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DOI: 10.4172/jcmhe.1000102
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ISSN: 2161-0711

Research Article Open Access

Demographic, Socio-Economic and Cultural Factors Affecting Knowledge

and Use of Contraception Differentials in Malda District, West Bengal
Nazmul Hussain
Research Scholar, Department of Geography, Aligarh Muslim University, Aligarh-202002

Abstract
The demographic profile of India is characterized by one of the high levels of fertility, low ages at marriage and
relatively low contraceptive prevalence. The present paper aims at analyzing the level of awareness and adoption of
family welfare methods, assessing the source of information and ascertaining the reasons of non-acceptance. Our
study was planned to know the contraceptive practices among females in the reproductive age groups in rural area of
Malda, West Bengal. The study used data collected from 2587 married women (age 15 to 44) were selected through
systematic random sampling techniques. Data were analyzed by simple percentage for easy understanding of the
problem. The findings of the study Revealed that the level of knowledge of family planning were high, 98.69 per
cent. However, the actual practice of family planning methods was found to be low where only 55.28 per cent were
using any family planning method in their life span. The substantial variations in awareness as well as in adoption of
contraceptive methods have been observed across the various societies, castes and religious groups in this study.
On an average awareness level accounts for 78.18 per cent and adoption rate 68.73 per cent. The concerted effort
is needed from Governmental, Non- governmental and Multimedia organizations for enhancing the awareness
about the family welfare programme so that it could lead automatic enhancement in adoption rate. The behaviour
related to reproduction is determined by cultural and religious values in some communities. No significant association
of contraceptive usages was observed with age of marriage and literacy. A statistically significant association of
contraceptive usage was seen with number of living children, religion and the age of female.

Keywords: Adoption; Contraceptive; Family Welfare; Family; Joint;
Knowledge; Methods and Nuclear.
Introduction
One out of six people on this globe live in India. It occupies
second place after China. More so, the population of India expected
to exceed of that of China by year 2045. The country has steady
population growth has put tremendous pressure on the land and
natural resources and has strained them. As the population of the
developing countries increase day after day, most of the people
residing in the developing countries like India face economic and
social unfairness which leads to poverty [1]. Population explosion has
been India’s major problem since Independence due to its high fertility.
Government has been taking various steps to combat this problem.
Adoption of family planning methods is one of the best solutions to
tackle the problem of high fertility and ultimately lead to population
explosion. Modern contraception has been one of the several paths
for people to control the high fertility and large size of the family.
India is the first country in the world officially adopted the Family
Planning Programme in 1952. Rao [2] argued that in spite of political
commitment for the Central Government funded National Family
Planning Programme, the birth rate has not come down as desired.
A lot of changes have been made to this programme to make it
more acceptable and accessible to the larger section of the society.
Government goes to the extent of monitory benefits for those keeping
their family size small. However, fifty years later this has not prevented
the population touching the one billion mark. It is obvious that despite
good intentions and concerted efforts the state has failed in controlling
our population. Considering the seriousness of the situation it is
appropriate to introspect and ascertain as to what went wrong. The
National Family Welfare Programme was launched to promote
responsible and planned parenthood through voluntary family
planning methods. Couples have the choice of adopting temporary or
preventive measures. Facilities for medical termination of pregnancies
which provide access to contraceptive information and services, make
it easier for couples to plan the number of children that they would like
to have. In an effort to lower the desired family size, they also help to
spread the idea that birth control is within the realm of human choice
and they provide information about the benefits of small families [3].
Family planning could prevent as many as one in every three
maternal deaths by allowing women to delay motherhood, space birth,
avoid unintended pregnancies and abortion and stop childbearing
when they reached their desired family size [4]. A WHO expert
committee has defined five methods in 1975 to evaluate the success
of Family Planning Programme. One of them is the evaluation of
knowledge, attitude, motivation and behavior among people. The
knowledge and attitude of people towards Family Planning methods
are important determinants in the adoption of Family Planning
methods [5]. Much is known about womens’ role in the adoption of
Family Planning methods. Females have often been neglected in both
Family Planning programme and in surveys used to design and evaluate
such programmes. But the reproductive and child health programme
of the Government of India has felt the need for involving women
in Family Planning Programme. Since women are not the dominant
decision makers in India family system as Indian society is patriarchal,
it is prudent to discover the knowledge, perception, attitudes and
contraceptive adoption of women and improve their involvement in
reproductive health needs of family.
Corresponding author: Nazmul Hussain, Research Scholar, Department of
Geography, Aligarh Muslim University, Aligarh-202002, Tel: +91-9410060741;
Email: nazmul10@gmail.com
Received September 09, 2011; Accepted November 16, 2011; Published
November 18, 2011
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors
Affecting Knowledge and Use of Contraception Differentials in Malda District, West
Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

in certain circumstances are also available. The use of contraceptives Copyright: © 2011 Hussain N. This is an open-access article distributed under
has increased in recent period. Family planning programs have been the the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
centerpiece of government efforts to reduce fertility. These programs, source are credited.

