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Peer-reviewed

Research Article

Family Planning Knowledge, Attitude and Practice among Married Couples in Jimma Zone, Ethiopia

Contributed equally to this work with: Tizta Tilahun, Gily Coene, Stanley Luchters, Wondwosen Kassahun, Els Leye, Marleen Temmerman, Olivier Degomme

* E-mail: [email protected]

Affiliation College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia

Affiliation Rhea, Research Center on Gender and Diversity, Brussels University, Bussels, Belgium

Affiliations International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Ghent University, Ghent, Belgium, Burnet Institute, Monash University, Victoria, Australia

Affiliation International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Ghent University, Ghent, Belgium

  • Tizta Tilahun, 
  • Gily Coene, 
  • Stanley Luchters, 
  • Wondwosen Kassahun, 
  • Els Leye, 
  • Marleen Temmerman, 
  • Olivier Degomme

PLOS

  • Published: April 23, 2013
  • https://doi.org/10.1371/journal.pone.0061335
  • Reader Comments

Table 1

Understanding why people do not use family planning is critical to address unmet needs and to increase contraceptive use. According to the Ethiopian Demographic and Health Survey 2011, most women and men had knowledge on some family planning methods but only about 29% of married women were using contraceptives. 20% women had an unmet need for family planning. We examined knowledge, attitudes and contraceptive practice as well as factors related to contraceptive use in Jimma zone, Ethiopia.

Data were collected from March to May 2010 among 854 married couples using a multi-stage sampling design. Quantitative data based on semi-structured questionnaires was triangulated with qualitative data collected during focus group discussions. We compared proportions and performed logistic regression analysis.

The concept of family planning was well known in the studied population. Sex-stratified analysis showed pills and injectables were commonly known by both sexes, while long-term contraceptive methods were better known by women, and traditional methods as well as emergency contraception by men. Formal education was the most important factor associated with better knowledge about contraceptive methods (aOR = 2.07, p<0.001), in particular among women (aOR women  = 2.77 vs. aOR men  = 1.49; p<0.001). In general only 4 out of 811 men ever used contraception, while 64% and 43% females ever used and were currently using contraception respectively.

The high knowledge on contraceptives did not match with the high contraceptive practice in the study area. The study demonstrates that mere physical access (proximity to clinics for family planning) and awareness of contraceptives are not sufficient to ensure that contraceptive needs are met. Thus, projects aiming at increasing contraceptive use should contemplate and establish better counseling about contraceptive side effects and method switch. Furthermore in all family planning activities both wives' and husbands' participation should be considered.

Citation: Tilahun T, Coene G, Luchters S, Kassahun W, Leye E, Temmerman M, et al. (2013) Family Planning Knowledge, Attitude and Practice among Married Couples in Jimma Zone, Ethiopia. PLoS ONE 8(4): e61335. https://doi.org/10.1371/journal.pone.0061335

Editor: Hamid Reza Baradaran, Tehran University of Medical Sciences, Iran (Islamic Republic of)

Received: November 28, 2012; Accepted: March 7, 2013; Published: April 23, 2013

Copyright: © 2013 Tilahun et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: We also thank Belgium Institutional University Cooperation programme with Jimma University, Ethiopia for funding the research. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

The lifetime risk of maternal mortality of women in sub-Saharan Africa is 1 in 39 live births, which is the highest when compared to other world regions. The World Health Organization (WHO) estimated in 2012 that 287,000 maternal deaths occurred in 2010; sub-Sahara Africa (56%) and Southern Asia (29%) accounted for the global burden of maternal deaths [1] . One of the targets of the Ethiopian Ministry of Health, with respect to improving maternal and child health, is to increase the contraceptive prevalence rate (CPR) from 32% to 66% by 2015. In order to achieve this target, the Ministry has given priority to the provision of family planning services in the community [2] .

With 87 million people, Ethiopia is the second most populous nation in sub-Saharan Africa, with a continuing fast growing population of 2.7% per year [3] . The maternal mortality ratio (MMR) is 676 per 100 000 women aged 15 to 49, with an estimated 32% of all maternal deaths attributed to unsafe abortions [4] . A study conducted in Northwest Ethiopia in 2005 indicated that prevalence rates of spontaneous and induced abortions were estimated at 14.3% and 4.8% of all pregnancies respectively [5] .

Despite the recent increase in contraceptive use, sub-Saharan Africa is still characterized by high levels of fertility and a considerable unmet need for contraception [6] . The total fertility rate in Ethiopia is 4.8 births per woman and is considerably higher in the rural then the urban areas. Observed fertility rates among women are 33% higher than the wanted fertility rates. In absolute numbers, this means 0.6 additional children in urban areas and 1.5 in rural areas. This is particularly the case in Oromiya region where the total fertility rate is as high as 5.6 children per woman and 30% of the currently married women have an unmet need for contraception which represents the highest figure of all regions in Ethiopia [4] . In the five years preceding the Ethiopia demographic Health Survey (EDHS) in 2011 it is estimated that, three births of every four (72%) were wanted at that time, 20% were wanted but not at the time of pregnancy, and 9% were unwanted [4] . A better use of family planning could reduce many of these mistimed and unplanned pregnancies, while at the same time it could reduce the number of unsafe abortions as well as the mortality related with child birth [7] .

On the other hand, couples have a right to choose and decide upon the number of children they desire. This means that both partners have the right to be involved in fertility matters and as such husbands play a crucial role in fertility decision-making in most of the world [8] . Clearly, male-involvement in family planning has positively affected contraceptive use and has caused an overall decline in fertility in the developing world. Men's fertility preferences and attitudes towards family planning seem to influence their wives attitudes towards the use of modern contraceptives [9] . Therefore, programs that attempt to promote reproductive health through increasing the use of modern contraceptives need to target men specifically at all levels of the program. Hence, men should be actively involved at the ‘knowledge’ level (the concept of family planning), the ‘supportive’ level (being supportive for other to use contraception) and the ‘acceptor’ level (as contraceptive user). Their decision-making role should be taken into account in order to promote contraceptive use [10] . Similar research indicates that women's feelings about their partners and about involving men in contraceptive and reproductive decisions must always be taken into account [9] . Previous studies indicated that acceptance of children as God's will, attitudes towards preventing pregnancy, knowledge on different method choice and the understanding of the side effects of different methods are among the factors related to contraceptive use [11] , [12] . Moreover, studies on perception of spousal approval and opposition from husbands are positively associated with low contraceptive use [13] .

Given the above factors associated with contraceptive use, the primary objective of this study was to examine the contraceptive prevalence rate among married couples and to study the factors that influence contraceptive use. A secondary objective was to determine knowledge on contraceptives (method-specific; including barrier, hormonal, permanent and dual protection methods), and attitudes towards family planning. Finally, fertility preference among married couples was assessed to see the variation between men and women.

Materials and Methods

This analysis forms part of a baseline assessment for a broader study aimed at determining the effect of a family planning education intervention on the knowledge, attitude and practice of married couples regarding family planning as well as male involvement (will be disseminated separately). The study is conducted in Jimma Zone, one of 14 administrative zones of Oromyia region located in the Southwest of Ethiopia. Its capital, Jimma, is found 352 km to the south west of the national capital, Addis Ababa. Jimma Zone is an area of 15,568.58 Km 2 with 17 woredas (districts) and one special zone. According to the 2007 national census, the total population is 2,486,155, of whom 1,250,527 are men and 1,235,628 women [14] .The rural part counts for 89.5% of the total population size of the zone in which the dominant ethnic group is the Oromo. The study area is thus a typical rural setting.

The study population consisted of couples (women and their husbands) who were legally married, lived for more than six months in the study area and of which the wives were 15–49 years (the reproductive age group) but not pregnant at the time of the survey. Husbands within a polygamous marriage (who had more than one wife) were excluded from the analysis to decrease redundancy of information. A multi-stage sampling design was used with districts ( woredas ) as primary sampling units (PSU), and sub-districts ( kebeles ) as secondary sampling units (SSU). The study covered three woredas i.e. Seka, Manna and Gomma, in which six kebeles were randomly selected: Goyoo qechema, Koffie, Gobiemuleta, Haro, Gembie and Bulbulo. In each selected kebele , a complete census of married couples was prepared to use as a sampling frame. Married couples were then randomly sampled from each locality, based on a computer generated random number list until the required size was achieved.

The sample size was computed using Minitab version 14 statistical software in the context of the broader intervention study. Adding 10 percent for non- responses resulted in a final sample size of 427 couples per group or 854 for the entire sample to be drawn equally from each sub-districts.

This study consisted of two parts, including quantitative and qualitative data collection techniques. Data for the quantitative study were collected using semi-structured questionnaires. Separate questionnaires were administered for male and female respondents but with similar contents including socio-demographic characteristics (age, sex, ethnicity, occupational status, income, age at first marriage), reproductive characteristics (number of children, sex preference of couples), as well as question modules on knowledge, attitudes and practice regarding contraceptive use (types of contraception, use of contraception, user perspective, attitudes of a husband and wife towards contraceptives, husband-wife communication on family planning, ever use of contraceptives, current use of contraceptives and reasons for not using contraceptives).

The questionnaire includes not only types of contraceptive as knowledge part but also how to use, where to get family planning service, side effects of contraception and other points too. The survey instruments were developed from a validated questionnaire and were considered valid and reliable through the favorable comments of experts for obtaining information on couples about knowledge, attitude and contraceptive practice [8] , [9] , [15] , [16] . Pilot testing of 5% of the sample revealed that respondents were able to understand and answer questions. Six male and six female data collectors participated in the study and were supervised by three field coordinators. Data collectors were recruited from the local community. We paired the data collectors by sex: men to husbands and female to wives because of the sensitivity of the issue. Interview conducted in private location, each couple at a time but separately keeping the interviewee privacy. Interview conducted if both spouses willing to participate.

For the qualitative data, focus group discussions, using a semi-structured topic guide were employed. Focus group discussions were done to probe to understand the phenomena of couples contraceptive practices within the society. The semi-structured topic guide covered the socio-cultural factors related with contraception and husband's responsibility towards contraception. Four groups consisted of married women and four groups consisted of married men, making a total of eight focus group discussions. Each focus group discussion consisted of 8 to 12 participants. Participants were selected purposively based on who can give the most and best information about coupes contraceptive practice. The participants were married individuals. The group discussions were moderated by university graduates who speak the local language. Similar to the quantitative part, focus group discussions were done female to female and male to male moderators. For the qualitative data participants were first given number a code and their characteristics registered (age and sex). At each time the participant wanted to give an idea first he/she has to call the number. Notes on points of discussion was taken in addition to tape recording.

Data analysis

The data set for this analysis contained data from 854 husbands and their wives. For the quantitative data analysis, STATA® 10 for Windows® was employed. Analyses were done at the level of the individual independently from the spouses. Simple descriptive analysis was done to explore levels of awareness, knowledge (on different types of contraceptive and knowledge level), attitude and practice among respondents. Bivariate analysis was used to investigate the effect of demographic and socioeconomic variables on fertility preferences and contraceptive practice. Finally, multivariate logistic regression was used to identify predictors of these outcome variables. Statistical significance was considered at p-values less than 0.05.

Qualitative data from focus group discussions were recorded as sound files using tape and subsequently transcribed to text files. Transcripts of the recorded discussions were coded and analysed using thematic areas manually and participants' identifying details were removed. No computer software was used for qualitative data analysis.To check the internal consistency and reliability, data from the quantitative part was used to triangulate with the qualitative results

Ethical considerations

Ethical clearance of the study was obtained from the research and ethics committee of the College of Public Health and Medical Sciences, Jimma University, Southwest Ethiopia and Ghent University's Ethical Committee in Belgium. Written consent was obtained from each man and woman participating in the study after the data collectors explained about the purpose of the study using a predefined information sheet. Written informed consent was taken from spouses on the behalf of those wives for who were in the age less than 18 years. No compensation was rendered as direct incentive to the participants. The ethics committees approved this consent procedure.

Socio Demographic Characteristics

A total of 811 out of 854 sampled couples responded, equating to a response rate of 94.9%. All women were between 15 and 49 years (as per inclusion criteria), with a median age of 30 (IQR = [25;35]). Median age among males was 36 (IQR = [30;45]) (see Table 1 ).

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Almost two-thirds of the women (n = 532, 66%) had not received education, but 204 (25%) had completed primary education; among men, 184 (23%) had not received education while 437 (54%) had completed primary schooling.

Oromos were the principal ethnic group accounting for 1,417 (87%) individuals; 97 (6%) others were Dawro, 28 (2%) Keffa, 25 (2%) Yem, 23 (1%) Amhara, and 32 (2%) from other ethnic groups. The majority of the respondents, 743 (92%) women and 737 (91%) men, were Muslim; second most prevalent religion was Orthodox Christianity with 55 (7%) women and 53 (7%) men. Education levels were different across these two most prevalent religions: 66 out of 1480 (4%) Muslims had completed secondary education in comparison to 16 of the 108 (15%) Orthodox Christians (χ 2 (1, N = 1588) = 19.98, p<0.001). Similarly, Amhara, Yem and Tigrie, of which approximately 25% are Orthodox Christians, showed higher levels of literacy than the other population groups (χ 2 (1, N = 1622) = 10.46, p = 0.001).

Agriculture was the main occupation of the interviewees with 732 (90%) men and 668 (82%) women; 71 (9%) of the women reported being housewives. The median income of couples was 225 Birr (IQR = [150;370]), which is approximately 9.3 Euro, per month, according to information obtained from the wives. Daily laborers had a median income of 150 Birr per month, government employees 700 Birr.

The median household size was 5 (IQR = [4;6]), with a median of 3 children, and 422 (52%) households comprised of five to seven members. Literate respondents had smaller household sizes than the illiterate (χ 2 (11, N = 811) = 28.23, p = 0.003), as well as less children (χ 2 (10, N = 811) = 30.48, p<0.001). The median age at first marriage for men aged 20–59 was 21 (IQR = [20;25]) and 16 (IQR = [15;18) for women aged 20–49. There were 40 (5%) males and 518 (65%) females who married before age 18. The median duration of the couple's marriage was 11 years (IQR = [6;19]). Among the husbands, 209 (26%) stated having been married already prior to the current union.

One-third of the female respondents (n = 296, 36%) reported having ever lost at least one child; 209 (70.6%) reported ever having lost at least one boy, 181 (61%) at least one girl.

More than 98% of the study participants had access to health facilities providing family planning services in their surrounding (at least health post i.e Primary level health care in Ethiopia (can serve 3,000–5,000 individuals).

