Trends of Utilization of Family Planning Methods at Divisional Headquarter Hospital of Mirpur, AJ and K

G Research Article Trends of Utilization of Family Planning Methods at Divisional Headquarter Hospital of Mirpur, AJ and K Hina Zubair, Saima Perveen, Saeed Alam, Akkad Rafiq* and Sara Ejaz Assistant Professor of Obstetrics and Gynaecology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur Azad Kashmir; Associate Professor of Obstetrics and Gynaecology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur Azad Kashmir; Assistant Professor of Cardiology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur Azad Kashmir; Assistant Professor of Orthopaedic Surgery, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur Azad Kashmir; Professor of Obstetrics and Gynaecology, KEMU/ Lady Willingdon Hospital, Lahore. Abstract | Controlling the population growth is one of the most feasible solutions to reduce burden on the country and it can be achieved by effective use of contraception. This study was designed to analyze the trends of utilization of different family planning methods in relation with socio-demographic factors at divisional headquarter hospital in a year time. A retrospective study was performed by analyzing one year records from family planning clinic at divisional headquarter hospital. At family planning centers, a total of 920 individuals attended the Reproductive Health Services from April 2015 to March 2016. Among them, 92% individual utilized temporary methods and only 8% utilized permanent methods. Regarding temporary solutions, a total of 299 (33%) selected intrauterine device, 233 (25%) had used injectable, 191 (21%) adapted oral contraception pills and 121 (13%) selected Barrier methods (condoms). Among permanent solutions, a total of 76 (8%) had bilateral tubal ligation and no vasectomy. Investigations highlighted that males were not convinced to adapt male sterilization owing to social pressure of family. Findings of this study showed that the majority of the individuals are comfortable with the use of intrauterine contraception devices; however need of the hour is to introduce awareness compaigns to educate general public for better use of contraception especially male partner as it is less invasive compared to female partner.


Introduction
rowing population is the burning issue adversely affecting the development and social security in the world today, mainly in Asia, South America, Africa and especially in Pakistan and our neighboring country India. (1) Pakistan is one of the populous country with population of 190 million and a growth rate of 1.6% annually, New projections released by the United Nations indicate that Pakistan is among 6 th of the 10 populated countries in world and the population has been expected to exceed three hundred million by 2050. (2), (3) Right now, the population has been assessed to be around one hundred ninety million. In year 2030, the population would be around 244 million, and by 2100 population could be 364m.
The population of our region is at its tremendous increase, which is alarming for both individual and government, as it is adversely affecting the resources, endowment and environment. Unwanted pregnancies results in unsafe septic abortion, uterine perforation and hemorrhages leading to increase maternal morbidity and mortality. It mandates proper child spacing via contraception use to save mother and child, but unmet need of contraception poses a challenge to family planning program -to reach and serve. (4) Millions of women for some or other reason are not using contraceptive. It is a well-known fact that the acceptance of contraception by a couple is governed by many factors such as availability of services and facilities for provision of contraceptive devices. Apart from this, various socio demographic factors such as age, sex, religion, education, income, occupation, urban/rural differences, and family size also affecting the use of contraceptives. Thus this study attempts to analyze the trends of utilization of different contraceptive methods in one year at Divisional Headquarter Hospital of Mirpur AJ & K. (5)

Material and Methods
A retrospective record based study was performed to analyze the trends of utilization of different contraceptive methods in a year. The data was collected by analyzing the records from April 2015 to March 2016 from family planning clinic in Divisional Headquarter Hospital of Mirpur AJ & K. Inclusion criterion for this study was the individuals who used different contraceptive methods at family planning clinic. The various socio-demographic factors such as age, gender, religion, family size and utilization pattern in reference to urban and rural area were analyzed for adoption of different family planning methods. Data were analyzed using percentage algorithm.

Results and Discussion
During the one-year period, a total of 920 individuals attended the reproductive health services from April 2015 to March 2016 at family planning clinic. Among them, 92% individual utilized temporary methods and only 8% utilized permanent methods. Among temporary, out of total 299 (33%) selected intrauterine device, 233(25%) had used Injectable, 191(21%) took oral contraception pills, and 121 (13%) selected Barrier Methods (condoms). Among permanent 76 (8%) had bilateral tubal ligation and no vasectomy. Males are not convinced for male sterilization due to social pressure of family. The most contraceptive methods were used between age group 28-40 years age. (Figure 1)

FIGURE 1
Types of contraceptive method  The present study revealed that 92% individuals accepted temporary methods for contraception whereas only 8% chosen permanent methods. Out of 92%, majority of individuals (33%) preferred the use of IUCD and followed by injectable contraceptives by 25% and then oral contraceptive pill (21%). Out of permanent methods, utilization of tubectomy with no vasectomy was adapted by 8% of subjects. Studies conducted by Sajiid A., Malik S. at Lady Aitchison Hospital, Lahore, 2010 and another study by Seema Bibi, Amna Memon in two districts of Sindh, shown contrary findings indicating that tubal ligation was the most common method of family planning followed by condom and IUCD which may be due to social customs, fear and cultural misbelieves about accepting IUCD of that particular area (5), (6) . A study by Rozina Mustafa and Haleema A Hashmi in Karachi and another in urban population of North India in 2008 had found that condom was the most common method, which is also in contrast to our study. This could be due to high risk of failure of condom as compared to IUCD with which failure rate is low. (7) The interesting finding emerged out of this study is that adoption of injectable methods was more as compared to oral contraceptives. This is most probably due to fear of forgetting taking oral tablets and burden of remembering to take tablets daily. (8), (9), (10) Multicenteric study shows methods for contraception use differs country-to-country according to their cultural and traditions values in terms of total use and the sorts of methods used. (11) , (12) Around the globe, a total of 63% of married women ages 15 to 49 years use a contraceptive method; 57% use a new modern methods. While more women in much developed countries use contraception, in most of the under developed countries, less than one in five married women use any of the method. Contraceptive use has risen steadily over time in most developing countries, as is the case in Colombia and Bangladesh. (13), (14 ), (15), (16) Still, use of family planning methods has continued stable or even dropped in others, for example Jordan and Nepal. Most popular method right now in the world is Female sterilization for the birth prevention. (17), (18) United Nations global survey of reproductive health declared in his statement that in married women one fifth depends on female sterilization (tubal ligation). In China, India and Brazil more than one third of all married women have been sterilized for birth control. (19)

Conclusions
In present study, trend of utilization was found most common for temporary (92) as compared to permanent (8%). Female are mostly using the contraception. Male should be counseled for vasectomy as it is simple procedure as compared to female tubectomy. All resources like Media Maulanas in Mosques and leaders should be involved to avoid the myths. More and more camps should be arranged to provide education and awareness to the both rural as well as urban population for benefits of use of contraception.

Authors Contribution
Hina Zubair: Data collection.
Saima Perveen: Data collection and supervision.