European Journal of Cardiovascular Medicine

India, the second most populous country in the world, faces significant challenges due to its rapidly growing population^1,2. The country’s family planning program, launched in 1952, was a pioneering step towards controlling population growth and addressing maternal mortality^3,4. Over the years, the focus of the national family planning program has shifted from mere population control to improving maternal and child health outcomes^5,6. However, despite substantial efforts, unintended pregnancies remain a major concern, often leading to unsafe abortions and complications.One of the primary reasons for unintended pregnancies is insufficient knowledge and misconceptions surrounding contraceptive methods⁷. Socio-economic factors, cultural beliefs, and lack of education further complicate the adoption and correct usage of contraceptives^6,7. While awareness about contraceptive methods is increasing, actual utilization, especially in rural areas, remains suboptimal.

This study was conducted to assess the knowledge, attitude, and practices regarding contraceptive use among married women of reproductive age attending a family planning clinic. It also aimed to identify factors influencing the acceptance and proper utilization of contraception. The findings of this study will provide valuable insights into the barriers faced by women in adopting family planning methods, contributing to the improvement of maternal health policies and family planning strategies.

A cross-sectional study was conducted among 200 married women of reproductive age attending the family planning clinic in the Department of Obstetrics & Gynaecology at Konaseema Institute of Medical Sciences and Research Foundation, Andhra Pradesh. The study was carried out over a period of six months, from June 2023 to November 2023.

Study Population:

The participants were selected based on the inclusion criteria, which included married women aged 18-40 years who gave consent to participate in the study. Women who were unmarried or who did not provide consent were excluded from the study.

Data Collection:

A pre-designed proforma was used to collect data. The questionnaire included sections on socio-demographic characteristics, knowledge about contraceptive methods, attitudes towards contraception, and current practices regarding contraceptive use. The socio-demographic section gathered information such as age, religion, region, educational status, and socioeconomic status using the Modified Kuppuswamy scale. Questions related to knowledge assessed the women’s awareness of different contraceptive methods, while the attitude section explored their perceptions, beliefs, and cultural influences related to family planning. The practice section focused on the current use of contraception, reasons for using or not using contraceptive methods, and the factors influencing their choices.

Data were collected by trained medical staff through face-to-face interviews lasting approximately 10 minutes per participant.

Statistical Analysis:

The data were analyzed using descriptive statistics to calculate frequencies and percentages for categorical variables. Fisher’s exact test was used to determine the association between the educational status of women and their knowledge of contraceptive methods, with a significance level set at p < 0.05.

The study included 200 married women in the reproductive age group attending the family planning clinic. The socio-demographic profile of the participants is presented in Table 1. Among the participants, 54% were in the 18-25 age group, followed by 30% in the 26-30 age group. The majority (71%) were Muslim, and 95.5% resided in rural areas. Regarding parity, 37.5% of women had one child (Para 1), while 25.5% had two children (Para 2).

Table 1: Socio-demographic profile of the patients

The socioeconomic status of the participants, categorized using the Modified Kuppuswamy score, is shown in Table 2. A large proportion of women (44%) were from the lower middle class, while 24.5% belonged to the upper middle class. Only 3.5% of women belonged to the lower socioeconomic class.

Table 2: Socioeconomic status (Modified Kuppuswamy Score)

Figure No:1. Socioeconomic status (Modified Kuppuswamy Score)

In terms of contraceptive knowledge, 92% of the participants were aware of at least one contraceptive method, as detailed in Table 3. The most recognized method was oral contraceptive pills (OCPs), known to 86% of participants, followed by intrauterine contraceptive devices (IUCD) at 55% and condoms at 54.5%. Other methods such as tubectomy, Injection DMPA, and PPIUCD were also known by a significant number of women, although fewer were aware of vasectomy (7.5%).

Table 3: Knowledge of different contraceptive methods

Figure No:2. Knowledge of different contraceptive methods

As for the sources of contraceptive knowledge, Table 4 indicates that 41.5% of women received information from ASHA workers, while 40% obtained information from television. Relatives were another significant source of information for 21% of women, while fewer women cited paper groups, radio, or healthcare professionals such as nurses and doctors.

Table 4: Source of knowledge about contraception

Figure No:3. Source of knowledge about contraception

The contraceptive methods preferred by the women, as shown in Table 5, revealed that 39% chose oral contraceptive pills (OCPs) as their preferred method, while 15.5% preferred the natural method. The least preferred methods were PPIUCD (1.5%) and IUCD (4%). Among the 200 participants, 77% were either using or willing to use contraception, with 41% using it correctly.

