ORIGINAL ARTICLE

Contraceptive Knowledge, Attitude and Practice

Among Rural Women
Rozina Mustafa, Uzma Afreen and Haleema A. Hashmi

ABSTRACT
Objective: To assess the knowledge, attitude regarding family planning and the practice of contraceptives among rural
women.
Study Design: A cross-sectional observational study.
Place and Duration of Study: The gynaecological outpatient clinic of Fatima Hospital, Baqai Medical University, Karachi,
from July to December 2005.
Methodology: One-hundred women between the ages 15-45, living with their husbands and coming from rural area
(villages) were interviewed. Women who were pregnant, had a child younger than 2 years, or had any medical disorder
were excluded. Their knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned
questionnaire. The other variables used were the age of women, parity and educational status. Descriptive analysis was
conducted to obtain percentages.
Results: Out of 100 interviewed women with mean age of 29.7 years, 81(81%) had some knowledge about family planning
methods. The media provided information of contraceptives in 52 out of 81 (64%) women. Regarding the usage of
contraceptive methods, only 53 (53%) of the respondents were using some sort of contraception. Barrier method
(condoms) was in practice by 18 (33.9%) and 12 (22.6%) of women had already undergone tubal ligation. The women
using injectables and intrauterine contraceptive devices were 10 (18.8%) and 7 (13.2%) respectively. Six were using oral
contraceptive pills (11.3%). Positive attitude towards contraception was shown by 76 (76%) of them, while 41(41%) stated
their husbands’ positive attitude towards contraception.
Conclusion: In the present study, there was a low contraceptive use among women of rural origin despite good
knowledge. Motivation of couples through media and health personnel can help to achieve positive attitude of husbands
for effective use of contraceptives.

Key words: Knowledge. Practice. Contraception. Methods. Rural. Women.

INTRODUCTION defined as the percentage of married women, aged

15-49 years, using modern and traditional methods of
Pakistan, with an estimated population of 145-149
contraception. In Pakistan, the contraceptive prevalence
million, is the seventh most populous country in the
rate is increasing rather slowly. National surveys
world with over 40% of its citizens under the age of 15
carried out in 1974-75 (Pakistan Fertility Survey) and
years.1 Pakistan’s population was growing at the rate of
1990-91 (Pakistan Demographic and Health Survey)
2.7% per annum at around 1960. The Total Fertility Rate
documented essentially unchanging contraceptive
(TFR) continued to hover between six and seven births
prevalence less than 12%.3,4 Contraceptive prevalence
per woman throughout the 1970s and 1980s, and the
increased from 12% to 24% in the 1996-97 Pakistan
population growth rate approached 3% per annum.2
Fertility and Family Planning Survey,5 (a rise of roughly
According to UN projections, Pakistan will become the
2 percentage points per annum) followed by a reported
fourth most populous country by the year 2050. It is one
CPR of 27.6%.6 Pakistan’s statistics given by UNFPA in
of the only eight countries as in the mid 1990s with a
2002 showed contraceptive prevalence of any method
population in excess of 25 million in combination and a
as 28% and of modern methods as 20%.7 In 2004,
total fertility rate in excess of five births per woman.1
Pakistan had a lower contraception use than most other
An important factor, which affects the fertility of any Muslim countries.8
population, is Contraceptive Prevalence Rate (CPR)
This study was carried out to assess the knowledge,
attitude and practice of contraceptive methods in the
Department of Gynaecology and Obstetrics, Fatima Hospital, rural women of reproductive age group.
Baqai Medical University, Karachi.
Correspondence: Dr. Rozina Mustafa, 91-A, Street 23,
Main Rashid Minhas Road, Askari-IV, Karachi. METHODOLOGY
E-mail: [email protected] This cross-sectional, observational study was carried out
Received June 6, 2006; accepted June 16, 2008. at Fatima Hospital, a community-based hospital in Karachi.

