Factors Affecting Family Planning Practice Among Women of Reproductive Age

Abstract

This study “Factors affecting Family Planning Practice among Bangladeshi women of Reproductive Age group of Bangladesh was conducted in Bogura rural community of Bogura  District. This was a descriptive type of cross sectional study to find out factors affecting family planning practice among Bangladeshi women of reproductive age in a selected rural area of Bangladesh. The objectives of the study  were to access the knowledge about family planning methods, to find out the level of knowledge about predisposing factors associated with family planning practices, to access various enabling factors associate family planning, to access reinforcing factors associated with family planning practice, to find out social and demographic characteristic of the respondents. The study include 104 women of reproductive age group of Bogura district. In the study, majority of the respondents were in age group between 20-24 years. Most of the respondents and their spouses were primary level education. Majority of the respondents were  housewives.  Most of the respondent have children and they don’t want  to have son so they are using modern contraceptive methods. There was significant association with family planning and the communication with their husband as a biggest strengths for continuation. Most of them started taking family planning methods when they are 20-24 years. The family planning methods are easily available near the health post at any time.  After analyzing the finding pills are one of the most popular family planning method followed by Depo-Provera  among women of reproductive age . It is strongly  recommended that emphasis should be given in social mobilization approach in the  community as well as in the district level focusing on family planning.

Introduction

The population is dynamics of Bangladesh is not fundamentally different from these of other countries of the Asia Pacific region at a similar stage of development. The population of Bangladesh is characterized by its youthful structure, high and stable fertility, declining mortality and early near universal marriage.

Bangladesh is one of the most densely populated country in the world with a high population growth rate (1.292% annually). The fertility is declined from 6.3 in 1975 to 2.74 in 2009

Bangladesh population has a tremendous growth potential. The population below 14 years is around 43% of the total population and the women of reproductive age (15-49) represent 46% of the total female population. The replacement of fertility level is 2.2 and the CPR is 58.1%

In Bangladesh Family Planning services are available from public and private facilities including NGOs. National Family Planning offers wide variety of contraceptive choice to the eligible couples such as oral pill, IUD, injectable (Depo-provera), Implant, Sterilization, condom etc through 3 levels primary, secondary and tertiary. Due to various concern and health region the women are not continue using family planning method for the long time. Nearly two third of the user discontinue within a year. Unmet need of family planning within married women of reproductive age is 11%.

A Bengali women has 1 in 21 chance of dying because of pregnancies or child birth in comparison to women in a developed country where chance is 1 in 4000. At present 570/100,000 die due to pregnancy and childbirth.

The WHO estimates that world wide each year at least 350,000 to 500,000 women die as a result of pregnancy and child birth and almost 99% of these deaths occur in developing countries.

It is estimated that approximately 30 millions women became pregnant in each year in out of total pregnancy 40% said to be risk pregnancy due to various reasons. The leading immediate most of causes of maternal deaths are preventable and with the provision of adequate antenatal car, delivery practices, timely referrals and well referral and organized accessible Family Planning Services. ^[3] It take more than 60 years for Bangladesh to double its population from 28.9 million in 1965 and the population nearly double in 1981.The population is increased to 156,050,883 in 2009 .

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

Government of Bangladesh view rapid population growth as a serious and top priority problem and National Family Planning Program is recognized as a success story in the contemporary in the Third World. However, the country still has a high population growth rate and needs to reach replacement level fertility 2.0 as soon as possible. The contraceptive prevalence rate should be raised to 70% to achieve replacement level of fertility.

There are various influencing factors which influence Bangladeshi women due to traditional family system or extended families and respect for the opinion of the family head. There are difference factors influencing Family Planning Methods use such as socio-demographic factors, husband’s attitude, mother-in-law’s attitude, son preference, religion and the culture.

The contraceptive method acceptances were used by more than 80% of users. Permanent methods are of particular importance in Bangladesh because many women have more children than they expected.

Our present study will help us to know the current contraceptive prevalence rate and also to look factors related to acceptance and non-acceptance of contraceptive among the villagers. This will help to success of National Family Planning Program.

Justification

Many survey shows, the awareness of Family Planning has increased among the people in Bangladesh. About 90% of Bangladeshi people have heard of limiting family size, especially pills and injectable. In spit of this, the use of some form of contraception is very low. The Cumulative probability of first method failure within one year of method acceptance were 12.9% pills, 2% for IUDs, 0.5% for injectables, 22% for condoms and 13.4% for other methods. This is the crux of the family planning problem.

