A study of knowledge, attitude and practice of family planning
among the women of reproductive age group in Sikkim
Renjhen Prachi 1, Gupta Shuva Das 2, Barua Ankur 3, Jaju Shipra 1, Khati Binita 2,
Paper received on 15/02/2006 ; accepted on 23/09/2007
Dr. Renjhen Prachi
Department of Obstertrics and Gynecology
Sikkim Manipal Institute of Medical Sciences
5th Miles, Tadong, Gangtok,
Sikkim - 737102 Email : firstname.lastname@example.org
Department of 1 Obsterics and Gynaecology 2 College of Nursing and 3 Department of Community Medicine, Sikkim
Manipal Institute of Medical Sciences, Gangtok
Family planning is defined by WHO as “a way of
thinking and living that is adopted voluntarily, upon
the basis of knowledge, attitudes and responsible
decisions by individuals and couples, in order to
promote the health and welfare of family groups and
thus contribute effectively to the social development
of a country”.
India is the second most populous country of the
world. The Govt of India launched a family welfare
program in 1950’s to accelerate the economic and
social development by reducing the population
growth. But this program has met with only marginal
success. This is because people of India being
multilinguistic, multireligious and multiethnic, have
different levels of awareness and acceptance of
methods of family planning. It is thus, necessary to
develop special program to tackle the needs of
different groups. But before launching a special
program, a thorough understanding of the different
Objectives : To assess the knowledge and attitude regarding family planning and the practice of contraceptives among
the women of reproductive age group in east Sikkim and to determine the barriers for contraceptive use among them.
Methods : A cross sectional descriptive study was done in the Obstetrics and Gynaecology Department of the STNM
Hospital and Central Referral Hospial, both attached to the Sikkim Manipal Institute of Medical Sciences. The study
group included 443 women of reproductive age group (15-44 years) attending the two hospitals during the month of
January 2004 to March 2005. Their knowledge, attitude and practice on contraceptives were evaluated with the help of
a predesigned questionnaire. Results :It was found that 98% of the women had knowledge about family planning and
94.2% of them had knowledge aboaut contraceptives. Over 50% had gained information from media. Majority (98%)
thought that contraceptive use was beneficial but only 55.2% had used contraceptives and 84% of them were satisfied.
Sixty-two percent were currently using contraceptives, 37.9% of them were using oral contraceptives, 37.9% of them
were using oral contraceptive pills and 31% were using condoms. Conclusion: The study highlights that knowledge and
awareness doen’t always lead to the use of contraceptives. There is still a need to educate and motivate the couples and
improve family planning services to achieve more effectie and appropriate use of contraceptives and to arrest the trend
towards increase in population.
Key words : family planning, contraception, knowledge, attitude, practice
J Obstet Gynecol India Vol. 58, No. 1 : January/February 2008 pg 63-67
levels of awarenss and acceptance of methods of
family planning. It is thus, necessary to develop
special program to tackle the needs of different
groups. But before launching a special program, a
thorough understanding of the differentials and
determinants of fertility and mortality is essential. In
recent years, the need for such studies to understand
the factors determining the fertility and family
planning acceptance and practices by particular
communities has been felt, so that more specific
knowledge can be gained about factors determining
family planning acceptance by particular
communities, which can then be used for developing
suitable program for them.
Our study was undertaken to find the reasons for
these unmet needs and factors affecting the outcome
of family planning program and to have a better
understanding of the situation in order help
government in formulation of polices and modify its
approach in east Sikkim.
A cross sectional descriptive study was done in the
Obstetrics and Gynaecology Department of the
STNM Hospital and Central Referral hospital
Gangtok. The study group included all the 443 women
of reproductive age group (15-44 years) attending
the two hospitals., from January 2004 to March 2005.
The literacy rate and religious wise distribution of
women attending the two hospitals is similar.
The inclusion criteria: women of reproductive age
group, visiting STNM and Central Referral Hospital,
who were willing to participate in our study. The
exclusion criteria: women below or above
reproductive age group and those who were, not
willing to participate in our study. Purpose Sampling
with snowball technique was used. A well-structured
questionnaire was used for data collection on general
information, knowledge and attitude regarding family
planning methods, and contraceptive practices.
Permission for the study was obtained from the heads
of both the hospitals. Data were collected through
questionnaire by interview technique.
The dependent variables were knowledge, attitude,
and practice of women regarding family planning.
Independent variables were age of the women of
reproductive age group, age at menarche, age at
marriage, duration of married life, consultation of
family planning at marriage, and religion.
Descriptive statistics was used for data analysis. All
the collected data were analyzed with regard to the
information given by the subjects in the set
Amoung the 443 women in the study group more than
80% were in the age group of 15 to 34. Majority were
Hindus (76.7%) followed by Buddhist (14.3%).
Muslims and Christians formed a minority. Eighty
percent of females were literate. Almost all (95.7%)
were married and majority (80.1%) of were
housewives (Table 1).
Table 1. Sociodemographic correlates (n=443).
Age 15-24 years
Unskilled / Skilled worker
Ninety eight percent of the women had heard about
family planning methods and only very few (2%) were
unaware. About 54.4% of women got information
about contraceptives form mass media (Table 2)
Renjhen Prachi et al
According to most of the women family planning
meant having small and happy family and only 29.8%
said it was for birth spacing. Almost all (95.8%) of them
had heard about oral contraceptive pills. 74.2% of the
them had heard about condoms and 72% were aware
about Copper-T, and over half (67%) of them had heard
about tubectomy and nearly one third (34%) were aware
about vasectomy. Most of them knew that contraceptive
were available in Government Hospital (62.8%) and
Medical shops (52.5%) (Table 2).