542 Journal of the College of Physicians and Surgeons Pakistan 2008, Vol. 18 (9): 542-545
Contraceptive knowledge, attitude and practice among rural women

The study was conducted in the outpatient clinic of Positive attitude for contraception was shown by 76
Gynaecology Unit-1, from July to December 2005. The (76%) females. The patterns of either partner’s attitude
functional definition of rural was women residing in the is described in Table IV.
interior of Sindh (Goths/villages). The selection criterion
was married women between the ages of 15-45 years, Table II: Knowledge and awareness regarding contraception.
n (100) %
living with their husbands at the time of interview. Heard/aware of contraceptives 81 81
Women who were pregnant, had a child younger than Methods n (81) %
2 years or had any medical disorder were excluded from Pills, injectables, IUCD, condoms, norplant, tubal ligation 21 26
the study. After taking an informed consent, women vasectomy and withdrawal method
Pills, injectables, IUCD, condoms, norplant, tubal ligation 17 21
who fulfilled the inclusion criterion were interviewed
and withdrawal method
by the postgraduate trainees. The questionnaire elicited Pills, injectables, IUCD, condoms, tubal ligation and 27 33
information regarding their age, educational status, withdrawal method
number of children, knowledge and source of Pills, injectables, condoms, tubal ligation and 14 17
contraceptive methods, practicing of either male or withdrawal method
Pills, injectables, IUCD, condoms, tubal ligation, 02 2.4
female family planning methods. The attitude of females vasectomy and withdrawal method
towards contraception was asked, while the attitude of Source of knowledge n (81) %
husbands was assessed what their females perceived. Media 52 64.1
To assess the knowledge, the following 8 methods were Health personnel 17 20.9
Social circle 12 14.8
separately asked: pills, injectables, Intra-uterine
Contraceptive Devices (IUCDs), condoms, tubal
ligation, vasectomy, Norplant and withdrawal method. Table III: Practices of contraception.
Contraceptive methods in users n (53) %
The practice defines the usage of contraceptive
Barrier method (condom) 18 33.9
methods by either partner. Descriptive analysis was Tubal ligation 12 22.6
conducted to describe the results in percentages. Injectables 10 18.8
Intrauterine devices 07 13.2
RESULTS Oral pills 06 11.3
Reasons for using contraceptives USERS = 53 %
The socio-demographic characteristics are shown in Completed their families 20 37.7
Table I. The mean age was 29.7 + 7.2 years. Ninety Spacing of birth 16 30.0
Improvement of health 05 09.4
(90%) women were completely illiterate, and only 10%
Economical problems 12 22.6
had primary education. Reasons for not using contraceptives Non-users = 47 %
Table II shows the spectrum of knowledge in the 81 Lack of knowledge 19 40.4
Partner opposition 28 59.5
(81%) women who had heard about family planning
methods.
Table IV: Attitude towards contraception.
Out of 81 women, who had knowledge and awareness Attitude for contraception Total =100 Users = 53 Non-users = 47
of family planning methods, about 52 (64.1%) of women n (%) n (%) n (%)
got information from mass media. The importance and Females
Approval 76 (76) 45 (84.9) 31 (65.9)
use of contraception had been explained by a health
Disapproval 24 (24) 8 (15.1) 16 (34.1)
personnel to 17 (20.9%) of respondents and 12 (14.8%) Males
heard it from their social circle. Approval 41 (41) 31 (58.4) 10 (21.2)
Disapproval 59 (59) 22 (41.5) 37 (78.7)
Of 100 interviewed women, 53 (53%) were practicing
different contraceptive methods as shown in Table III.
DISCUSSION
Table I: Sociodemographic characteristics of the interviewed rural
women. Family planning is defined by WHO as, “a way of
Characteristics n = 100 Percentage thinking and living that is adopted voluntarily, upon the
Age in years basis of knowledge, attitudes and responsible decisions
< 20 8 8%
21 – 30 53 53%
by individuals and couples, in order to promote the
31 – 40 31 31% health and welfare of family groups and thus contribute
41 – 45 8 8% effectively to the social development of a country”.
Parity
<3 15 15% The increasing growth of population has become an
3–5 25 25% urgent global problem. Between 1951 and 2004,
>5 60 60% Pakistan’s population grew from 34 million to 167 million,
Educational status a 400% increase in approximately two generations.9
Illiterate 90 90%
Primary 10 10%
Although its total fertility rate (4.8) has begun to decline,2
Pakistan still has the highest rate in South Asia and