Population problem is the burning issues in the country as it is raised to 17 corers. This number may be increased to 21corers by 2020. The increasing population is the main hindrance in social, economic, political and environment development of the country.

There are many discrepancies in target setup and achievement of family planning program. There are still achieve the target of NRR= 1, TFR+2 and CPR 72%. This will be possible when different family planning methods will be practiced by the people with their satisfaction and affordable price.

It is necessary that without economic development of the people it is not possible to achieve family planning goal. In the same way effective family planning is one of the best way to tackle the over population of Bangladesh.

Research Question 

What are the factors affecting family planning practices among Bangladeshi women of reproductive age group?

Objectives

General Objectives

To access the factors affecting family planning practice among Bangladeshi women of reproductive age group.

Specific Objective

1. To assess the knowledge about family planning methods.
2. To find out the level of knowledge about predisposing factors associated with family planning practice.

• To assess attitude towards family planning
• To assess knowledge on family planning

To access various enabling factors associated with family planning practices.

• Availability of family planning services.
• Accessibility of family planning practice.

1. To access reinforcing factors associated with family planning practices.
2. To find out social and demographic characteristics of the respondent.

Variables

Dependent Variable

Factors affecting Family Planning practice among women of Reproductive age group

Independent variable

• Condom
• Oral pill
• Injectable
• IUD
• Implant
• Permanent

Socio-demographic characteristics

• Age
• Sex
• Occupation of women
• Occupation of husband
• Education
• Family size
• Age of marriage of respondents
• No of living children
• Number of son
• Number of daughter

Operational Definition

Contraceptive use

Total numbers of eligible respondents are using different contraceptive method i.e. permanent or temporary.

Determinants

Factors influencing or affecting the use of different contraceptive methods. Example: educational status, occupation, religion, total number of living children, desire to have son, fear of complication etc.

Socio demographic Characteristics

All the characteristic of the respondents which includes age, sex, religion, occupation, education, income, family size, age of marriage etc.

Knowledge of Contraceptive Methods

The knowledge regarding different family planning methods including temporary methods and permanent methods including side effects.

Occupation

This includes the occupation of the husband of the respondent as well as respondent’s occupation.

Illiterate

Those who had no institutional education and who could not write or read.

Literacy

Primary Level –      Up to five class

Secondary Level-    From Class six to HSC

H. Secondary-         From class 11 above

Age of Marriage

Respondents’ age of marriage were recorded as stated by the respondent.

Number of Children

Present number of living children of the respondent.

Ethical Consideration

Ethical issues were considered in this research . Researcher has considered the risk and benefits of the respondents during collection of data and the national interest has given highest priority during publication . The nature and purpose of the study was explained  before starting the data collection process. Formal approval was taken from the authority for collecting data.

Limitations of the study

As the study place was be selected purposively in Bogura so, the result of the study might not reflect the whole community scenario

The size of the sample was very small due to lack of resources and time constraint.

Only 104 respondents were taken as samples.

The study was done very small area in comparison to nation therefore this study may not be valid in national context and may be valid for similar area only having similarity in many aspects.

 Review of Literature

 In the past, Family planning was considered a means to control population and to prevent unwanted pregnancy. But now, after decades of implementing family planning program world wide it has been discovered that family planning have a lot of benefits for improving overall health status of mothers, children, families and quality of life of people. A women’s ability to space or limit the number of her pregnancies has a direct impact on her health and well- being as well as the outcome of her pregnancy. In enabling women to exercise their reproductive rights, family planning program can also improve the social and economic circumstances of women and their families. Realizing the importance of family planning, the International Conferences on Population and Development held in Cairo, Egypt in 1994 in corporate this as one of important component of overall Reproductive Health. The ICPD rejected a narrow focus on population issues in favour of a broad development approach based on realizing women’s reproductive right and gender equity; calling for family planning to be provided as an integral part of wide ranging reproductive health services. According to ICPD plan of action, Reproductive rHealth  implies that  people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice. Similarly reproductive rights rest on the recognition of the basic right of all couples to decide freely and responsibility the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. So, family planning information and services are therefore a critical means for the articulation and attainment of reproductive rights and reproductive health and a central component of reproductive health program.

Today, family planning program has been incorporated as one of the important part of health program in almost all countries of the world. WHO, USAID,UNFPA, IPPF and other many INGOs and donor organizations have put a lot of effort and resources to access the quality family planning services in worldwide especially focusing in developing countries. In addition, almost all nations in this world have put their limited resources into family planning program. Due to these efforts, family planning is making a great progress than in past decades. Their have been tremendous advantages in the development of new contraceptive technologies. New methods have been introduced and existing methods are constantly being refined and improved (more effective intrauterine devices that contain copper or release the progesterone levonorgestrial). Many of available family planning methods are easier and safer to use.