J Community Med Health Edu Volume 1 • Issue 1 • 1000102

ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102
Women attitude is much more important in the adoption of
temporary methods of contraception and also in limiting the family
size. Many rural women are reportedly reluctant to accept any method
of contraception. Several studies also revealed that rural women who
were unwilling to accept family planning methods were concerned
about child survival and viewed children as a source of support in old
age [6]. The perceptions and the behaviour related to reproduction are
strongly, even predominantly, determined by prevailing cultural and
religious values [7]. Ntozi and Kabera [8] found that the low use of
modern methods of contraception was caused by the lack of knowledge
of supply sources, low education, low levels of employment outside the
home, unavailability of supplies and cultures. The focus of this study
is to analyze the demographic and socio-economic factors influencing
contraceptive knowledge and use. Understanding the pattern of
contraceptive use among married women is very important in relation
to designing programs and policies to control fertility in order to
maintain a low fertility level.
In view of the above narrated facts, it was decided to study the
knowledge, attitude and adoption of married women regarding the
adoption of Family Planning methods. As India is a country of great
diversities of religion, culture, socio-economic status and literacy
so there is a varied range of attitude and perception of the people
towards the family planning. These diversities exist even within the
region, states and even district also. Various studies have been done
to know the contraceptive practices in different regions of the states
and country. During the last few years, studies have documented
that family planning service is influenced by various factors which
includes demographic characteristics, psychological, knowledge and
attitudinal factors and the like [9]. Above all the religion is one of the
important factor influence the decision of adopting the family planning
programme. The present study attempts to know the contraceptive
practices among currently married women (CMW) in the reproductive
age groups (15-44 years) in rural area of Malda district, West Bengal.
To be specific, the paper aims at answering the question: the status
of determines factors the family planning decision to the family and
women in a particular.
This paper attempts to know the level of awareness and prevalence
of methods of family planning among the female of the rural areas
of Malda district, West Bengal. Researchers have found that many
factors affect contraceptive use. The efforts have also been made to
study the relationship of socio-economic determinants various factors
i.e. age, education, total family income, occupation, religion, caste,
and number of children and sons on to the level of knowledge and
use of contraceptive practices. On the basis of above discussion the
following questions will be attempted, what the factors are related to
the contraceptive usage of reproductive age in Malda district of West
Bengal, how far married women are informed about the methods of
contraception.
The study was conducted in Malda district of West Bengal. Malda
district is a centrally located district of West Bengal. Geographically,
Malda district is extended between 24o40’20” and 25o32’8” North
latitudes, and 87o45’50” and 88o28’10” East longitudes, according to the
2001 census the district is covering an area of about 3733 sq. km (4.2
per cent of the total geographical area of the state) and supporting
3.29 millions of people (4.1 per cent of the state population). Out
of total district population 1.63 million are Muslim and 1.62 million
Hindu. There is small number of others religious group’s people
(Christians 8388, Sikhs 283, Buddhists 164, Jains 293 and others
23701). The district records about 92.68 per cent of the population is
rural living over 1642 villages (including 44 uninhabited). The district
J Community Med Health Edu
ISSN: JCMHE, an open access journal
Page 2 of 9
is socio-culturally and economically one of the lagged behind districts
in West Bengal. The district is inflicted with dire socio-economic and
cultural disparities across the region and human groups as well. Malda
district stands at bottom having lowest index of Human Development
in the state [10].
Material and Methods
The study was carried out in rural area of Malda district, West
Bengal. It was a cross sectional and descriptive study. The main data
for this study has come from primary data source. The information
for the present study has been collected from 2390 households, selected
from 80 villages at 5 per cent from rural area of Malda district, West
Bengal. Study was interview based one respondent from one household.
A total of 2587 currently married women (CMW) who were in the
reproductive age group of 15-44 years from the selected household of
2390.
For the purpose of collection of data a pre-coded structured
interview schedule was prepared and then required data were collected
from the women by direct interview method. The survey was conducted
during January-March 2010. On an average, one interview lasted for
about 45-50 minutes. All the selected households were interviewed,
based upon a semi-structured pre-designed and pre-tested interview
scheduled after taking consent from the subject. The study area is
characterized by all castes and communities. The information pertaining
to demographic and socio-economic characteristics of households, and
attitudes of spouse regarding family planning acceptance, has been
collected through in depth interviews with structured questionnaire.
The respondents were categorized on the basis of their age, caste,
occupation, education and income, etc. The data collected was analyzed
by using percentages.
After the collection of data from the field, for some of the un coded
information contained in the interview schedule, coding was done and
then they were entered in the computer using the SPSS 12 for windows.
Results and Discussion
The following section gives a brief demographic and socio economic
profile of the sample household and women of Malda district selected
for the present study/survey.
Background characteristics of Household and women
Before going to discuss the family planning and its factor it is
worthwhile to discuss the background characteristic of the survey
households and the women under the survey. The study covered 2390
households from the rural areas of Malda district of West Bengal
and it includes in total of 2587 currently married women (CMW)
within 15-44 years age group. Among the sample households 9.69
per cent were from female-headed households. There 25.95 per cent
of the households are complex family and the rest (74.05 per cent)
are simple family. Majority (74.05 per cent) of women belonged to a
simple family. Out of the total sample households (2390), 50.20 per
cent (1200) household are Muslims while 1190 households (49.80 per
cent) are drawn from non-Muslims. Table 1 shows that 69.34 per cent
households belong to general castes 14.59 per cent people are OBC and
remaining 16.06 per cent households are SC/ST. The average household
size is 5.72 persons. The average monthly family income of the family
ranges from rupees below 2000. Most of the respondents are farmer (46
per cent) as they are engaged in agriculture and allied activities, and 46
per cent respondents are labourers employed in primary sector. Only
8 per cent respondents are engaged in secondary and tertiary sectors.
The percentage distribution of ever-married women by background
characteristics is given in Table 1.
Volume 1 • Issue 1 • 1000102
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

