The study aimed to assess the level of effective knowledge of women on different family planning methods to see the impact of quality of care. The study was carried out in two villages chosen from ICDDR,B intervention and comparison areas of Matlab thana where BRAC’s Rural Development Programme (RDP) has also been working since 1992. From both the areas 600 women of reproductive age were randomly selected and interviewed.
The findings reveal that in the MCH-FP area 56% of women practiced family planning while only 33% did so in the comparison area. In both the areas the main methods used were pills and injectables.
Regarding the knowledge of contraceptives, most women in the MCH-FP area were able to name five modern methods while the majority in the comparison area could name only three methods. Virtually all women in both the villages could describe the nature of the pill and ligation while many had no idea about IUD and condom. Correct categorization of methods as temporary or permanent was found to be higher in the MCH-FP area than in the comparison area. The study found that women in both the areas had little or no knowledge of the specific indications of all methods.
The majority of women n the MCH-FP area knew about proper use of pill, injection and condom compared to those in the comparison area where none had complete knowledge regarding any method. However, even in the MGH-FP area women did not know what to do if two pills were missed. The nature and the function of the brown tablets were not known to the women in the comparison area but some women in the MCH-FP area had some idea of the former.
In the MCH-FP area 78.4 % of the women knew the specific date of menstrual period from which injection should be started compared to the comparison area where only some of them knew about that. The majority of respondents in both the areas knew that it should be taken regularly at an interval of three months on a fixed date, which was significantly higher in the MCH-FP area. The study found that majority of women in the MCH-FP area knew the exact time and frequency of using condom compared to the comparison area where only a few knew that. This is not surprising given that only a small proportion of women in the comparison area ever heard of condoms and that none of the couples were using it. Women had no knowledge about the timing of insertion of IUD, but only that it had to be replaced periodically at an interval of 2-4 years.
Women’s general perception about the mechanism of action of the different methods was that they act by damaging the sperm or ovum. Women had no clear idea about the advantages of any of the methods. It was found that most of the women in the MCH-FP area were interested in injection, as the main advantage was that one injection provided three months’ protection and maintained privacy (as it was administered like any other injection). This was specially appreciated by those who were shy about using contraceptives.
Women had little knowledge of the side effects of contraceptive methods. The commonly mentioned side effects of pill and injection were: giddiness, weakness, headache, and irregular and heavy menstrual bleeding. Some respondents mentioned that injection caused prolonged amenorrhoea which in turn caused bodyache, and burning sensation in hands and feet. The women in the MCH-FP area had misconceptions about condoms such as that it might cause genital ulcer. The side effects of ligation were more often assumed than actually experienced. The respondents believed that ligation was dangerous for health and caused heavy and irregular menstruation, severe weakness, which makes women unable to do heavy work and even causes death.
Women’s confidence in the management of the side-effects, as well as the knowledge of the safety of a method is directly related to user’s health and its use. But this study shows that women had no adequate knowledge of side effect management. Majority of the women in both the areas said that the side-effects had to be compensated by eating more nutritious food. The perceived effectiveness in preventing pregnancy is a prime consideration in method choice. The findings revealed that most women in both the areas had a satisfactory level of knowledge about the effectiveness of different methods.
The study showed that in the MCH-FP area, fieldworkers and in the comparison area government fieldworkers, relatives and neighbours were the major sources of information. From our findings it is understood that service providers put emphasis mainly on pill and injection. They did not provide information, education and motivation (IEM) about female clinical methods such as IUD and ligation or of male methods.
This study provided deeper insights into the impact of quality of care. The study conclusion is that, both contraceptive users and non-users do not possess adequate knowledge of family planning methods. Women are doubtful and confused about the contraceptives in general. The ICDDR,B MCH-FP Programme and BRAC’s rural development programme in the area have paved the way to improving quality of services through appropriate LEM. This will help make people more aware about family planning, MCH facilities and their benefits on individuals, families and communities. However, the study suggests the following for further improvements in the family planning programme.
1. The programme should think about the ways of widening individuals’ knowledge of availability, source, cost, suitability, etc. of all methods including male methods.
2. The non-users should be made aware of family planning. This may be done by arranging an informal discussion with them on a weekly basis in the community in small groups. Collaboration with the government of Bangladesh and other NGOs may be taken into consideration.
3. Programme should provide detailed and equal accounts about indication, proper use, inherent characteristics, benefits, consequences and possible complications of different methods for the success of family planning programme, as well as for clients’ own satisfaction and confidence.
4. Women should be provided with detailed information about the common side-effects, psychological problems, and ‘warning signs’, how to deal with them at home and when to inform the providers. They should be given proper counseling before and after adopting contraception. The information about the mechanism of action of these methods and basic knowledge on the physiology of the reproductive system may play an important role. It will be helpful to eliminate anxiety about their health, traditional beliefs, misconceptions and fears.