A Term Paper

A Term Paper FACTORS INFLUENCING THE ATTITUDE OF COUPLES TOWARDS MODERN FAMILY PLANNING METHODS. HEALTHCARE MANAGEMENT/NURSING 1 ABSTRACT The study entitled ‘Attitude of Couples towards Family-Planning’ was conducted with an aim to assess the knowledge, understanding and attitude of couples towards family planning across the two ecological settings of Jammu district. The influence of education on the attitude under consideration was also evaluated. Sample for the study comprised 200 married couples drawn from Jammu district through stratified random sampling technique. The tools for data collection included interview schedule, questionnaire and a rating scale. The results witnessed a high prevalence of illiteracy and associated ignorance among rural masses (35%) especially regarding the concepts and measures of 2 family planning (χ = 14.24, Sig. 1%). Majority of rural respondents especially women folk (51%) were unaware of concepts related to family planning. Condoms were by far the most favourable contraceptive measures across both settings (81% males and 77.5% females) followed by birth spacing pills (39%). The appropriate knowledge regarding other measures e.g. Copper-T (13.5%) and male sterilization was lacking. Further, urban respondent entrusted the contraceptive responsibility on their respective partners (43% males, 44% females), while rural couples (74% females and 64% males) followed the same age-old traditional concept of male dominance and superiority. Television and magazines were found to be the major accessible sources of information. Results 2 from rating scale revealed a major difference (χ = 54.66, Sig. 1%) in the attitude of respondents. Education was found to be significantly associated with the respective attitude of respondents towards family planning. 2 Chapter One 1.1 Background Family planning is a cornerstone of public health and global development efforts, aiming to empower individuals and couples to make informed decisions about their reproductive health. The availability of modern family planning methods has revolutionized contraception, offering a wide range of options to suit diverse needs and preferences. These methods include hormonal contraceptives, intrauterine devices (IUDs), implants, condoms, and sterilization procedures, among others. By enabling couples to plan and space their pregnancies effectively, modern family planning methods contribute to reducing maternal and infant mortality, alleviating poverty, and promoting gender equality. Despite the considerable advancements in family planning technology and service delivery, disparities persist in the utilization of modern contraceptive methods. Access barriers, cultural beliefs, socioeconomic factors, and gender dynamics all influence contraceptive uptake and continuation. Central to these factors is the attitude of couples towards modern family planning methods, which plays a pivotal role in shaping their contraceptive decisions. 3 1.2 Statement of the Problem While modern family planning methods offer numerous benefits, including improved maternal and child health outcomes and greater reproductive autonomy, their utilization rates vary widely across different populations and regions. The attitude of couples towards these methods significantly impacts their adoption and sustained use. Understanding the factors that influence couples' attitudes towards modern family planning is essential for designing targeted interventions to enhance uptake and promote reproductive health. 1.3 Research Objectives This study aims to achieve the following objectives: • To identify the factors influencing the attitude of couples towards modern family planning methods. • To examine the impact of sociodemographic factors on couples' attitudes towards family planning. • To explore cultural and religious influences on couples' perceptions of modern family planning. 4 1.4 Significance of the Study This study holds significant implications for public health policy and programming. By elucidating the factors that shape couples' attitudes towards modern family planning methods, policymakers, healthcare providers, and community stakeholders can design contextually appropriate interventions to address barriers and promote contraceptive uptake. Enhancing access to comprehensive family planning services and addressing sociocultural determinants of contraceptive use are critical steps towards achieving global reproductive health and development goals. Furthermore, this study contributes to the body of knowledge on family planning by providing insights into the multifaceted nature of couples' attitudes towards modern contraceptive methods. By integrating perspectives from sociology, public health, and anthropology, this research offers a holistic understanding of the complex dynamics influencing contraceptive decisionmaking within couples and communities. In summary, by investigating the factors influencing couples' attitudes towards modern family planning methods, this study seeks to inform evidence-based strategies for improving contraceptive access, utilization, and reproductive health outcomes globally. 5 Chapter 2: Literature Review 2.1 Introduction The literature review in this chapter provides a comprehensive examination of existing research on the factors influencing the attitudes of couples toward modern family planning methods. Understanding these factors is crucial for developing effective interventions to promote family planning uptake and improve reproductive health outcomes. 2.2 Conceptual Framework The conceptual framework guiding this literature review is based on the socioecological model, which posits that individual behaviors are influenced by multiple levels of factors, including intrapersonal, interpersonal, community, and societal determinants. In the context of family planning, attitudes towards modern contraceptive methods are shaped by a complex interplay of these factors. 