Contraceptive Practice Among the Fertile Couples Having at Least one Child of Bangladesh

Introduction:

Bangladesh is one if the most densely populated country in the World (948 persons /sq. km living in comparatively small area of 14, 7570/sq. km cauterized by a high population growth rate (1.54% annually).¹Decline in fertility from 6.3 in 1975 to 3.4 in 1994 was a good achievement but from 1994 (TFR-3.4) to 2000 (TFR-3.3) than 2004(TFR-2.7) fertility rate is usual ².

Bangladesh population has a tremendous growth potential. Still population below  145 years is around 43% of the total population and women of productive age (15-49 years) represent 46%of the total female population.Net Reproductive Rate one still have to be achieved and it is possible if the CPR (Contraceptive Prevalence Rate) become 60% more ³ .

Historically contraceptive mainly oral contraceptives were introduced in the early 1960s.⁴ Bangladesh national Family Planning Program offers a wide variety of contraceptive choice to Bangladeshi couples such as Oral Pill, IUD, Injectable,Norplant, Sterilization etc.But key concern for the family planning programs the discontinuation rate. Nearly two third of the user discontinue with in 12 months of starting use. Unmet need of family planning within married women of reproductive age is 16% ⁵.

It takes more than 60 years for Bangladesh to double its population from 28.9 million in 1965.But later only in 20 years (1961-1981) the population nearly double ⁶.

 Marked increase in population will have several adverse implications for our socio-economic development. Low socio-economic condition, poor sanitary practices, inadequate sanitary facilities,poverty,ignorance, low literacy, congested living and most important is religious factors are related wide fertility.

Government of Bangladesh views rapid population growth as a serious and top priority problem and national family planning program is an integral component of Bangladesh’s development plans. From the very beginning the planning activates in Bangladesh have based on the strategy of providing information, education, motivation to couples to help them understands the small family norm ⁷.

Bangladesh national family planning program is recognized as a success story in the contemporary Third World. However, the country still has a high population growth rate and needs to reach replacement level fertility as soon as possible. The contraceptive prevalence rate should be raised to 70% to achieve replacement level fertility ⁸.

Contraceptive practice in Bangladeshi Women can not take isolated decisions by them or by the couple alone. This is because traditional family systems or extended families and respect for the opinions of the family head still prevail. Different studies had done before to find out factors influencing contraceptives, socio-demographic factors, family sex composition specially son preference, husbends attitude, elder family members attitude, religion were found as determinants of contraceptive use.

Previous studies found failure in deferent contraceptive methods was very high. The cumulative probability of first method failure within one year of method acceptance were 12.9% for pills,2% for IUDs,0.5% for inject able, 22% for condoms and 13.4% for other methods ⁹ .

Modern temporary methods are used by more than 80% of users. Permanent methods are of particular importance in Bangladesh because many women have achieved their family size ¹⁰.

Our present study will help us to know the current contraceptive prevalence rate and also to look for factors related to acceptance and non-acceptance of contraceptives among the villagers. Thus will contribute to more success of National Family Planning Program (NFPP).

Justification

Population problem is the burning problem in our country. Now it is raised to 14 crore.This number may be increased to 21 crore by 2020. The rate of increasing population may make obstacle in social, economic, political and environmental sanitation of the country.

From 1994 to 2004 Contraceptive Prevalence Rate (CPR) was increasing (44.6%, 53.8%.58%).But total fertility rate (TFR) was still in the same point (3.4, 3.3, 2.7). This picture denotes that fertility rate are not decreasing expectedly, they are decreasing very slowly.

There are many discrepancies in target setup and achievement of family planning program. Still we have to achieve NRR=1,TFR=2.2 & CPR=72%.This will be possible when deferent family planning method specially permanent methods will be practiced by the people.

Based on the present study result all subsequent discussion with relevant Literatures it can be concluded that the finding the study may be useful for future research and planning regarding contraceptive and planning regarding contraceptive method of the rural population

So this study will be very much helpful for demonstrating the real picture of awareness, knowledge regarding contraceptive use and different factors affecting this use rate which will ultimately help the policy makers making strategy for taking motivational programs to increase effectiveness of family planning services.

