INTRODUCTION:

An Indian women plays a vital role in contributing and preparing responsible citizen for the nation. The health of the women is an important component not only during reproductive years but also throughout her life. Women's health focuses on the physical, psychological and social needs. Reproductive capacity of women plays an important role in helping their life and health experiences. The ability to reproduce and regulate this fertility depends upon a healthy reproductive life.¹

Reproductive health implies that people are able to have a responsible, satisfying, safer sex life, as well as to have the capability to reproduce and have the freedom to decide if, when and how often to do so. One’s interpretation of this implies that the men and women ought to be informed of and how to have access to safe, effective, affordable and acceptable methods of birth control, also have access to appropriate health care services of sexual, reproductive medicine and implementation of health education programs to stress the importance of women to go through a safe pregnancy.² Every women and girl no matter where she lives in the world-has the right to live with dignity and have a voice in decisions that affect her life.³

Population, environmental sustainability and reproductive health are inextricably linked. Growing population leads to increasing demands on the environment, while meeting the reproductive health needs of women usually slows their growth.⁴

Extension of family tree leads to devaluation of women’s reproductive capacity, Few reasons are cultural responses to have less spacing pregnancies; that includes, foster son preference, which results in abortion, female infanticide, negligence and overwork of girls, dowry deaths, discrimination of widows and so on. The results of these practices are a manifest in sex ratios that are culturally rather than naturally controlled in demographic facts. Ways to help the women in these situations includes limiting population growth humanly through family planning and adoption of contraceptives to improve the women health.⁵

Good timing and spacing of pregnancies helps women bear children at healthy times in their lives. Mother and infants are then more likely to survive and stay healthy. United State Agency for International Development (USAID) analysis found that if all birth-to-pregnancies interval were increased to 3 years, 1.6 billion under five deaths could be prevented annually. This brief recommends three key programmatic actions to strengthen family planning as an essential intervention for child survival. Such as

· Educate families on family planning’s role in ensuring pregnancies occur at the healthiest times in a woman’s life. This helps avoid high-risk pregnancies.

· Expand the mix of available contraceptives, including long-acting, reversible methods, to help couples effectively space and limit pregnancies to achieve their fertility intentions.

· Enact policies to reap the benefits of the demographic dividend.⁶

Birth spacing is an effective way to reduce maternal, perinatal, and child morbidity and mortality. WHO recommends a period of at least 24 months between the delivery and conception to reduce the adverse risk of pregnancy and use of effective contraceptive can ensure sufficient spacing between pregnancies. The Government has committed to ending preventable child and maternal deaths by 2030.⁷

A birth-to-pregnancy interval less than 6 months is associated with elevated risk of maternal mortality and morbidity and also less than 18 months is associated with elevated risk of infant, neonatal, perinatal mortality, low-birth, and small for gestational age and pre-term delivery. Birth-to-pregnancy interval of 24 months tends to improve maternal and child health outcome.⁸

The family planning methods includes all temporary and permanent measures to prevent pregnancy resulting from coitus. The contraceptive methods are broadly grouped into two classes; They are, Spacing methods (Physical, Chemical methods and Combined methods, Intrauterine devices, Hormonal methods, Post-conceptional methods) and Terminal methods (Male and Female sterilization).⁹

Fig. 1: Source: Doi: 10.1371/journal.pone.0061335.g001

There are several significant factors associated for the non-acceptance of contraceptive methods; like, family structure which is a significant factor, socio economic status, religious factors, decision making is done by elders in family or by the husband, who have outlook that it might affect their maternal life. The commonest prevalent myths are fear of malignancy, fear of menorrhagia. Some potential side effects of contraceptives often form the basis for a wide range of misconception and the frequency of fear that the temporary prevention of pregnancy with contraception can lead to permanent infertility.¹⁰

By proper education regarding various contraceptive methods, it helps the women to limit the family size and improve the maternal and child health outcome.¹¹

One of the research study results showed that there was least knowledge in the domain of emergency contraceptive and natural methods of contraception. The study concluded that there is still some knowledge gap on certain specific aspects and needs to be addressed to improve the quality of life of people.¹²

The above mentioned reviews and from the past clinical experiences, the investigator identified that the rural women were lacking in knowledge, had negative attitude towards the birth spacing and even awareness regarding the importance of birth spacing was inadequate. Thus the researcher felt that there is a strong need to assess the knowledge of married women regarding birth spacing and use of IUCD with a view to develop information booklet.