Fertility preferences

A majority wanted to have more children: 494 (72%) among the men, 439 (64%) among the women. The median desired number of children before using family planning among both women and men was 4 (IQR = [3;5]). Of the 233 women who had reached or exceeded their desired number of children, 90 (39%) still reported a need for more children; on the other hand, among the men having reached or exceeded that number, 131 out of 252 (52%) wanted more children.

Overall, 413 (44%) respondents of the 933 desiring more children expressed a sex preference for the next child. Among men, 172 (35%) wanted a boy versus 47 (10%) a girl; among women these numbers were respectively 120 (27%) and 74 (17%). Sex preference varied depending on the number of boys and girls already living in the family (see Table 2 ). Respondents with no boys had a distinct desire to have a boy as the next child. This preference disappeared among women once they had at least one boy and among men once they had two boys. A similar preference for a girl is noticed for respondents that did not have girls yet, although the extent of this preference is more limited. On average, both men and women had a preference for a boy if they had at least one girl.

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Knowledge about Family Planning

The concept of family planning was well known to respondents: 760 (94%) women and 795 (98%) men responded ever having heard of it. The median number of methods of contraception that were known among men was 5 (IQR = [2;8]) which was the same among women 5 (IQR = [3;6]); the mean was 5.4 for both sexes (95%CI men  = [5.2;5.7] and 95%CI women  = [5.2;5.5]). As such, there was no statistical difference between the sexes (p = 0.6585). Different levels of knowledge were found across the kebeles : only 3 of the 265 (1%) respondents in Haro knew more than 5 methods of contraception compared to values ranging from 34% to 60% for the other kebeles . No relationship was found between knowledge level and age, religion or ethnic affiliation. Formal education on the other hand, was associated to a higher knowledgeability about contraceptive methods (aOR = 2.07, p<0.001), in particular among women (aOR women  = 2.77 vs. aOR men  = 1.49; p<0.01).

Method-specific knowledge levels varied from 12% for vaginal contraceptives (diaphragm, foam, jelly) to 94% for injectable contraceptives. Differences were found between men and women ( Table 3 ). Only short-term hormonal methods like the contraceptive pill and injectable contraceptives were consistently well known by both sexes. Least known were the permanent methods, traditional methods and emergency contraception. Major differences between women and men were noted for the long-term hormonal methods (χ 2 (1, N = 1622) = 217.96, p<0.001) and emergency contraception (χ 2 (1, N = 1622) = 140.12, p<0.001). A total of 1064 (68%) respondents knew how to use contraceptives, with more women (77%) being knowledgeable about it than men (58%) (χ 2 (1, N = 1622) = 67.42, p<0.001). Similarly, knowledge on contraceptive use decreased with increasing age even when correcting for sex (aOR per additional year of life  = 0.98; p = 0.003).

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Attitudes towards Family Planning

Of the 1622 respondents, 91% (1479) were in favour of family planning; logistic regression showed that factors associated with a more positive attitude towards family planning were: being a man (aOR = 1.67; p = 0.021), young age (aOR per additional year of life  = 0.97; p<0.001) and being literate (aOR = 1.89; p = 0.002). Male respondents were asked specifically whether they would support their wives to use family planning. Of the 811 male respondents, 751 (93%) answered positively and 22 (3%) negatively. This finding was corroborated during the focus group discussions with married men.

“Couples should limit their number of kids for the seek of child's health and for the household economy.” (Male, 18 years)

Contraceptive Practice

We did not consider husbands' number of children at first contraceptive use as only 4 (0.2%) males reported having ever used contraceptives. Condom use was thus very low. Among women, 517 (64%) ever used a method of contraception; 350 (43%) were using contraception at the time of the survey. This difference in contraceptive use between men and women was corroborated by the focus group discussions as these showed that both married women and men mostly considered contraceptive use as a woman's task:

“What will I do in a family planning clinic, contraception is women's business, I will just give my wife the necessary financial support she needs” (Male, 45 years)

Two hundred sixty five (51%) wives had one to two children at their first contraceptive use. The median number of children a woman had when starting contraception was 2 (IQR = [2-2]) which corresponds to 2 children less than what they considered the ideal number of children.

The most commonly used methods when starting contraception were injectable (316 out of 515, 39%) and oral (174 out of 515, 21%) hormonal contraceptives. The prevalence of these hormonal contraception methods was much related to the age of the woman. Injectable methods were most common among younger women (aOR per additional year of life  = 0.94; p<0.001), while oral contraceptives were more frequently used by older women (aOR per additional year of life  = 1.06; p<0.001). Of the 350 women who were using contraceptives at the time of the survey, 283(81%) were using injectables and 33 (9%) oral contraceptives.

Multivariate analysis showed that higher current use of contraception among women was associated with being literate (aOR = 1.58; p = 0.005), the number of children (aOR per additional child  = 1.11; p = 0.027) and being highly supportive of family planning (aOR = 4.01; p<0.001). Household income didn't show an association with current contraceptive use (p = 0.593). The same factors were also determinants for contraceptives having ever used.

Reasons given by males for not using contraception included being recently married 235 (29%) and lack of knowledge of the different types of methods 235 (30%). The reason for not using contraception given by both male and females was the desire to have children (419 (51.8%) men and 203 (44%) women). Among women fear of side effects was reported by 106 (23%) as the reason for not using contraception (see Figure 1 ). Likewise, the qualitative findings also indicate fear of contraceptives' side effects as a barrier to use contraception by women:

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“Women don't use contraceptive because they don't want to get pain by the side effect of pills and injectable” (Female, 25 years)

Additional results from focus group discussions indicate that males are at least partly responsible for women not using contraceptives:

“sometimes husbands oppose wife use of contraceptive because they think she does not want to give birth and instead she has an intention to go for another man” (Female, 33 years)

Among women, 183 (36%) of current contraceptive users reported ever having switched between methods, with 175 (96%) of them giving lack of comfort as one of the reason and 99 (54%) fear of side effects. Likewise the qualitative part supports this result.

“I used one type of contraceptive and it result in burning sensation and excessive menses so I changed to other contraception method” (Female, 20 years)

Despite the recent increase in contraceptive use, Ethiopia, Africa's second most populous country, is known to have a low contraceptive prevalence and high total fertility. The objective of the study presented in this paper was to investigate differences among males and females regarding knowledge on contraceptive methods, fertility preference and contraceptive practice among married men and women in Jimma zone, Ethiopia.

The results of this analysis demonstrate that more than 98% of the couples had access to health facilities that deliver family planning. The median household size of five in the study area (Jimma zone) was comparable to the national household size (4.6 persons), especially that of rural areas (4.9 persons) [4] . Literacy was found to be linked to smaller household sizes, which is in line with previous findings [4] , [16] .

Age at first marriage was lower in our study population compared to national figures. For females aged 20–49 years, the median age at first marriage was 16 years, i.e. one year younger than the national median (17.1 years) and a previously published study from Butajira (16.9 years). Among men aged 20–59, a one year difference with the national median was observed (22 years vs 23.1 years). This also corroborates general trends that men marry at older ages than women [4] , [17] .

Similar to EDHS (2011), this study revealed that more men than women have a desire for more children [4] . This suggests that the low use of contraception among men is partly a well-reasoned decision, and not only a consequence of limited knowledge. In this study the mean ideal number of children was 4.2 and 4.6 among men and women respectively. This is in contrast to the national figures that show a difference in the mean ideal number of children between men and women, i.e. 5.9 and 4.9 respectively [4] .

A study conducted in Tigray, Ethiopia reported that the mean desired number of children among men differed significantly as compared to that of women ( Δ = 1.2; 95%CI: [0.87;1.53]) [10] . The inconsistency with our study could partly be explained by a different formulation of questions since we inquired about the ideal number of children before starting contraception, instead of the actual desired number of children. Furthermore, we identified discrepant results with respect to the desired number of children and the desire to have additional children. Considerable numbers of couples that had reached the desired number of children still desired more. Research should be done exploring the causes of this finding.

With regards to sex preference, respondents with no boys had a distinct desire to have a boy as a next child; the same pattern of wanting a girl was observed among couples that didn't have a girl yet. However, the extent of the preference for a girl was more limited. In addition, the preference was stronger among men, a finding that is supported by the results of a study conducted in Ethiopia in which most men (48%) reported that they would like more sons than daughters [18] . This might be due to cultural norms around son preference or, as suggested by others, the interest for more sons could be based on subsistence reasons, such as economic security and maintaining their status within the traditional family structure [19] . From the focus group discussants, a woman (25 years) described that she wants to have five male and three female; because male stay with me but after marriage female follows her husband. Moreover this study reveals nearly 36% women reported ever had child death of which almost 70% boy child. This could be the other possible expatiation for boy sex preference.

The high level of knowledge on at least one form of contraception among the participants of this study (96%) is in line with previously reported national figures (98.4%). In our study, we observed no significant difference between men and women with regards to knowledge: the average number of methods known in both sexes was 5.4 contraceptive types. In contrast, at national level, the average number of contraceptive methods known by men is higher than women (6.3 and 5.4 respectively) [4] . As such, men included in our study were less knowledgeable about different methods compared to the average Ethiopian man.

In the present study, short-term hormonal contraceptive methods like the pill and injectable contraceptives were consistently well-known by both sexes. Permanent methods, traditional methods and emergency contraception on the other hand were the least known contraceptive methods. Compared to the results from the Ethiopian Demographic Health Survey (2011) women and men are more familiar with long term and standard days methods, but in the case of barrier methods (diaphragm/jelly and male condom) and emergency contraception the reverse is true for the study population [4] . In addition our study identified major differences in knowledge of emergency contraception between the two sexes. The limited knowledge of women on emergency contraception suggests that this type of contraception is not part of the standard information package that is given to women in our study area.

Overall, our respondents had a positive attitude towards family planning (91%), but less than 1% of the males and 64% of the women reported having ever used any type of contraception. Other studies have already described similar findings, i.e high awareness but low utilization of contraceptives, making this situation a serious challenge in developing countries [8] , [20] . The EDHS 2011 reported a current contraceptive prevalence rate of 29% for married women, which is lower than our finding (43%) [4] . A reason for this could be that the majority of our respondents have access to health facilities in the study site. With respect to the method-specific contraception, injectables (39%) and oral hormonal contraceptives (21%) were the main methods used. Compared to EDHS 2011, a noteworthy finding in our study is the low use of implants, suggesting that health facilities in our study area are not able to deliver this service.

Among background characteristics of women, literacy, age, the number of children, and being highly supportive of family planning were found to be important indicators of current contraceptive; this is confirmed by different studies [4] , [20] – [22] . Fear of side effects was identified as the reason for not using contraceptives among married women, a finding that has been described already in other studies conducted in Ethiopia and Bangladesh [23] , [24] .

Our qualitative study findings also assured that fear of side effects is one of the most important reasons of not using contraceptives by women. In addition, this study reported that men's reasons for not using contraception were being recently married and the desire for more children. The latter is also one of the most important reasons of not using contraception among women. In general, in the study area the findings indicate a prevailing belief that contraception is only a women's business.

This study has limitations resulting from the design that was used, in the sense that cross-sectional studies do not allow to establish cause-effect relationships. In addition, an important limitation is the exclusion of couples with pregnant women from this baseline study as per the intervention protocol. This clearly affects the contraceptive prevalence rate and could potentially affect some other indicators too. The group of pregnant couples however represented only 7% of all couples from our sampling frame. This leads us to believe that the effect on the figures is probably relatively small. A final potential limitation is reporting bias. It also suffered from social desirability as it is a community based study. In that context, we decided to exclude one kebele (Gobbie Mulata) from the analyses of the ideal number of children as there was evidence of an erroneous comprehension of the question.

Conclusion and Recommendations

The analysis of this study provides information on married men and women on knowledge, attitudes and contraceptive practice in Jimma zone, Ethiopia. Our results demonstrate that good knowledge among males and females was observed, yet differences on knowledge of specific contraception methods exist. The study reveals that mere physical access (proximity to clinics for family planning) and awareness of contraceptives are not sufficient to ensure that contraceptive needs are met. We also noticed the existence of a sex preference for boys both among men and women. Condom use by men is above the national average but it is low compared to most Sub-Saharan African countries. It is evident from this study that high knowledge on contraception is not matched with the high contraceptive use. Among reasons for not using contraception, want to have a child and side effects of contraceptive were given by men and women respectively. Therefore, family planning interventions should pay particular attention to both wives' and husbands' participation in family planning, while at the same time further educating married women and men on specific methods of contraception and their possible side effects. Moreover, a considerable amount of child death mainly boy child linking with boy sex preference reflects family planning interventions to see the ways beyond only for contraceptive purpose.

Acknowledgments

We would like to forward our gratitude to Jimma University, college of Public Health and Medical Sciences and Ghent University. Our special thanks goes to the supervisors, data collectors and respondents, the zonal health department and health center staffs. All authors read and approved the final manuscript.

Author Contributions

Critically reviewed drafts of the report: TT GC SL WK EL MT OD. Conceived and designed the experiments: TT MT GC SL. Performed the experiments: TT. Analyzed the data: TT OD. Wrote the paper: TT OD.

  • 1. World Health Organization U, UNFPA, World Bank (2012) Trends in maternal mortality: 1990 to 2010 World Health Organization Geneva.
  • 2. Health EMo (2010) Ethiopian Health Sector Development Programme IV,2010/11-2014/15. Addis Ababa.
  • 3. Bureau PR (2011) World Population Data Sheet 2011.
  • 4. Central Statistical Agency (Ethiopia) OM (2011) Ethiopia Demographic and Health Survey. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro: 2011.
  • View Article
  • Google Scholar
  • 6. UNFPA (2005) Reproductive health fact sheet.
  • 9. Levy J (2008) Reaching the Goals of Cairo; Male Involvement in Family Planning. Caroline 2011 papers on International Health Chapel Hill. pp. 8–12.
  • 13. Kulczycki A (2008) Husband-Wife Agreement, Power Relations and Contraceptive Use in Turkey International Family Planning Perspectives 34.
  • 14. Central Statistical Agency (Ethiopia) OM (2007) Ethiopian Census 2007 Tables: Amhara Region, Tables 2.1, 2.4, 2.8, 3.1, and 5.1.: Central Statistical Agency (Ethiopia), ORC Macro.
  • 15. National Institute of Population Research and Training (2008) 2006 Bangladish urabn health survey (UHS) Dhaka.
  • 16. Central Statistical Agency (Ethiopia) OM (2006) Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA.
  • 17. Wubegzier M, Worku A (2011) Determinants fertility in rural Ethiopia : the case of Butajira Demographic Survelliance System (DSS). BMC public health 11.
  • 18. Short S, Kiros G (2002) Husbands, wives, sons, and daughters: Fertility preferences and the demand for contraception in Ethiopia. Population Research and Policy Review. 2002 ed. pp. 377–402.
  • Open access
  • Published: 02 May 2022

Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: a cross-sectional study

  • Md. Abul Kalam Azad 1 ,
  • Muhammad Zakaria   ORCID: orcid.org/0000-0002-6492-7900 1 ,
  • Tania Nachrin 2 ,
  • Madhab Chandra Das 1 ,
  • Feng Cheng 3 , 4 &
  • Junfang Xu 5  

Reproductive Health volume  19 , Article number:  105 ( 2022 ) Cite this article

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Considering the high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, and the unmet need for contraceptives prevalent among the Rohingya refugees, this study aims to explore the knowledge, attitude, and practice (KAP) of family planning (FP) and associated factors among Rohingya women living in refugee camps in Bangladesh.