Journal of the College of Physicians and Surgeons Pakistan 2008, Vol. 18 (9): 542-545 543
Rozina Mustafa, Uzma Afreen and Haleema A. Hashmi

continues to experience rapid population growth. The Women not practicing contraception were 47% and was
widespread adoption of family planning, in a society, is lower as compared to other studies of Pakistan that
an integral component of modern development and is showed a non-users proportions of 72.3% and 91.5%
essential for the integration of women into social and respectively.16,17 Two Indian studies showed 55% and
economic life. In spite of efforts exerted by the 44.6% of non-users, which are close to the results of this
Government of Pakistan, the family planning program is study.11,23 Partner’s opposition and lack of knowledge
not yet as successful as in some neighbouring were the reasons as found in other studies.19,24
countries. According to Pakistan Reproductive Health and Family
Planning Survey 2000-2001 and Eastern Turkey,
The present study aimed to assess the knowledge,
husband’s disapproval was the main factor for not using
attitude and practice of family planning methods to
any family planning method among married women.6,25
enhance the contraceptive practice in the rural
community in future. Results showed that the Approval of family planning was shown by 41% of
knowledge for contraception was 81% as compared to males, as perceived by their wives in contrast to other
97.4% and 99% in studies conducted at Lahore.6,10 studies of Sindh and Punjab, where 78% and 74% of
However, similar awareness rate of 82.2% was found in husbands approved the use of contraceptive methods at
an Indian study.11 Women illiteracy is one of the factor the time of survey.12,20 In the present study, 59% of
respondent’s husband disapproved family planning,
similar to 54% of results in a study conducted by Etuk et
that affects the knowledge regarding contraception.

al.19 A similar pattern was also found in Eastern Turkey,

Pakistan has low literacy rate, even lower in rural areas.
This is also reflected in the present study where illiteracy
level was 90% in contrast to 78% in India and 62% in where husband’s disapproval was the main factor for not
another study of same province.11,12 Literacy level using any family planning method among married
among the women emphasizes the need for education women.25 However, husband support for family planning
as a key component to combat overpopulation and will was significantly higher in a Jordanian study.18 Attitude
encourage the use of contraceptives. of husband was found to be an important predictor for
contraception use. In rural areas, husband being the
Another factor responsible for knowledge of family
dominant member plays the pivotal role in approving the
planning methods are the exposure of messages
family size and contraceptive practices. Education is,
through media. Electronic media play an important role
in a society where literacy level is low. Fikree et al. stated
therefore, considered to improve the ability of women to
resist subjugation and to acquire greater power in
that women were more likely to use contraceptives decision-making. Family Planning services thus need to
when messages of family planning were delivered provide a range of quality methods for family planning
through media.13 In the present study, media (64.1%) that can allow women to either limit or space births, and
followed by health personnel (20.9%) and social circle to focus services to the individual needs of women with
(14.8%) have contributed to impart knowledge for differing sociodemographic characteristics.
contraception. In India, where social circle (70%) and
This study had several limitations. The sample size was
media (39%) were the main sources.11 Similarly, study
small. Secondly, the women came alone so male
from rural Nepal also reported an exposure to electronic
partners were not directly involved in the study. A low
media messages as the main factor for use of family
response may be found to question the use of methods
planning methods among women.14 An Ethiopian study
and husband’s attitude. Although every possible effort
showed that 80.3% of health personnel contributed in
was made to obtain the correct information, the
providing information regarding contraception, which is possibility of misreporting can not be ruled out keeping
opposite to the results.15 in mind the low level of female literacy also. Further
Only 53% of the interviewed women were practicing studies should be done with proper involvement of
family planning methods, whereas other studies in couples to obtain more accurate knowledge on the
different provinces of Pakistan showed lower subject in rural population.
contraceptive prevalence rates of 27%, 8.5% and 27.9%
respectively.12,16,17 The positive aspect is that the
presently reported contraceptive prevalence rate is high CONCLUSION
with regard to knowledge, as opposed to Jordan and The study reveals good knowledge and favourable
Nigeria where it was 31.7% and 8.7% with awareness attitude of rural women towards contraception.
rate of 91% and 85% respectively.18,19 Regarding the Contraceptive knowledge and practice was influenced
usage of family planning methods, an important by media exposure and partner opposition. Women
dimension is the type of contraception used. Condom education and counseling of couples can play an
was the most common chosen method used by 33.9% important role to adopt family planning methods.
of couples as shown in other studies as well.20,21,22 Oral Electronic media, health personnel and government’s
pills were used by 11.3% of women in comparison with organizations can play a positive role to provide
32% and 10% in other areas of Pakistan.12,20 knowledge and overcome the knowledge/practice gap.