It is axiomatic that economics development is the best contraceptives. So our 1^st is to uplift the economics conditions. But the developing country Bangladesh family planning by the contraceptive is one of the best tool to tackle the over population.

 Review of Literature

Different literature such as books, journals, and magagines were reviewed in order to gain a through knowledge on contraceptive use and determinants.

“Contraceptive failure: levels, trends & determinants in Matlab Bangladesh” a follow up study was carried out by Bairagi Radheshyam, Mazaharul et.el at Matlab from 1974-94 among 25,960 women of reproductive age. The data were extracting from the Record Keeping System. If there was any live birth during the use or within 7 month after the discontinuation of use it was considered as a failure. The result suggest that use-failure for Pills,IUDs,Cu-T,200 & Injectables & other temporary methods increased from 1978 to 1988, than began to decline.

For Pills, Condoms and other methods the likelihood of failure declined with duration of use, by contrast, the probability of an IUD failure increased over time, peaking at 3 years of use. The injectables maintained a low likelihood of failure regardless of the duration of use. The quality of Community Health Workers performance was associated with the risk of failure of all temporary methods except condoms; women background characteristics associated with failure varied by method ⁶.

“Effects of Family Sex Composition of Fertility Preference & Behavior in Rural Bangladesh” a longitudinal study was conducted from 1977-88 in Matlab by A I Chow. Bairagi, Micheal et al.The sex composition of living children was found to be symmetrically related to fertile preferences & behavior, with a higher number of sons at each family associated with higher percentage of women wanting no more children,higeir percentage currently using contraception & lower subsequent fertile. The result suggest that while sex preference remained largely uncharged during the study period, its effect on contraceptive use declined & its impact on actual fertility remained modest & fairly stable ¹⁶ .

“The influence of husbands on contraceptive use by Bangladeshi women”- a study was conducted by Kamal N. et al in 2000.This study used the 1993-94 Bangladesh DHS to evaluate the effect of the women’s  perception of her husbands approval of family planning on her current & future use of modern contraception, after controlling for selected socio-economic & demographic factors. While most husbands support family planning, contraceptive use among those whose husband did not give approval of family planning was much lower. In some areas of Bangladesh, however, husband disapproval of family planning was still a major determinant for women’s fertility    control ¹².

‘Factors Affecting Desired Family size in Bangladesh’-This study was conducted by Kabir,Ruul et,al.using data from contraceptive prevalence surveys conducted between 1983 & 1991. In each CPS used in a present study, a national representative sample of every married woman below the age of 50 years was selected & interviewed. The analysis suggests that mothers having one son & one daughter are more inclined to perceive their family as complete than those having three sons & one daughter.Logestic regression analysis indicates that important determinants of desire for more children are age of women, current contraceptive use status & family planning workers visits ¹⁵ .

Determinants of Contraceptive Continuation in Rural Bangladesh – a study conducted by Halida, Saifuddin et, al. in 1988. The data were derived from reinterviewed respondents of the 1985 Contraceptive Prevalence Survey. Out of total of 10.303 urban & rural respondents interviewed in 1985, there were 7682 eligible. (Over married) women from 120 rural clusters (Mitra 1987).The urban respondents were excluded because they were very mobile and difficult to locate. Women having no living children during the 1985 CPS interview were excluded from follow up, as were women who had been sterilized. A list of contraceptive ever users and non users (current & past) & 50% of non users were included in the sample. In all 3463 women were selected for interview, of these 3117 were located & 2717 were interviewed & a history of use obtained. This study indicated that the previous death of children and son preference were important determents of contraceptive continuation.

The importance of the factors varies to some extent with use of different contraceptive methods ¹⁴.

Factors Affecting Use of Contraception in Matlab, Bangladesh, this study examines the relationship between family planning, perceived availability of contraceptives, socio demographic factors in rural Bangladesh. The study was conducted by Mehrab in 1990.Data were collected from the 1990 KAP survey in the Matlab treatment & comparison areas, using a sample of 85,00 married women of reproductive age. The contraceptive rate was 57% in the treatment area but substantially lower in the comparison area where mainly traditional methods of family planning were used by women who did not know of a source of supply of contraceptives. Education had no effect on contraceptive use in the treatment area but in the comparison area, modest but consistent differentials in use by level of education were found. Number of living children was the best predictor for contraceptive use, followed by number of living sons & the attitude of respondents & their husbands towards family planning ¹⁷.