Four hundred Rohingya women were interviewed. Data were collected using a structured and pretested questionnaire, which included study participants’ socio-demographic characteristics, access to FP services, knowledge, attitude, and practice of FP. Linear regression analysis was performed to identify the influencing factors of FP-KAP.

Of the 400 Rohingya refugee women, 60% were unaware that there was no physical harm brought by using a permanent method of birth control. Half of the women lack proper knowledge regarding whether a girl was eligible for marriage before the age of 18. More than two-thirds of the women thought family planning methods should not be used without the husband’s permission. Moreover, 40% were ashamed and afraid to discuss family planning matters with their husbands. Of the study participants, 58% had the opinion that a couple should continue bearing children until a son is born. Linear regression analyses found that study participants’ who have a profession, have less children, whose primary source of FP knowledge was through a physician/nurse, have had FP interventions in the camp, and talk with a health care provider on FP were found to have better FP-KAP.

The study showed that Rohingya refugee women are a marginalized population in terms of family planning and their comprehensive FP-KAP capability was low. Contraceptives among the Rohingyas were unpopular, mainly due to a lack of educational qualifications and family planning awareness. In addition, family planning initiatives among Rohingya refugees were limited by a conservative culture and religious beliefs. Therefore, strengthening FP interventions and increasing the accessibility to essential health services and education are indispensable to improving improve maternal health among Rohingya refugees.

Plain Language Summary

Considering the high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, and the unmet need for contraceptives prevalent among the Rohingya refugees, this study aims to explore the knowledge, attitude and practice (KAP) of family planning (FP) and associated factors among Rohingya women living in the refugee camps in Cox’s Bazar, Bangladesh. Four hundred Rohingya women participated in the study. We found that Rohingya refugee women were a marginalized population in family planning and their comprehensive FP-KAP status was low. Contraceptive uptake among the Rohingya women was low due to a lack of education and family planning awareness. In addition, family planning initiatives among Rohingya refugees were limited by various traditional cultural and religious beliefs. Therefore, strengthening FP interventions and increasing accessibility to essential health services and education are indispensable to improving maternal health among refugees.

Peer Review reports

Over the last few decades, the number of stateless people who are usually identified as refugees has grown exponentially around the world. The most recent focus is Myanmar’s Rohingya diaspora, who have left their homes since 25 August, 2017 [ 1 , 2 , 3 ]. This influx of more than 700,000 Rohingya into Bangladesh has produced the fastest-growing refugee crisis in the world [ 1 , 2 , 4 , 5 , 6 ]. Bangladesh’s total number of unregistered refugees was about 220,000 before the recent influx [ 2 , 7 ]. However, as of 31 March 2021, approximately 884,000 Rohingya refugees who are Forcibly Displaced Myanmar Nationals (FDMN) resided in 34 camps in Ukhiya and Teknaf Upazilas (sub-districts) of Cox’s Bazar District of Bangladesh [ 8 ], which have grown to become the largest and most densely populated camps in the world [ 9 ]. Among the refugees, women and children make up the majority [ 6 , 10 , 11 , 12 ], which accounts for more than 50% [ 1 , 13 , 14 , 15 ].

The Government of Bangladesh and development partners, including the United Nations High Commissioner for Refugees (UNHCR), United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Health Organization (WHO) are working together to provide humanitarian relief to the Rohingya people [ 4 ]. The Rohingya, while living in Myanmar, were deprived of nationality and fundamental rights to education and health care. These restrictions have substantially affected their knowledge of contraception and family planning [ 16 , 17 ], indicating that adverse health outcomes related to maternal health may be extremely high [ 18 ]. Evidence also suggests that worldwide, forcibly displaced women and adolescent girls are experiencing intensified sexual and reproductive health (SRH) concerns, including a high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, and an unmet need for contraceptives [ 1 , 14 , 19 ]. For example, 179 mothers die from preventable causes related to pregnancy and childbirth for every 100,000 live births in the camps [ 20 ]—nearly two-and-a-half times the global maternal mortality goal [ 21 ]. Save the Children estimated that 76,000 babies were born in the Rohingya camps in Bangladesh over the past 3 years [ 22 ]. Correspondingly, more than 60 babies were born every day in the refugee camps of Bangladesh [ 23 ].

In order to address reproductive and maternal health issues of Rohingya women and adolescent girls, humanitarian actors collaborated with the Ministry of Health and Family Welfare (MOHFW), providing basic health services including family planning (FP) programs, intrauterine devices (IUD) and implants, as well as other short-acting modern methods of FP (condoms, oral contraceptive pills, injectables) [ 11 , 14 , 15 , 16 , 24 , 25 ] to increase community awareness [ 1 , 14 ]. Moreover, at the community level, health workers are implementing different interventions including FP counseling sessions and community meetings with the intended population at reproductive age [ 1 , 4 , 16 ].

According to estimations from recent studies, the Rohingya women’s contraceptive prevalence rate (CPR) was higher than reported in 2018. A survey conducted by the International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) [ 3 ] exposed that contraceptive use amongst Rohingya refugees rose by 2.1 percentage points from 33.7% in 2018 to 35.8% in 2019. Increasing awareness of modern contraceptive methods among Rohingya refugees may contribute to these positive outcomes. However, challenges also exist due to cultural values, traditional misconceptions, and dogmatic beliefs towards contraceptive use among the majority of the Rohingya people [ 1 , 4 , 6 , 14 , 16 , 17 , 26 , 27 , 28 , 29 ]. The hindrances may include: the religion of Islam not permitting use of contraceptives [ 1 , 4 , 16 ], husbands’ disapproval of contraceptive use [ 1 , 14 , 16 , 29 ], actively trying to fall pregnant [ 28 , 29 ], the belief that lessening the number of children is a sin [ 1 , 4 , 29 ], the belief that a child is a gift of Allah (God) [ 1 , 4 , 16 , 29 ], considering children as economic assets [ 4 ], considering that a large family would enable better chances of survival in refugee camps [ 4 , 30 ], the belief that use of contraceptives can lead to adverse health outcomes including infertility [ 16 ], and the negative role of husbands and mothers-in-law as the two most influential decision-makers regarding contraceptive use [ 4 ]. In addition, despite various organizations’ providing FP services, Rohingya women and girls do not have adequate and equal access to these services [ 16 ]. This highlights the significance of increasing contraceptive use among Rohingya women and improving their maternal health. Under this background, we aim to analyze FP in terms of knowledge, attitude and practice and other associated factors among the Rohingya women living in Cox’s Bazar refugee camps, Bangladesh. It is hoped that this study could provide evidence for developing interventions in a coordinated and effective manner to improve maternal and child health for Rohingya women in refugee camps.

Study design and setting

This study used a quantitative research approach designed with a camp-based cross-sectional survey. It was conducted at Rohingya refugee Camp-4 (located at Lombashiya, Modhurchora in Kutupalong Mega area) in Cox’s Bazar, a district under the Chittagong Division, geographically the largest of the eight administrative divisions of Bangladesh. This camp was selected as the study area as it is one of the largest camps in Bangladesh.

Participants

The population of the study consists of married Rohingya refugee women of reproductive age (18–49 years old) who had been living with their husbands at the camp and had delivered at least one child at least 1 year before the survey was conducted. A total of 32,389 Rohingya people were living in Camp-4 during the study period while the number of women was 16,968, and 7683 of them were women of reproductive age [ 31 ]. The sample size was determined using the single population proportion formula considering the following assumption: p = 50% (it was hypothesized that the percentage frequency of having better FP-KAP in the population was 50% for the estimated proportion of Rohingya women), significance level 5% (α = 0.05), Z \(\frac{\mathrm{\alpha }}{2}\) = 1.96, margin of error 5% (d = 0.05) and assuming 10% non-response rate. The required sample size was 422, which is the number of individuals the research team invited to participate in the survey. Finally, a total of 400 refugee women (94.79% response rate) participated in the study. Study participants were selected following convenient sampling, due to the humanitarian context and inadequate funds. A previous study [ 32 ] also faced this methodological challenge due to the structure of the camps. In the camp, the houses were built sporadically on hills with no identification numbers. Furthermore, there was no complete list of Rohingya persons living in a particular block or camp. Registered Rohingya people were also hesitant to provide their registration numbers, making it difficult to establish a sampling frame. Due to time constraints, we were unable to compile a list of households to construct a sampling frame for simple random sampling. As a result, the study team chose convenience sampling.

Reliability and validity of the instrument

In order to ensure the relevance of the questionnaire items with the study aims, the content validity of the questionnaire was reviewed by three experts working in the same field. Each expert reviewed the questionnaire separately and various changes were made to the questionnaire based on their recommendations. The internal consistency was also measured to check the reliability. Cronbach’s Alpha (α) values of the scale of FP knowledge, attitude, and practice suggested very good internal consistency reliability for the scales of this study. The alpha (α) value was good among knowledge-related 10 items (α = 0.84) and attitude-related 10 items (α = 0.89) and strong among practice-related 10 items (α = 0.95).

Study variables

There were three dependent (outcome) variables in our study which included knowledge of FP, attitude towards FP, and practice regarding FP. The independent (potential predictor) variables included the respondents’ region of residence in Myanmar, age, educational status, occupation, amount of land owned in Myanmar, and number of children. We included the respondents’ educational and residential status and amount of land owned in Myanmar under the socio-demographic variables as we hypothesized that these past statuses might be an important indicator of health behavior in the current settings. Media use–related variables were respondents’ listening to radio and internet use, while access to NGO programs and health facilities included respondents’ prime source of FP knowledge, person(s) who make respondents’ SRH-related decisions, availability of NGO FP activities in camp, respondents’ participation in FP programs, visiting of clinic/health facilities, talking with a health care provider. To gain further context, we also collected information on different FP methods heard and used by the Rohingya women and the main reasons for not using a contraceptive.

Data collection

Data collection began on October 14 and was completed on December 26, 2019. Data were collected using a pretested, structured, and facilitator-administered questionnaire. The questions used in the questionnaire were prepared based on a review of related literature. The questionnaire was developed in Bengali (Bangla) language applicable to the context in Bangladesh. It was not translated into the Rakhine/Arakanese language of the Rohingya people since it lacks an appropriate written form the majority of the Rohingya people in the camp are illiterate. The survey was guided and conducted by ten female data collectors who had graduate degrees and work experience in the Rohingya camp and were quite familiar with the study setting. The data collectors were fluent in the Rakhine/Arakanese language, which helped them explain the questions to the interviewees and understand the responses. Ten Rohingya women, who were known as the community leaders in the survey area, assisted with the data collection process in the camp. They helped build rapport and gain the trust of the participants. Thus, it is believed that the participants felt comfortable speaking openly and sharing issues in their personal life. The Rohingya women trust these community leaders, so therefore they agreed to cooperate and participate in the study [ 32 ]. All the recruited Rohingya women had experience working with their community. The interviews took place at different blocks of the camp. Before the survey, a pilot study was conducted among 40 Rohingya women to test the understandability of the survey and to ensure its comprehensiveness and consistency in providing the information needed for the study.

Despite the limitations encountered due to camp’s layout, privacy and confidentiality were ensured during the data collection process. The community leaders obtained permission from the respondents beforehand to ensure that the respondent would be free and comfortable to talk. Before starting the questionnaire interview, the purpose and confidentiality of the study were clearly explained to the respondents. Interviews were conducted in a quiet room of the house of the respective refugee women situated in a particular block of the camp where only the data collector and a community member were present. An appropriate level of privacy was able to be met whilst collecting the data as the male members of families generally undertake daily work during the day and children go to the learning centers, child-friendly spaces or madrasas (religious center to study Quran). Moreover, prior to the interview the respondents asked the other family members to go to another room so that they could talk with data collectors comfortably.

Measurements

KAP items having 10 items for each section were designed with a five-point Likert scale. For the FP knowledge section, the score of each positive statement ranged from 1 to 5 for ‘definitely false’, ‘probably false’, ‘do not know’, ‘probably true’ and ‘definitely true’. For the FP attitude section, the score of each positive statement ranged from 1 to 5 for ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’, and ‘strongly agree’. For the FP practice section, the score of each positive statement ranged from 1 to 5 for ‘never’, ‘rarely’, ‘sometimes’, ‘often’, and ‘always’. The score was reversed for negative statements. The total score of FP knowledge, attitude, and practice was the sum of the score for questions under each section respectively. In order to understand the level of FP knowledge and attitude, we categorized both variables’ scores into two levels using the mean as the cut-off value. However, five scales of each section were recoded into three categories because of the low frequency at the endpoint of the scale for the percentage distribution of respondents’ responses regarding KAP.

Statistical analysis

Descriptive statistics were used to analyze the respondents’ FP-related KAP. A linear regression analysis was performed to estimate the proportion of variance in FP knowledge, attitude, and practice based on socio-demographic, NGO, and health facility-related factors. The linear regression models included the variables with p < 0.05 in bivariate analyses (independent-samples t-test and Pearson correlations). Multicollinearity was also checked. The ANOVA values for overall FP knowledge ( F  = 64.84, p  < 0.001), attitude ( F  = 59.56, p  < 0.001), and practice ( F  = 170.36, p  < 0.001) report that the regression model was a good predictor of the main outcome variables. R 2 of each step was changed considerably, and F changes were also statistically significant ( p  < 0.001). These analyses were performed with a 95% confidence interval using SPSS 24.0. Variables with p  < 0.05 were considered statistically significant.

