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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 33
| Issue : 2 | Page : 79-84 |
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Knowledge and usage of family planning methods among clients of Bab Al-Moatham Training Primary Health Care, Baghdad
Sahar A Esa Al Shatari, Khelowd Salih, May A M. Saeed, Suhair S Al-Khaledi, Saba Abbas Fadhil
Iraqi Ministry of Heath, Baghdad, Iraq
| Date of Submission | 03-Oct-2020 |
| Date of Decision | 30-Oct-2020 |
| Date of Acceptance | 20-Nov-2020 |
| Date of Web Publication | 6-Jul-2023 |
Correspondence Address:
Dr. Sahar A Esa Al Shatari
Bab Al-Moatham Training PHC Center for Family Health Approach, Resafa Sector, Baghdad Health Directorate, Iraqi Ministry of Heath, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/IRJCM.IRJCM_8_21
Background: Family planning programs represent a chance for family size control, development, and good planning for future. Objective: We aimed to assess the prevalence of usage of family planning methods, to evaluate client knowledge about these methods, and to determine the most common family planning used. Methods: A cross-sectional study was conducted in Bab Al-Moatham Primary Health Care catchment area. One hunderd and forty-one married women aged 15–49 years were given a structured questionnaire developed mainly from the Family Planning WHO guidelines, ten experts' opinions were taken into consideration. And also, a pilot study of 14 married women was done. Data analysis was done by using SPSS ver. 23. Frequency, percentage, and Chi-square tests were used. P < 0.05 was considered significance. Answer scoring was done for knowledge. Results: Sixty-three women (44.7%) aged 29–39 years, with 56% complete primary school, 92.2% homemakers, 34% married, 68.1% with good obstetric history, 87% of them used family planning methods, and 58% using it now, the most method used is CCP. 66.7%, studied women had good knowledge in the withdrawal method (65.2%), CCP (55.3%), and poor/no knowledge in vasectomy. A significant association between educational level, working, year of marriage, and previous use of family planning while only working state has significant with recent use of family planning. Conclusions: Low rate using of family planning methods, and the most method used is CCP, followed by withdrawal method with good knowledge in both and poor/no knowledge in vasectomy.
Keywords: Baghdad, CCP, family planning, knowledge, withdrawal method
How to cite this article:
Al Shatari SA, Salih K, Saeed MA, Al-Khaledi SS, Fadhil SA. Knowledge and usage of family planning methods among clients of Bab Al-Moatham Training Primary Health Care, Baghdad. IRAQI J COMMUNITY MED 2020;33:79-84 |
How to cite this URL:
Al Shatari SA, Salih K, Saeed MA, Al-Khaledi SS, Fadhil SA. Knowledge and usage of family planning methods among clients of Bab Al-Moatham Training Primary Health Care, Baghdad. IRAQI J COMMUNITY MED [serial online] 2020 [cited 2023 Oct 2];33:79-84. Available from: http://www.journalijcm.org/text.asp?2020/33/2/79/380716 |
| Introduction | |  |
The WHO announced in 2017 that “Every man and woman has the right to be informed of, and to have access to, safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth as well as provide couples with the best chance of having a healthy infant.[1] In addition, family planning offers a positive view of reproductive life and enables people to make informed choices about their reproduction and well-being.[2]
Uncontrolled population growth is recognized as the single most important impediment to national development.[3] To prevent unwanted pregnancies, birth control program was established in the 20th century.[4]
The Iraqi Family Planning Organization was established in 1971, and the Iraqi Ministry of Health initiated a family planning program during 1974–1981.[5] However, till now, Iraq had unmet need for family planning as the official united nation cite for the millennium development goals indicators.[6] In Bab Al-Moatham Primary Health Care (PHC) planned to get the health-care accreditation HCAC;[7] one of the standards needed is finding solutions to PHC problems through indicators. Low family planning clients to the monthly goal consider a big problem, so we do this study.
