|Year : 2015 | Volume
| Issue : 3 | Page : 650-656
Evaluation of family planning services in a rural area in Al-Shohdaa district, Menoufiya governorate
Hewaida M Anwar El-Shazly, Osama Elkilani, Nagwa Nashat, Ragaa E Elshishiny MBBch
Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||06-Aug-2014|
|Date of Acceptance||16-Nov-2014|
|Date of Web Publication||22-Oct-2015|
Ragaa E Elshishiny
Kafer Elsawalmia Elshohdaa, 32841 Menofia
Source of Support: None, Conflict of Interest: None
The aim of our study was to examine improvement in women's health through assessment of knowledge, attitudes, and practices of family planning in our locality, which may help identify health problems associated with contraceptive methods to face them properly.
The rewards of family medicine come from knowing patients well over time and developing a mutual trust, respect, and friendship, and from the variety of problems encountered in practice that keep the family physician professionally stimulated and challenged. The postpartum period is a convenient time to address family planning; women are particularly motivated to prevent conception just after birth, and so the family physician is in a good position to provide the necessary counseling in terms of contraception for the new mother.
Patients and methods
This study included 200 women who were selected randomly from Kafer El-Sawlmia village, a rural area in Egypt. An interview in the Arabic language was completed through a precoded questionnaire by each one of the women, ranged in age from 18 to 49 years.
Sociodemographic factors played a minor role in the usage of contraceptive methods; women's level of education and socioeconomic status were not significant determinants of the likelihood of contraceptive use. Contraceptive methods were not used in this study by 7.5% of women. Most of the women in the study were not aware of physiological, surgical, and emergency contraceptive methods; hormonal methods were the most common contraceptive method used in the area of the study.
Improvement in the use of contraceptives methods and women health can be achieved by conducting awareness-raising seminars for husbands, mass media contraceptive methods awareness, proper counseling both before and at during the method selection and regular contact between the family doctor and the client.
Keywords: Family planning, method of contraception, role of family physicians
|How to cite this article:|
Anwar El-Shazly HM, Elkilani O, Nashat N, Elshishiny RE. Evaluation of family planning services in a rural area in Al-Shohdaa district, Menoufiya governorate. Menoufia Med J 2015;28:650-6
|How to cite this URL:|
Anwar El-Shazly HM, Elkilani O, Nashat N, Elshishiny RE. Evaluation of family planning services in a rural area in Al-Shohdaa district, Menoufiya governorate. Menoufia Med J [serial online] 2015 [cited 2021 Mar 5];28:650-6. Available from: http://www.mmj.eg.net/text.asp?2015/28/3/650/167854
| Introduction|| |
According to the results of the population census in Egypt that was carried out in November 2006, the population was 72.2 million. This number excludes the roughly 3.9 million Egyptians who are living abroad. By the beginning of 2008, it was estimated that the population had increased by around one and half million to reach 74.3 million (without considering the group living abroad) ,.
To overcome the problem of overpopulation, the family planning program in Egypt was started as early as February 1966, which aimed to help families to have a suitable number of children, help mothers to have pregnancies within the safest childbearing period, and postpone pregnancy for a required period of time, when indicated, for medical and social purposes .
Both the availability and the quality of family planning services are believed to have contributed toward increasing contraceptive use and decreasing fertility rates in developing countries. There is general agreement that the quality of family planning and reproductive health services positively affects contraceptive use and behavior of the clients, and that clients should receive safe and high-quality services with respect and dignity .
| Patients and methods|| |
This study was carried out in Kafer El-Sawlmia village, Al-Shohdaa district, Menofia governorate, which was selected by simple random sampling. The study was carried out over a time period of 3 months (starting on the 1 of May 2013 till the end of July of 2013). A convenient sample (200 women ranging in age from 18 to 49 years) was chosen by simple random sampling from among women who attended the health unit for any reason.
- Female adults ranging in age from 18 to 49 years.
- Consent from the participants.
All participants were volunteers. Consent was obtained from all participants in the study after explaining the purpose of this study. The consent form was developed according to the standard of the Quality Improvement System in the Ministry Of Health and Population in Egypt, which was introduced in all family centers and units. Also, it was modified according to international ethical guidelines for Biochemical Research involving human participants as established by the Council for International organization for Medical Science in collaboration with WHO (IOMS &WHO, 1993).
(1) Literature review:
A review of the current and past literatures on family planning in primary healthcare was performed.
(2) Preliminary visits:
Three preliminary visits to the Kafr Elsawalmia family health unit were conducted to:
- Obtain basic information about the environment of the research.
- Obtain approval from authorities to carry out the research.
Pilot study: A pilot study was carried out on 10 women 18-49 years of age who attended the primary healthcare unit for any reason.