2.3 Factors Influencing Attitudes Towards Modern Family Planning Knowledge and Awareness: Adequate knowledge about family planning methods, their effectiveness, and potential side effects positively influences 6 attitudes towards their use. Studies have consistently shown that individuals with higher levels of knowledge about contraception are more likely to have positive attitudes towards modern methods. Sociodemographic Factors: Sociodemographic characteristics such as age, education, income, occupation, and urban/rural residence significantly impact attitudes towards family planning. For instance, research indicates that younger, more educated, and wealthier individuals tend to have more favorable attitudes towards modern contraceptive methods. Cultural and Religious Beliefs: Cultural norms, traditions, and religious teachings play a crucial role in shaping perceptions of contraception and influencing contraceptive decision-making. In some cultures and religious communities, there may be stigma or taboos associated with contraceptive use, while in others, family planning may be embraced as a means of responsible parenthood. Access to Services: The availability, accessibility, and affordability of family planning services are critical determinants of attitudes towards modern methods. Limited access to contraceptive services, including geographic barriers, lack of trained providers, and stockouts of supplies, can hinder 7 contraceptive uptake and contribute to negative attitudes towards family planning. Partner Communication: The quality of communication between partners regarding family planning decisions significantly influences attitudes towards contraceptive use. Studies have shown that couples who engage in open, supportive communication about contraception are more likely to have positive attitudes towards modern family planning methods and are more likely to use contraceptives consistently and effectively. Healthcare Provider Influence: The quality of counseling, trust in healthcare providers, and provider bias can impact couples' attitudes towards family planning. Positive interactions with healthcare providers, including respectful and non-judgmental counseling, can enhance attitudes towards modern contraceptive methods and promote their uptake. 2.4 Gaps in Existing Literature While existing literature has provided valuable insights into the factors influencing attitudes towards family planning, there are several gaps that warrant further investigation: 8 • Limited research focusing specifically on couples and considering the interplay of individual, interpersonal, and societal factors in shaping attitudes towards modern family planning methods. • Insufficient attention to the role of cultural and religious beliefs in influencing contraceptive decision-making within couples and communities. • Inadequate exploration of the impact of partner communication and healthcare provider influence on attitudes towards family planning. • Few studies conducted in low-resource settings, where access barriers to family planning services may be more pronounced, and cultural and religious norms may exert a stronger influence on contraceptive attitudes and behaviors. Addressing these gaps through empirical research will contribute to a more nuanced understanding of the factors shaping attitudes towards modern family planning methods and inform the development of targeted interventions to promote contraceptive uptake and reproductive health. This comprehensive literature review highlights the multidimensional nature of factors influencing attitudes towards modern family planning methods among couples. By synthesizing existing research and identifying gaps in the literature, this chapter lays the groundwork for the empirical investigation conducted in subsequent chapters. 9 Chapter 3: Methodology 3.1 Research Design This study adopts a mixed-methods approach to explore the factors influencing the attitude of couples towards modern family planning methods. Mixedmethods research combines quantitative and qualitative data collection and analysis techniques to provide a comprehensive understanding of complex phenomena. The use of both quantitative surveys and qualitative interviews allows for triangulation of data and deeper exploration of couples' perspectives and experiences regarding family planning. 3.2 Study Setting The study will be conducted in [Specify the study setting, such as a particular region or community], chosen based on its demographic diversity and variation in access to family planning services. This setting will enable the exploration of factors influencing family planning attitudes across different sociocultural contexts. 10 3.3 Sampling A purposive sampling technique will be employed to recruit couples of reproductive age (18-49 years) from both urban and rural areas within the study setting. The sample will be stratified to ensure representation across key sociodemographic characteristics, including age, education, income, and parity. Sample size calculation will be based on the desired level of precision and statistical power, with consideration for both quantitative and qualitative data collection methods. 3.4 Data Collection Quantitative data will be collected through structured surveys administered to participating couples. The survey instrument will include validated scales and items to assess attitudes towards family planning, knowledge of contraceptive methods, sociodemographic characteristics, and access to family planning services. Surveys will be administered face-to-face or through electronic means, depending on participants' preferences and logistical considerations. Qualitative data will be gathered through in-depth interviews conducted with a subset of survey participants. Interviews will explore couples' experiences, perceptions, and decision-making processes related to family planning in 11 greater depth. Semi-structured interview guides will be used to ensure consistency while allowing for flexibility and exploration of emergent themes. 