Unmet need for contraception among married women (15-49 years) of an urban slum of South Gujarat - A cross-sectional study

ABSTRACT: Background: Rising fertility rate and population growth is one of the direct indicators of poor family planning. Unmet need for contraception plays a significant role in fertility control and also health of mother and child by decreasing infant and maternal mortality rate by bringing wanted and planned pregnancy. Fertility pattern is distorted mainly in under developed or vulnerable society like rural areas, urban slums or among migrants or nomads. Therefore, this study is conducted in the urban slum. Methods: Community based cross sectional study done in the urban slum of field practice area of the Department of Community Medicine. Sample size estimated as 305 as per the prevalence of unmet need for contraception of married women of reproductive age of 15-49 years and so house to house survey done to obtain it and hence interviewed by predesigned semi-structured questionnaire. Prior ethical and scientific committee approval obtained. PICF and written consent also obtained from participants. Data entry done in excel sheet and analysed using SPSS. Results: Proportion of protected couple is 52.13% (159) in which 18(11.3%) women discontinued thus 46.2% (141) whereas proportion of unprotected couple is 47.87% (146) among them 32 (21.91%) women excluded due to pregnancy, infertility and hysterectomy. So, precisely 37.4% (114) women had unmet need for contraception. Among protected women using spacing method were 17(12%) and opted limiting method by 124 (88%) women. Chi- square shows significant association between age, literacy, occupation and number of children for contraception usage. Conclusion: Unmet need for contraception is high among young married women of urban slum and also influenced by various socio-demographic characters. This needs policy makers and program managers to address the scenario in a holistic manner by giving more emphasis on the determinants influencing unmet need for contraception. Keywords: unmet need, married women, family planning, urban slum. INTRODUCTION: Women and Child health is always a challenge to public health and medicine world which is the root foundation of our human population without which human life on earth is questionable. Healthy life on earth is brought about by healthy women with good health for which family planning is necessary or even mandatory in coming near future. For which family planning is the structured way of building and way of living and making a family, in turn a healthy and sizeable society and ultimately population controlled and lead to a healthy country. Family planning is not only the mere use of contraception yet it is a way of lifestyle or living considering the good health of mother and child which in turn brings about a planned pregnancy which ultimately bring about negligible morbidity or mortality. Apart from the above view growing population is also another threat to the society to avail basic health care in an equitable and equal manner. Accounting the current population of our country, India which has overtook China by 1.43 billion. Rapid population growth also serves as a shortage for human basic needs like water, housing, sanitation, clothing, nutritious food, primary health care, etc. to be met by them. In 1951, India became the first country in the world to launch family planning program to control rising population. (1) India ranks 1st most populous country in the world overriding China with population of 1.4 billion. Current Surat population is 60 lakhs according to census 2011 by Surat municipal corporation. (2) There is also increase in urban population which has been attributed both to natural growth and migration from villages because of employment opportunities, attraction of better living condition and availability of social services as education, health, transport, entertainment, etc. (1) Surat is such an example for high migration as being the Diamond, silk and textile city. Total number of slum pocket in Surat city is 344 according to census 2011. (2) Urban slums usually have clusters of population living in lesser square kilometre area having low socio-economic status along with primitive living conditions, 22 insecurities related to accommodation and employment and diverse cultural factors. All this variable has impact on the fertility pattern of the area. Operational Research studies support the hypothesis that economic status bears an inverse relationship with fertility. The total number of children born declines with an increase in per capita expenditure of the household. Similarly, education also has inverse association whereas caste and religion have direct impact as e.g. Muslims have higher fertility than Hindus. (1) In last 50 years exceptional intervention has taken place in areas of reproductive health. New and modern contraceptives are available and as a part of social marketing many people started purchasing on their own. There is also another set of population who are unaware or not using contraception due to lack of knowledge like vulnerable section of the community. Currently few data are available in this topic among them. Unmet need for family planning means when a married women who are able to give birth and want to stop or delay childbearing but not using any method of contraception to prevent pregnancy. (1) The concept of unmet need points to the gap between some women’s reproductive intension and their contraceptive behaviour. (3) The urban field practice area of Department of Community Medicine GMC Surat is situated at Ambedkar Nagar located in South West Zone, Ward no 23. This is under Surat Municipal Corporation (SMC) and known as ward no 23 having population of 1 lakh. Urban health centre situated at Althan, Community Health Centre at Bamroli and New Civil Hospital of Surat are the Primary, Secondary and Tertiary Health Care centres for the Study area. The need for this study in this urban slum of field practice area is that the area is having high number of children showing high fertility, where large number of people are living in small area with poor living condition, education and occupation. So, it would be useful to study various sociodemographic parameters and fertility pattern of eligible couples in this area to serve them better for family Welfare. Thus, the study is planned to be conducted in the urban field practice area of GMCS. It would be useful to assess demographic data and to estimate eligible couples to list them out and to identify who have unmet need. After the study analysis necessary plan can be executed for the benefit of this population in future. Because contraception is one of the good indicators, of the extent to which couples have access to reproductive health services. The purpose of this study is to strengthen the clinic and field-based services provided at Urban Health clinic (UHC) of GMCS. For example, fulfilling unmet need prevents unintended pregnancy thereby its benefits are like lesser unsafe abortions, healthier mother and children, reduction of population pressure on environment, economic growth, etc. So, it helps in preventing chain of events in the society. Also, it will provide direction by helping to pinpoint the obstacle in society and weaknesses in services that need to overcome. Aim: To study the proportion of unmet need for contraception among study population. Objectives: a) To assess the unmet need for contraception and to assess the proportion of protected couple. c) To determine socio-demographic characteristics among protected and unprotected eligible couple. Methodology: Study Design: A community-based cross-sectional study was conducted to assess the unmet need among eligible couples. Sample Size Calculation: According to the Family Welfare estimates as quoted in Park’s Textbook of Preventive and Social Medicine, there are approximately 150–180 eligible couples per 1000 population in India. In the selected study field area, there were approximately 500 households, with an estimated population of 2500. Based on this estimate, the expected number of eligible couples was around 300–400, all of whom were considered for inclusion in the study. Additionally, using the prevalence of unmet need from a previous study (27.3%), the sample size was calculated using the OpenEpi sample size calculator. With a 95% confidence level, the minimum required sample size was found to be 305. Sampling Technique and Study Site: The study site was selected using convenient sampling. The study was conducted in Ambedkar Nagar, Althan, which is the Urban Field Practice Area of Surat city. A total of 305 participants were selected using purposive sampling, including married women aged 15–49 years. Initially, a house-to-house survey was conducted to collect basic demographic information and the number of eligible couples using a Google Sheet. Subsequently, detailed data related to unmet need among eligible women were collected using a separate Google Form. Study Population: Married women aged 15–49 years residing in the selected study area were included in the study. Study Duration: The total duration of the study was 12 months, which included: · 8 months for data collection · 2 months for data analysis · 2 months for report writing and documentation Inclusion criteria: · Eligible couple in which wife is in age group of 15-49 years. · Participants who accepting written consent. Exclusion criteria: · Non available and non-traceable even after 3 home visits. · Non cooperative couples. Outcome parameters, primary and secondary: Primary Outcome: 1) Estimated proportion of met and unmet need for contraception among eligible couple and documented the awareness and usage of type of contraception. 2) Estimated various socio-demographic determinants in relation to the outcome variable. Secondary outcome: 1) Estimated various fertility indicators l