(3) The tools needed for data collection were as follows:
(a) Detailed assessment of history was carried out using a semistructured sheet to obtain information on age and socioeconomic status (occupation, education, income, crowdness index, family size). Furthermore, the socioeconomic status was assessed according to Ibrahim and colleagues.
(b) Knowledge assessment questions included five questions of two types:
(i) None scored qualitative questions: which were two questions to reveal the source of first knowledge of family planning and whether the client had any idea about family planning before marriage.
(ii) Questions to score the degree of knowledge (good, fair, or poor): these questions were about different known methods of contraception [intrauterine device (IUD), hormonal, barrier, surgical, physiological], and two other questions on whether they were aware of emergency contraception and its definition. These questions were scored 1 for known method and 0 for unknown method, also for the answer about meaning of emergency contraception scored 1 for the correct answer and 0 for the incorrect one. In this domain, the maximum obtainable score was 7 and the minimum score was 0.
(c) Attitude assessment questions:
The attitude domain of the questionnaire had three items rated on a three-point Likert scale from never discussed (scoring 0), to disapproved (scored 1) and approved (scored 2). In this domain, the maximum obtainable score was 6 and the minimum score was 0.
(d) Practice assessment questions:
The practice domain of the questionnaire had 12 questions; five of these questions were scored for assessment of the practice (good, fair, or poor). These questions focused on the number of children the client had: one or two children: scored 3; three or four children: scored 2; and more than four children: scored 1. The second question was about spacing between births: 2-5 years was scored 1 and less than 2 or more than 5 years was scored 0. The third question asked whether the client was using any contraceptive method at the time of the study: use of a contraceptive method was scored 1 and nonuse was scored 0. The fourth question was about satisfaction with the contraceptive method used: satisfaction with the method was scored 1 and nonsatisfaction with the method was scored 0. The final question focused on barriers to seeking medical services: yes was scored 0 and no was scored 1.
Procedure of the study and data collection.
Participants were recruited from the family health unit attendance who met the inclusion and exclusion criteria during the period of the study.
The results were collected, tabulated, and analyzed statistically using Microsoft Excel and SPSS, version 17 software programs (SPSS Inc., Chicago, Illinois, USA). Data were described as range, mean, SD, frequencies (number of cases), and relative frequencies (percentages) when appropriate. A probability value (P-value) less than 0.05 was considered statistically significant.
| Results|| |
This study included 200 participants aged 18-49 years. They were selected randomly from among individuals attending Kafer El-Sawalmia family health unit (FHU) to determine their knowledge, attitude, and use of contraceptive methods by an Arabic questionnaire.
[Table 1] shows that ~58% of the individuals studied gained knowledge of contraception from primary healthcare facilities (family planning clinic and family health unit), 27.2% gained their initial knowledge from school and the media, whereas only 15% gained knowledge from their families, which represents a good source of knowledge of contraception.
|Table 1: Knowledge of contraception methods among 200 clients distributed by contraceptive use status|
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This table also presents the number of women who were aware of different contraceptive methods; only 1% had heard of the surgical method versus 99%, who were not aware of this method; this was a statistically significant difference, 0.03. Only 10.5% of the women were aware of the physiological method versus 89%, who were not aware of this method; this was a statistically significant difference, 0.004. A total of 97% of the women were aware of IUDs and only 3% had never heard of IUDs. 98.5% of women were aware of hormonal contraceptive methods versus only 1.5%, who were not aware of hormonal contraceptive methods versus. Only 33% of women were aware of the barrier method versus 67%, who were not aware of the barrier method, with no statistically significant difference. This indicates that hormonal methods are the most commonly used contraceptive methods in this village.
[Table 2] shows that only 13% of the women studied were aware of emergency contraception versus 87%, who were not aware of emergency contraception. A total of 61.5% of women were aware of emergency contraception and defined it correctly.
[Table 3] highlights the mean scores of knowledge and attitude toward contraceptive methods according to the sociodemographic determinants of the sample studied. The mean scores of both knowledge and attitude among the different age groups were not significant statistically (P > 0.05).
|Table 3: Mean scores of knowledge and attitude toward contraceptive methods according to sociodemographic determinants of the studied sample|
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The mean scores of knowledge among groups with different levels of education were statistically significant (P = 0.0001). Higher education levels were associated significantly with knowledge score. However, this result was not found in attitude scores, where there was no significant difference between different education levels in attitude scores.
Regarding occupation and income per month, both follow the same pattern as education.
In terms of the source of information, the same pattern was observed. The mean scores of knowledge among different sources of information level groups (with school or the media showing the highest mean knowledge score, followed by FPU) were statistically significant (P = 0.0001). However, this result was not found for attitude scores; there was no significant difference between both income levels in attitude scores. For socioeconomic levels, the same pattern was observed. The mean scores of knowledge among different socioeconomic levels (with women from low socioeconomic levels showing the highest mean knowledge score, followed by women from moderate socioeconomic levels) were statistically significant (P = 0.0001). However, this result was not observed in attitude scores; there was no significant difference between socioeconomic levels in attitude scores.