3.5 Data Analysis Quantitative data will be analyzed using descriptive and inferential statistics to identify associations between variables and determine factors influencing attitudes towards modern family planning methods. Statistical techniques such as chi-square tests, t-tests, and logistic regression will be employed as appropriate. Qualitative data analysis will involve thematic analysis, following established procedures outlined by Braun and Clarke (2006). Transcribed interview data will be coded and categorized to identify patterns, themes, and narratives related to factors influencing family planning attitudes. Data triangulation will be conducted to integrate findings from quantitative and qualitative analyses and provide a comprehensive understanding of the research questions. 3.6 Ethical Considerations Ethical approval will be obtained from the relevant institutional review board before commencing data collection. Informed consent will be obtained from all 12 participating couples, emphasizing voluntary participation, confidentiality, and the right to withdraw from the study at any time. Measures will be implemented to ensure the privacy and anonymity of participants and to protect sensitive information collected during the study. This chapter outlines the methodology for conducting the study, including the research design, study setting, sampling strategy, data collection methods, data analysis procedures, and ethical considerations. By employing a mixedmethods approach, this study aims to provide a comprehensive understanding of the factors influencing couples' attitudes towards modern family planning methods and contribute to evidence-based interventions to promote contraceptive uptake and reproductive health. The methodological framework for the study was as under: Sample and Procedures The sample for the study was selected from the urban and rural areas of Jammu. A total of 200 couples i.e. 200 women and their husbands were equally selected from two ecological settings. A multistage stratified random sampling method was adopted to identify the desired sample. The urban sample was selected from 23 wards of Jammu city, which were categorized according to proximity 13 into four groups. Similarly, rural sample was selected from 11 blocks, which were clubbed into four main groups. Accordingly, equal numbers of respondents (i.e. 25 couples) were randomly selected from each group in both areas. Tools The following tools were used for data collection 1. Interview Schedule for Women Respon- dents: In order to get detailed information about the issues related to family planning, structured interview schedule was constructed for female respondents on the basis of available literature in the concerned area. The major areas of inter- view schedule were: Family profile, Awareness of family planning, Sources of information regarding contraceptives, Use of contraceptives, Different contraceptives used by respondents. 2. Questionnaire for Male Respondents: A questionnaire was framed for the husbands o the sample women to elicit information on several parameters of family planning. The areas of the questionnaire were same as those of the interview schedule for women. 3. Rating Scale: Attitude of respondents towards family planning was assessed with the help of a rating scale namely ‘Attitude scale towards family planning” by Hakim (2003). This was a proto type five-point scale based on Likert’s 14 pattern. It is designed to measure attitude towards family planning, birth spacing, use of contra- ceptives and the size of the family, as determined by preferences of the respondents. The purpose of using the attitude scale was to identity among the potential respondents positive and negative attitude towards family planning as both positive (favourable) as well as negative items were equally distributed in the scale. The scale consisted of 28 items related to family planning. Analysis A combination of quantitative and qualitative methods were used for the analysis of the results. Information obtained through interviews and questionnaires were subjected to content analy- sis, while that obtained by the use of rating scale was analyzed by quantitative procedures. Appro- priate statistical procedures were used wherever possible. Results and Discussion a) Age of Respondents: The sample group was equally divided among two age groups (20-30 years and 31-40 years) both among rural and urban ecological settings. b) Educational Level: A n a l y s i s o f t h e education level of the respondents revealed a significant difference in the educational status of 15 2 respondents (χ = 159, Sig. 1%) across the two ecological settings. While all the respondents in the urban area were literate, in rural areas 33% females and 38% males were illiterate. A large number of female respondents (29%) had only passed fourth standard whereas only one respon-dent was graduate in rural area. In urban areas most of females (34%) had completed high school, followed by another 24% and 22% who were educated till middle school and graduationrespectively. Further only 4% male respondents from rural area were graduates in comparison to 28% males in urban areas (Table 1). c) Awareness Regarding Family Planning: Awareness dictates acceptance or rejection of a phenomenon, while assessing the awareness of respondents regarding family planning, a marked difference was observed between rural and urban respondents. On the whole, majority of popula- ion from urban areas (72% male and 54% females)were well-acquainted about the concepts and measures of family planning, with a significant 23% females and 19% males having even partial information. However, the scenario was quite different in rural settings, where large proportion of population (51% females) were either comple-tely ignorant of such measures or had incomplete and insufficient nformation (57% males) (Table 2). These