Globally, since reliable methods became available in the 1960s, the use of modern contraception has risen steadily to 54 percent of all women currently married or in union. The figure rises to 61 percent when traditional methods taken into account. But the use of contraception is varying from one country to another. It varies according to income, education, ethnicity, proximity to clinic and strength of family planning programs. In Africa, only 20 percent are relying on more effective methods. The wealthiest women are four times more likely to use contraception than poorest.

Within South Central Asian countries, Sri Lanka and Bangladesh have high contraceptive prevalence rate whereas Afghanistan has the lowest use of contraception.

Family planning is the planning of when to have children⁸ and the use of birth control^9,10 and other techniques to implement such plans. Other techniques commonly used include sexuality education,^11,12 prevention and management of sexually transmitted infections,^[3] pre-conception counseling^[10 and management, and infertility management.

Family planning is sometimes used in the wrong way also as a synonym for the use of birth control, though it often includes more. It is most usually applied to a female-male couple who wish to limit the number of children they have and/or to control the timing of pregnancy (also known as spacing children). Family planning may encompass sterilization, as well as pregnancy termination.

Family planning services are defined as “educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved.

Despite this progress in family planning, there are 201 million women in developing countries who need but are not using modern contraception: 137 million women at risk of intended pregnancy are not using any method and an additional 64 million are relying on less effective traditional methods. Many vulnerable groups, including the poor and adolescent, do not have ready access to good- quality family planning services. An estimated 38 percent of all pregnancies occurring around the world every year are unintended, and around 6 out of 10 such unplanned pregnancies result in an induced abortion. There are many reasons for not meeting the family planning needs which includes; poor access to quality services, a limited choice of methods, lack of information concern about safety or side effects and partner disapproval.

Benefit of Family Planning

Family planning has a lot of benefits for men, women, children, community and nation. Previously family planning was related only to control population but now the areas of benefits have been broaden. Following are benefits of family planning.

For women:

Around the world, million of women use temporary and permanent contraceptive methods to achieve their preferred birth intervals and limit their children respectively. Still an estimated 38% of all pregnancies occurring around the world every year are unintended and around 6 out of 10 such unplanned pregnancies result in an induced abortion.

Family planning helps women to protect themselves from unwanted, too early, too late and too frequent and too many pregnancies. These types of pregnancies are risk for health for women. In other ways family planning program saves lives of many women by preventing high-risk pregnancy and unsafe abortion. It is estimated that if all women could avoid high-risk pregnancies, the number of maternal death could fall by one quarter. It has been discovered that family planning has other health related benefits for women besides preventing unintended pregnancies. For example: combined oral cramps and pain, and even help to prevent several type of cancer. Condom help prevent STDs/HIV transmission. Similarly family planning also helps women to continue education, learn skilful training and develop career to improve over all quality of life.

For children:

Family planning saves the lives of children by helping women space births. A 200 study by researcher at the Demographic Health Survey program finds that children born 3 years or more after a previous births are healthier at birth and more likely to survive at all stages of infancy and childhood through age five. It is estimated that between 13 and 15 million children under age 5 die each year. If all children were born at least 2 years apart, 3 to 4 million of these deaths would be avoided.

For men:

Family planning method especially condom helps men to protect STDs/HIV for themselves as well as for their spouses. If a man use family planning to protect pregnancy, it would planning to protect pregnancy, it would be one of good support to their spouse in reproductive health and better live of whole family members being the main responsible person of the family, family planning helps men to educate children, provide nutritious food, less money to provide treatment for ill health and too many deliveries and less absenteeism form office and regular work.

For families

Family planning improves over all quality of life of family members. Couples with fewer children are in a better position to provide quality education, good food, clothing and shelter. This will ultimately help to enjoy life.

For Couple:

Family planning improves over all quality of life of family members, couples with fewer children are in a better position to provide quality education good food, clothing and shelter. This will ultimately help to enjoy the family life.

For nation:

Family planning helps a nation to improve status of economics and overall development by reducing child and mother death, providing opportunity develop career for men and women, giving good schooling to children especially women, there will be chance to have good food for people. These all factors will help to develop nation.

 For Earth

In the current situation, the number of world population is doubling in less than fifty years. This will create the problems in Earth such as; disaster, environment, natural resources, shortage of food etc. it a couple give birth only the limited number of children, there will be fewer healthy children in future and it will create fewer problems in the earth and there will be better place to live for everyone.