[Table 4] highlights the frequency of use of contraceptive methods use among 200 studied clients. Thirty-nine out of 200 clients were not using contraceptive methods, constituting a percentage of approximately one-fifth (19.5%). The main reason for not using contraceptive methods was 'want to be pregnant now' 28/39 (71.8%). However, among those who were using contraceptive methods, for the majority of clients (80.5%), oral contraceptive pills (OCP) was still the most common type of contraceptive methods used in the village studied (36.6%). The second common type was IUD 29.8%, followed by injections, 26.7%. The rarest methods were implants and condoms (5.6 and 1.2%, respectively).
|Table 4: Frequency of practice of contraceptive methods use among 200 studied clients|
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| Discussion|| |
The aim of the Family Planning Program is to help each family in fulfilling their reproductive intentions, and to have the desired number of children; this can be achieved with the use of contraceptives .
As El-Menoufiya governorate is a highly populated Egyptian governorate so it is essential to motivate every client to come and to use the suitable type of contraception thus the family doctor is the one who is capable to do that. Women are particularly motivated to prevent conception just after the birth of a new baby; thus, the postnatal period is the best time to focus on family planning. A family physician is in a good position to provide the necessary counseling on contraception for the new mother, and any other attendant for any other reason in any age group.
In this study, the frequency of practice of contraceptive methods was studied on 200 individuals. Thirty-nine out of 200 individuals were not using contraceptive methods, constituting a percentage of approximately one-fifth (19.5%). The main reason for not using contraceptive methods was 'want to be pregnant now' 28/39 (71.8%).
Egyptian demographic heath survey (EDHS) (2008) had shown that knowledge of family planning methods is universal among currently married women in Egypt. Almost all currently married women age 15-49 years interviewed in the EDHS had good knowledge of the pill, IUDs, and injections, and 94% were aware of implants. Fifty-eight percent were aware of female sterilization, and almost 50% knew about the condom. Other methods were less widely recognized. Only 13% knew about vaginal methods, 9% knew about male sterilization, and around 6% were aware of emergency contraception. Prolonged breastfeeding was the most commonly recognized traditional method, 70% .
El-Rafie reported that the contraceptive prevalence rate has increased at a modest rate in the last 10 years . In Egypt 2008, contraceptive prevalence rate was 60.3% for any family planning method and 57.6% for modern methods. Recently, contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, the use of contraceptives has increased, from 54% in 1990 to 63% in 2007. Regionally, the proportion of married women aged 15-49 years reporting the use of any contraceptive method has increased minimally between 1990 and 2007, from 17 to 28% in Africa, 57 to 67% in Asia, and 62 to 72% in Latin America and the Caribbean, with significant variations among countries in these regions .
In this study, the percent of use of condom was only 1.2%, and among the attitudes of the husbands of the participants toward discussion of contraceptive methods with wives and friends, 68.5% were positive, only 10% were negative, and 21.5% were neutral. The husbands of only two females (1%) of the studied group were using male condoms.
Direct evidence on the use of male methods is scarce as men have been excluded from most national surveys, and small-scale studies exploring the contracaptive behavior of men are limited. Nationally, data on the responses of currently married women show that one in 10 currently married 'couples' were using male/couple-dependent contraceptive methods .
In the present study, the percentages of methods used were 29.8% for IUD, 36.6% for pills, 26.7% for injections, 1.2% for condoms, and 5.6% for implants.
According to the Bangladesh Reproductive Health Profile , the percentages of method used were as follows: pills 23.0%, injectables 7.2%, implants 0.5%, IUD 1.2%, female sterilization 6.7%, male sterilization 0.5%, condom 4.3%, and traditional or natural methods 10.3%.
Both levels and patterns of contraceptive use in Egypt have shown positive changes. El-Rafie reported that contraceptive use has doubled during the period between 1980 and 1992 from 24 to 48% reach 60% in 2008. The proportion of married women not currently using any contraceptive methods, by then, had decreased significantly by nearly 25% from 1980 to 1992 and almost by 50% till 2003, although there has been a plateau in the last 5 years. However, achievement of the target of increasing contraceptive use rate to nearly 70% among women by 2015 is still a huge challenge, and taking into consideration the level of progress achieved over the past 15 years, dramatic shifts from pill use to IUD have been reported over the years. Pill users decreased from 16.6% in 1980 to 11.9% in 2008, whereas IUD users increased from 4.1 to 36.1% over the same time period. Urban women were more likely to be using contraceptives than rural women: 64 and 58%, respectively.
