].

Against this backdrop, this study was conducted to assess the current state of contraceptive awareness, usage patterns, and method preferences among women in a rural population in North 24 Parganas, West Bengal. The goal was to generate community-level insights that could inform targeted public health interventions and improve uptake of modern contraceptive methods in similar resource-constrained settings.

Aims and Objectives

This study aimed to assess the level of contraceptive awareness, actual usage patterns, and method preferences among women residing in rural areas of North 24 Parganas, West Bengal. Recognizing the critical role that education, age at marriage, and reproductive history play in shaping contraceptive behaviour, the study also sought to explore how these sociodemographic variables influence knowledge and continuity of contraceptive use.

The specific objectives were:

1. To examine the relationship between education level and awareness of various contraceptive methods across age groups.
2. To describe the demographic and reproductive health profile of the study participants, including age at menarche, age at marriage, family size, and history of medical termination of pregnancy.
3. To assess continuity of contraceptive use, defined as sustained use of a method for 90 days or more, across different age cohorts.
4. To explore women’s method preferences and willingness to adopt specific contraceptive options in the future.

This cross-sectional study was conducted over a one-year period at the College of Medicine and Sagore Dutta Hospital, located in North 24 Parganas, West Bengal, India. A total of 300 women of reproductive age, attending the outpatient department or residing in the hospital's rural catchment areas, were recruited using a consecutive sampling method. Eligibility criteria included being aged 18–49 years and providing informed verbal consent. Women with cognitive impairment or those unwilling to participate were excluded.

Data were collected using a pretested, semi-structured questionnaire administered via face-to-face interviews in the local language. The questionnaire captured key domains including age, education level, age at menarche, age at marriage, family size, history of medical termination of pregnancy (MTP), awareness of contraceptive methods (defined as having heard of the method), continuity of contraceptive use (defined as use for at least 90 consecutive days), and willingness to use specific contraceptive methods.

The questionnaire included a checklist of modern and traditional contraceptive methods: oral pills, intrauterine contraceptive devices (IUCD and PPIUCD), condoms, withdrawal, Chhaya (Centchroman), Antara (injectable DMPA), vasectomy, and tubectomy. Responses were categorized by age groups: <20 years, 21–30 years, 31–40 years, and >40 years.

Data were entered into Microsoft Excel and analyzed using SPSS version 20. Descriptive statistics including frequencies and percentages were used to summarize participant characteristics and contraceptive-related outcomes. Comparative interpretations were drawn between age strata and education levels. No inferential statistics were applied due to the descriptive nature of the study.

Ethical approval was obtained from the Institutional Ethics Committee prior to data collection. All participants provided verbal informed consent after explanation of the study’s purpose and confidentiality protocols.

Sociodemographic Profile

The largest segment of participants belonged to the 20–30 years age group, with the majority concentrated in the 'Primary education' category. A progressive decline in educational attainment was observed with increasing age, particularly in the 31–40 and >40 years groups. Literacy levels were lowest among participants aged under 20 and over 40 years. These patterns underscore the need for age-targeted educational interventions within reproductive health programs. Table 1 displays the distribution of educational attainment across the four age groups.

Table 1. Distribution of Participants by Age Group and Educational Status

Reproductive and Family Demographics

The majority of respondents reported menarche between 13 and 14 years (52%), while a substantial number (37%) experienced it before 12 years. Teenage marriage remains prevalent, with 32% married before 20 years of age, while only 12% reported marrying after 25 years. Average family size skewed towards larger families, with more than 60% reporting over three members. History of medical termination of pregnancy (MTP) was common, with 81% reporting at least one prior MTP, and over 40% reporting more than two.

Table 2. Distribution of Participants by Reproductive and Family Demographics

Figure 1. Distribution of Participants by Reproductive and Family Demographics

Contraceptive Awareness by Age Group

Contraceptive awareness was highest among women aged 21–30 years across most methods, including pills (K=96), PPIUCD (K=92), and condoms (K=102). The <20 and >40-year groups showed relatively lower awareness, with a large proportion unfamiliar with modern methods like Chhaya and Antara. The findings suggest that targeted awareness campaigns are most needed for the youngest and oldest reproductive age groups. Table 3 presents detailed figures on known and unknown methods by age group.

Contraceptive Continuity (90 Days Use)

This section explores the distribution of continued contraceptive use over a 90-day period across different age groups. The 21–30 years age group demonstrated the highest overall engagement in sustained contraceptive use, particularly with condoms (52 users), PPIUCD (21 users), and pills (26 users). Injectable contraceptive Antara was less commonly used across all age groups. A relatively high percentage of participants below 20 years and above 40 years reported 'no method used'. This indicates the presence of both a missed opportunity and a potential area for targeted contraceptive counseling. Table 4 presents the detailed numerical breakdown, and Figure 4 visually summarizes these patterns by method and age group.