Economic benefits:

Investing in family planning opens a window of opportunity for faster economic growth in nations as a whole by reducing fertility and changing the population’s age structure and dependency ratio. As the number of workers increase relative to the number of children they must support, saving and investment can increase. Investing in family planning also cuts the cost of social services as for example fewer children attend school and fewer, healthier pregnant women seek antenatal and delivery care, depending on which social services offered, each dollar spend on family planning may save government up to US $ 31 in expenditure on health, education, food, housing, water sewage and the like. Slower population growth also places less stress on limited natural resources, including fresh water and arable land.

A recent analysis has calculated that the money spend on providing modern contraceptive services in the developing world US $ 7.1 billion in 2003- prevents 187 million unintended pregnancies, 60 million unplanned births, 105 million induced abortions, 22 million spontaneous abortion, 215,000 pregnancy related deaths each year and the loss of 60 million disability- adjusted life years- 16 million among women and 44 million among infants and children. In other words, every $ 33.000 invested in family planning prevents one maternal death. A study in Vietnam found that over time, every dollar invested in family planning would save about $ 8 in health, education, and other social services.

Role of Family Planning

The Millennium summit in 2000, which brought world leaders together to produce a common framework for international development priorities and set the agenda for the United Nations in the twenty first century. The summit focused on reduction of poverty and produced series of eight Millennium Development Goals, notably omitting the ICPDs goal of universal access to reproductive health information and care. Yet family planning and reproductive health contribute directly or indirectly to achieving each of the MDGs, which are:

•     Eradicate extreme poverty and hunger
•     Achieve universal primary education.
•     Promote gender equality and empower women.
•     Reduce child mortality.
•     Improve maternal health.
•     Combat HIV/AIDS, malaria and other illnesses.
•     Ensure environmental sustainability.
•     Develop a global partnership for development.

The Millennium Project’s five year progress report on the MDGs recognized this oversight, especially the links between population growth and poverty, population dynamics and climate change, reproductive rights and gender equality, and reproductive health and the well being of mothers, infants and those at risks of HIV/AIDS. Indeed Millennium Project’s task forces have recently added indicators that explicitly address family planning and reproductive health. Family planning and reproductive health advocates must continue to work at both the international and national levels to make reproductive health part of the MDG agenda and a policy and program priority.

Methods of Family Planning

There are several methods of family planning available to couples not ready to start a family. The methods differ greatly. It is good to completely understand all the available options when making a choice on birth control.

1.     Natural Family Planning

Woman mark take hints from the body’s natural fertility signs and follow their menstrual cycles to know when they are most likely fertile. During those times Intimacy is avoided to prevent pregnancy. This method is not always accurate, but it does offers a hormone and chemical free alternative.

2.     Barrier methods condoms, diaphragms and cervical caps

Condoms are now available for men and women. All barrier methods of family planning are made more effective with the use of spermicides. Spermicides are liquids, foams, or films that contain a chemical to kill sperm. The barrier method works well as prevent pregnancy, but can cause sex to loose some spontaneity.

3.     Pills

Birth control pills are taken once daily to prevent pregnancy. The same medication in the pill is also available as a patch worn on the woman’s skin or a ring inserted into the vagina. Both are worn for three week and then removed for one week during menstruation.

4.     An injection.

Depo-Provera is a shot given to women every three months to prevent pregnancy. This method of family planning is highly effective.

5.     Internal Uterine Device (IUD) into her uterus

  An IUD is a T shaped device made of either plastic or copper and may stay in uterus up to twelve years, however if family plans change the IUD can be removed at any time by a doctor.

 6.     Sterilization

Men and women can decide on surgical sterilization as a permanent method of family planning. Men receive an outpatient procedure called, vasectomy, where the tubes that carry sperm out the urethra are clipped. Women also get tubes clipped in a tubal ligation to stop ovaries from entering the uterus. This is an operation that does require hospitalization and recovery time. ¹⁶

Bangladesh

The population of Bangladesh has been steadily increasing at a moderate rate 2.3% and now stands at an estimated 175 million. This presents a formidable challenge to the policy makers for improving the quality of life through socioeconomic development. Improvements however are being made Life expectancy at birth has increased from 44 in 1970 in 1970 to the present 62 years. ^[17]

The Ministry of Health and Family Welfare (MOHFW) has adopted the Health, Nutrition and Population Sector Program (HNPSP) to provide quality, affordable reproductive health services, including family planning, to contribute directly to the attainment of the Millennium Development Goals (MDGs). Although there has been considerable success in the health services, still more than 60% of the population do not have access to basic health care, despite the fact that many government health facilities at various levels are not being adequately utilized (MOHFW 2003). Although the total fertility rate (TFR) has dropped significantly, maternal mortality ratio remains high – the latest national data shows it to be around 300 per 100,000 live births.^{[17, 18]}