The impact of out reach on the continuity of contraceptive use in rural Bangladesh – a study was conducted by Mian, James et, al. Longitudinal data for this study from 1984 to 1992 were provided by the maternal & child health-family planning (MCH-FP) Extension project, a field research program of the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDRB) from two rural districts. This study assessed the effect of the household visit program on the continuity of contraceptive use. Results of a multivariate analysis showed that household out reach had a pronounced net effect on the continuity of contraceptive use throughout the study period and that the magnitude this effect had increased with time. This finding suggests that sustained contraceptive use continues to benefit from home based out reach even after a decade of service encounters^18.

Amin, Ahmed, Chowdhury et, al conducted a study on “Recent evidence on trends and differentials in Bangladesh fertility”: an up date on1994. The present study their was a comparison of contraceptive fertility data for 1985-91 with data for 1983, showed that fertility had continued to declined in Bangladesh, in all segments of society, which began in the pre-1983period, had accelerated in the late 1980s and the early 1990s. The magnitude in decline varied according to educational level, region and urban rural locality. The percentage decline in total marital fertility was some what higher among urban than rural residents; educated women showed greater declines than uneducated, increasing the overall educational differences in total fertility by 1991²¹.

High infant mortality rates and death rates induce a desire for more children as a reaction to insecurity. Many do not accept sterilization unless they have two sons, irrespective of religion. If sterilization is considered as a method of choice, increasing security through survival should be built into the family planning program ²³.

Limitations of the Study

1. The conclusion of the study cannot be generalized because data were collected from selected villagers. So this result might not be repetitive of the whole country. Large scale survey may give more generalized information.

2. Study time was limited; data was collected within a short period of time.

3. The number of sample was inadequate.

4. The study was cross sectional in nature and most of the information was collected retrospectively. Thus the study suffered from all the shortcomings, which are inherent in traditional single short retrospective surveys.

Research Question

What is the Contraceptive Practice rate among the fertile couples having at least one child in selected rural area of Bangladesh?

Objectives

General Objectives

To asses the contraceptive practice in the fertile couples having at least one child in a selected rural area of Bangladesh.

Specific Objectives

1. To determine the socio-demographic characteristics of the respondents.
2. To determine the methods of contraceptive practice the respondents.
3. To find out the contraceptive practice variation among the couples.
4. To find out any relationship between level of education and use of contraceptives methods.
5. To find out any relationship between profession of husband and contraceptive practice.

Variables

 Dependent Variable

Male methods

• Condom
• With drawl method
• Vasectomy

Female methods

• Oral pill
• Indictable
• IUCD
• Norplant
• Safe period method
• Ligation

Independent Variables

Socio-demographic Characteristics

• Age
• Sex
• Religion
• Occupation
• Income
• Family size
• Age at marriage of respondents
• Number of living children
• Number of living
• Number of living daughter
• Breast feeding

Operational Definitions

 Contraceptive Use

Total number of eligible respondents (in percentage) using the deferent contraceptives methods both temporary and permanent methods.

Determinants

 Factors influencing or affecting the use of deferent contraceptives methods such as occupation, educational status, total number of childern, desire more child son or daughter preference religious barrier, fear of complication, fear of operation etc.

 Socio-demographic Characteristics

Are the characteristics of the respondents which include age, sex, religion, occupation, education, income, family size, age at marriage of respondents, age of last child?

Knowledge of Contraceptive Methods

 Is the knowledge of respondents regarding deferment Family Planning Methods (FPM) whether they know about deferent contraceptives methods or not – both temporary methods and permanent methods (Ligation & Vasectomy); whether they know that mistake during use of temporary methods will cause unwanted pregnancy.

Total Monthly Family Income

This included the combined total monthly income of the family the husband’s income, income of the wife (where applicable) & income of the other family member if present.