Table 2. Knowledge and awareness regarding
Heard about family planning
Aware of contraceptives
Know where to get
Concept regarding small family norm * N=434
Small and happy family
Methods of contraception*
Source of availability * N=413
Private health institute
Medical shop / Pharmacy
Reason for using contraceptive aN = 417
Having a child when required
Spacing of birth
Prevention of unwanted births
Prevention of Sexually
Improvement of health
a * Multiple responses
83.5% of women knew that contraceptives were used
for preventing unwanted births and only 8.2% knew
that condom can be used to prevent sexually
44.6% women were not using contraception, but were
willing to adopt family planning in future and over
98% women though that family planning was
beneficial and 93.2% said hat they would like to
encourage their friends and relatives to use family
planning (Table 3).
Of 215 women who had used contraceptives, 85%
were satisfied with contraceptives that they had used
in the past and 62% were still using contraceptives
and were satisfied with the contraceptives they were
presently using. Among the user of contraceptives
37.9% of had oral pills and 31% the barrier method
(condom). Twenty seven percent had undergone
tubectomy and 24% had used Copper T
55.5% of the women chose the methods because they
found it comfortable, and easy to use. In 41.6% of
the women the choice of methods used was decided
by their husbands (Table 4).
Barriers to using contraceptions
30.8% of women did not disclose the reason for not
using contraceptives. 25.5% were not using any
contraceptive because they were planning
pregnancy, while 14.8% because they did not have
knowledge about contraception. 10.6 were currently
pregnant (Table 5).
Table 3. Attitude towards family planning (n=434).
Attitude n=434 % age
Use of contraceptives is beneficial42598
Would practice-family planning, or
encourage a friend to40493.2
If you have never adopted family planning 198 44.6
Willing to adopt family planning if not done earlier.
A study of knowledge, attitude and practice
Table 4. Contraceptives in the past used ** (n=215)
Oral Contraceptive used Number Percentage
Others (Injection)18 8.6%
Reason for using them a
Comfortable and easy to use11955.5%
Husband’s choice89 41.6%
Multiple responses by some patients.
Table 5. Bariers to using contraceptives * (n=198)
Barrier of contraceptive
Currently Pregnant21 10.6
Desire to have a child 50 25.5
Currently in puerperium period8 4.2
Lack of knowledge regarding
Against religious beliefs8 4.2
Opposition of partner4 2.1
Fear of side effects17 8.5
Husband vasectomised25 12.7
Respondent tubectomised15 7.6
willing to disclose
Multiple responses by some patients
During the course of literature review many books,
newspapers, articles and journals were searched. The
literature about family planning in the context of
Sikkim was limited.
In the present study more than 80% were in the age
group of 15 and 34 years and were literate. The age
group characteristics were similar to the study
conducted by Shrivastava et al in Ghorakhpur 1 but
in their study nearly half of the women were illiterate
and from rural background. Mohanan et al 2 in a study
from Dakshina Kannada concluded that majority
(52.4%) of the women using contraception were in
the age group of 15-34 years.
A survey conducted in Manipur by Donati et al 3
concluded that the use of modern family planning
methods increases with education, while female
sterilization prevalence decline sharply with women’s
education level. Muslims had lower rates of
contraceptive use (17%) than Hindu (62%) even after
controlling for education. This is also corroborated
by our study wherein majority of users were Hindus
76% compared to only 3% Muslims.
In our study 54.4% had gained information from T.V
/ Radio, Newspapers and Magazines, 37% from
friends and relatives, and only 7.9% from health
personnel, whereas in Srivastava et al’s 1 study 70%
had gained knowledge of contraceptives from friends
and family and 39% from television and radio.
95.8% of our subjects knew about the oral
contraceptive pills, 74.2% about condoms, 72% about
copper T, 67% about tubectomy and 34% about
vasectomy while in Srivastva et al’s 1 study 82% were
aware about female sterilization, 50% were aware of
vasectomy, and IUCD was the most known (61%)
temporary method followed by OC pills (60%) and
condoms (50%). In their study 17% were not aware
of any form of contraception as against 6% in our
In our study 44.6% had never used any contraceptive
compared to 55% in Srivastava et al’s 1 study and 8%
in Young et al’s study done in New Zealand.
In our study among the users of contraceptives 37.9%
had taken oral contraceptive pills and 31% had used
condoms while in Srivastav et al’s 1 study 34 % had
used condoms, 26% natural methods and only 18%
In a study done in fishermen in Tamil Nadu 4 almost
two-fifths of the respondents had ever used some
type of contraception during their married life and
sterilization was the most accepted method. Singh 5
Renjhen Prachi et al
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et al in a study from Manipur conclude that 70% of
the couples had adopted permanent family planning
methods. In our study 27% of the used had accepted
tubectomy. India being multilinguistic, multireligious
and multiethnic population, it is necessary to develop
special program to tackle the needs of different
Our study highlights that knowledge and awareness
doesn’t always lead to the use of contraceptives.
One needs to understand the level of awareness and
practices in the community before implementing the
family planning program. There is a need to educate
and motivate the couples along with improvement in
family planning services to promote the
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Contraceptive knowledge attitude and practice (KAP)
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knowledge attitude and practice survey in Manipure
state J Obstet Gynecol India 2003;53:485-90.
3. Mohanan P, Kamath A, Sajjan BS Fertility pattern
and family planning practices in rural area in dakshina
Kannada. Indian J Com Med 2003;28:15-8.
4. Rao, GR. Moulasha K, Surrender S. Knowledge
attitude and practice of family planning amoung
fishermen in Tamily Nadu Family Welfare. September
5. Singh RKN, Ibetomb Devi, Bidhumukhidevi et al.
Acceptability o contraceptive methods among Urban
eligible couples of Imphal, Manipur. Indian J Com
A study of knowledge, attitude and practice