A serious challenge to government efforts to improve the health of women, newborns and children is, that the number of urban poor has increased from 7 million in 1985 to 12 million in 1999, and their health indicators are worse than these of the rural poor. According to the 2001 population census, the urban population in Bangladesh is 29 million, and has increased at the rate of 38% during the last 10 years, which is about 4 times the rural rate.¹⁹ This shift may have a negative impact on the urban health service delivery system, and it is usually women and children that suffer the most. There has however been substantial improvement between 1994 and 2004 in the survival

As there is a broad general relation between population and economic growth, the fertility rate is, through the economic growth the total number of children borne declines with an increased in per capita expenditure of the household. The world population conference in Bucharest in fact stressed that the economic development is the best contraceptive.

The practice of sterilization on a voluntary basis is necessity in the country where the standard of living is low. The population increase rapidly due to high birth rate as well as migration from neighbouring country and high infant mortality. High percentages of mothers and newborns are at risk of adverse health outcomes due to too closely spaced pregnancies

In Bangladesh 16% of births occur in less than the recommended interval (international data show that there is 170 to 300% increased risk of a neonatal, post-neonatal or infant death associated with birth-to-birth intervals of less than 18 months and a 265% increased risk of a child death associated with births of less than 24 month intervals. Number of short birth intervals decreasing but still high.

During the last 10 years, the portion of births occurring after an interval that is less than what is recommended to reduce avoidable health risks has declined by 19%, but 16% of births still face unnecessary levels of pronounced health risks due to short intervals.

Although the contraception use rate is gradually increasing in Bangladesh, it is still very low compared  with developed country and many developing countries. Since the average age at marriage (14.8 years) in Bangladesh remain one of the lowest in the world , a large portion of the potential acceptors of contraction are married women.

Younger women have unmet need for family planning.

Younger women face unnecessary health risks on both the timing and spacing of pregnancies. In Bangladesh 2 in 5 women (43%) have begun childbearing by the time they are 18 years old and 35% of births to women aged 15-19 are of too short intervals. According to the 2004 DHS, nearly 50% of all married women of reproductive age in Bangladesh use a modern contraceptive method, however, only 1 in 3 of 15 to 19 year old married women are current users of modern contraceptives. There is even demand to space among zero-parity women; for example, 30% of the 15-19 year olds with spacing demand in Bangladesh have not yet had a child (Jansen 2005.)

Spacing Patterns and Programmatic Implications

A major reproductive health issue. All available data and information indicate that the higher risks of short birth intervals and early. The pregnancies represent a major reproductive health issue in Bangladesh. The problem of short birth intervals is even more pronounced in younger women, among whom the highest risks from very short birth intervals are more common. The existing demand for spacing and the high frequency of short birth intervals demonstrates how much further family planning services must progress to better address birth spacing needs. Strategies are needed to reduce the current number of pregnancies that occur less than recommended intervals; couples will need easier access to spacing services that are responsive to their circumstances. Since most of the births occurring among women 15-19 years old are first births, the main issue for this age cohort

Contraceptive failure: level trends and determinants in matalab Bangladesh” a follow up study was carried out by Bhairagi Radheshyam, Mazaharul et. at matalab from 1974-94 among 25960 women of reproductive age. The data were extracting from the Record Keeping System. If there was any live birth during the use or seven months after the discontinuation of use of contraceptive it was considered as a failure. The result showed that the failure for Pills, IUD, Implant and Injectable and other temporary methods increased from 1978 to 1988.

Pills and Condom and other methods the likelihood of failure declined with duration of the uses. The injectable maintained a low likelihood of failure regardless of duration of use. The failure was associated with the quality of ‘Health workers performance including women’s background.

AI Chow Bairagi, Micheal et al did a longitudinal study from 1977-88 in Matlabon “Effect of Family Sex Composition on Fertility Preference and Behaviour in Rural Bangladesh.” It was found that sex composition of living children  was found to be symmetrically related to fertile preference and behaviour , with a higher number of sons at each family was associate with higher percentage of women wanting  no more children, higher percentage of currently using contraception and lower subsequent fertile. The result suggest that while sex preference remained largely unchanged during the study period, its effect on contraceptive use declined and its impact on actual fertility remained modest and fairly stable.

