A study on knowledge, attitude and practice of contraception among college students in Sikkim, India

Abstract

Introduction

The global population today stands at over 6 billion, one-sixth of which is in India. Uncontrolled population growth is recognized as the single most important impediment to national development. Despite the fact that India was the first country in the world to implement a national population control programme in 1952, the country is still struggling to contain the baby boom. A lot of efforts and resources have gone into the National Family Welfare Programme but the returns are not commensurate with the inputs. The programme has targeted eligible couples in its efforts to control the population.

The United Nations Fund for Population Activities (UNFPA) notes that future population trends will hinge on the fertility decisions of today’s men and women aged 15–24 years and on their ability and freedom to act on those decisions (1). Concern about adolescent fertility arises from its health implications both for the mother and the child, its demographic implications in societies with rapid population growth and its social development implications. Because of the young age-structure of India’s population, the reproductive attitude and behaviour of teenagers are likely to have an important impact on overall reproductive health, demographic and social outcome. Adolescent sex and exposure to the risk of pregnancy has attracted considerable research attention to understand its magnitude and address it as a problem. Studies in developed countries have shown a high level of such exposure (2–5), as also in Latin America (6, 7), China (8) and some African countries like Uganda and Nigeria (9–11), South Africa (12–14) and India (15, 16).

These facts warrant an investigation into the knowledge and attitude of this age-group regarding fertility control and contraception.

Material and Methods

A cross sectional study was conducted in the Government College, Gangtok, the capital town of Sikkim, a small state in north-east India. A Knowledge Attitude Practice (KAP) study was conducted among 156 students during the month of April 2009. The inclusion criteria: Students enrolled in the first year bachelor course, who were willing to participate in the study.

The exclusion criteria: Those students who were not willing to participate in the study.

Purposive Sampling with snowball technique was used. The questionnaire was designed by the authors after an extensive review of available literature, and the questionnaire was pretested. After obtaining written informed consent, the questionnaire was administered for data collection on general information, knowledge and attitude regarding family planning methods, and contraceptive practices.

Ethical committee clearance and permission from the principal of Government College was obtained. The students were assured regarding the confidentiality and secrecy of the information provided by them. The data was collected through the questionnaire which was voluntarily filled out by the students. Variables were knowledge, attitude, and practice of students regarding family planning and contraception.

Descriptive statistics was used for data analysis. The collected data was analyzed with regard to the information given by the subjects according to the set questionnaire items and the analyzed data is presented in the following tables.

Results

The study showed that 98% (153/156) of the students had knowledge about family planning and 86% (134/156) of them had heard about contraceptives. and 69% knew about the source of availability of contraceptives.

73% (115/156) had gained information about family planning and contraception from the media, 33% from newspapers, 32% from friends and 21% from health personnel.

Discussion

Many studies have been conducted all over the world to study the knowledge, attitude and practice of contraception in adolescent and young adults. A study conducted among 991 senior students (15–17 years) in North Gondar in 1995 by Fantahun MI et al showed the level of knowledge of contraception to be 75% (17). Another study conducted in Nigeria itself in 1998 by Araoye et al in randomly selected 971 males and females aged 18–24 years in a Nigerian tertiary institution showed that 97.7% of males and 98.4% females respectively knew at least one method of contraception (18). Adinma JI et al. conducted two studies in 1995 and 1999 and reviewed contraception in 498 Nigerian Tertiary School Girls-228 from the Medical Discipline (MD) of study and 270 from the Non-Medical Discipline (NMD) in 1995 and in 314 teenage Nigerian school girls comprising 128 students at secondary and 186 at tertiary levels of institution in 1999. The overall mean awareness of contraception was 70.9% in the first group, however the mean level of contraceptive awareness for the various methods of contraception was 38.2% for the second survey group: 22.6% for the secondary school girls and 54.4% for the tertiary school girls (19, 20).

In India, two such studies have been carried out in Delhi and Ludhiana in the past. Aggarwal O et al. in Delhi (21) conducted the survey in 500 undergraduate students of the medical colleges of Delhi and reported the knowledge regarding, contraception to be 83.5%, which was comparable to the study conducted in Ludhiana by Benjamin (22) et al. among 527 senior secondary school children, where 87% were aware of contraception. Similar results were reported by Arowojolu AO (23) et al. from Nigeria, where a survey of 2388 Nigerian undergraduate students showed the contraceptive knowledge level to be 87.5%. In the present study group 86% of the college students had knowledge of contraception and 69% knew about the source of availability

The source of knowledge about contraception in most of the studies, like that of Fantahun MI et al. in North Gonder by Adinma JI in Nigeria and Aggarwal O et al. in Delhi, was from school and friends respectively, whereas in the present study it was the media which had played the most important role in spreading awareness about contraceptive methods among the students. In the study done by Fantahun MI et al. among 991 senior high school students in north Gonder, the most common reason for not using modern contraceptive methods among sexually active respondents was little or lack of knowledge of contraceptives followed by no access to contraceptives and harmful effects of contraceptives. In the present study the most common reasons (23%) cited for not using contraceptives were that it was against their religious beliefs to use contraceptives and that their sexual life would not be happy respectively. However, 19% felt that use of contraceptives would result in weakness, and nearly 10% felt that it would result in obesity. Arowojolu AO et al. surveyed 2388 Nigerian undergraduate students and reported that 87% had experienced sex but only 34% had used some method of contraception. In the study done by Fantahun et al. about 30% of students had experienced sex but only 17% had used contraception. The two studies done by Adinma JI et al. also had similar results, where the number of students who experienced sex was 57% and 26.8% and the use of contraceptive was 23.5% and 17% respectively. Lowes et al. from USA reported that 68% of 283 unmarried school students (at average 19 years of age) had experienced sex and 44% had used contraception, which is the highest among all the studies documented so far (24). In the present study experience of sex was not analysed but the use of contraceptives was the lowest, being only 17%, which was the same as that of the study conducted by Fantahun MI et al. in North Gonder in 1995 and Adinma et al in Nigeria.

The most preferred method of contraception in young adults was the condom followed by OCPs as reported in the study conducted by Fantahun MI in North Gonder in 1995 and by Araoye MO et al. in Nigeria in 1998. However, OCPs were the most preferred method of emergency contraception (43.9%) in a study conducted by Tamire W (25) in Ethiopia in 2007. In the present study the condom was the most preferred method of contraception used by the students (past users 70% and current users 81%).

In India also there is evidence from studies amongst senior secondary school students that adolescents are becoming increasingly sexually active. A study in four public and two government schools of South Delhi conducted in 1992 showed that 63.3% of boys and 37.4% of girls were of the opinion that students of their age had sex; 17% boys and 9% girls agreed to take the risk of AIDS rather than miss the chance of having sex with an attractive stranger (15). In another study conducted in four senior secondary schools in rural Delhi (in 1992), 23.4% boys and 15.1% girls admitted to having had sex, while 5.7% boys and 9.6% girls did not deny it (16).

Conclusion

The use of contraceptives among adolescents is significantly different from that of older married couples, and it is influenced by educational, developmental, social, and psychological factors.

The study highlights that knowledge and awareness do not always lead to a positive attitude towards the use of contraceptives. Although in the present study the actual number of sexually active young adults was not known, there appears a need for continuing education about sexuality and contraception. Also there is a need to motivate the youth for effective and appropriate use of contraceptives and arrest the trend towards unwanted pregnancy and increase in population. The media as we see has played a pivotal role in spreading awareness among the college students regarding contraceptives in the state of Sikkim. This can thus be used for motivating the young adults to adopt family planning methods and use of contraception.

Footnotes

References