Socio-demographic characteristics of Rohingya women

Table 1 showed that of the 400 respondents, 210 (52.4%) were residents of Buthidong sub-district of Myanmar before taking shelter in Bangladesh. The mean age was 25.53 (± 6.34) years. More than half (51.8%) of them had no formal education and more than three-quarters (78%) were housewives. On average, the study participants had 4 (3.98 ± 2.60) children. Regarding media use, 233 (58.2%) listened to the radio and 103 (25.8%) used the internet. In addition, 181 (45.3%) women reported that NGO workers and health workers were their primary sources of FP-related information.

Different contraceptive methods heard and used by Rohingya women

Table 2 presents data on contraceptive methods that respondents had heard of and currently used. Of the Rohingya refugee women, 195 (48.7%) heard about condoms, however, only 8 (2%) of their husbands used them during the survey period. Moreover, 336 (84%) were aware of the oral contraceptive pill (OCP) and 115 (28.8%) were using it. In addition, only 42 (10.5%) heard about intra-uterine devise (IUD), 9 (2.3%) were aware of Norplant as the contraceptive, but no one had used either of the two methods. Furthermore, 356 (89%) knew about the injection Depot-Provera and 162 (40.5%) had used it during the survey.

Reasons for not using FP by Rohingya women

Figure  1 displays the distribution of the causes for not adopting contraceptive measures among the respondents (N = 102) who were given the option. More than half of them, 53 (51.96%), acknowledged that they were not using the family planning method due to their husbands’ disapproval; 47 (46.08%) were not using it as they wanted to get pregnant; 45 (44.12%) felt that using the FP method was considered as a sin; 29 (28.43%) thought that irregular sexual intercourse was a way to avoid pregnancy; 23 (22.55%) did not know how to use a contraceptive; 22 (22.57%) were worried about probable side effects; 17 (16.67%) did not want to use any; 11 (10.78%) believed that more children might bring financial solvency to the family; and 7 (6.86%) respondents felt that contraceptive usage would reduce the pleasure of sexual intercourse.

figure 1

Reasons for not using contraceptive by the Rohingya women (N = 102)

Rohingya women’s access to FP programs and services

Figure  2 illustrates the respondents’ access to health services and participation in different FP-related programs. Of the 400 Rohingya refugee women, 62.8% reported participating in a FP related meeting or event organized by GoB/INGOs/NGOs, and almost three-quarters (74.5%) received FP-related interventions of government and NGOs in the camp. Furthermore, about 80% of the study participants visited a health center or facility due to FP and 68.3% talked with a health worker about FP and SRH issues.

figure 2

Rohingya women’s access to FP and RH services

Rohingya women’s FP knowledge

Percentages with mean scores of Rohingya women’s FP knowledge-related items are reported in Table 3 . Of the 400 respondents, 180 (45%) were aware of the appropriate age of marriage for a girl. Only 162 (40.5%) respondents answered correctly whether taking a permanent contraceptive has any physical harm. Regarding whether contraceptive use had a negative effect on the husband-wife sexual relationship, 45.5% of respondents had appropriate information. Moreover, 63% responded correctly regarding the consequences of unintended or unplanned pregnancy. In addition, two-thirds of the participants (66.5%) answered correctly that there might be a risk for a woman if she has two births in a period of less than 2 years. In addition, Fig.  3 depicts that 223 (56%) respondents had good knowledge regarding FP.

figure 3

Distribution of the study participants’ level of FP knowledge (left) and FP attitude (right)

Rohingya women’s FP attitude

Table 4 shows that only 159 (39.8%) Rohingya refugee women agreed that having two children is enough for a couple. Besides, 120 (30%) thought that using FP might be regarded as a sin, and slightly less than one-quarter (23.3%) believed that discussing FP with their husband might lead to sin. In addition, 272 (68%) believed that one should not use FP if her husband objects. Of the study participants, 57% supported the idea to bear children until a male child is born and 40% of them would express more happiness if a male child is born. More than half (52%) of the respondents agreed that having more sons would ensure a more secure life for parents in elderly age. Moreover, 216 (54%) respondents had a positive attitude towards FP.

Rohingya women’s FP practice

Table 5 showed that 43% of the respondents reported that they always felt ashamed to discuss FP and 45% were usually afraid of FP discussions with their husbands. In addition, about one-quarter felt shy while discussing FP with relatives and neighbors. About three-quarters of Rohingya refugee women regularly used contraceptives during the survey period. Furthermore, 60% of the respondents regularly obtained new contraceptives after running out of them and 62 percent continued FP use despite experiencing side effects.

Influencing factors associated with FP-related KAP

Table 6 demonstrates that Racidong in Myanmar as the region of residence (β = 0.09, t = 2.84, p = 0.005), having a profession (β = 0.10, t = 2.73, p = 0.007), having less children (β = − 0.28, t = − 7.28, p < 0.001), having a physician/nurse as the source of FP knowledge (β = 0.21, t = 6.45, p < 0.001), having GoB/INGOs/NGOs’ FP interventions at the camp (β = 0.15, t = 3.62, p < 0.001), visiting a clinic/health facility (β = 0.22, t = 4.96, p < 0.001), and talking with any health care provider (β = 0.24, t = 5.54, p < 0.001) were significantly associated with Rohingya women’s better knowledge on FP and accounted for 66% of the variation in this regard.

Furthermore, the amount of land owned in Myanmar (β = 0.11, t = 3.02, p = 0.003), having less children (β = − 0.17, t = − 3.83, p < 0.001), having a physician/nurse as the source of FP knowledge (β = 0.18, t = 4.88, p < 0.001), having GoB/INGOs/NGOs’ FP interventions in the camp (β = 0.25, t = 5.45, p < 0.001), participating in a FP awareness program (β = 0.12, t = 2.82, p = 0.005), visiting a clinic/health facility (β = 0.19, t = 3.78, p < 0.001), and talking with a health care provider (β = 0.16, t = 3.19, p = 0.002) contributed significantly to the regression model (F = 59.56, df = 4/387, p < 0.001) and appeared as predictors of Rohingya women’s more positive attitude towards FP and accounted for 56% of the variation of the outcome variable.

It was also found that, having resided in Racidong in Myanmar before coming Bangladesh (β = 0.07, t = 2.57, p = 0.010), having a profession (β = 0.07, t = 2.27, p = 0.024), having less children (β = − 0.15, t = − 4.54, p < 0.001), having a physician/nurse as the source of FP knowledge (β = 0.13, t = 4.66, p < 0.001), having GoB/INGOs/NGOs’ FP interventions in the camp (β = 0.10, t = 2.81, p = 0.005), participating in a FP awareness program (β = 0.07, t = 2.33, p = 0.020), visiting a clinic/health facility (β = 0.46, t = 12.31, p < 0.001), and talking with a health care provider (β = 0.24, t = 6.32, p < 0.001) were the most important factors influencing a more regular, healthy practice of FP and accounted for 74% variations of good FP practice.

This study assessed Rohingya refugee women’s knowledge, attitude, and practice towards FP along with the overall status of FP in the camps. Our study found that despite their familiarity with the traditional contraceptives like injections, oral pills, and condoms, most of the respondents are not familiar with the modern contraceptive methods such as IUDs and Norplant. According to local media reports, Rohingya refugee women would take oral pills given by health stations in the camps and would throw them away upon returning home. Later, when they were given the 3-month injection method they accepted it. Although contraceptive methods have been introduced among the Rohingyas who took shelter in Bangladesh since the 1990s, recently FP programs increased after a massive influx of Rohingyas into the country. Indeed, NGOs do not disseminate the information of different modern birth control methods among the Rohingya women as the women are reluctant to use them [ 3 , 26 , 33 ].

Consistent with other studies [ 34 , 35 ], our findings also demonstrate that there is a dearth of accurate and sufficient knowledge of FP among the Rohingya women living in the refugee camp of Cox’s Bazar even though they have some ideas about FP and using contraceptives. Even for women who report to be willing to pursue FP approaches, discontinuation of use may be motivated by a general feeling of uncertainty and fear, particularly about health-related side effects [ 4 ]. Away from the positive knowledge gained through education, this group is influenced by traditional religious practices [ 33 ].

Half of the respondents lack proper knowledge of whether a girl is eligible for marriage before the age of 18. Among the Rohingyas, girls are likely to get married at an early age. A previous study [ 4 ] noted a clear preference for girls but not boys for child marriage. There are some reasons behind early marriage of girls in Rohingya society [ 1 , 4 ]. Firstly, this tendency is more prevalent in families with more daughters because parents feel that more than one daughter still living with the parents is a burden, and older parents want all their daughters to get married while they are still alive. Secondly, members of the community also say different types of harsh words and pass nasty comments if more than one young girl lives with them in the household, so, the parents want to marry their daughters off as early as possible. Thirdly, as is prescribed by their faith, girls are deemed suitable for marriage until they hit puberty. Parents believe that keeping young girls unmarried at home for a long time is a sin. Fourthly, the financial insolvency of Rohingya people leads them to send their daughters to the in-laws’ house so that they do not have to bear their living costs for too long a period. Ainul et al. [ 4 ] identified some important shifts in the trends and behaviors of marriage among Rohingya refugee after displacement. Unlike Myanmar, the camps in Cox’s bazar have no age limit for marriage, consequently, Rohingya girls and boys tie the knot as early as the age of 14/15 years.

The present study found that Rohingya women have also shown interest in having more children. Our finding is supported by a previous study [ 16 ]. Lagging in their education, they still see childbirth as an achievement [ 36 ]. Half of the respondents think having more children will give them more protection and support in their old age. They believe that children are a God-given blessing and they will receive more rewards or benefits if they have more children. Getting food cards is also a factor in the camps since it is allocated to every child [ 37 ]. By showing that card, parents get various benefits, including food, medicine, and clothes. They know that they will get more food cards or help if they have more children [ 38 ]. Many of the children's food items they get with food cards are sold outside the camp for money. During the study it was also found that at the Teknaf bus station food items provided by the UN were being sold openly among the host community and tourists. Therefore, a cohort of the Rohingya families does not use contraceptives, although they are urged by the government to practice this FP method. Another reason the Rohingya population has more children may be explained by their thinking of the Myanmar government’s oppression to eradicate them ethnically [ 39 , 40 ]. Having more children can also be an attempt to sustain their existence as a nation. This assumption is also supported by media reports [ 40 ].

Our study findings also showed that more than two-thirds of the Rohingya women thought family planning methods should not be used without their husband’s approval. In Rohingya society, patriarchy prevails and women mostly obey their husbands as they regard it as a sin to do anything without their husband’s permission. Therefore, the use of CPR is low due to the husbands’ reluctance for their wives to use contraceptives [ 41 ]. In addition, according to our findings, 58% of respondents said that they should continue childbearing until the birth of a son. Besides, 40% of the respondents said that having a son is a matter of pride, whereas one-fifth attributed having daughters as a burden. Parents also have a similar feeling as arranging the marriage of a daughter costs a lot, and daughters would not be responsible for taking care of their parents in the future. On the contrary, a male child is highly desired by the Rohingya couples, as the think that boys can earn money and will be responsible for taking care of their parents later in life.

Our data also found that more than 40% were ashamed of and afraid of discussing FP with their husbands, considering it a sin. In Rohingya society, FP or birth control are perceived as a high-level taboo. Rohingya women are typically conservative due to their religious and social values. There is no positive viewpoint regarding FP or birth control in Rohingya society, and religiously it is considered an immoral behavior [ 29 ]. Those who have not used FP yet and are still reluctant to use it might be regarded as being extremely against FP. This type of people is called the hard-core resister group by Rogers [ 42 ]. A typical couple in this category would be very religious and the husband an older religious leader. A strategic communication program would need to be implemented in order to make them more open to FP methods. If nothing is done to deal with the KAP of this radical group, then it is likely that they will contribute to significant population growth in the refugee camps.

Comparing Rohingya women from the surveyed areas, the knowledge and behavior of the women from Rachidong area are better than those of the women from Maungdaw and Buthidong area as the transportation system in Rachidong is better and Rachidong people have more opportunities of commuting to the city for study and work.

According to the results, Rohingya women involved in various professions had a better KAP of FP. They usually work with various NGOs serving as the teacher for providing education and psychosocial support, community mobilizers for nutritional activities, cleaners, or day laborers. NGOs offer different training and awareness sessions for them, so their attitudes and behaviors towards FP are more positive. They are also interested in learning new things and have a better chance to communicate with the Bangladeshi staff more closely.

Women with fewer children were found to have better FP-KAP in our study. This cohort is more conscious and progressive than others as they engage and remain focused actively in various awareness programs. Consequently, they become the primary and early receivers of FP services. Family members, particularly husbands and mothers-in-law, play a key role in making decisions about a married girl’s childbearing and contraceptive options in Rohingya society [ 4 ]. Nevertheless, Rohingya women who can make their own decisions about their health have better FP-KAP. Generally, these women are more aware and self-reliant. They also have a better attitude and perspective since their husbands and families allow them to express their views independently.

We observed that the Rohingya women who received a consultation from doctors and nurses had better FP-KAP. In this case, the women’s interest in FP plays a significant role in listening carefully to the information provided by health care providers and applying it in real life. Health care providers have been able to talk to them, change their attitudes and make them regard FP in a more positive way. According to the Department of Family Planning, besides raising awareness of birth control attitudes among the Rohingya men and women, doctors and nurses working in clinics and health facilities also provide various suggestions and medicines for pregnancy, maternity, child health, and general health services. Such efforts are more significant than those of NGO health workers. Many Rohingya couples now do not want to have 10–12 children; instead, they want to limit the number of children to 4–5 [ 36 ]. Most of these programs and services have created a positive outlook on FP that makes women and girls more aware and engaged on the topic than before [ 33 ].

The Rohingya women who had visited a clinic and talked to a doctor were more likely to have better FP-KAP. Doctors and nurses play a supporting role in understanding FP. Visiting a clinic, they can observe the posters and communication materials and can be informed about different aspects of FP and maternal health issues.

The study has some limitations. Firstly, the data from the participants may have been influenced by social desirability, which could affect the validity of the outcome. Secondly, this analysis could provide a more precise understanding and a more in-depth insight if qualitative data were collected. Thirdly, the data was collected from only one camp due to inadequate research funds.