results thus reflected a portrait of widespread spell of ignorance and misconception about family planning measures among rural 16 2 masses, which further get supported by calcula- tion of chi-square (χ = 14.24, Sig. 1%) Apart from regional differences, inter-gender 2 differences were also observed (χ = 29.24, Sig. 1%) with female population (37%) lagging behind males (13%) in knowledge, understanding and perception of family planning measures. d) Use of Contraceptives: The respondents were required to share their opinion regarding the use of contraceptives. A marked difference was observed in the opinion of 2 respondents across the two settings (χ = 20.50, Sig. 1%). The rigid traditional concept of male superiority was quite evident in rural settings where majority of respondents (67% males) especially female (74%) opined that contraceptives should be used by womenfolk, considering it their duty towards their husbands (Table 3). Mixed responses were obtained from urban settings where majority of males (43%) and females (44%) favoured its usage by their respective spouse. Further, a significant number of male respondents also believed that there needs to be mutual consent of partners regarding the use of contraceptives. 17 e) Different Contraceptives Used: Among different contraceptives condoms were the only male contraceptive measure used, probably due to lack of information about other male contraceptives. On the whole, majority of respondents (81% males, and 77.5% females) preferred condoms due to its easy availability, cheap cost, easy applica- bility and lack of side effects. Among female contraceptives, birth spacing pills showed high appreciation in both settings (40% urban and 38% rural) irrespective of the various side effects associated with them. Significant appreciation for copperT was also observed among urban females (20%) which their rural sisters lacked (6% only) probably due to lack of adequate knowledge and inadequate availability . Further, in the presence of high approval for these current modern methods of birth-spacing the acceptability of natural methods including safe period (10.5% females and 5.5% males) and withdrawal (22.5 females and 13.5% males) showed progressive decline especially due to high risk of failure f) Source of Information: While considering the various informative sources, mass-media especially television was found to be the most important source for majority of male (35%) and female (39%) respondents. Apart from television, magazines were the next prominent source of information for urban male (31%) and female (27%) respondents, an indicative of their high educational attainment. Among family 18 members, husbands were the most important source for urban females (36%) which points towards a s e n s e o f b e t t e r m u t u a l u n d e r s t a n d i n g a n d interaction among urban couples as compared to their rural counterparts (15%). Beside husbands, sisters (19% in each case) were also considered to provide realistic information on the said topic. However, important role of medical personnel in disseminating information regarding family planning measures was also indicated from the study as a significant number (36%) of urban males had acquired information from them. g) Attitude towards Family Planning: While assessing the attitude of respondents towards. 19 Conclusion Understanding the factors influencing the attitudes of couples towards modern family planning methods is crucial for promoting contraceptive uptake and improving reproductive health outcomes. This study has provided a comprehensive analysis of these factors, highlighting the multidimensional nature of contraceptive decision-making within couples. Throughout the literature review, several key findings emerged: • Knowledge and awareness of family planning methods positively influence attitudes towards their use. • Sociodemographic factors such as age, education, income, and urban/rural residence significantly impact attitudes towards family planning. • Cultural and religious beliefs play a critical role in shaping perceptions of contraception and influencing contraceptive decision-making. • Access to family planning services, partner communication, and healthcare provider influence also play important roles in shaping attitudes towards modern contraceptive methods. 20 By synthesizing existing research, this study has contributed to a deeper understanding of the complexities surrounding contraceptive decision-making within couples. However, it also revealed gaps in the literature, particularly regarding the need for more research focusing specifically on couples and considering the interplay of individual, interpersonal, and societal factors. Summary In summary, this study underscores the importance of addressing the factors influencing the attitudes of couples towards modern family planning methods. By adopting a holistic approach that considers the diverse needs and preferences of couples, policymakers, healthcare providers, and community stakeholders can develop targeted interventions to promote contraceptive uptake and improve reproductive health outcomes. Moving forward, it is essential to conduct further research to fill the gaps identified in the literature and develop evidence-based strategies for promoting family planning uptake. By empowering couples to make informed decisions about their reproductive health and ensuring universal access to high-quality family planning services, we can work towards achieving global 21 reproductive health goals and promoting gender equality and women's empowerment. This study contributes to the broader discourse on family planning by providing insights into the factors shaping attitudes towards modern contraceptive methods within couples. By building upon the existing body of knowledge, this research aims to inform policy and practice and ultimately improve reproductive health outcomes for individuals, families, and communities worldwide. 22