Table 5: Choice of Contraceptive methods

Figure No:4. Choice of Contraceptive methods

Factors influencing the choice of contraception are outlined in Table 6. The primary reasons for selecting a method were its safety (25%) and ease of use (19%). A smaller proportion of women selected a method because it was easily available (16.5%) or because their husbands wanted it (6.5%).

Table 6: Reason for selecting contraceptive methods

Figure No:5. Reason for selecting contraceptive methods

Table 7 presents the reasons for non-use of contraceptive methods. Myths and misconceptions about contraception were prevalent. Among the 136 women who had heard of Cu-T, 25% believed it could cause cancer, and 27.9% thought it could cause perforation. Fear of side effects such as weight gain, irregular bleeding, and the fear of infertility were reported as reasons for avoiding oral contraceptive pills. Moreover, 71% of women cited husband opposition as a reason for not using condoms, while 60% of women refused tubectomy due to religious beliefs.

Table 7: Reasons for non-use of contraceptive methods

Finally, the association between educational status and contraceptive knowledge was examined and is presented in Table 8. There was a significant correlation between the level of education and contraceptive knowledge. Of the 200 women, 68.5% were literate, with the majority (120) being undergraduate educated. A significant number of illiterate women (51 out of 63) were aware of contraceptive methods, but the knowledge level was notably higher among literate women. This was statistically significant (p < 0.0002).

Table 8: Association between education and knowledge of contraceptives

This study assessed the knowledge, attitude, and practices of contraception among married women attending a family planning clinic in a tertiary care center. Our findings revealed a high level of awareness regarding contraceptive methods, with 92% of participants knowing at least one method. This is consistent with studies by Agarwal et al. [8] and Nath et al. [9], who also reported high awareness levels in similar populations. However, despite this knowledge, the actual use of contraception was lower, with only 77% of participants either using or willing to use contraception, and only 41% using it correctly. This gap between knowledge and usage underscores a significant challenge in family planning interventions.

The most recognized contraceptive methods in our study were oral contraceptive pills (OCPs), intrauterine contraceptive devices (IUCD), and condoms, which aligns with findings from other studies conducted in India (Srivastav et al., 2014) [8]. However, despite the high awareness of OCPs, it was surprising to find that 13% of women refrained from using them due to concerns about weight gain, and 11.7% avoided them due to fears of irregular bleeding. These side effect-related concerns are consistent with findings from similar studies, where fear of side effects and misconceptions about fertility were major barriers to contraceptive use (Agarwal et al., 2017) [8].

One of the most notable findings was the significant role played by ASHA workers and media in disseminating information, with 41.5% of women citing ASHA workers as their primary source of knowledge. This highlights the importance of community-based health workers in rural settings, where access to formal healthcare may be limited. Television also emerged as a key source of information, emphasizing the potential of media campaigns to reach a broad audience.

The study also highlighted that socio-cultural factors, such as opposition from husbands and religious beliefs, played a crucial role in contraceptive decisions. 71% of women who did not use condoms cited their husband’s opposition as the primary reason. Similarly, 60% of women refused tubectomy due to religious beliefs, which underscores the need for culturally sensitive family planning interventions. These findings are in line with similar studies conducted in Saudi Arabia, where cultural factors played a role in contraceptive decisions [9, 10].

Our study found a strong association between educational status and contraceptive knowledge. Women with higher educational levels were more likely to be aware of and use contraceptive methods correctly. This finding is consistent with existing literature, which suggests that education improves awareness and acceptance of family planning methods (Nath & Islam, 2015) [9]. The significant correlation between education and contraceptive knowledge (p < 0.0002) emphasizes the importance of improving women’s educational levels as a strategy to enhance contraceptive usage, as seen in similar studies by Pal et al. [11] and Al-Musa et al. [10],Imtishal et al. [13], and Alwabari et al. [14].

The study's limitations include its cross-sectional design, which does not allow for causal inferences, and the reliance on self-reported data, which may be subject to social desirability bias. Additionally, the study was conducted in a single tertiary care center, and the results may not be generalizable to other settings, especially in urban areas.

This study highlights that while awareness of contraceptive methods is high among married women in the reproductive age group, the actual usage and correct application remain significantly lower. Misconceptions, such as concerns about side effects and opposition from spouses, hinder the adoption of contraception. Socio-cultural factors, including religious beliefs, also play a crucial role in family planning decisions. Additionally, the study found a strong association between educational status and contraceptive knowledge. To improve contraceptive use and reduce unintended pregnancies, it is essential to enhance educational programs, particularly in rural areas, and address socio-cultural barriers through community-based interventions. Empowering women with accurate information and involving men in family planning decisions are key to improving contraceptive practices.

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