Illiterate

Those who had no institutional education, who could not write or read who may, could only sign or who could read only Arabic.

Literacy Level

Primary Level – Up to Class five

Secondary Level – From Class six to H S C.

Graduation & above.

Bachelor Degree (B A, B Sc, B Com) Master Degree (M A, M Sc, M Com)

Age at Marriage

 Respondents age of marriage were recorded as stated by the respondents (male & female both) by asking some indirect questions like what was the interval between onset of ministration & marraige, what was the interval between the marriage and first child birth , how old first child etc.

Number of Children

Present number of living children of the respondents.

Methodology

Study Design

It was descriptive type of cross sectional study to find out the contraceptive practice among the fertile couples having at least one child in a selected rural area.

Study Place

The study was conducted at Sreepur union and Manikgonj union under Manikgonj district which is situated about 45 km from Dhaka.

Study Period

 A period of one month has been taken for collecting and analyzing data.

 Study population

Study population was conducted on selected fertile couples where the females were from age group between 15 – 49 years residing in Sreepur and Manikgonj union under Manikgonj district.

 Sample Size

 Total number of respondents was 340.

 Sampling Technique

Sampling technique was purposive sampling.

  Data Collection Instrument

 Data was collected with questionnaire containing semi structured questions which was prepared on the basis of survey objectives. The questionnaire was protested in separate place on the same type of study.

 Data Collection Procedure

Data was collected from respondents by face to face interview. Before collecting data the purpose of the study was explained to the respondents.

 Data Analysis

After collections data were checked, verified, edited for consistency & to reduced error. Data were analyzed by using SPSS software program.

 Results:

The study was conducted in the rural community of Sreepur & Manikgonj upozila in Manikgonj district and it was conducted by individual household visiting.

The results are –

Table – 1 shows the distribution of respondents by age of wife of 340 families. Among them must of wives age in between 25-29 years (30%).

 Table – 2 shows among the contraceptive users, most of them use oral pill (48.5%) followed by condom users (18.8%). Only 0.3% use both condom and oral pill.

 Table – 3 shows contraceptive practice is more among younger age groups 15-19 years and this is 92.3%.

 Table – 4 shows deferent methods practiced in different age groups. Indeed almost in all groups most if them use oral pill 71% women of 25-29 years old, 65% women of    20-24% years old use oral pill. Above 40 years the use of permanent method is comparatively higher than younger age groups. Vasectomy practices more than tubectomy.Norplant and IUD are not popular contraceptive methods the respondents.

Table – 5 shows maximum responders get information regarding contraceptive methods from family planning workers (45%) followed by paramedics / doctors (12.4%) and from media like Radio, Television etc (10.9%).

Table – 6 shows different reasons of most practicing the contraceptive among the responders. Most of them (6.8%) desire more children and 5% don’t know about family planning. Large numbers of them (3.5%) not practicing contraceptives for religious believe.

Table – 7 shows most respondent’s occupation is agriculture (30.8%), next to agriculture, almost 30.2% are doing business. Contraceptive practices are more among service holder (Salary 2500 taka). The relationship between husbands occupation and contraceptive practice is non significant (x² =29.29, df=40, P=0.894).

Table – 8 shows among the responders 38.8% breast feed their children and 41.8% have no history of breast feeding.

 Table – 9 shows the length of breast feeding among the responders who breast feed their children. 12.6% mother fed breast milk their children for two years and 4.4% for 6 months.

 Table – 10 shows number of children in different age groups of wives among the responders. Maximum responders have 2 children and more children in the age group of 25-29 years.

Table – 11 shows contraceptic practice more among those responders having a son.

Table – 12 shows female contraceptive methods are practiced more in comparison with male ones.

Presentation of the Data

Table – 1: Distribution of respondent’s age of wife

N = 339, Missing = 1

                  Table – 1 shows the distribution of respondents by age of wife of 340 families. Among them most of wives age in between 25 years to 29 years (30%).

Table – 2: Method of Contraceptives Practiced by Couples

The above table shows among the contraceptive users, most of them use oral pill (48.5%) followed condom users (18.8%). Only 0.3% use both condom and oral pill.