Objective
- To assess the prevalence of family planning usage and the most common family planning method used
- To evaluate client knowledge about these methods.
| Methods | | |
A cross-sectional study (with an analytic element) was conducted in Bab Al-Moatham PHC from March to July 2017.
After taken permission from the Resafa-Baghdad Health Directorate, 141 nonpregnant married women aged 15–49 years who attended the Bab Al-Moatham PHC for “any” reason was enrolled in this study. Privacy and confidentiality were considered. Participants were given the right to withdraw from the study at any time. Also a verbal consent from each participants was taken.
A structured questionnaire was divided into four parts: demographic (age, educational level, and working status), obstetric history, previous and recent usage of family planning methods, and knowledge about each family planning method; consisting of 6–8 questions for each method taken from the WHO Family Planning: a Global Handbook for Providers, 2011[8],[9] and two questions about participant beliefs about family planning.
Ten experts' opinions (five community physicians, three obstetric and gynecologists, and three family physicians) were taken into consideration; also, a pilot study of 14 married women was conducted but they were not included in the study. The knowledge questions was tested by the pilot study and they were reliable (Cronbach's alpha = 0.848).
Sampling technique
Nonpregnant married women aged 15–49 years attend the Bab Al Moatham PHC for “any” reason within the March 1 to May 31, 2017 (data collection period), were accepted to participate in this study. One-hundred and forty-one women were interviewed with the questionnaire.
Scoring
Each family planning method has a number of questions 8–6, developed depending on the WHO FAMILY PLANNING: a Global Handbook for Providers, 2011[8],[9] and scored as if the woman answered more than half the questions correctly consider good knowledge in that method, while if the woman answered half or less than half the questions correctly consider poor knowledge in that method.
Data analysis
Statistical Package for the Social Science (SPSS) version 20 (USA) was used for data entry and analysis. Frequency and percentage were used to describe the data and suitable statistical tests were used accordingly. Chi-square test and Fisher's exact probability test were used to test the association between dependent and independent variables. Statistical significance was determined as P < 0.05.
| Results | | |
Descriptive statistics of sociodemographic characteristics of the studied female studied women are summarized in [Table 1]: highest percentage was 63 (44.7%) of the studied women aged 29–39 years, 79 (56.0%) completed primary school, 103 (92.2%) were homemakers, and 48 (34.0%) were married between 2000 and 2005. Moreover, based on the distribution of women according to obstetric history, most of them have 2–3 babies and have no abortion or stillbirth. | Table 1: Distribution of women according sociodemographic characteristic and obstetric history
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Most of the women (136, 96.45%) heard about the family planning and 122 (87%) of them previously used them, but only 82 (58%) now have family planning methods; this is shown in [Figure 1]. | Figure 1: Distribution of women according to hearing about previous usage and recently usage of family planning methods
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Contraceptive pills are the most family planning methods used method in the past and recently, followed by the withdrawal method [Figure 2]. In [Table 2], 58% of women who used family planning discontinued it for many causes, the highest percentage due to complications or to get pregnancy. Half of the studied women have good knowledge in companied contraceptive pills, male condoms, IUCD, tubal ligation, withdrawal method, and lactation amenorrhea method, while half of the studied women have poor or no knowledge in vasectomy, progestin-only tablet, progestin injection, vaginal spermicidal, and cervical cap, with highly significant relation, as seen in [Table 3]. Majority of women believed that family planning is accepted in all religious doctrines (63.1%), while 22.7% were not sure, and 14.2% did not believe in that. As shown in [Figure 3], there is a strong association between the female work and both previous and recent use of family planning methods, while the educational level and marriage year are associated with the previous use of family planning methods only, and there is no statistical significance with the age for both previous and recent use of family planning methods, as shown in [Table 4]. | Figure 2: Distribution of women according to methods previously and recently used in family planning methods
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 | Table 2: Frequency of women according discontinuity family planning by woman herself, and its causes
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 | Table 3: Relation between the women's knowledge about modern and traditional family planning methods and type of the methods
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 | Figure 3: Distribution of women according to their opinion of family planning accepted in all religious doctrine
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 | Table 4: Association between previous and recent use of family planning methods and the women's demographic factors
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| Discussion | | |
This study revealed that studied women's age, educational level, and working status follow the normal announcing feature of Bab Al-Moatham PHC catchment area in all its catchment area survey done at the beginning of usage of the family approach model in it, 2013. Moreover, according to obstetric history, most of them have no abortion or stillbirth (not published).