A knowledge, attitude and practice survey of 8,500 CMWRA was conducted in 1990 in both treatment and non-treatment areas, with about equal numbers of respondents from each area. Villages were randomly selected in both areas, with CMWRA selected from a sampling frame based on a census-type enumeration of all respondents in the selected villages.

The 1990 survey found a CPR of 57.1% in the experimental area and 27.2% in the control area. A 1984 survey had found a CPR of 38.2% in the experimental area and 15.8% in the control area (Koenig et al, 1992). For Chittagong Division, the CPR in 1989 was 19.8%, in 1991 27.1%. In 1990, the difference between the experimental area and either the control area or Chittagong Division was predominantly in the use of injectables. Most women report that their husbands approve of family planning. Only 5.7 percent of wives nationwide believe that their husbands do not approve, and another 7.8 percent say that they do not know their husbands’ opinions. But, the vast majority of men, 78.4 percent, whose wives think they do not approve of family planning actually do approve.

During the 1970s and early 1980s, whensterilization was the main focus of the family planning program and compensation was provided for accompanying sterilization clients to clinics, the village based workers spent much of their time promoting sterilization and assisting female sterilization clients. Even now, it is not unusual for a family planning worker to take a client to a clinic for sterilization, keep her company before and after the procedure, and provide other assistance.

such as watching the client’s children or bringing water, food or medications. ^[23]

A study conduct by Islam et al,1998 found that contraceptive use was much lover among the women who had never been pregnant.” Also women who suffer from complication during and after pregnancy are  more likely to use FP methods either to space or limit   future birth.

Methodology

Study Design

It was descriptive type of cross sectional study to find out the contraceptive practice among the reproductive women in a selected rural area.

Study Place

The study was conducted in Bogura under Bogura district.

Study Population

Study population was conducted on selected women with reproductive age between 15-49years residing in Bogura.

Sample Size

Sample size is calculated by using the formula:

n= z² pq/d²

n= The desired sample size

z = The standard normal deviation usually set at 1.96 which corresponds to the 95% confidence level.

P = .58

  q = 1-.58

d = degree of accuracy desired, usually set at 0.05.

          = (1.96)²(0.58)(1-.58)/(0.05)²

          = 3.84(0.2436)/0.005

          = .935424/0.005

          = 187

In this study I collected data from 104 respondent because of time constraints and availability of the resources . Finally my study population in this study was 104 and data analysis was done on 104 respondents.

Data collection instrument

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

Data collection procedure

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

Data Analysis

All the data were checked, verified, edited for consistency and to reduce the errors. Data analysis was done by using various statistical techniques using scientific calculator by SPSS Program.

Results

Presentation of the Data

The study was conducted in the rural community of Bogura upozila in Bogura

District and it was conducted by individual household visiting.

The result Table  show the distribution of respondents by age of women of

Reproductive age 19-49 years

 Distribution of Respondent’s Age

N= 104

The above pie chart shows the distribution of respondents by age of 104 families. Among them most of the respondents are age in between 20-24 years (26.9%)  40years  and above 40 years (24 %)

 Level of Education of respondent and her spouse

N=104

The above chart shows the distribution of respondents and her spouse education. Most of the responders (43.3%) are primary level of education and only 4.5% of responders have higher secondary.

In the same way 39.4% responders’ spouses have Primary level of education and only 6.7% are literate.

 Distribution of respondent’s and the spouse’s occupation

N=104

The above table shows that occupation of the respondent and her spouse. Most of the respondents are house wife (92.3%) and only 3.8 % are labours and service holders. In the same way 56.7% of their spouses are labor and 4.8% have no work.

Responders’ family type

N=104

The above chart  shows the distribution of respondents’ family type. Most of the respondents (60.6%) are living in nuclear family only 5.8% are living in extended family.

Distribution of age when the respondents’ got married

N=104

Above table  show that most of the respondents’ (87.5%) got married in (16-20 ) years.

 Distribution of respondents and the children

N=104

The above table shows that 89.4% have children and 10.6 % have no child.

Number  of children according to respondents  age

N=104

Table -shows the number of children according to the respondents’ age.(20-24) ages group have more children (26.60 %) and (15-19) age group have least number of children (2.13%)

Distribution of number of  children of the respondents

N=104

Table – shows that 28 % of the respondents have 3 children and 1.9% have 6 children .

Distribution of children according to the respondent

N=104

Table -9 shows that the respondents of (20-24) age group have more children (29.81%) and 15-19 age group have least children (7.68%).

 Distribution of total number respondent’s children.

N=104

 The above chart shows that 39.4% respondents have 1 son and 30.8 % of the respondents have 2 daughters.