544 Journal of the College of Physicians and Surgeons Pakistan 2008, Vol. 18 (9): 542-545
Contraceptive knowledge, attitude and practice among rural women

REFERENCES 7: 379-99.
15. Senbeto E. A study on knowledge, attitude, practice and quality
of care in family planning at Dessie Zuria District. J Ethiop Med Pract
1. World Bank. World development report 2004: making services
work for poor people. Washington: World Bank; 2003.
2001; 3:70-6.
2. Sathar ZA, Casterline JB. The onset of fertility transition in
Pakistan. Popul Develop Rev 1998; 24:773-96.
16. Naeem Z, Bux H, Shaukat F, Memon HM. Family planning:
knowledge, attitude and practice among married couples in
3. Population Planning Council of Pakistan. Pakistan fertility Northern Pakistan. Med Channel 2006; 12: 51-4.
survey: first report. Islamabad: The Council; 1976.
17. Ali S, Rozi S, Mahmood MA. Prevalence and factors associated
4. National Institute of Population Studies, IRD/Macro International with practice of modern contraceptive methods among currently
Inc. Pakistan demographic and health survey 1990-1991. married women in District Naushahro Feroze. J Pak Med Assoc
Columbia: IRD/Macro International; 1992. 2004; 54:461-4.
5. National Institute of Population Studies. Pakistan fertility and
family planning survey 1996-1997. Islamabad: The Institute; 1998.
18. EL-Qaderi SS, AL-Omari N. Knowledge, attitudes, and practices
of family planning among currently married women in Jordan
6. Hakim A, Sultan M, Ahmed F. Pakistan reproductive health and Badia. Int Q Community Health Educ 2000-2001; 20:171-91.
family planning survey 2001. Islamabad: The Institute 2001. p.60-2. 19. Etuk SJ, Ekanem AD. Knowledge, attitude and practice of family
planning amongst women with unplanned pregnancy in Calabar
– Nigeria. Niger J Physiol Sci 2003; 18(1-2):65-71.
7. UNFPA worldwide. Population, health and socioeconomic
indicators/policy developments. Overview Pakistan: key
statistics 2002. Available from: http://www.unfpa.org/profile/ 20. Khawaja NP, Tayyab R, Malik N. Awareness and practices of
pakistan.cfm
contraception among Pakistani women attending a tertiary care
8. Population growth and its implications. Islamabad: hospital. J Obstet Gynaecol 2004; 24:564-7.
National Institute of Population Studies; 2004.
21. Oyedeji OA, Cassimjee R. A gendered study of young adult
9. Ministry of Finance. Economic Survey of Pakistan 2003-04, contraceptive use at one university in Kwa Zulu-Natal. Curationis
2005. [cited 2004 Dec]. Availble from: http://www.finance.gov.pk/ 2006; 29 (3):7-14.
survey/home.htm
22. Essien EJ, Ogungbade GO, Kamiru HN, Ekong E, Ward D,
10. Humayun S. Knowledge and practices of family planning in
grandmultiparas. J Coll Physicians Surg Pak 2002; 12: 522-5.
Holmes L Jr. Emerging sociodemographic and lifestyle
predictors of intention to use condom in human
immunodeficiency virus intervention among uniformed services
personnel. Mil Med 2006; 171:1027-34.
11. Srivastava R, Srivastava DK, Jina R, Srivastava K, Sharma N,
Sana S. Contraceptive knowledge, attitude and practice
(KAP Survey). J Obstet Gynecol India 2005; 55: 546-50. 23. Prachi R, Das GS, Ankur B, Shipra J, Binita K. A study of
12. Ali S, White FMM. Family planning practices among currently knowledge, attitude and practice of family planning among the
married women in Khairpur District, Sindh, Pakistan. women of reproductive age group in Sikkim. J Obstet Gynecol India
J Coll Physicians Surg Pak 2005; 15: 422-5. 2008; 58: 63-7.
13. Fikree FF, Khan A, Kadir MM, Sajan F, Rahbar MH. What 24. Fantahun M. Comparative study of the characteristics of family
influences contraceptive use among young women in urban planning services users and non-users in north-west Ethiopia.
squatter settlements of Karachi, Pakistan? Int Fam Plann Perspect Afr J Reprod Health 2006; 10(1):62-70.
2001; 27:130-6.
25. Sahin HA, Sahin HG. Reasons for not using family planning
14. Boulay M, Storey JD, Sood S. Indirect exposure to a family methods in Eastern Turkey. Eur J Contracept Reprod Health Care
planning mass media campaign in Nepal. J Health Commun 2002; 2003; 8:11-6.

● ● ● ● ● ✯
● ● ● ● ●

Journal of the College of Physicians and Surgeons Pakistan 2008, Vol. 18 (9): 542-545 545