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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