According to the Office of National Statistics (ONS), the pill remains the most popular contraceptive method in the UK. Among women aged 16 to 49 years, 27% were using the pill in 2007, 22% were using the male condom, 11% had undergone a vasectomy, 9% had undergone female sterilization, 4% were using IUD, 3% were using the withdrawal method, 2% were using injections, 2% were using Mirena (intrauterine system), 1% was using skin patch, 1% was using diaphragm, and less than 1% was using female condoms. Among women 15-44 years of age currently using contraception in the USA in 2002, 16.7% underwent female sterilization, 6.3% underwent male sterilization, 19.2% were using pills, 0.8% was using implants, 3.3% were using 3-month injectables (Depo-Provera), 1.3% were using an IUD, 0.4% was using diaphragm, 14.7% were using condom, 1.3% were using periodic abstinence-calendar, 0.2% was using periodic abstinence-temperature, 5.4% were using the withdrawal method, and 1.0% was using other methods .
In this study, nonuse of contraception was reported by 7.5%. The reasons for not using contraceptive methods were desire to get pregnant (71.8%), preference for a physiological method (15,4%), fear of side effects (10.3%), and other causes including nonavailability of accessible family planning methods, and limitations on women's mobility and lack of awareness (only 2.6%) of the studied group.
In contrast to Egypt, the Turkey Demographic and Health Survey found that nonuse for contraception was reported by 6.0% . The reasons for this are many, including lack of awareness, nonavailability of accessible family planning services, and limitations on women's mobility ,,.
A major barrier to the widespread acceptability and use of emergency contraceptive (EC) is concern in terms of the mechanisms of action of EC methods. Although a number of available contraceptive methods are effective when used for EC, the knowledge of the mechanism underlying the contraceptive effects remains incomplete .
In this study, only 13% of the studied group were aware of emergency contraception, of whom 61.5% defined it correctly and 87% had never heard about it.
| Conclusion and recommendations|| |
On the basis of the results of the study, we recommend to the following:
- Encourage and reward any heath facility that has high rates of attendance and client satisfaction, and motivate young family doctors and junior members.
- Train service providers to provide family planning counseling and equip them with practice guidelines.
- Activate the role of family files, recording and updating the local data to help continuous communication between family doctors and clients.
- Respond to clients' needs by proper counseling, which is a key element in quality of care and is also an important part of both initiation and follow-up visits, and provide adequate information to clients to enable proper selection of a suitable contraceptive method.
- Help clients make informed and voluntary decisions about their fertility.
- Train health providers (physicians, nurses) to manage the side-effects of contraceptive.
- Provide family planning advice through:
- Information on birth spacing and postpartum contraception should be an integral component of antenatal care services: the advantages of delaying the next pregnancy for 2-3 years, postpartum family planning methods, criteria for effective use of lactational amenorrhea method (LAM), and importance of the 40th-day visit.
- Services provided on the mother's 40th-day postpartum visit should be combined with health services for contraception.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
| References|| |
CAPMAS Central Agency for Public Mobilization and Statistics. Census in Egypt, 2008. Available at: http//:www.en.wikipedia.org/central agency for public_m
[Last accessed on 2014 May].
Eltomy EM, Saboula NE, Hussein AA. Barriers affecting utilization of family planning services among rural Egyptian women. East Mediterr Health J 2013; 19
International Institute for Population Sciences (IIPS) and ORC Macro. National Family Health Survey (NFHS-2). Bombay: International Institute for Population Sciences 2000; 1
Erdem, Ebru. "Islam,secularism and gender equality: Empirical findings from 1998 Demographic and Health Survey in Turkey." Annual Meeting of the American Political Science Association. Toronto, Canada, September 3-6, 2009.
RamaRao S, Lacuesta M, Costello M, Pangolibay B, Jones H. The link between quality of care and contraceptive use. Int Fam Plan Perspect 2003; 29
Ghobashy M, El Rabbat M, El Lawindi M. Public health and community medicine. Egypt population policy & family planning program, J Midwifery Women′s Health 2011; 51
Office of National Statistics (ONS). Contraception and sexual health. Contraceptive use among women aged under 50, NHS 2008; 9
Bangladesh Country Health Profile, WHO/SEARO. Bangladesh and family planning 2003: an overview.
Ibrahim M, Abdel-Ghaffar A. Estimation of the social and economic state of the family. Ain Shams Univ J Appl Psychol 1990; 14
El-Zanaty F, Way A. Egypt demographic and health survey report. Contraception 2009; 1
Erica L, Natoshia M, Gelman E, Losch M. Young women′s knowledge, attitudes and behaviors related to long-acting reversible contraception. Women′s Health Issues 2010; 20
Gemzell-Danielsson K, Marions L. Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception. Human Reproduction Update 2004; 10
[Table 1], [Table 2], [Table 3], [Table 4]