The study showed that the comprehensive FP-KAP capability of Rohingya refugee women was low. Contraceptives among the Rohingyas were unpopular, mainly due to a lack of general education and awareness of family planning. In addition, family planning initiatives among Rohingya refugees were limited by various traditional cultural and religious beliefs. Participation in the FP program, visiting a health facility, and talking with a health care provider were reported as the most significant predictors for a better FP-KAP. Therefore, designing appropriate campaigns and developing effective communication materials is important to improve this vulnerable community’s maternal health status. Accordingly, politicians, program managers, and implementers should educate and equip Rohingya women on essential FP, SRH, and maternal health-related topics through a sustainable and continuous training program. Moreover, the program should involve religious leaders in planning and implementations phases, and provide them with appropriate training so that they can play a supportive role as community leaders.

Availability of data and materials

All of the primary data has been included in the results. Additional materials with details may be obtained from the corresponding author if required.

Abbreviations

Analysis of variance

Family planning

Government of Bangladesh

International Centre for Diarrhoeal Disease Research, Bangladesh

International non-governmental organizations

Inter Sector Coordination Group

Intrauterine device

Knowledge, attitude and practice

Non-governmental organizations

Oral contraceptive pill

Standard deviation

Statistical Package for Social Sciences

Sexual and Reproductive Health

United Nations Children’s Fund

United Nations High Commissioner for Refugees

United Nations Population Fund

World Health Organization

Women’s Refugee Commission (WRC). A clear case for need and demand: accessing contraceptive services for Rohingya women and girls in Cox’s Bazar. 2019. https://www.womensrefugeecommission.org/wp-content/uploads/2020/04/Contraceptive-Service-Delivery-in-the-Refugee-Camps-of-Cox-s-Bazar-Bangladesh-05-2019.pdf .

Inter Sector Coordination Group (ISCG). Situation report Rohingya refugee crisis: 1 November 2018. 2018. https://reliefweb.int/sites/reliefweb.int/files/resources/iscg_situation_report_1_nov_2018.pdf .

Chowdhury MAK, Billah S, Karim F, Khan ANS, Islam S, Arifeen SE. Report on demographic profiling and needs assessment of maternal and child health (MCH) care for the Rohingya refugee population in Cox’s Bazar, Bangladesh. Dhaka: Maternal and Child Health Division, ICDDR,B; 2018. http://dspace.icddrb.org/jspui/bitstream/123456789/9067/2/Special%20Report%20153.pdf .

Ainul S, Ehsan I, Haque E, Amin S, Rob U, Melnikas AJ, Falcone J. Marriage and sexual and reproductive health of Rohingya adolescents and youth in Bangladesh: a qualitative study. Dhaka: Population Council; 2018. https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?article=1467&context=departments_sbsr-pgy .

International Organization for Migration (IOM). Needs and population monitoring (NPM) site assessment: round 11. 2018. https://www.humanitarianresponse.info/en/operations/bangladesh/assessment/needs-andpopulation-monitoring-npm-bangladesh-round-11-site .

Melnikas AJ, Ainul S, Ehsan I, Haque E, Amin S. Child marriage practices among the Rohingya in Bangladesh. Confl Health. 2020;14(1):1–12. https://doi.org/10.1186/s13031-020-00274-0 .

Article   Google Scholar  

Inter Sector Coordination Group (ISCG). Situation report: Cox's Bazar influx. Cox’s Bazar: ICSG; 2017. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/170920_iscg-sitrep_influx-august-2017-1_0.pdf

United Nations High Commissioner for Refugees (UNHCR). 2021 joint response plan for Rohingya humanitarian crisis. 2021. https://reporting.unhcr.org/sites/default/files/2021-12/2021%2520JRP.pdf

Malteser International. Inside the Kutupalong refugee camp, Cox’s Bazar. 2019. https://www.malteser-international.org/en/our-work/asia/bangladesh/life-in-a-refugee-camp.html .

International Organization for Migration (IOM). Rohingya refugee crisis response; External update 19–25 January 2018. 2018. https://reliefweb.int/report/bangladesh/iom-bangladeshrohingya-refugee-crisis-response-external-update-19-25-january-2018 .

Inter Sector Coordination Group (ISCG). Situation report: Rohingya crisis: 27 September 2018. 2018. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/iscg_situation_report_27_sept_2018.pdf .

United Nation Population Fund (UNFPA). Rohingya humanitarian response: monthly situation report. 2018. http://bangladesh.unfpa.org/sites/default/files/pubpdf/UNFPA_SitRep_External__16-March percent202018 percent20Final.pdf.

Government of Bangladesh (GoB), United Nations High Commissioner for refugees (UNHCR). March 2021: joint government of Bangladesh-UNHCR population factsheet. https://data2.unhcr.org/en/documents/details/86233 .

Health Sector Cox’s Bazar, Government of Bangladesh, SRH Working Group Cox’s Bazar. SRH Working Group’s strategy on family planning for the Rohingya humanitarian crisis 2021–2023. https://bangladesh.unfpa.org/sites/default/files/pub-pdf/clean_final_srh_wg_s_family_planning_strategy_2021.pdf .

United Nations Population Fund (UNFPA). UNFPA Rohingya humanitarian response monthly situation report. 2017. https://bangladesh.unfpa.org/sites/default/files/pub-pdf/UNFPA%20External%20SitRep%20November%202017_Final.pdf .

Khan MN, Islam MM, Rahman MM, Rahman MM. Access to female contraceptives by Rohingya refugees, Bangladesh. Bull World Health Organ. 2021;99(3):201.

Palma P. Family planning: too important, yet ignored: Rohingya mothers, children in danger for lack of services. Daily Star. 3 November 2017. https://www.thedailystar.net/frontpage/family-planning-too-important-yet-ignored-1485694 .

Varagur K. The Muslim overpopulation myth that just won’t die. Atlantic. 14 November 2017. https://www.theatlantic.com/international/archive/2017/11/muslim-overpopulation-myth/545318/ .

Austin J, Guy S, Lee-Jones L, McGinn T, Schlecht J. Reproductive health: a right for refugees and internally displaced persons. Reprod Health Matters. 2008;16(31):10–21. https://doi.org/10.1016/S0968-8080(08)31351-2 .

Article   PubMed   Google Scholar  

Save the Children. 3 in 4 Rohingya refugee babies are born in unsanitary bamboo shelters. 3 June 2019. https://www.savethechildren.org/us/about-us/media-and-news/2019-press-releases/rohingya-refugee-babies-born-unsanitary-shelters .

World Health Organization (WHO). SDG 3: ensure healthy lives and promote wellbeing for all at all ages. 2015. https://www.who.int/sdg/targets/en/ .

Daily Star. 76,000 Rohingya children born in last 3 years. 26 August 2020. https://www.thedailystar.net/frontpage/news/76000-rohingya-children-born-last-3-years-1950989 .

United Nations Children's Fund (UNICEF). More than 60 Rohingya babies born in Bangladesh refugee camps every day. 2018. https://www.unicef.org/press-releases/more-60-rohingya-babies-born-bangladesh-refugee-camps-every-day-unicef .

World Health Organization (WHO). Rohingya refugee crisis in Cox’s Bazar, Bangladesh: health sector bulletin. 2018. https://www.who.int/docs/default-source/searo/bangladesh/bangladesh---rohingya-crisis---pdf-reports/health-sector-bulletin/health-sector-bulletin-no-3---01-january---22-february-2018.pdf?sfvrsn=7f675357_4 .

United Nations Children's Fund (UNICEF). Humanitarian action for children: Bangladesh. 2022. https://www.unicef.org/media/112081/file/2022-HAC-Bangladesh.pdf .

Tanabe M, Myers A, Bhandari P, Cornier N, Doraiswamy S, Krause S. Family planning in refugee settings: findings and actions from a multi-country study. Confl Health. 2017;11(1):9. https://doi.org/10.1186/s13031-017-0112-2 .

Freeman J, Rashid M, Bangladesh expands family planning in Rohingya camps. Voice of America. 3 November 2017. https://www.voanews.com/a/bangladesh-family-planning-rohingya-camps/4098284.html .

Maslak M. UN contraception campaign 'undermines' Rohingya refugees. Catholic News Agency. 5 June 2018. https://www.catholicnewsagency.com/news/un-contraception-campaign-undermines-rohingya-refugees-47587 .

Islam MM, Hossain MA, Yunus MY. Why is the use of contraception so low among the Rohingya displaced population in Bangladesh? Lancet Reg Health-Western Pac. 2021. https://doi.org/10.1016/j.lanwpc.2021.100246 .

Rashid M. Dhaka, UN to coordinate contraception campaign in Rohingya camps. The Irrawady. 25 May 2018. https://www.irrawaddy.com/news/dhaka-un-coordinate-contraception-campaign-rohingya-camps.html .

United Nations High Commissioner for Refugees (UNHCR). UNHCR: Rohingya refugee response–Bangladesh, population factsheet, (as of 30 September 2019).

Ahmed R, Aktar B, Farnaz N, Ray P, Awal A, Hassan R, Shafique SB, Hasan MT, Quayyum Z, Jafarovna MB, Kobeissi LH. Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox’s Bazar, Bangladesh. Confl Health. 2020;14(1):1–8. https://doi.org/10.1186/s13031-020-00329-2 .

Hasan K. Rohingya crisis: population exploding as 91,000 babies are born in two years. Dhaka Tribune. 29 August 2019. https://www.dhakatribune.com/bangladesh/rohingya-crisis/2019/08/29 .

Karin S. Status of Rohingya in refugee camps of Bangladesh: a review study. Open Access Libr J. 2020;7(09):1. https://doi.org/10.4236/oalib.1106575 .

Inter Sector Coordination Group (ISCG). JRP for Rohingya humanitarian crisis: March–December 2018. 2018. https://reliefweb.int/report/bangladesh/jrp-rohingya-humanitarian-crisis-march-december-2018-0 .

DBC News. Excessive birth rate in Rohingya camps. 23 June 2019. https://dbcnews.tv/news/15d0efeaa736e0 .

Azad S. The child was born in a Rohingya camp in search of relief. Daily Jugantor. 23 May 2019. https://www.jugantor.com/todays-paper/city/180508 .

Bangladesh Journal. Rohingyas have more children at home to increase strength. 16 May 2019. https://www.bd-journal.com/bangladesh/72869 .

Uddin N. Ethnic cleansing of the Rohingya people: the Palgrave handbook of ethnicity. Singapore: Palgrave Macmillan; 2019. https://doi.org/10.1007/978-981-13-0242-8_116-1 .

Islam MM, Nuzhath T. Health risks of Rohingya refugee population in Bangladesh: a call for global attention. J Glob Health. 2018. https://doi.org/10.7189/jogh.08.020309 .

Article   PubMed   PubMed Central   Google Scholar  

Aziz A. Why are Rohingyas not interested in birth control? Daily Dhaka Tribune. 24 October 2017. https://www.dhakatribune.com/bangladesh/2017/10/24/rohingyas-not-interested-birth-control/ .

Rogers EM. Communication strategies for family planning. New York: Free Press; 1973.

Google Scholar  

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Acknowledgements

We thank all the participants for their support during data collection.

This work was partially funded by Zhejiang Soft Science Program (No.2021C35015), the Research and Publication Office of the University of Chittagong, Bangladesh (No. 3752/GOBE/PORI/PROKA/DOPTOR/CU/2019), China Medical Board (No. 202033) and Research Fund, Vanke School of Public Health, Tsinghua University (No. 2021ZZ004).

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Md. Abul Kalam Azad, Muhammad Zakaria & Madhab Chandra Das

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Tania Nachrin

Vanke School of Public Health, Tsinghua University, Beijing, 100084, China

Institute for Healthy China, Tsinghua University, Beijing, 100084, China

Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China

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AKA, MZ, TN, and JX were involved in the study design and conceptualization; AKA and TN supervised the data collection; MZ, MCD, and JX performed the data extraction and analysis; AKA and MZ drafted the manuscript; MCD, TN, JX, and FC reviewed and edited the manuscript; AKA was involved in project administration; FC supervised the study. AKA and MZ contributed equally to the study and shared first authorship. All authors read and approved the final manuscript.

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Correspondence to Feng Cheng or Junfang Xu .

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The study was reviewed and approved by the Research and Publication Office of the University of Chittagong. The study was conducted in accordance with the Declaration of Helsinki, and ethical approval for the study was provided by the Ethical Review Board of the University of Chittagong (No. CU SOC-21-0003). An informed consent form by via signature or thumb-stamp was obtained from each participant.

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Abul Kalam Azad, M., Zakaria, M., Nachrin, T. et al. Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: a cross-sectional study. Reprod Health 19 , 105 (2022). https://doi.org/10.1186/s12978-022-01410-0

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  • Family planning knowledge
  • Family planning attitude
  • Family planning practice
  • Contraceptive use
  • Rohingya displaced women
  • Refugee camps

Reproductive Health

ISSN: 1742-4755

literature review on knowledge attitude and practice of family planning

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  • Published: 13 August 2018

Knowledge, attitude and practice towards family planning among reproductive age women in a resource limited settings of Northwest Ethiopia

  • Ayele Semachew Kasa   ORCID: orcid.org/0000-0003-3320-8329 1 ,
  • Mulu Tarekegn 1 &
  • Nebyat Embiale 2  

BMC Research Notes volume  11 , Article number:  577 ( 2018 ) Cite this article

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Metrics details

To assess the knowledge and attitude regarding family planning and the practice of family planning among the women of reproductive age group in South Achefer District, Northwest Ethiopia, 2017.

The study showed that the overall proper knowledge, attitude and practice of women towards family planning (FP) was 42.3%, 58.8%, and 50.4% respectively. Factors associated with the practice of FP were: residence, marital status, educational status, age, occupation, and knowledge, and attitude, number of children and monthly average household income of participants. In this study, the level of knowledge and attitude towards family planning was relatively low and the level of family planning utilization was quite low in comparison with many studies. Every health worker should teach the community on family planning holistically to increase the awareness so that family planning utilization will be enhanced. Besides, more studies are needed in a thorough investigation of the different reasons affecting the non-utilizing of family planning and how these can be addressed are necessary.

Introduction

Family planning (FP) is defined as a way of thinking and living that is adopted voluntary upon the bases of knowledge, attitude, and responsible decisions by individuals and couples [ 1 ]. Family planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods [ 2 ].

Family planning deals with reproductive health of the mother, having adequate birth spacing, avoiding undesired pregnancies and abortions, preventing sexually transmitted diseases and improving the quality of life of mother, fetus and family as a whole [ 3 , 4 ].

The Federal Ministry of Health (FMOH) has undertaken many initiatives to reduce maternal mortality. Among these initiatives, the most important is the provision of family planning at all levels of the healthcare system [ 5 , 6 ]. Currently, short-term modern family planning methods are available at all levels of governmental and private health facilities, while long-term method is being provided in health centers, hospitals and private clinics [ 6 ].