Distribution of sons according to the respondents’ age

N=104

The above table shows that most of the respondents have one son (33.88% )  and few respondents have 3 sons (9.92 %).

Distribution of daughters according to the respondents’ age

N=104

      The above table_-12 shows that most of the respondents have two daughters

       (31.73 % )  and few respondents have 3 daughters (10.56.%).

Distribution of respondents’ desire for children

N=104

Above table shows that 72.1% of the respondent does not want to have any child and 27.9% want to have children.

Distribution of respondent desire to have son

N=104

The above table shows that 81.7% do not desire to have any son only 2.9% desire to have two sons.

Distribution of respondents who hear about Family Planning.

N=104

Above table shows 97.1% of the respondents heard about family planning and only 2.9% did not heard about FP.

Source of Information on Family Planning received by respondents.

N=104

Source of Information on Family Planning 

Most of the respondents (74%) got information about FP by radio and only 4.8% respondents got information from their spouses.

 Heard  about FP methods

N=104

90.00 of respondents heard about Family Planning methods only 10% did not hear about FP methods.

Family planning

N=104

Most of the respondents spontaneously gave answer about Pills (73.1%), Condom (73.1%) and Depo-Provera (84.6 %)but very little knowledge about Implant (1.9%) and Sterilization. There is no knowledge about Intra Uterine Device.

Attitude Measure

 Knowledge about Family planning

Most of the respondents (97%) believe that family planning methods do not cause side effect. 100% respondents disagree that contraceptive use may cause infertility in women. 98% respondents agreed that having few children may cause a person to feel economically insecure in the old age but they also agree that Parents with fewer children have better financial status. 82.7% respondent also believe that using contraceptive is against their religion.

Currently users of Family Planning

N=104

Table – shows 86.5% of the respondents are currently using family planning and 13.5% are not using FP.

According to the age user of Family Planning methods

N=104

The above figure show that most of the family planning user are (20-24) age group (30%) in the same way 35.71% of 40 years and above are not using  any family planning (35.71%)

Currently users of FP methods

The above figure shows 56.7% of the respondents are taking pills and only 1.9% of the respondents are using condom as family planning method..

Discussion with your husband their spouses on F 

Table shows that 67.3% of the respondents had discussion with their spouses and19.2% did not discussed with their spouses on Family Planning.

Availability of Family Planning Method

Currently users of FP were asked to report the source from where they obtained the  FP methods. The above table shows number and percentage of modern methods users obtains methods from various sources.

Among those, majority i.e. 94.2% obtained the methods from a local FP clinic (Health Post).

Availability of Family Planning Methods in the nearby health centres

 50% of the health centres are distributing Pills and Depo-Provera (injectable) and 26.9% are distributing Condom, Depo-provera and Pills in their centers.

Time required to reach health facilities for Family Planning

Nearly half  of the users, i.e. about 48.1 % replied that it took one hour to reach the nearby FP service outlet , while 46.2% users had to walk only 30 minutes to reach to take service.

Discussion

The study on “Factors Affecting Family Planning Practice Among Women of Reproductive Age Group of  Bangladesh” was conducted at Bogura district for the period of one month.Data was collected from the target women of reproductive age group from Bogura District. A total of 104 respondents were interviewed by face to face by using a questionnaire.

In the present study the mean age at marriage for the women was 22 years. Bangladesh fertility survey (BFS, 1989) data suggested that 96% of ever married women were married when they were teenagers. During the period of 1975-1976 , the mean age at marriage among all ever marriage women in Bangladesh was repor to be 12.3 years (BFS, 1975)

According to the BDHS 2006 data, literacy rate among adolescent was found to be 61%. Illiteracy was found among 25.1% of female and secondary level education was completed by 47% female In the present study we found that the proportion of women having primary level of  education was 43.3% which is higher that  national  statistics.

The present study reveal that 39.4% of the respondent had one child  and 28.8% had  not ever experienced pregnancy. A study conducted by islam et al, 1998 found that contraceptive use was much lower among the women who had  never been pregnant.

In the present study 82.7% are using modern contraceptive but a study conducted in Family planning World Health Organization in 1960, the  use of modern contraception has risen steadily to 54 % and in Africa    20 % , According to Bangladesh’s Family Planning success in Bangladesh nearly 50% of all married women of reproductive age use a modern contraceptive method. More than 60% of the population do not have access to basic health care (MOHFW 2003)  but in our study show 56.7% of the respondents are taking pills,27.9% are using Depo provera.