Most of the studied women heard about the family planning methods; even though 13 of them never used any method previously, and recently only nearly half of the women used one of the family planning methods. This is similar to what the WHO found in 2015 that Iraq unmet the millennium development goals in the family planning program,[7] and with Statistical Snapshot, 2018 Multiple Indicator Cluster Survey (MICS6) Briefing-family planning.[10] In addition, we agree with study done in Basra city where all the respondents were aware of at least one method of contraception,[11] and with Cameroon study were found that 96% of the women had already heard about family planning;[12] but disagreed with Iraqi study done in 2014 in Al-Karkh side of Baghdad that found 75% of respondents heard about family planning.[13]
Contraceptive pills are the most family planning methods used method in the past and recently, followed by the withdrawal method. This is similar to the Basrah study[11] and preliminary finding report-MICS-4-Iraq, 2011.[14]
Unfortunately, more than half of women discontinued the family planning method by themselves for many causes, mainly complications and pregnancy welling. This is similar to Statistical Snapshot 2018 MICS6 Briefing-family planning[10] and in Al Karkh study, 2014.[13]
Good knowledge about CCPs, male condom, IUCD, and tubal ligation was found among half of the studied women, while half of the studied women have poor or no knowledge in vasectomy, progestin-only tablets, and progestin injection; this is maybe due to the prevalence of usage of the CCPs, male condom, IUCD, and rarely used the others, this result was similar to the findings of Statistical Snapshot, MICS6 IRAQ-2018-Family Planning;[10] Basrah study, 2015;[11] Al-Karkh study, 2014;[13] and MICS-4, 2011.[14]
Women's knowledge in the traditional methods was good about two methods; the withdrawal method and the lactation amenorrhea method; but poor/no knowledge about the vaginal spermicidal and cervical cap, because the last methods were not available in the local markets.
Family planning is accepted in all religious doctrine as a belief of the majority, this is not like the al Karkh study,[13] in which nearly half of the participants had a negative attitude toward family planning.
There is a strong association between the female work and both previous and recent use of family planning methods; this is very expected because most worker women need to plan about their pregnancy to suit their work and it is consider as one of the domains of empowerment to the working women as a report published in 2018 brief Women's Empowerment and Savings Groups: What Do We Know?”[15] And this is similar to a systemic review of the literature done in 2017[16] and similar to another report from the International Center for Research on Women 2012.[17]
The educational level and marriage year had a significant association with the previous use of family planning methods only; this is agreed with a study done in France in 2006[18] and similar to a study done in Nepal in 2009, which studied the influence of wives' and husbands' education levels on contraceptive method choice international perspectives on sexual and reproductive health;[19] Another study done in India, 2013 found that women's education has a significant effect on fertility.[20]
The current study revealed that there is no statistical significance with the age for both previous and recent use of family planning methods. This is disagreed with a study done in Angola in 2016[21] and another study done in occupied Palestine.[22]
| Conclusions | | |
Low rate usage of family planning methods, and the most method used, is CCP, then withdrawal method. Most of them start family planning methods after the second baby; the most cause of discontinuation is the complication followed by willing in pregnancy; and only few end with unexpected pregnancy (family planning method failure). Good knowledge in CCP, withdrawal method, IUCD, and condom, with significant association. Also Significant association between educational level, work, year of marriage, and previous use of family planning, while only the working state has a significant with recent use of family planning.
Recommendation
Increase the health education to the community about family planning importance and its types inside and outside the PHC, and continuous availability of hormonal methods, especially progestin tablet only, IUCD, and other methods in the PHC with increase family planning counseling training courses for PHC doctors.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]
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