Knowledge and practice of contraceptive methods towards women

Introduction: Reproductive health has been a great concern for every woman. It is a crucial part of general health and a central feature of human development. Reproductive ill-health has been an apprehension to many stakeholders as maternal mortality and morbidity are very high in developing countries, especially in Bangladesh compared to developed world. In the past few years, the issues of Reproductive Health/Rights (RH/RR) have been increasingly perceived as social problems; they have emerged as a matter of increasing concern throughout the developed and developing countries. Bangladesh has achieved remarkable progress in important aspects of health and family welfare since Independence. However, the overall health status, particularly the status of reproductive health, still remains unsatisfactory. The insufficient health services available to women and children are evident from high infant and maternal mortality rates.The common health problems faced by both rural and urban women of Bangladesh are lower abdominal pain accompanied by heavy bleeding, white discharge and irregularity of the menstrual cycle . The major concern, though, is that they do not discuss these since they do not consider these normal illnesses. Although urban educated women sometimes visit doctors, but women in rural areas are taken to some traditional healers, like Kabiraj/Hakim, who prescribes Tabij and herbal medicines, Pir (saints), Fakir (religious persons) or Huzurs (mullah), who prescribes Panipora (sanctified water) . Family planning helps women to protect from unwanted pregnancies, thereby saving them from high risk pregnancies or unsafe abortions.Health knowledge is considered as one of the key factors that enable women to be aware of their rights and health status in order to seek appropriate health services. It is very important to study the overall situation and to know the differences between rural and urban Bangladeshi women in order to focus on reproductive health issues. The results could be used as an important guide to assist policymakers and administrators in evaluating and designing the programs and strategies for improving reproductive health services with a special consideration for rural women.Modern facilities, such as TV, radio, newspaper, etc., have played a vital role to ensure the reproductive health of the respondents. Possession of modern facilities is a very important issue for a society, and a society with enough modern facilities is more developed, while people enjoy their reproductive health. Consequently, mass media such as radio and television can create awareness about issues affecting the daily life, family planning programs, poverty alleviation programs, gender issues, human rights issues, etc.The focus of this study, therefore, was to find out the level of knowledge regarding reproductive health among rural and urban women of Bangladesh.

Materials and methods: A cross sectional study was conducted among 200 reproductive age group women (15-49 years), whereas 100 respondents were randomly selected from urban community of Dhaka and rest of 100 were selected from rural community of Sirajgonj. This area was selected purposively to get adequate sample. The study subjects were included women who sought reproductive health services in the health facilities like antenatal care, self-immunization during pregnancy, child immunization, choice of family planning methods and safe abortions, and who were willing to participate and to provide required information. Physical and mental retarded people and very sick were excluded from the study. The study consisted of both data gathered by structured and semi structured questionnaires and in depth interviews with Bangladeshi women. The field work was conducted from April to July 2013 in four clinics/hospitals providing reproductive health care for women from the two districts: Dhaka and Sirajgonj. Out of the four hospitals, two were selected from urban areas in Dhaka City Corporation (Marie Stopes Clinic and Dhaka Medical College Hospital, Dhaka), and other two hospitals were selected from rural community of Sirajgonj (Kamarkhando and Belkuchi Upazilla Health Complex, Sirajgonj), which was about eighty kilometers away from Dhaka. The socioeconomic scenario of rural areas of Bangladesh were almost same all over the country with lack of roads, transportations, sanitary facilities, electric supply, women education, and women empowerment, while they have less access to mass media, newspapers, health service facilities and so forth. The clinics/hospitals were selected purposively, and from one clinic/hospital, fifty respondents were interviewed. The respondents were selected consecutively who meet the inclusion and exclusion criteria. Data were collected by interviewer-administered questionnaires. The socio-economic classification in this study was made according to 2006 Gross National Income (GNI) per capita using the calculation of World Bank (WB) (6) [The groups were: low-income $75.41 or less (BDT ≤ 5360), lower middle-income $75.5 - $299.58 (BDT 5361-21270), upper middle-income $299.68 - $926.25 (BDT 21271-65761) and high-income $926.33 or more (BDT ≥ 65762)]. It is noteworthy that scores 0 and 1 were allocated to each of the questions of reproductive knowledge. Three categories were defined on the basis of the score obtained by each participant: poor (<50% of the total score), moderate (50%-70% of the total score), and good (>70% of the total score). After collection, data were checked thoroughly for consistency and completeness, and all analysis was done by appropriate statistical methods using Statistical Package for Social Sciences (SPSS; SPSS Inc., Chicago, IL, USA) software for Windows version 16.0. Univariate and bivariate analysis were done as appropriate to show results.

Results:  The study results revealed that among the 200 respondents, mean (± SD) age of them was 26±5 years. Among the respondents, 50% belonged to urban and another 50% were from rural areas. Most of them (61%) had primary education; this was followed by those who (9%) had higher secondary level of education. Preponderance of housewives (66%) was observed, whereas rest of them was involved with NGO job, garments work and student. Majority of the respondents belonged to lower middle income family (77%), and only 1% was from high income family

Discussion: Reproductive health knowledge is important for women as woman's health and well-being, contraception, as well as those of her family may depend on her being able to delay the birth of her first child or space the birth of her children (7, 8).Women started antenatal care at a relatively early stage of their pregnancy (before 4-month pregnancy), and 78.2% of women made six or more antenatal care visits during their entire pregnancy, but present study found that most of the respondents made three or four antenatal care visits during their entire pregnancy which was not similar to Palestine study (9). On the other hand, our study found that poor knowledge on reproductive health was more among rural women (84%). Urban women were more knowledgeable about reproductive health than rural women. Thus overall knowledge on reproductive health among urban women was better than rural women.  Knowledge on safe abortion is found less good in comparison about safe motherhood. Besides 90% urban women had good knowledge on birth spacing and family size, but 64% rural women had knowledge on birth spacing and family size.

Conclusion: A wide gap was found between urban and rural respondents in Bangladesh regarding their reproductive behaviors and exercising their reproductive rights