STATEMENT OF THE PROBLEM:

A descriptive study to assess the knowledge and attitude regarding Birth Spacing and use of IUCD as a temporary family planning method among the married women of selected rural area of Byahatti

PHC, Dharwad district with a view to develop informational booklet.

OBJECTIVES:

1. To assess the knowledge regarding birth spacing and use of IUCD as a temporary family planning method among the married women.

2. To assess the attitude regarding birth spacing and use of IUCD as a temporary family planning method among the married women.

3. To find out the Co-relation between the knowledge and attitude regarding the birth spacing and use of IUCD as a temporary family planning method among the married women.

4. To find out an association between the knowledge scores of married women with their selected socio demographic variables.

5. To find out an association between the attitude scores of married women with their selected socio demographic variables.

6. To develop informational booklet regarding birth spacing and use of IUCD.

HYPOTHESES:

H₁: There will be a statistical co-relation between knowledge and attitude scores of married women regarding birth spacing and use of IUCD at 0.05 level of significance.

H₂: There will be a significant association between knowledge scores of married women regarding birth spacing and use of IUCD with their selected socio-demographic variables at 0.05 level of significance.

H₃: There will be a significant association between attitude scores of married women regarding birth spacing and use of IUCD with their selected socio-demographic variables at 0.05 level of significance.

MATERIAL AND METHODS:

Research approach:

Descriptive approach

Research design:

The research design used for present study was descriptive survey research design.

Variables:

The variables for present study were:

Study variables:

Knowledge and attitude regarding birth spacing and use of IUCD as a temporary family planning method.

Attribute variables:

Age, religion, education of mother, occupation of mother, age at marriage, type of family, family planning method adopted, number of children, family income, source of information.

Setting and Sample:

The present study was conducted among 60 married women in selected rural area of Byahatti PHC, i.e. Hebsur, Kusgal, Byahatti.

Measurements:

Knowledge section consists of 35 items for obtaining level of knowledge of married women regarding births spacing and contraceptive method (IUCD). A score value of one (1) was allotted for each correct response and zero (0) for each incorrect response. Total maximum score limit was 35. Attitude section consists of 13 items for obtaining level of attitude towards the birth spacing and use of IUCD among married women. A score value of each statement allotted was 3 points. A Score value for positive statements was as follows, Agree (3), Neutral (2), Disagree (1). A score value for negative statements was Agree (1), neutral (2), Disagree (3). Total maximum score limit was 39. The reliability of the tool was checked by Split-half reliability technique and Karl Pearson’s Correlation Coefficient formula was used for reliability testing. The reliability of knowledge score was r = 0.72 and reliability of attitude scale was r = 0.73.

Data collection:

The research investigator had taken permission from the Medical officer of Byahatti PHC, Dharwad district. Investigator introduces herself to the married women and explains about her aims, objectives, and steps of study. Informed consent was obtained from the subjects. Data was collected using the interview schedule (knowledge and attitude). The collected data was tabulated and analyzed.

Data Analysis:

The data obtained were analysed in terms of the objectives of the study using descriptive and inferential statistics. Tabulation of the data in terms of frequency, percentage, mean, median, mode, standard deviation, and range to describe the data. Classification of the knowledge scores as follows:

· Good knowledge -- (X+SD) and above

· Average knowledge -- (X-SD) to (X+SD)

· Poor knowledge -- (X-SD) and below

Classification of the attitude scores as follows:

Ø Positive attitude -- (X+SD) and above

Ø Neutral attitude -- (X-SD) to (X+SD)

· Negative attitude -- (X-SD) and below

RESULTS:

Section I: Distribution of sample characteristics according to demographic variables.

Table No 1: Frequency and percentage distribution of subjects according to socio-demographic variables. n=60

SL No	Demographic Variable	Frequency (f)	Percentage (%)
1)	Age in Years
	a) 21-25 b) 26-30 c) 31-35 d) 36-40	22 30 08 00	37 50 13 00
2)	Religion
	a) Hindu	32	53
	b) Muslim	19	32
	c) Christian	2	3
	d) Others	7	12
3)	Education of the mother
	a) No formal education b) Primary	0 24	00 40
	c) Secondary	21	35
	d) Graduate and above	15	25
4)	Occupation of the mother
	a) Private employee	12	20
	b) Govt. Employee	03	05
	c) Housewife	33	55
	d) Daily labour	12	20
5)	Age at marriage a) 15-20 years b) 21-25 years c) 26-30 years d) 31-35 years	20 30 9 01	33 50 15 2
6)	Type of family
	a) Joint family	26	43
	b) Nuclear family	34	57
	c) Extended family	00	00
7)	Family planning method adopted
	a) Yes	0	00
	b) No If yes, specify….	60	100
8)	Number of children
	a) One b) Two c) Three d) More than three	38 22 00 00	63 37 00 00
9)	Family income (In rupees) a) 5000 b) 5000 to 10,000 c) 10,000 to 15,000 d) 15,000 & above	09 31 14 06	15 52 23 10
10)	Source of Information a. Print Media	2	3
	b. Electronic media	05	9
	c. Friends and peer	06	10
	d. Relatives & family members	11	18
	e. Health Professionals	36	61