Page 3 of 9

The age wise distribution of currently married women (CMW) least one method (Table 1). However the latest National family Health
shows that slightly more than a fifth (22.61 per cent) of women are Survey (2005-06/NFHS-3) provides that the knowledge of family
belongs to the age group of 15-24 years, 44.80 per cent and 32.59 per planning methods among currently married in rural Malda district is
cent are belongs to the age of 25-34 and 35-44 years of age respectively. slightly low when it compare to the state of West Bengal (99.3 per cent)
Most women were illiterate (44.87 per cent) and only 2.18 per cent of and country level (99.1 per cent). The current contraceptive use rate
them are educated up to graduation and above. among married women age 15-44 is 55.28 per cent, while 44.72 per
cent did not use the contraceptive. However according to the NFHS-3
About the occupation of the CMW 1.82 per cent are farmer,
the contraceptive prevalence in the state of West Bengal is 61.62 per
16.31 per cent work as labourers 15.60 per cent are household based
cent and the national 56.31 per cent. Thus the rate of contraceptive use
workers and 0.86 per cent and 4.08 per cent are fall in the category of
in study sample is found to be much lower than the state and national
business and services respectively. While 31.02 per cent of them are
figures when it compared with NFHS-3. Even after four years (2005-06/
housewives which are the general trend in the district and other parts
NFHS-3) the district show lower rate of the knowledge and current use
of the country. The computed mean are at first marriage for the CMW
of family planning methods of currently married women, it may due to
is 20.09 years and by age below 18, 25 per cent of the women are got
the domination of SC, ST and Muslim population which also shows the
their first pregnancy, by age 18-21 and 22-25, 48.51 per cent and 18.32
backwardness of the district.
per cent get their first pregnancy while rest of the women are have their
first pregnancy after 25 years of age. In addition to, the reasons is the illiteracy among the married
women. As data reports large portion of the married women are
Knowledge and Use of Contraceptive/Family Planning illiterate they are unaware of the use of the contraception. At one
Methods time, all the religions of the world except Buddhism, are pro-natalist
or ‘populationist’. It may, however, argued that all these religions
The provision of contraceptive information is fundamental to the
like Judaism and Christianity, Islam and Hinduism have their origin
ability of women to make informed choices about reproductive health
in the distant past, which was a period of high mortality. As such
decisions. The awareness about family planning methods is widespread
the emphasis on prolific fertility was a functional adjustment to high
among the women with 98.69 per cent of currently married women
mortality in order to ensure the continuation of the group. In contrary,
reporting the knowledge of at least one method of family planning.
though mortality has been tackled by the advance medical technology,
Knowledge about contraceptive methods among the women is
old age perception of massage of populationist theory still persists and
generally high as 98.69 per cent currently married women know at
practiced among larger section of the people across all [11]. Of 2587
currently married women, 55.28 per cent were found to be ever users of
Currently Married
Households Per cent
Women (15-44 Years)
Per cent contraception. Thus, it is seen that knowledge about the family planning
Household headship Age
method is much higher even the acceptance/use level is low. The gap
Male 90.08 15-24 22.61
between the knowledge and the use of the contraceptive methods is
Female 9.92 25-34 44.80
associated with religion, caste, age, education, occupations, etc.
Nature of the Households 35-44 32.59 In a country like India, where a large number of women are illiterate
Simple 74.05 Education and have attained little or no formal school education, informal