The study done in Jimma Zone, Ethiopia showed that good knowledge on contraceptives did not match with the high contraceptive practice [ 7 ]. Different researchers showed that the highest awareness but low utilization of contraceptives making the situation a serious challenge [ 8 , 9 ].

Most of reproductive age women know little or incorrect information about family planning methods. Even when they know some names of contraceptives, they don’t know where to get them or how to use it. These women have negative attitude about family planning, while some have heard false and misleading information [ 10 , 11 ] and the current study aimed in assessing the knowledge, attitude and practice (KAP) of FP among women of reproductive age group in South Achefer District, Northwest Ethiopia.

Methods and materials

Study design and setup.

A community-based cross-sectional study was conducted in South Achefer District, Amhara Region, Northwest Ethiopia from March 01–April 01, 2017. Systematic sampling technique was used to recruit the sampled reproductive age women (15–49 years old). Based on the number of households obtained from the Kebele’s (Smallest administrative division) health post, the sample size (389) was distributed to the households. The sampling interval was determined based on the total number of 4431 households in the kebele. The first household was taken by lottery method and if there were more than one eligible individual in the same household one was selected by lottery method.

The data collection questionnaire was developed after reviewing different relevant literatures. The questionnaire, first developed in English language and then translated to Amharic (local language). Pretest was done on 5% of the total sample size at Ashuda kebele. After the pretest, necessary modifications and correction took place to ensure validity.

Those reproductive age women who answered ≥ 77% from knowledge assessing questions were considered as having good knowledge, those women who scored ≥ 90% from attitude assessing questions were considered as having favorable attitude and those women who scored ≥ 64% from practice assessing questions were considered as having good over all practice towards FP [ 7 ].

Data processing and analysis

The collected data was cleaned, entered and analyzed using SPSS version 21 software. Descriptive statistics were employed to describe socio-demographic, knowledge, attitude and practice variables. Chi squared (χ 2 ) test was used to determine association between variables. Associations were considered statistically significant when P-value was, < 0.05.

Socio-demographic characteristics of participants

The response rate in this study was 97.9%. Among 381 participants included, 185 (49%) were from rural villages. About 47% of the participants were illiterate and 52% were completed primary education. The monthly household income of the majority (42.5%) of the participants was between 1000 and 3000 Ethiopian birr. Regarding the family size of the participant’s, majority (48.3%) of them had ≥ 3 children.

The mean age of participants was 29.7 ± 6.4. Two hundred forty six (64.6%) and 133 (34.9%) were house wife’s and farmers respectively by their occupation. Almost two-third (65.4%) of participants were married, 24.9% were divorced by their marital status (Table  1 ).

Knowledge status of participants

All of participants ever heard about family planning methods. The major sources of information were from health workers (57.5%) and radio (41.5%). Regarding perceived side effects of using family planning, 13.1%, 24.9%, 9.7% and 52.2% of participants were responded heavy bleeding, irregular bleeding, an absence of menstrual cycle and abdominal cramp respectively were mentioned as a side effect. Among those who have children; 24.6% gave their last birth at home and 75.5% gave their last birth at the health institution. Regarding the overall knowledge of study participants, 161 (42.3%) had good knowledge towards family planning and the rest 220 (57.7%) had poor knowledge.

Attitude status of participants

The majority (88.5%) of the respondents ever discussed on family planning issues with their partners and wants to use it in the future. About 24.5% of the participants reported that they believe family planning exposes to infertility. Almost 23 (22.8%) of study participants reported that using family planning contradicts with their religion and culture. Regarding the overall attitude, 224 (58.8%) of the participants had favorable attitude and 157 (41.2%) had unfavorable attitude towards family planning.

Practice on family planning

Three fourth (75.3%) of study participants ever used contraceptive methods. The main types were pills (7.4%) and injectable (77.2%). The most common current reasons for not using were a desire to have a child (53.2%) and preferred method not available (46.8%). Almost half (50.4%) of study participants had good practice and the rest 49.6% had poor practice.

Factors associated with family planning practice

Study participants’ religion was not included in the analysis due to lack of variance, since almost all (99.2%) of participants were Orthodox Christians by their religion.

Women who had good knowledge were more likely to practice FP than those who have low knowledge (χ 2  = 117.995, d.f. = 1, P  < 0.001) and women who had favorable attitude towards FP were more likely to practice FP (χ 2  = 106.696, d.f. = 1, P  < 0.001). It was also seen that residence, age, educational status, occupation, marital status, number of children and monthly income of the were significantly associated with the practice of FP [(χ 2  = 69.723, d.f. = 1, P  < 0.001), (χ 2  = 104.252, d.f. = 2, P  < 0.002), (χ 2  = 119.264, d.f. = 1, P  < 0.001), (χ 2  = 41.519, d.f. = 1, P  < 0.001), (χ 2  = 39.050, d.f. = 1, P  < 0.001), (χ 2  = 144,400, d.f = 3, P  < 0.001) and (χ 2  = 179.366, d.f. = 1, P  < 0.002)] respectively (Table  2 ).

Increasing program coverage and access of family planning will not be enough unless all eligible women have adequate awareness for favorable attitude and correctly and consistently practicing as per their need. Increasing awareness/knowledge and favorable attitude for practicing FP activities at all levels of eligible women are strongly recommended [ 6 ].

The results of the present study showed that 42.3% of study participants had good knowledge, 58.8% had favorable attitude, and 50.4% had good practice towards family planning. This finding was lower than a study conducted in Jimma zone, Southwest Ethiopia [ 7 ], Sudan [ 9 ], Tanzania [ 12 ] and another study done in Rohtak district, India [ 13 ]. The difference may be due to; studies done in Jimma zone, Sudan, Tanzania and Rohtak district involve only those coupled/married women. Married women might have good knowledge and attitude for practicing family planning. But in the current study, all women of reproductive age group regardless of their marital status were studied and this may lower their knowledge and attitude.

The current study showed that, 50.4% of reproductive age women were practicing family planning which was almost in line with a study done in Cambodia [ 14 ] and higher than a study done in rural part of Jordan [ 15 ] and India [ 16 ]. But it was lower than studies conducted in Jimma zone, Ethiopia [ 7 ], Rohtak district, India [ 13 ], urban slum community of Mumbai [ 17 ] and in Sikkim [ 18 ] in which 64%, 62%, 65.6% and 62% of participants respectively used family planning. The difference might be due to that study participants in Jimma zone, Rohtak and Mumbi were relatively residing in large city/town and this may help them to have a better access for family planning compared to the study done in South Achefer District.

In the current study, urban residents were more likely to use family planning methods (71.4%) than their rural counterparts (28.1%). This finding was in line with the findings from Ethiopian Demographic Health Survey (EDHS) [ 2 ]. This might be due to the reason that urban residents are more aware of family planning and hence practicing better.

It has also found that women who completed primary & secondary education were practicing family planning than those who were uneducated (77.1% and 20.6%) respectively. This finding was in line with a study done in Jimma, Ethiopia [ 19 ]. This might be due to the fact that women who were able to read and write would think in which FP activities are useful to be economically, self-sufficient and more likely to acquire greater confidence and personal control in marital relationships including the discussion of family size and contraceptive use.

This study showed that, age of the study participants had an association with practicing FP. Those reproductive age women’s whose age > 30 years were practicing family planning better than those whose age < 18 years. This finding was in line with a study done in India [ 20 ]. This might be due to the reason that, when age increases mothers awareness, attitude and practice towards family planning may increase. In addition, as age increases the chance of practicing sexual intercourse increases and as a result they would be interested to utilize family planning in one or another way.

It has also revealed that women’s average monthly household income has an association with their FP practicing habit. Those study participants whose average monthly income < 1000 ETB were using FP better than whose average monthly income > 3000 ETB. This is might be because those relatively who had better income may need more children and those with low income may not want to have more children beyond their income.

The current study also showed that knowledge and attitude of reproductive age women were related to FP utilization. Those reproductive age women who had good knowledge were utilized FP better than from those who were less knowledgeable. Those participants with favorable attitude were practicing better than those who had unfavorable attitude. This is might be due to the fact that knowledge and attitude for specific activities are the key factors to start behaving and maintaining it continuously.

Conclusion and recommendation

The level of knowledge and attitude towards family planning was relatively low and the level of family planning utilization was quite low in comparison with many studies.

Study participant’s residence, marital status, educational level, occupation, age, knowledge, attitude, their family size and their monthly average income were associated with FP utilization habit of reproductive age women.

Every health worker should teach the community on family planning holistically to increase the awareness so that family planning utilization will be enhanced.

Besides, more studies are needed in a thorough investigation of the different reasons affecting the non-utilizing of family planning and how these can be addressed are necessary.

Limitation of the study

As the data were collected using interviewer administered questionnaire, mothers might not felt free and the reported KAP might be overestimated or underestimated.

We do not used qualitative method of data collection to gather study participant’s internal feeling about family planning, so that triangulation was possible. In addition, barriers for utilizing contraception not addressed.

Abbreviations

Ethiopian Demographic Health Survey

Ethiopian birr

Federal Ministry of Health

family planning

knowledge, attitude and practice

World Health Organization. Standards for maternal and neonatal care. Geneva: World Health Organization; 2006.

Google Scholar  

Central Statistical Agency. Ethiopian Demographic and Health Survey 2016 key indicators report. Addis Ababa and Maryland, Ethiopia; 2016.

World Health Organization. Fact sheets on family planning, World Health Organization. https://www.cycletechnologies.com/single-post/2017/02/14/World-Health-Organization-Updated-Family-Planning-Contraception-Fact-Sheet . Accessed 8 Feb 2018.

United Nations. World contraceptive use, 2009 wall chart. New York United Nations Population Division: United Nations; 2009. http://www.un.org/esa/population/publications/contraceptive2009/contracept2009_wallchart_front.pdf . Accessed 3 Mar 2018.

Central Statistical Agency. Ethiopia Mini Demographic and Health Survey 2014. Addis Ababa; 2014. http://www.dktethiopia.org/publications/ethiopia-mini-demographic-and-health-survey-2014 . Accessed 12 Feb 2018.

Federal Ministry of Health. National Guideline for Family Planning Services in Ethiopia; 2011. http://www.moh.gov.et/documents/20181/21665/National+Family+Planning+Guideline_Ethiopia_2011.pdf/ . Accessed 17 Feb 2018.

Tilahun T, Coene G, Luchters S, Kassahun W, Leye E. Family planning knowledge, attitude and practice among married couples in Jimma Zone, Ethiopia. PLoS ONE. 2013;8(4):e61335.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Menhaden AL, Khalil AO, Hamdan-Mansour AM, Sato T, Imoto A. Knowledge, attitudes, and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Heal J. 2012;18(6):1–6.

Handady SO, Naseralla K, Sakin HH, Alawad AAM. Knowledge, attitude, and practice of family planning among married women attending primary health centerin Sudan. Int J Public Heal Res. 2015;3(5):243–7.

Gaur DR, Goel MK, Goel M. Contraceptive practices and related factors among female in predominantly rural Muslim area of North India. Internet J World Heal Soc Polit. 2008;5(1):1–5.

Oyedokun AO. Determinants of contraceptive Usage: lessons from Women in Osun State, Nigeria. J Humanit Soc Sci. 2007;1:1–14.

Lwelamira J, Mnyamagola G, Msaki MM. Knowledge, attitude and practice (KAP) towards modern contraceptives among married women of reproductive age in Mpwapwa District, Central Tanzania. Curr Res J Soc Sci. 2012;4(3):235–45. https://www.researchgate.net/publication/299488265 . Accessed 9 Feb 2018.

Gupta V, Mohapatra D, Kumar V. Family planning knowledge, attitude, and practices among the currently married women (aged 15–45 years) in an urban area of Rohtak district, Haryana. Int J Med Sci Public Heal. 2016;5(4):627–32.

Article   Google Scholar  

Sreytouch Vong. Knowledge, attitude and practice (KAP) of Family planningamong married women in BanteayMeanchey. Cambodia: Ritsumeikan Asia Pacifi c University; 2006.

Mahadeen AI, Khalil AO, Sato T, Imoto A. Knowledge, attitudes and practices towards family planning among women in the rural southern region of Jordan. East Mediterr Heal J. 2012;18(6):567–72.

Article   CAS   Google Scholar  

Quereishi MJ, Mathew AK, Sinha A. Knowledge, attitude and practice of family planning methods among the rural females of Bagbahara block Mahasamund district in Chhattishgarh State, India. Glob J Med Public Heal. 2017;6(2):1–7. http://www.gjmedph.com . Accessed 5 Mar 2018.

Khan MM, Shaikh STSA. Study of knowledge and practice of contraception in urban slum community, Mumbai. Int J Curr Med Appl Sci. 2014;3(2):35–41.

Prachi R, Das GS, Ankur B, Shipra J, Binita K. A study of knowledge, attitude and practice of family planning among the women of reproductive age group in Sikkim. J Obs Gynecol India. 2008;58(1):63–7. https://www.researchgate.net/publication/228480182 . Accessed 16 Apr 2018.

Beekle AT. Awareness and determinants of family planning practice in Jima, Ethiopia. Int Nurs Rev. 2006;53:269.

Article   PubMed   CAS   Google Scholar  

Mohanan P, Kamath ASB. Fertility pattern and family planning practices in rural area in dakshina Kannada. Indian J Com Med. 2003;28:15–28.

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Authors’ contributions

AS: approved the proposal with some revisions, participated in data analysis. MT: wrote the proposal, participated in data collection analyzed the data and drafted the paper. NE: approved the proposal with some revisions, participated in data analysis. All authors read and approved the final manuscript.

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We are very grateful to all study participants for their commitment in responding to our questionnaires.

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Ethical clearance was obtained from the Ethical Review Committee of Bahir Dar University, College of Medicine & Health Sciences, and School of Nursing. The objective and purpose of the study were explained to officials at the Woreda and Kebele (smallest governmental administrative division) and a written permission consent was obtained from the study participants. For those study participants whose age is below 18 years consent to participate in the study was obtained from their parent during the data collection time.

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Ayele Semachew Kasa & Mulu Tarekegn

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Semachew Kasa, A., Tarekegn, M. & Embiale, N. Knowledge, attitude and practice towards family planning among reproductive age women in a resource limited settings of Northwest Ethiopia. BMC Res Notes 11 , 577 (2018). https://doi.org/10.1186/s13104-018-3689-7

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Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study

Navin bhatt.

