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A study to assess the contraceptive use among married women of urban slums: a cross-sectional study

The meaning of contraception is to prevent the sperm to unite with the ovum, which results in failure in implantation of fertilized ovum with uterus. Annually 60,000 women died globally due to pregnancy related causes and about 75,000 died due to unsafe abortion. Out of these, 20000 women died due to lack or failure of contraceptive devices. As a result of these unintended births, women suffered many physical and mental health problems. One of the study done by population action international in developing countries that due to increase in spacing between births, there was a decrease in twothird infant mortality rate.So, to increase the spacing between the births, Family Planning methods should be made accessible and available to all reproductive population so that they responsibly decide about when and how many children they have (by choice and not by chance).


INTRODUCTION
The meaning of contraception is to prevent the sperm to unite with the ovum, which results in failure in implantation of fertilized ovum with uterus. 1 Annually 60,000 women died globally due to pregnancy related causes and about 75,000 died due to unsafe abortion. 2,3 Out of these, 20000 women died due to lack or failure of contraceptive devices. As a result of these unintended births, women suffered many physical and mental health problems. 4,5 One of the study done by population action international in developing countries that due to increase in spacing between births, there was a decrease in twothird infant mortality rate. 6 So, to increase the spacing between the births, Family Planning methods should be made accessible and available to all reproductive population so that they responsibly decide about when and how many children they have (by choice and not by chance). 7 The Family Welfare Programme in India is a centrally sponsored programme/scheme to reduce the unwanted pregnancies with the introduction of contraceptives. As a result, it can reduce the maternal mortality because of reduction in high risk pregnancies as well as abortions. 8 It has been observed that with the use of modern contraceptives, we can prevent one-third of maternal deaths. 9

METHODS
Present community based cross-sectional study was conducted in the eligible couples of slums in the Trikuta Nagar area, District Jammu which is a field practice area of Department of Community Medicine, GMC Jammu, J and K. Trikuta Nagar consists of sectors 1 to 9 and extension with population of 16000 (Census 2011) and 14 scattered urban slums are under the centre and urban slum population consists of 900 (survey). According to recent data, number of eligible couples (which are in the age group of 15-44 years) are 180. Information was gathered from the married females of reproductive age group. 50% of the population was selected randomly by lottery method i.e. 90 females. But at the time of study, only 85 married females could be interviewed because of the nonavailability of females at the time of interview and some households were locked during the interview schedule. Except for the absence of married females/locked households, there were no other exclusion criteria in this study. After taking clearance, all the staff members as well as Anganwadi workers of Urban Health and Training Centre, Trikuta Nagar were sensitized about the objective of the study. They were then asked to inform the urban slum population during the Urban Health and Nutrition Days (UHND's) and through Anganwadi workers so that adequate cooperation of the families can be met because they are mostly Labour class. A semi-structured questionnaire was administered to the study participants.
The data was entered in Microsoft excel and analyzed in terms of number and percentages. Table 1 shows the demographic characteristics of the respondents with numbers and percentages. The results showed that the maximum females were in the age group of 15-25 years followed by 26-30 years age group. More than 50% were literate, 42.35% had education upto primary level. More than 50% females were selfemployed as they were labourers and rests were homemakers. The duration of marriage of most of the respondent women was 0-5 years and 44.70% of women had three living children. 65.88% women had one year gap between the first two pregnancies. Table 2 depicts that majority of females got the information about the contraceptive methods from media followed by health workers. Most of the females used Barrier method (male condom) as a choice of contraceptive followed by pill and IUD. Table 3 shows the level of awareness about the contraceptives among the married females.

DISCUSSION
The present study participants were mostly in the age group of 15-25 years which was more younger age group as compared to the another study where mostly females were in the age group of 25-29 years. 10 37.64% of females were illiterate and majority were literate upto secondary level. But some studies showed the contradictory results, wherein only 4-5% were illiterate. 11,12 Most of the females in urban slums were self-employed (64.70%), rest were homemakers (35.29%). They were mostly labourers by occupation working in various areas. But in one study done in Karnataka, majority of the females were housewives. 11 The source of information about the contraceptive methods was mostly from the media followed by health workers and similar findings were observed from the other study as well but some studies shows the contradictory results, as the maximum information about the contraceptives received by the females was from the health workers. 10,11 The present study revealed that they had 55.29% of awareness that the use of contraceptives prevent unwanted pregnancies followed by 29.41% females who had awareness that the usage of contraceptives increases the gap between the pregnancies and similar results were observed in another studies as well. 10,11 76.47% females were aware about the sideeffects of the contraceptives.
The contraceptive method used by married females of urban slums were mostly barrier method like male condom followed by pill and IUD and the similar results were reported by other studies as well. [12][13][14] Those females who were using the contraceptives, the commonest sideeffects were pain (45.88%) followed by bleeding (11.76%).

Limitation
Limitation of the study was small sample size.

CONCLUSION
Information, education and communication activities are needed to be increased to promote awareness among the females residing in urban slums, about the advantages of using contraceptives and its side-effects as well. The access of these contraceptive services is very problematic in urban slum population, as these are mostly labourer class and migrant population.