Section II: analysis and interpretation of knowledge and attitude score of married women regarding birth spacing and use of IUCD.

Table No 2: Mean, Median, Mode, Standard Deviation and Range of knowledge scores and attitude of subjects regarding birth spacing and use of IUCD n=60

Area of Analysis	Mean	Median	Mode	Standard deviation	Range
Knowledge	19.35	19	18.4	3.90	17
Attitude	26.35	31	40.3	3.1	10

Table No 3: Frequency and percentage distribution of knowledge scores of subjects regarding birth spacing and use of IUCD. n=60

Knowledge scores	Frequency (f)	Percentage (%)
Good (23 and above)	13	22
Average (15 to 23)	38	63
Poor (15 and below)	09	15

Graph 1: The stacked pyramid graph represents distribution of level of knowledge score subjects according to birth spacing and IUCD. The knowledge has seen into categories into good, average and poor. 22% had good knowledge, 63% had average knowledge and 15% had poor knowledge.

Table No 4: Frequency and percentage distribution level of attitude scores of subjects regarding birth spacing and use of IUCD. n=60

Attitude scores	Frequency (f)	Percentage (%)
Positive (28 and above)	14	23
Neutral (24 to 28)	42	70
Negative (24 and below)	04	07

Graph 2: The pie graph represents percentage distribution of level of attitude scores of the subjects regarding birth spacing and IUCD revealed that 14 (23%) subjects had positive attitude, 42 (70%) subjects had neutral attitude and 04 (7%) subject had negative attitude.

Section III: Testing hypothesis

Table No 5: Analysis and interpretation of data to find out correlation between knowledge scores and attitude scores. n=60

Karl Pearson

coefficient of correlation

19.35

36.35

r= 0.033

(0<rxy<1 moderately positive correlation)

Table No 5: revealed that r_xy= 0.033 therewas a positive correlation (0<r_xy<1) between the level of knowledge and attitude scores. Hence H₁was accepted.

DISCUSSION:

The present study was undertaken to assess the knowledge and attitude regarding birth spacing and use of IUCD as a temporary family planning method among married women of Byahatti PHC, Dharwad District.

Overall result of the study reveals that, 13 (22%) subjects had good knowledge, 38 (63%) subjects had average knowledge and 09 (15%) had poor knowledge. These findings were supported through a study conducted by Uddin TM, Barua S who observed that the majority of the subjects 71 (64.5%) had average knowledge, 30 (27.3%) had good knowledge, and 9 (8.2%) had poor knowledge.¹³

Overall result of the study reveals that 14 (23%) subjects had positive attitude, 42 (70%) subjects had neutral attitude and 04 (7%) subject had negative attitude. These findings were supported through a study conducted by Thappa P, Pokharel N, Shrestha M who observed that the majority of the subjects 189 (90.4%) had positive attitude and 20 (9.8%) had negative attitude.¹⁴

ACKNOWLEDGEMENT:

It is my pleasure and privilege to express my heartfelt thanks to my guide Dr. Asha H. Bhatkhande _{M.Sc [N], Ph.D}HOD Dept. of Obstetrics and Gynecological Nursing, KLES’ Institute of Nursing Sciences, Hubballi who provided me expert guidance and unselfish and noble support with optimism and zealousness. I desire to express my whole hearted sense of respect and genuine thanks to my co-guide Mrs. Shruti Kadam _M.Sc
[N]Lecturer Dept. of Obstetrics and Gynecological Nursing, KLES’ Institute of Nursing Sciences, Hubballi for her apt rallying, helpfulness and guidance and has abundantly supported me to complete this dissertation successfully.

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Received on 07.12.2022 Modified on 19.03.2023

Int. J. Nur. Edu. and Research. 2023; 11(3):218-222.

DOI: 10.52711/2454-2660.2023.00049