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Abstracts of Studies and Comments by Participants

Contraceptive awareness and acceptance in an Indian Metropolitan city
– Dr Suneeta Mittal, Dr M Lakhatia, Dr S Kumar and Dr Shalini Singh, AIIMS, New Delhi

We participated in two WHO multi-centric trials to recruit women for Emergency Contraception during 1996-2000. During this period a doctor, using a structured questionnaire to assess their knowledge and practices of contraception with special emphasis on Emergency Contraception, interviewed 4000 women attending gynaecological OPD and family planning clinics.

The surveyed population consisted of married women between 18-55 years of age, the median age being 28 years. The mean age at marriage was 23 years though nearly 6% were married while still in their teens (i.e. below 19 years of age).

A sizeable number of surveyed women belonged to lower middle socio-economic strata with low level of schooling. Only 33% had been to college and 20% were employed.

Most women were shy to discuss their needs for contraception but an overwhelming number (78%) wished to have two children only. Nearly half (55.4%) of the women did not show a personal preference for the male gender amongst their children but confessed that they have to bow to pressure from elders in the family to produce another child.

Majority (85%) of women had heard of more than one contraceptive method and 73% wished to space their children between 3-5 years but only 13% were regular contraceptive users. Common reasons for non-usage of contraception were incomplete knowledge about the method and its availability, fear of side effects and non-approval from the husband.

Many women (25%) relied on periodic abstinence but as many as three-fourths of them had incorrect knowledge about the safe period of the cycle. Twenty percent couples also practised withdrawal method. Among the modern methods, the ever-used contraceptives were condoms (52%), IUD (12%), oral pills (15%) and sterilization (5%). Knowledge of Emergency Contraception was negligible (3.2%) and only ten women had used it previously. However, 33% confessed that they could have avoided an unplanned pregnancy if they knew about EC. Our study also revealed that nearly half of the women did not use contraceptives soon after marriage due to fear of adverse effect on their fertility potential. Use of condoms was the popular recommendation for newly-wedded couples (60%).

Use of contraception during the post-partum and lactating period is not very popular. Women feel that they are not at risk of another pregnancy while lactating. Though 25% women resume sexual activity within 6 weeks of delivery and another 45% between 6 weeks and 3 months, only 15% used contraception during this period.

Thus, it is apparent that mere awareness of contraceptive methods is not enough to promote acceptance. Details of contraceptive methods, their availability, answers to questions regarding their side-effects and suitability to individual's need should be discussed with the couple (not only the woman) during counselling. The couple should be helped in making their choice of contraception by the counsellor, and advised about Emergency Contraception as a ‘back-up’ measure.

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