1 B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Bandana Bhatt

2 Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal

Bandana Neupane

3 Nepal Health Sector Support Programme (NHSSP)/DFID/Ministry of Health and Population, Kathmandu, Nepal

Ashmita Karki

4 Central Department of Public Health, Institute of Medicine, Kathmandu, Nepal

Tribhuwan Bhatta

5 Department of Electronics and Computer Engineering, Institute of Engineering, Tribhuvan University, Lalitpur, Nepal

Jeevan Thapa

6 Department of Community Health Sciences, School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal

Lila Bahadur Basnet

7 School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Shyam Sundar Budhathoki

8 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom

Associated Data

All relevant data are within the manuscript and its Supporting Information files.

Introduction

Family planning methods are used to promote safer sexual practices, reduce unintended pregnancies and unsafe abortion, and control population. Young people aged 15–24 years belong to a key reproductive age group. However, little is known about their engagement with the family planning services in Nepal. Our study aimed to identify the perceptions of and barriers to the use of family planning among youth in Nepal.

A qualitative explorative study was done among adolescents and young people aged 15–24 years from the Hattimuda village in eastern Nepal. Six focus group discussions and 25 in-depth interviews were conducted with both male and female participants in the community using a maximum variation sampling method. Data were analyzed using a thematic framework approach.

Many individuals were aware that family planning measures postpone pregnancy. However, some young participants were not fully aware of the available family planning services. Some married couples who preferred ’birth spacing’ received negative judgments from their family members for not starting a family. The perceived barriers to the use of family planning included lack of knowledge about family planning use, fear of side effects of modern family planning methods, lack of access/affordability due to familial and religious beliefs/myths/misconceptions. On an individual level, some couples’ timid nature also negatively influenced the uptake of family planning measures.

Women predominantly take the responsibility for using family planning measures in male-dominated decision-making societies. Moreover, young men feel that the current family planning programs have very little space for men to engage even if they were willing to participate. Communication in the community and in between the couples seem to be influenced by the presence of strong societal and cultural norms and practices. These practices seem to affect family planning related teaching at schools as well. This research shows that both young men and women are keen on getting involved with initiatives and campaigns for supporting local governments in strengthening the family planning programs in Nepal.

An unmet need for family planning results in unintended pregnancies and illegal abortions. This has major health and social implications and is often the leading cause of maternal and child mortality in low-income countries [ 1 , 2 ]. An estimated 214 million women of reproductive age lack access to contraception resulting in an estimated 67 million unintended pregnancies, 36 million induced abortions, and 76,000 maternal deaths each year [ 3 ]. Family planning (FP) is a key intervention to limit these adverse health outcomes [ 4 – 6 ]. Such interventions can prevent 90% of abortions, 32% of maternal deaths, 20% of pregnancy-related morbidity globally, and reduce 44% of maternal mortality in low-income countries [ 1 , 7 ]. FP reduces adolescent pregnancies, prevents pregnancy-related health risks, and helps to prevent HIV/AIDS [ 8 ]. Access to contraception promotes education, raises the economic status of women, and gradually empowers them resulting in improved health outcomes and better quality of life [ 3 , 5 , 9 , 10 ].

Global data show that only 32% of married women from low-income countries currently use modern contraceptives [ 9 ]. According to the Nepal Demographic Health Survey 2016, the total fertility rate was 2.3 births per woman, which is declining and approaching replacement fertility. This is an important achievement. However, the modern contraceptive prevalence rate (mCPR), which is 43%, is still below the target in Nepal [ 11 ]. Nepal has consistently failed to reach the target of mCPR for the past 20 years. The future projection of mCPR for 2030 is 60% [ 5 ], which may be a distant dream if the barriers and enablers are not identified on time to strengthen the current efforts.

Expanding the coverage and access to effective contraceptive methods are essential to meet the Sustainable Development Goals and to achieve universal access to reproductive healthcare services by 2030 [ 11 , 12 ]. For this, the government of Nepal has started a FP program with a focus on increasing the use of FP services and reducing the unmet need [ 5 , 11 ]. However, various factors negatively influence the delivery of FP services including lack of information, limited awareness of dissemination activities, lack of trained staff, and various cultural and religious factors [ 13 ].

Family planning is a choice for many youth, but they often experience barriers such as negative provider attitudes, long distances to healthcare facilities, and inadequate stock of preferred contraceptives [ 13 , 14 ]. Nepali youth are reluctant to use modern contraceptives due to misconceptions about long-term fertility risks, fear of side effects and overall lack of deeper knowledge [ 15 , 16 ]. Besides, FP decisions are mostly dependent on male household members, including husbands and other elder members [ 17 , 18 ]. Married women whose husbands are away as migrant workers face unique contraceptive challenges. When their husbands return home for a few weeks in a year, these women are not prepared with their contraceptives, which can result in unwanted pregnancies [ 18 ].

The extrapolation of the available literature on FP use among adults from Nepal and elsewhere suggests that youth is an under-researched population when it comes to FP There is also a dearth of evidence on perception and key barriers to the use of FP measures in this population. Hence, this study aims to identify the perceptions of the FP services and barriers to the use of FP among the youth in Nepal to assist policymakers in designing appropriate interventions to strengthen the family planning programs in Nepal.

Material and methods

Ethical considerations.

The study received ethical approval from the Institutional Review Committee of B.P. Koirala Institute of Health Sciences, Dharan, Nepal as per the Undergraduate Research Proposal review process (URPRB/01/015). We obtained informed written consent from all participants aged 18 and above. For minors, we obtained assent from the parents of the participants with the participants’ permission. For those who could not read, the information sheet was read aloud by a volunteer, verbal consent was given, and a thumbprint, in the presence of a witness, was used in place of a signature. To maintain the confidentiality of the information and the privacy of the participants, only selected participants and the moderators attended the sessions. Personal identifiers and locator information were not collected, and any identifying information accidentally mentioned was removed from the text before the analysis.

Study setting

The study was conducted among the participants from Hattimuda village of Morang district in Province One of Nepal. Hattimuda village is a community service area of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. BPKIHS is a public-funded health sciences university, which follows a teaching district concept adopted as a part of its community-based medical education curriculum. BPKIHS also runs a tertiary hospital service for the population of eastern Nepal [ 19 ]. There is a public health facility in Hattimuda village that provides primary health care services including FP services such as the distribution of contraceptives. The nearest secondary and tertiary levels of healthcare services are available 18 kilometers away in Biratnagar, which is the provincial capital and the headquarters of Morang district. According to the 2017/18 annual report of the Department of Health Services, the contraceptive prevalence rate of Morang district is 54.6% [ 5 ] whereas the unmet need for FP in Province One as per the Nepal Demographic Health Survey 2016 is 25% [ 11 ].

Study design

This was a qualitative study with an exploratory design to gather a deeper understanding of the perception of FP and its barriers. Focus group discussions (FGD) and in-depth interview (IDI) methods were used. The overall study lasted from November 2017 to October 2018.

Study population and sampling technique

Adolescents and young people between 15 and 24 years of age from Hattimuda were included in the study. We used the maximum variation sampling method to enroll participants. Pretesting, including one FGD and four IDIs, was conducted among residents in another village of the same district. The pretesting guided the selection of participants for FGDs and IDIs. Accordingly, FGDs were conducted among adolescents and young people, separately for male and female participants to allow for free expression of views during the discussion of potentially sensitive issues. Moreover, the respondents recommended that people at the forefront of the community such as the village leaders, schoolteachers, community health volunteers, religious leaders, youth leaders, and students be selected for the interviews to gather more information. Along with the recommendations from the pretesting, brainstorming was done with community volunteers to generate a list of people who understood the issues of adolescents and young people. More volunteers were added to the list upon the recommendation of the initial respondents. Thus, participants representing diverse backgrounds in terms of gender, profession, education, and social status, were selected. The IDIs were done among 25 prominent people in the community, which included leaders, school teachers, female community health volunteers, healthcare professionals working at the health post and FP service centers, and youth leaders from youth clubs. Health care providers were included in the interviews as their views would be invaluable due to their experience as FP service providers and as witnessing the health issues faced by youth. The teachers are regarded highly for their knowledge and opinions in Nepali communities. So, they were selected for the IDI to provide more insight into the educational barriers to FP and to help in youth mobilization for FP activities. Considering the vital role of local leaders in influencing the implementation and regulation of population-level activities in the village, they were selected for IDI. Six focus groups were conducted with a total of 48 respondents ( Fig 1 ).

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Data collection

The Focus Group Discussions (FGD) and In-depth interviews (IDI) were conducted by the researchers within the team with prior experience in qualitative research methods. The interview team included an undergraduate medical student, two postgraduate resident doctors, a public health graduate, and a public health academic researcher. Before data collection, an orientation session was conducted for the interviewers using the interview schedule and the topic guide. The IDI guidelines and interview schedules were developed from the literature review and were modified after pretesting. Validation of the tools was ensured by using the Item Objective Congruence (IOC) index and consultation with academics with experience in FP research. Using a semi-structured open-ended questionnaire, the participants were assessed on their knowledge and perceptions regarding sexual and reproductive health (SRH) and FP, SRH problems faced by youth, challenges and barriers to use of FP services, the role of youth in combating the perceived challenges, and suggestions for enhancing the use of services. Data were considered to have reached saturation when the responses from participants became repetitive and/or no new responses were received.

Focus group discussions

A representative group of youth from diverse backgrounds who could provide credible information about practices and factors affecting the use of FP in the community was selected. Separate FGDs were held for girls and boys to allow for free expression. A moderator was responsible for guiding the discussion and a note-taker for taking the notes, including recording non-verbal responses and ensuring the audio recording. A total of 6 FGDs, each containing 8 homogenous participants, were conducted. Each individual participated once in the FGD. Every member of the group could make their contribution to any question posed before proceeding to another question. Each FGD lasted for 60–90 minutes on average. The discussion was done in the Nepali language as preferred by participants and later translated into English during transcription.

In-depth interviews

In-depth interviews with the key stakeholders were conducted using the Interview Schedule after obtaining the informed consent and audio-recorded with participant permission. A total of 25 IDIs were conducted for the average duration of 30–45 minutes, at a location convenient to the participant, which included their homes and offices.

Data management and analysis

A framework method of thematic analysis was used. The analysis included stages of transcription, familiarization with the interview, coding, developing a working analytical framework, applying the analytical framework, charting the data into the framework matrix, and interpretation of the data. The data collected from the focus groups and interviews were transcribed verbatim. The notes taken were used as a guide to segregate the responses by different respondents during the discussion. An independent researcher conversant in the Nepali and English languages cross-checked the transcripts for accuracy and preservation of original meaning during translation. Preliminary codes were assigned to the available data and then organized into thematic units that were continually revisited and revised as necessary. To ensure consistency of data and findings, two authors were involved in data analysis and reporting. The recordings were stored and accessed by the research team only and were destroyed after the analysis and final report preparation.

Operational definition

According to UNFPA, all persons within the age of 15–24 years are considered youth [ 20 ].

The baseline characteristics of the participants can be seen in Table 1 .

The responses from the IDIs and FGDs revealed four broad themes. Within each broad theme were several substantive sub-themes that emerged from the data. The themes and subthemes are summarized in Table 2 below.

Theme 1: Knowledge and perceptions of FP

A) knowledge and sources of information on fp.

Participants demonstrated awareness of some form of FP. However, some knew nothing about it. Health workers were commonly referred to as the sources of information, while some also mentioned peers, radio, television, and books. Male participants openly disclosed their sources of information on FP while some female participants were reluctant to share their sources.

b) Perceptions of FP

Perceptions of FP varied among participants. Some male participants inferred FP measures as women’s business and did not show any interest in talking more about it. Some referred to FP as using condoms during intercourse, while others referred to oral pills and injectable hormones as FP. Some female participants looked at FP as a way of avoiding unwanted pregnancies.

“My sister used to say that she has been using injection (Depo-Provera) to control unwanted pregnancy . I think FP is about the same . ”- 19 years Female , FGD participant

Theme 2: Preference for FP methods and decision-making

Some female participants reported preference for traditional methods of contraception such as coitus interruptus and calendar method over modern methods. These people used modern methods of FP to start with, which they discontinued later due to the side effects. Participants also stated that the health facilities that provide FP services were far, and hence they had no alternative other than natural methods. Male participants hardly mentioned visiting any health facilities for FP purposes.

“Most of our clients who come for it (FP) are women. Even condoms are collected by women. Men rarely come alone or as couples for FP services.” - 35 years old Female, FP service provider, IDI participant

Yet husbands were responsible for the decision-making about FP and choices of methods for most couples. Some participants (both male and females) mentioned that women rather than men should use permanent FP measures. They believed that men being the breadwinner of the family, should not undergo sterilization, for example, as it would make them physically weak.

“Though I love my wife and I am concerned about her. But I have no options. I must work in a factory. I need to lift heavy weights there. All the major house chores are also done by me. These things (sterilization) would make me weak. How can I earn my livelihood then?”- 22 years Male, FGD participant

Some female participants expressed their concerns regarding the use of permanent FP methods. They mentioned that they had already been through various phases of pain, be it during menstruation, pregnancy, or delivery which has made them weak. Thus, they prefer their husbands to undertake any measures.

In contrast, unmarried participants stated that they would rather discuss and decide together with their partners regarding which method to choose in the future. Despite this interest, women were not sure how to engage their husbands in discussion. Some female participants said that they could not persuade their future husbands to use contraceptives as it would be disrespectful, whereas a few male participants believed it was a woman’s responsibility to use FP methods.

“It (FP) is stuff to be done by the women . So , there is no doubt about who would be doing it . Moreover , people would laugh at me if I do it -20 years Male , FGD participant “ Women have already gone through much pain in bringing up and taking care of the children and again keeping this stuff (FP) in their head is unjustifiable . As such, in comparison to the female operative procedure, I have heard that the male one is simple, less time consuming, and does not bring many complications . So, why not we men take the lead on this? ” -25 years Male, Youth leader, IDI participant

Theme 3: Barriers and challenges in the use of FP

A) supply-side barriers and challenges.

Participants indicated that contraceptive services are not always accessible nor affordable in rural areas. Health facilities are far, and many people feel reluctant to travel in a hot climate. Participants who were reluctant to travel said they were doubtful that the health facilities would have the methods in stock even if they managed to walk the distance. Others who were reluctant said they would be unable to afford the contraceptives from a private medical store regularly. A few participants raised the issue of privacy and unavailability of all services at the health centers. Similarly, young males from the community complained that the services at the health post were focused only on mothers and married couples, while the boys and the unmarried people were not given much attention. For this, they suggested changing the term to something other than FP because they believed that FP should include not only those who had families.