Table – 3: Contraceptive Practice in Different Age Group

N=332, Missing=8.

                    The above table shows contraceptive practice is more among younger age group (15-19) years and this is 92.3%.

Table – 4: Different Method of Contraceptives in Different Ages

Above table shows different methods practice in different age groups. Indeed almost in all groups most of them use oral pill.71 % women of 25-29 years old, 65% women of 20-24 years use oral pill. Above 40 years the use of permanent method is comparatively higher than younger age groups. Vasectomy practiced more than tubectmy. Norplant and IUD are not popular contraceptive methods among the responders.

Table – 5: Different Sources Regarding Contraceptive Methods

Total 276 responders were able to answer & remaining could not answer.

 Maximum responders get information regarding contraceptive methods from Family Planning Workers (45%) followed by Paramedics / Doctors (12.4%) and from media like Television, Radio etc. (10.9%).

Table – 6: Reasons of not practicing the Contraceptive

Above table shows different reasons of no practicing the contraceptive among the responders. Most of them (6.8%) desire more children and 5% don’t know about family planning. Large numbers of them (3.5%) not practicing contraceptives for religious believe. Table has been made among 100 couples

Table – 7: Levels of Education of wife & Contraceptive Practice

 N = 327, Missing = 13

 Above table shows among the responders 47% of wives have primary level of education and contraceptive practice is more than who have no education. Only 5% have education level graduate and above and contraceptive practice is 95% among them. The relation between level of education of wives and contraceptive practice is highly significant (x² =33.42, df=3, P=<0.0005).

Table – 8: Distribution of Breast Feeding among Respondents

 Remaining 66 women were not in lactation period.

Above table shows among the respondents 38.8% breast fed their children and 41.8% have no history of breast feeding.

Table – 9: Length of Breast Feeding among Respondents

Remaining was not in lactation period.

 Above table shows the length of breast feeding among the respondents who breast fed their children. 12.6% mother feed breast milk their children for 2 years and 4.4% for 6 months.

Table – 10: Number of Children in Different age Groups

Above table shows number of children in different age groups of wives among the respondents. Maximum respondents have 2 children and more children in the age group of 25-29 years.

Table – 11: Contraceptive practice among Respondents having Sons

Remaining couples are in unmet need.

 Above table shows contraceptive practice more among those respondents having a son.

Table – 12: Contraceptive practice variation in gender

Remaining was not practicing any methods.

  Above table shows female contraceptive methods are practiced more in comparison with male ones.

Discussion:

The study on “Contraceptive practice among the fertile couple having at least one child in a selected rural area of Bangladesh” was conducted at Mahona & Sreepur Union under Manikgonj district for the period of 15 days.

Data was collected from the target couples from two unions. A total of 340 respondents were interviewed by face to face by using a questionnaire. All of them were female.

Among the total respondents most couples (77.4%) practice contraceptiion which showed difference from the study of contraceptive failure, levels, trends and determinants.

Among the total respondents, most of them (48.5%) used oral pill followed by condom user (18.8%), 0.3% used both condom & oral pill.

92.3% of the respondents were younger in age (15-19 years).

Among the total oral pill users 71% women were between of 25-29 years, 65% women were between 20-24 years. Above 40 years, the use if permanent method was    higher than younger age group. Norplant & IUD were not popular contraceptive method.

Most of the respondents got information regarding contraceptive methods from family planning worker (45.5%) followed by paramedic / doctors (12.4%) & from media like Radio, TV (10.9%).

The reasons for not practicing contraceptive methods, 6.8% were desired more children, 5% didn’t know about family panning & 3.5% due to religious belief.

High infant mortality rates and death rates induce a desire for more children as a reaction to insecurity. Many do not accept sterilization unless they have two sons, irrespective of religion. If sterilization is considered as a method of choice, increasing security through survival should be built into the family planning program ²³.

About the education level, 47% had primary levels of education, 5% were graduate & above. Among the education level contraceptive were 95%.

