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Awareness, attitude and practice on contraception among the clients attending abortion service at a zonal hospital

Introduction: Contraceptive methods are important components to reduce unwanted pregnancy, abortion, maternal and child morbidity mortality. This study aim to identify awareness, attitude and practice on contraception among women attending abortion services at Seti Zonal


Introduction
Globally, 214 million women of reproductive age are not using modern contraceptive in developing countries to avoid unwanted pregnancy. 1 However, unmet needs for modern contraceptives was still very high, especially in south Asia at 34% and western Asia 50%. 2 The contraceptive prevalence rate (CPR) among women aged 15-49 years is 53% whereas 24% reproductive age woman have an unmet need for family planning. 3 In the Far Western Development Region (FWDR) of Nepal the use of modern CPR decreased from 42% to 38%. 4 Each year 25 million women around the world have unsafe abortion, among them 44,000 die or suffer serious injuries from unsafe abortion. 5 Center for Research on Environment, Health and Population Activities (CREPHA) Nepal, estimated 42 abortions per 1,000 were performed in Nepal in 2014. 6 The positive impact of family planning can avoid unwanted pregnancies. 7 The aim of the study was to identify awareness, attitude and practice on contraception among clients attending abortions services.

Method
A cross-sectional research was conducted in the abortion unit of Seti Zonal hospital, Nepal, from 12 th August 2018 to 7 th September 2018. All woman who attended abortion services during this period were included in the study. Health professionals were excluded from the study. Enumerative sampling technique was used to collect data.
A self-developed questionnaire was used. The interview tool was developed by reviewing pertinent literature, consulting with a research advisor and subject faculties. 8,9,11,13 Data was collected by using structured face to face interview schedule in Nepali version.
The data was collected by the researcher herself. Separate counseling room was used to collect data. The time selected for data collection was 10 am to 4 pm, after the abortion when their pain relieved (half an hour to one hour after abortion). The average time required to complete the interview was about 20 to 25 minutes, 3-6 respondents were included in the study per day. The data was collected 6 days a week excluding public holidays.
The data were processed using the Statistical Package for Social Science software (SPSS version 16). The data were analyzed using descriptive statistics such as frequency, percentage, mean, standard deviation, and quartile. The Inferential statistics, Chi-square and Pearson's correlation test was used.
Ethical approval was obtained from the Institutional review committee (IRC) of Patan Academy of health Sciences (PAHS). Permission was obtained from the Administrative Department and safe abortion service unit of Seti Zonal Hospital, Nepal, before data collection. Verbal Informed consent was taken from every woman by explaining the objectives of the study. Confidentiality of all the data was maintained.
Majority of respondents 78 (82.9%) were literate, 1 (1%) was unmarried, 54 (57%) had nuclear family, 67 (71%). Two third got married before the age of 20 years, mean age was of marriage 19.3±3.12 years, minimum 12 years first pregnancy was 20.4±3.03 years. There is an association between types of family and level of awareness (p<0.001).
There is no relationship between awareness, attitude and practice, Table  5. (2.1) 3.01±1.14 Note 1:-Strongly Disagree 2:-Disagree 3:-Neutral 4:-Agree 5:-Strongly Agree Among the participants, 52 (55.3%) agreed that the contraceptive methods were not assumed to affect the ability to become pregnant after terminating its use. In contrast to the study that many concerns were expressed about effects on future fertility. 12 The current study showed a positive attitude towards contraception among the clients attending abortion services. Similar finding that all respondents had a positive attitude was found in other study. 13 The current study shows that the reasons for previous abortion were due to completed family, bleeding and congenital anomalies respectively. Similarly, 20.68% clients reported history of abortion and the main reason was complete family. 8 The current study shows, 84% had the intention to use contraception after terminating the pregnancy, similar to the findings reporting 84% woman had the intention to use contraception after terminating the pregnancy. 14 The present study shows woman in nuclear family had a high level of awareness, in contrast to the findings reporting association of knowledge of emergency contraception with the place of origin, religion, occupational status and education. 15 This study shows that there is no relationship between awareness and practice, similar to other reported study. 15 The current study shows that there is no relationship between awareness, attitude and practice. Similarly, there was no relationship between awareness and attitude. 9 The possible implication of outcomes of the present study could be the management committee of Seti Zonal hospital to improve and strengthen the awareness program regarding contraception that helps to reduce unwanted pregnancies.
The possible limitation of the study includes the use of tool that has not maintained reliability, and may affect the understanding and thinking about contraception.

Conclusion
The findings of the study show that one-third of the women who attended abortion clinic had adequate level of awareness of contraception, and more than one-third had positive attitude towards contraception.