Participants expressed their frustration that FP and SRH services in their village had not been running well for more than a year. They felt that the government was not doing anything about it either. Some students expressed the need for an integrated curriculum at school covering every aspect of SRH and FP that would ensure adequate and proper knowledge of such crucial subjects. Despite the students’ desire to learn and understand FP, their teachers are often reluctant to talk about FP in detail. The participants also indicated that family members, in general, forbid girls and women from getting involved in FP awareness activities.

“Though we are eager to learn about those lessons (reproductive organs and health), our teacher skips them. They tell us to read it by ourselves.” -18 years Female, FGD participant

b) Demand-side barriers and challenges

A few participants were confused about which method to choose, how to use it properly and did not even know where to seek FP services locally.

“My husband works abroad. Last year, when he came home during Dashain (festival), we had (intercourse). Later, he returned to his workplace. Meanwhile, I came to know that I was pregnant, after 3 months. I was shocked to hear that. We already had 3 children; 2 of them were unplanned. I did not have enough information about contraceptive measures in this situation. Had I known about them; I would have used them. I had serious trouble travelling to get it aborted.” - 24 years Female, FGD participant

Some female participants expressed their reluctance to use FP methods due to their own or other people’s past experiences and the fear of side effects, including vaginal bleeding, spotting, abdominal pain, nausea, vomiting, headache, acne, and infertility. These female participants expressed the need for a single-use FP method with fewer side effects for women which could be used without their husbands’ consent. The male participants were worried about the risk of unwanted pregnancy due to the breaking of condoms and a few participants also expressed concern that they experienced allergic reactions after the use of condoms. Moreover, they were concerned about not having any alternative methods of contraception other than condoms.

“I have a much bitter experience. I was using Depo injection before. But I started having over bleeding for which I was admitted to the hospital for a few days. Later, I was switched to implants but they also did not suit me. In between I also used pills, but they aggravated my acne and I was feeling nauseated every day. Uff…. I am fed up now. I swear, I won’t ever use any methods.” - 19 years Female, FGD participant “I have heard that keeping these things (Copper-T) in the uterus can cause cancer. Better to avoid it.” - 20 years Female, FGD participant “There aren’t many choices for men. I think using a condom during sex is like tying plastic around the tongue and eating food.” - 21 years Male, IDI participant

Religious and ethnic variation affected use of FP. Participants reported that people belonging to upper caste groups used FP measures more than lower caste groups. Likewise, people who had migrated from the hilly areas used FP services, whereas people from the local ethnic community did not use as they were less aware of it. FP decisions among young people seem to be influenced largely by religious beliefs, stigma, and the perceived role of men and women based on existing social norms. Some participants regarded children as a gift from God and denied using any FP methods. Some believed using FP was going against the law of nature, religion, and culture; thus, they would not avoid childbirth, but rather celebrate every birth. Some indicated that if couples did not have children within 1–2 years of marriage, then people would question the woman’s fertility. Most couples preferred sons to daughters as they believed sons would look after them and their property, while the daughters would be married and sent away, resulting in avoidance of FP measures until they have a son. Some couples even wished to have two sons because if anything unfortunate happened to one, the other son would still be with them to carry the generation forward.

“My aunt gave birth to a son after 5 successive daughters. She is pregnant again this time in the hope to have a son. She says that she cannot trust to have only one son because if anything happens to their only son, then she will have no one to pay tribute after her death.”- 22 years Female, FGD participant

Participants also said that people felt shy talking about FP openly. Female participants also felt uncomfortable asking for contraceptives with male health personnel at the health post. Similarly, teachers felt uncomfortable teaching about reproductive health and FP as their children and relatives could be present as students in the classroom. Participants indicated that some students would laugh and smile, making it difficult for the teachers to run the classroom sessions smoothly.

It was reported by a FP service provider that some men opposed their wives using any FP measures as they perceived that the use of FP measures allowed their wives to become promiscuous when they go abroad for work.

“Some husbands working abroad forbid their wives from using any FP measures because they fear the use of FP measures may provoke a sexual relationship with someone else in their absence”- 30 years Female, Health professional providing medical abortion services, IDI participant

Theme 4: Role of youth and suggestions to improve FP

The youth were interested in getting involved in a “peer to peer education” approach to increase awareness among the community about FP use. This approach would include peer training programs, role-plays/dramas, and counseling sessions to break the key barriers linked with such services. Activities ranging from redesigning the school’s curriculum to strengthening FP services in primary care centers, and from launching mobile outreach clinics to facilitating “spousal communication” were intended to change attitudes and support gender equality in sexual and reproductive health. Participants emphasized forming youth centers and collaborating with other youth clubs in the village. Furthermore, they suggested bringing religious leaders, teachers, doctors, and politicians as advisors of the youth centers would be beneficial as they are influential members of the community.

“I feel bad for my sister who is not given much importance from my parents. She got married against her choice due to her parents’ pressure. Now, they are forcing her to have kids. She is just 15 and if she gets pregnant, what will happen to her health and her child, how can she take care of a baby? I had a long debate with my father yesterday. I have now decided to start a youth club to promote awareness regarding FP and preventing early marriage and teenage pregnancies.” - 23 years Male, FGD participant

Male participants indicated that family planning programs are effective only when men prioritize women’s autonomy. Moreover, they expressed disappointment with the local government for not encouraging the involvement of men in FP programs in their village. To help address this issue, they expressed their interest in supporting the local government in bringing inclusive FP programs to their village.

“For a long time, women have been using those (Contraceptives) by hiding. We are always in fear about what others would say if they came to know about us using it. This can be addressed through male involvement and support.” -24 years Female, FGD participant

This qualitative study provides in-depth information on the understanding and perceptions of youth in Eastern Nepal regarding FP. This study generated findings regarding knowledge and perceptions of rural residents regarding FP and its methods; decision-making and preference among participants; supply-side and demand-side barriers and challenges regarding the use of FP measures; steps that can be taken to improve their use; and the role of youth in increasing FP coverage. Although most participants knew something about FP, a few female participants were completely unaware of it. And while some participants agreed that all married couples should be using FP measures, some unmarried male participants believed that those measures should be exclusively for women. These men said that they would let their wives use them after getting married. Current FP methods for men are either coitus-dependent, such as condoms or withdrawal, or permanent, such as vasectomy. Limited choices for men may have resulted in misconceptions that contraceptives are mostly for women.

Men often claimed to be the sole decision-maker of the family on important matters, including those related to family health and contraception. In most circumstances, men solely decide the FP measure to be used without having a discussion with their partner. This might be one of the reasons why women are bound to adopt a FP method that is not necessarily their choice. Besides, this problem is further reinforced by the limited options of FP methods available for men other than condoms and permanent sterilization. These findings are supported by other studies in South Asia, where family planning measures are mostly considered women’s responsibility [ 21 – 24 ]. Health workers, peers, and mass media were the most common sources of information regarding FP similar to prior studies in India [ 21 , 24 ] and Nepal [ 22 ]. Participants in this study seemed to assign FP responsibility to the other gender in terms of using FP. This could mean that there is a gap in communication within the couples when deciding about FP. There is a need for further research to identify ways to improve communication among couples.

Religious and ethnic variation influence FP use. People belonging to privileged ethnic groups used FP measures more than underprivileged groups. This is despite family planning services being free for all citizens in Nepal. In this study, people who had migrated from hilly regions knew about and used FP services more than those belonging to the ethnic community in the local region. This is an area for further research to understand differences in knowledge and perceptions regarding FP between the population groups. This can be argued as a limitation of the current FP promotion programs, which may not have considered the different needs of people from different religious and ethnic backgrounds [ 25 ]. A few participants reported that their holy scriptures forbade them from using FP methods as they viewed children as a gift from God; any artificial process interrupting pregnancy or preventing the possibility of life is a religious offense for them [ 26 ]. Previous studies from Nepal have shown that this belief has long been rooted in some communities [ 27 – 29 ].

Apart from religious beliefs, fear of side effects, having experienced adverse health consequences after using hormonal contraceptives, and fear of potential infertility in the future are reasons for reluctance using FP methods among women [ 30 ]. Besides, we can speculate that language and cultural barriers, and fear of discrimination especially by male counterparts negatively influence the use of FP measures among some women despite their strong interest in using them. The use of IEC materials in raising awareness and empowering married couples for shared decision-making could help generate demand [ 28 , 29 ]. Local cultural taboos restrict open communication about safer sex measures and sexual health in Nepal, prohibiting young girls and boys from receiving adequate information and guidance regarding sexual and reproductive health and FP [ 31 ].

Most of the married women and men stated that the decision-makers of the family are men. The husband decides whether or not to use contraception, or more specifically, whether or not to let their wives use it. However, unmarried participants expressed their willingness to decide mutually with their spouse regarding FP use in the future [ 21 , 32 ]. Most women in this study seemed comfortable letting their male partners decide on contraceptives. This attitude could be explained by the patriarchal dominance in decision-making [ 19 , 33 , 34 ].

Some men mentioned that condoms inhibit their sexual pleasure, which is why they prefer women to use other methods instead. A study conducted in Far West Nepal and another nationwide study reported similar concerns among men [ 31 , 35 ]. Adolescent girls stated that they were not comfortable talking to a male health worker about FP or to a female worker in the presence of a male health worker, which has also been reported elsewhere [ 36 ]. Some women said that their husbands forbade the use of contraceptives because they thought that contraceptives would allow their wives to become promiscuous and that using FP was a sign of infidelity. This issue, however, was not raised by any men in the study. Some women reported violence as a consequence of using contraceptives without their husband’s consent. Prior qualitative studies also reported that women may suffer domestic violence for opposing their husbands. Studies suggest that a multi-sectoral action involving stakeholders from health, women’s rights, and education sectors is imperative to further research and address this issue [ 29 , 36 , 37 ].

Supply constraints (distance to a provider for getting contraceptives, out of stock, limited choices of contraceptives, unaffordable methods, etc.) could aggravate the unmet need for contraception. These constraints are similar to all regular supplies faced by the health system in Nepal. However, supply-side interventions such as increasing the number of health facilities distributing FP services, policy focusing on consistent operating hours, and full stock of a wide variety of FP methods could largely improve uptake and increase contraceptive coverage [ 18 , 38 ].

Most female participants did not speak up when asked about their perception of the role of men in FP. On the other hand, male participants explained that the role of the youth could be disseminating FP information, conducting awareness campaigns, organizing dramas and role-plays to educate people about the religious and cultural barriers of FP use, etc. With appropriate training, the young men said they would be willing to work for FP advocacy in the community.

Reproductive health leaders and planners should identify men who are willing to share decision-making authority with their wives and devise behavioral change interventions [ 39 ]. Male participation could support the FP programs and also help empower women [ 40 ]. The participants in the study expressed the need for the current FP programs to consider the community members as key stakeholders in planning FP programs. There is a need to further explore possible ways of working with the rural, marginalized communities and hard-to-reach or specific ethnic groups to improve their update of FP services [ 41 ]. There is evidence that mass media messages increase the likelihood of FP use, which could be considered by advocacy and dissemination programs [ 42 ]. Evidence from maternal and newborn health care research shows that interventions that engage men result in more equitable couple communication and shared decision-making. This may be a relatable concept to be considered for FP programs as well [ 43 ].

We urge those in charge of the health and sexual education curriculum to find ways to encourage teachers to give equal attention to these topics, including FP education, as they would to any other. It was reported that teachers were reluctant to teach about FP as they perceived the young students felt discomfort around this topic. Further research to identify innovative youth-friendly methods to teach sexual and reproductive health topics to students may be helpful. Youth groups should be regarded as important stakeholders in the redesign of school health curricula, particularly for their insight into culturally sensitive and otherwise effective ways for delivery. Health professionals, members of local organizations, and community leaders pointed to the necessity of addressing unmet FP needs and the stigma associated with FP use through community education approaches that take into account cultural norms and beliefs [ 44 ]. Interventions focusing on reproductive health education curricula involving school teachers could be considered [ 45 ]. Strengthening health systems, bridging service gaps, improving the integration of contraceptive services and counseling with routine health care are important strategies for increasing contraceptive uptake in eastern Nepal [ 22 ].

Among the study’s limitations was the fact that it was conducted in a single village in eastern Nepal. Our findings might differ if the sample had been drawn from other parts of the country. Although participants spoke fluent Nepali, some phrases used in local dialects could not be perfectly translated into Nepali or English. These responses could have been affected by social desirability as the participants may have felt constrained from speaking freely with people from health institutions. To help reduce these obstacles we held open meetings and drop-in sessions with the support of community youth to disseminate the purpose of the study and build rapport with the young people in the village before we approached them for the study. Moreover, participants were assured anonymity and confidentiality, which may have increased their willingness to participate in the research.

Conclusions

There appear to be information and communication gaps between women and men regarding FP services and programs. The information gap could be addressed by exploring ways to increase information uptake in schools through redesigning the curriculum delivery. Mass media may be used to disseminate appropriate health education regarding FP. Health institutions could consider approaches to create FP information and service centers that are male-friendly. The communication gap may be more deeply rooted in the culture and traditions of Nepalese society. In a mostly patriarchal society, further identification of motivations for men to participate in FP related activities could be challenging. However, it is promising that men may be willing to support their partners for FP decision-making and engage in strengthening FP programs through the “peer to peer” approach via youth-led centers and community clubs. Program managers and policy makers need to take into account the fact that youth are willing to contribute to ongoing FP programs. Doing so would help bridge the information and communication gaps between school education and practice. Innovative research to further explore perceived benefits by youth on the uptake of family planning, sexual and reproductive health services is needed.

Supporting information

Acknowledgments.

We extend our sincere thanks and regards to Dr. Agata Parfieniuk, Kirsty Lunney, and Anu Regmi for their invaluable contributions to the manuscript. We acknowledge the support received from Dr. Meika Bhattachan, Dr. Avinash Kumar Sunny, and Dr. Pawan Upadhyaya during data collection. The authors acknowledge the support received from the BPKIHS and participants for their participation in the study. Special thanks to Dr. Bibisha Baaniya, Dr. Garima Pudasaini, Dr. Soniya Gurung, Dr. Shristi Nepal, Bisha Baaniya, and Arshpreet Kaur for their generous support throughout the study.

Abbreviations

Funding statement.

The author(s) received no specific funding for this work.

Data Availability

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