 Effect of Family Sex composition of Fertility Preference and Behavior in rural Bangladesh” a study was conducted in Matlab (1977-88) by AI Chow. Bairagi, Micheal et al. The sex composition of living children was found to be directly related to fertile preference and behavior with number of sons at each family associated with higher percentage of women wanting no more children . in the result suggest that while sex  preference remained changed  (72.1%)during the study period .

According to Bangladesh ‘s Family Planning Success story   in 1970-1980, sterilization was the main focus of the family planning program and compensation was provided for the clients but in our study none of the respondent has gone through sterilization and all of them depend upon short family planning methods.

In the present study shows that pills are the most like family planning method than other method . But according to Amy gale Dunston  and Peter C. Miller report on Chittagong Division show the predominantly in the use of injectable.

Participation in family planning decision-making is the one of the most important factor influencing the current use of contraceptive methods. the present study show 67.3% discussed with their husband and 19.2% do not communicate with their partner.  In Men and family Planning in Bangladesh (1996 by Debbie Donahoe) s in his report that  5.7% of wives national wide believe that their husband do not approve and another 7.8% say that they do not know their husband’s opinions and majority of men, 78.4% approve family planning.

High  infant mortality rates and death rates include a desire for more children for security. Many do not accept sterilization and long term spacing irrespective of religion.

In this studyant aspects of contraceptive behaviour  very limited attempt has been made to investigate some important aspects of contraceptive behaviour among married women in Bangladesh. The study attempt to investigate the attitude of towards family planning methods among the respondents who were using family planning  methods and their continuation . 67.3%  mentioned that their husband approved to use contraceptive without any problem.

Although contraceptive prevalence among currently married women in Bangladesh is increasing insidiously, the rates have not yet reached those of developed countries. The level  of contraceptive use in most developing countries is highest among wonen in late 30 and lower among teenage. (United Nations1987). The study in developed  and developing countries demonstrate that the behavioural pattern of contraceptive acceptance and use differ significantly between age groups. Studies including the present one have also revealed that apart fe external influences at the socio-cultural and policy levels that affect woman’s contraceptive behaviour, factors, influencing unmet contraceptive need vary at the individual  as well as the regional level and are of practical significance in the light of policy implication.

Conclusion

This research is descriptive cross-sectional study to explore the factors associated with factors affecting family planning practice among women of reproductive age group at Bogura district. A conceptual framework is introduce  in analyzing the basic causes and situations of the problems. The villages  were selected by simple random sampling method. The total sample size was 104. The data were collected from the women at that time with structural questionnaires. Inclusion criteria are the women with reproductive age between the ages of 15-49 women Investigator was explained to them on the objectives and purpose of the survey and assured that there were no consequences of answering those questions, the students who were absent from school in the day of data collection were excluded.

Regarding with general information, it is found that the average age of respondents are 26.9 % age group 20-24 years. Most of them have children and living in nuclear family. All of them are Muslim in religion.  Most of them are house wife and their spouses were working as housewife. Majority of them ha e at least one son and 2 daughters. Most of the respondent do not want children and 81.7% don’t want to have son. Majority  of the respondent heard about family planning from radio and discussed with their spouse for using contraceptive methods..

For data about family planning , it is found that user of pills ,condom and depo- provera as 56.7%, 13.5% and 1.9% respectively. The family planning methods are  easily available in health centre .. The main sources of information about family planning are parent, school, TV, radio and health worker. There was association between respondents and their spouses for continuously practicing family planning

Almost all of the respondents had good level of knowledge and favorable attitude about family planning methods. The study’s result stated that significant relationship between knowledge level, attitude level and family planning status.

Recommendation

It is important that economic development is the best contraceptive. So it is necessary to uplift the economic condition of the people to develop the country as well as productive life. .In the same way to tackle the over population in Bangladesh, the contraceptive use is the best way to control the family for the development. There need to increase popularity to contraceptive methods among the rural as well as urban population, the following measures should be considers-

1. Emphasis on social mobilization approach at community and district level as a strong tool concerning on family planning.
2. Every married couple should be given opportunity in the educational session during their visit in the family planning centre.
3. Government facilities as well as non-government organizations should supplied in free of cost in all over Bangladesh.
4. Involvement of the Youths in reproductive health awareness and reproductive right activates and other mass campaigns.
5. Train more health personnel and volunteers on family planning counseling. And family planning distribution.
6. There need to develop training  curriculum on condom negotiation skills and other communication skill to all development workers including politician for active involvement of the male participation.
7. Various Information, Education and Communication activities should be develop for literate and illiterate population on Family Planning.