About the occupation status 30.8% were agriculturist,30.2% were businessmen,14% were day labour,9.7% were industrial labor, 9% service holder having more than 5000 Tk/ month & 6% service holder having <5000 Tk/ month.

Regarding breastfeeding 38.8% respondents breastfed their children & 41.8% had no history of breast feeding. Regarding the length of breast feeding 12.6% mothers fed their babies foe two years & 4.4% for 6 months.

Regarding the number of children maximum respondents had two children having age group between 25-29 years.Regading the male child, Contraceptive practices were more among those respondent who had sons & who had daughters.

“Effects of Family Sex Composition of Fertility Preference & Behavior in Rural Bangladesh” a longitudinal study was conducted from 1977-88 in Matlab by A I Chow. Bairagi, Micheal et al.The sex composition of living children was found to be symmetrically related to fertile preferences & behavior, with a higher number of sons at each family associated with higher percentage of women wanting no more children, higher percentage currently using contraception & lower subsequent fertile. The result suggest that while sex preference remained largely uncharged during the study period, its effect on contraceptive use declined & its impact on actual fertility remained modest & fairly stable ¹⁶ .

 Regarding the acceptance contraceptive devices, female practiced more than 57% compared to male 18%.

“The influence of husbands on contraceptive use by Bangladeshi women”- a study was conducted by Kamal N. et al in 2000.This study used the 1993-94 Bangladesh DHS to evaluate the effect of the women’s  perception of her husbands approval of family planning on her current & future use of modern contraception, after controlling for selected socio-economic & demographic factors. While most husbands support family planning, contraceptive use among those whose husband did not give approval of family planning was much lower. In some areas of Bangladesh, however, husband disapproval of family planning was still a major determinant for women’s fertility    control ¹².

As this study was carried out at village level, it was seen that the educational level, monthly income, numbers of male child, religious belief, activities if family health workers etc had influence over the Contraceptive Method Practice (CMP) among the fertile couples.

 Conclusion:

The program (The Contraceptive practice among the fertile couples having at least one child in a selected rural area of Bangladesh) was conducted in a rural community at the Sreepur & Manikgonj upozila in Manikgonj district. The study was descriptive type of cross sectional study. The objective of the study was to find out the contraceptive acceptance among the selected fertile couples.

It has been observed from this study result that comparatively female contraceptives methods are widely used. The oral pills are mostly used by the respondents. It is also found that most of the respondents get the information about contraceptive methods form the family planning workers.

Among the responders 38.8% breast feed their children and 41.8% have no history of breast feeding.

The length of breast feeding among the responders who breast feed their children. 12.6% mother fed breast milk their children for two years and 4.4% for 6 months.

Number of children in different age groups of wives among the responders. Maximum responders have 2 children and more children in the age group of 25-29 years.

Contraceptic practice more among those responders having a son.

A number of responders practice contraceptive have a daughter.

Female contraceptive methods are practiced more in comparison with male ones.

Based on the present study result all subsequent discussion with relevant Literatures it can be concluded that the finding the study may be useful for future research and planning regarding contraceptive and planning regarding contraceptive method of the rural population.

Recommendation:

It is axiomatic that economics development is the best contraceptives. So our 1^st is to uplift the economics conditions. But the developing country Bangladesh family planning by the contraceptive is one of the best tool to tackle the over population. To increase popularity to contraceptive methods among the rural population, the following measures should be considered –

1. Mass education & communication about the control via Radio & Television.

2. Contraceptives & family planning methods should be cheap & easily available.

3. Employment facilities should be provided.

4. Education about the family planning.

5. Improvement of MCH services & women status.

6.  Domiciliary supply of contraceptives should available.

7. It will be very fruitful if contraceptive supplied in free of cost.

8. Government facilities will encourage the contraceptive users.

9. Economic support should be given to the users.

10. The couple who has only two child free education support should be provided for their children.

11. The villagers who are using contraceptive, Sharee, Lungi, money and daily necessities should be provided for them.

12. Family planning workers should be strongly trained.

13. Government facilities for the family planning workers should be provided.

14. Various encouragement programs should be arranged for the mass population.

15. Training program should be fruitful for birth control purpose.

References:

Bibliography

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