Figure 4: Contraceptive Continuity by Method and Age Group

Willingness to Use Contraceptive Methods by Age Group

The willingness to use different contraceptive methods varied significantly by age group. Women aged 21–30 demonstrated the highest openness to a range of methods, particularly pills (32), PPIUCD (31), and tubectomy (29). Interest in long-term or permanent methods such as sterilization (tubectomy and vasectomy) was markedly higher in this group. In contrast, participants under 20 favored pills and had minimal preference for more invasive methods. Respondents aged 31–40 displayed moderate interest across all methods, whereas the >40 age group showed low engagement, primarily favoring condoms, withdrawal, and limited interest in sterilization. Table 5 presents the distribution of preferences across all age brackets.

Figure 5: Willingness to Use Contraceptive Methods by Age Group

This study aimed to understand the awareness, usage, and preferences surrounding contraceptive methods among 300 rural women in North 24 Parganas, West Bengal. The findings highlight significant demographic, educational, and cultural factors that shape contraceptive behavior in this population. The most represented age group was 20–30 years, which also coincided with higher literacy rates and more active contraceptive awareness and usage. However, the overall literacy level remained modest, particularly among women under 20 and over 40 years. This aligns with Kumar et al. [7], who found a similar correlation between education and contraceptive uptake among low-income women in urban India.

The demographic profiles reveal early menarche, with most women experiencing it between 13–14 years, and an alarming trend of early marriage. Nearly one-third of the participants were married before the age of 20. Early marriage limits reproductive autonomy and awareness, often curtailing the ability to make informed contraceptive choices, a pattern also observed by Ghule et al. [8], [9] in rural Maharashtra. The average family size data reveals that a significant portion of the population had three or more children, indicating unmet contraceptive needs and reflecting potential gaps in outreach and counseling.

When examining contraceptive awareness, it is clear that methods such as oral pills, condoms, and IUCDs were widely recognized, especially among women aged 21–30. Yet, awareness of newer or long-acting methods like Chhaya, Antara, and surgical options was inconsistent, particularly among the youngest and oldest participants. This echoes findings from Osborn et al. [10], who emphasized regional discrepancies in contraceptive knowledge. Takkar et al. [11] also observed similar trends among educated working women, suggesting that general awareness does not always translate into comprehensive understanding or sustained usage.

Despite moderate awareness, contraceptive continuation over a 90-day period revealed inconsistencies. The highest continuation was seen for condoms and post-placental IUCDs among the 21–30 age group. Yet, non-use rates remained concerning, particularly in women under 20 and over 40. This indicates an age-dependent drop in active contraceptive engagement, which may result from myths, misinformation, or societal pressures. These patterns resonate with Lindstrom and Hernández [12], who discussed the impact of socio-cultural and migratory influences on contraceptive continuity in marginalized populations.

Willingness to use contraception showed a preference for short-acting and reversible methods such as pills and condoms. However, the lack of preference for permanent methods like sterilization, especially vasectomy, underlines persistent gender norms in contraceptive responsibility, as highlighted by Singh et al. [13]. Additionally, a substantial number of women still preferred no method at all, which may reflect religious beliefs, fear of side effects, or mistrust in the health system, as discussed by Shruddha et al. [15].

Finally, this study affirms findings from recent literature indicating that despite a moderate level of awareness, usage patterns are influenced by education, age, marital timing, and cultural norms [14–17]. The urban-rural divide continues to affect contraceptive access and choice, emphasizing the need for grassroots-level behavior change interventions. Health workers, ASHA outreach, and school-level reproductive education could be leveraged to fill the knowledge gaps, particularly among adolescent girls and newly married couples.

Limitations

This study was conducted in a single tertiary care hospital located in a rural region of North 24 Parganas, which may limit the generalizability of findings to other geographic or cultural settings. The reliance on self-reported data introduces the potential for recall and social desirability bias, especially in sensitive areas like contraceptive use. Furthermore, the cross-sectional design limits the ability to infer causality between demographic factors and contraceptive behaviour. Finally, some subgroups (e.g., those aged under 20 and over 40) had smaller sample sizes, potentially affecting the statistical robustness of findings within those cohorts.

This study reveals that while basic contraceptive awareness exists among rural women in North 24 Parganas, actual usage—particularly of long-acting or permanent methods—remains limited. The predominance of younger women with lower educational attainment, early marriage, and high parity underscores the urgent need for sustained, targeted reproductive health education. Notably, while short-term methods like pills and condoms are relatively known and used, awareness and uptake of newer or less visible methods such as PPIUCD, Chhaya, and Antara remain suboptimal.

Strengthening frontline health worker outreach, integrating culturally tailored education programs, and improving accessibility to a broader range of contraceptive options could significantly advance reproductive autonomy and maternal health outcomes in such rural settings. Policy-level focus on adolescent education and male involvement may further enhance long-term contraceptive practices and gender-equitable decision-making.

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