Complex 25.95 Illiterate 44.87 channels such as mass media plays an important role in bringing
Religion Below Primary 9.34 about modernization and thereby influencing and motivating women
Non-Muslim 49.80 Primary 20.36 about their reproductive rights and choice. There are differentials
Muslim 50.20 Middle 9.66 in knowledge and use of contraceptive by different variables was
Castes High School 11.09 observed. It is found that women in fact are aware of certain methods.
Gen 69.34 Intermediate 2.50 The source of knowledge is interesting. Majority of women knew
OBC 14.59 Graduation and Above 2.18 more than one source to obtain information about contraceptives.
ST/SC 16.06 Occupations The major source of information about family planning is through
Habitation Type Farmer 1.82 both electronic media and government employees. As expected TV
Kaccha 43.05 Agricultural Labours 9.30 was the best source of knowledge following by radio and government
Non-Agricultural workers. The radio which once upon a time used to be the main
Pucca 27.14 7.01
Laboures
source of communication had losing its role to play in this matter.
Mixed 26.56 Business 0.86
Watching television substantially increased the odds of women seeking
Jhopri 3.24 HHBW 15.60
knowledge of contraceptive. Among different sources of knowledge
Average Household Size 5.72 Service 4.08
on contraception, health professional viz. Doctors, paramedical staff,
Marginal Workers 30.30
Anganwadi workers PHC/ ASHAs and friends seem to be the main
Unemployed/ House
Sex Ratio 925
Wives
31.02 source for acquiring knowledge on family planning methods about
Household Income Mean age Marriage 20.09 47.45 per cent of the respondents came to know about these methods
Below 2 000 13.93 Mean Age of Pregnancy through such government employees. It is followed by other sources i.e.
2001-5000 36.90 Below 18 25.09 relatives, husbands and friends with 16 per cent and NGOs initiatives
5001-10000 35.40 18-21 48.51 with 40 per cent respectively.
10000-15000 9.08 22-25 18.32 Majority of the couples do not discuss matters related to family
Above 15000 4.69 Above 25 8.08 planning information, the use of spacing methods and sexual matters.
Data Source: Based on Field Survey by the Researcher, 2010 The reasons for not discussing are that these issues are not as relevant
Table 1: Background Characteristics of Survey Household and Currently Married
and pertinent as financial matters, purchase of household items and
Women in Rural Malda, West Bengal. education of children etc [12]. The poor role of mass media among the

J Community Med Health Edu Volume 1 • Issue 1 • 1000102

ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

Page 4 of 9

unaware and non-acceptor female population could be due to the non- the status of women and gives them a higher sense of freedom in the
availability of electronic media such as T.V. and radio and also, due decision making process in the family. Women who were working
to the poor literacy status they could not get much information from exhibit a higher probability of using modern contraceptives than
family welfare programme. Many rural women are reportedly reluctant women with no work [17]. The Table 7 shows that the women from the
to accept any method of contraception. Several studies also revealed service and business class adopt family planning more vigorously than
that rural women who were unwilling to accept family planning the other sectors like agriculture and allied activities and labourers.
methods were concerned about child survival and viewed children as a The knowledge of family planning methods has been found highest in
source of support in old age [6]. government sector while highest adoption rate is recorded in private
service and business class.
Education level of the women has a highly significant effect on the
contraceptive use and it is expected that the better educated women It is observed that the knowledge and acceptance of family planning
may delay to marry and freely discuss about family planning with methods increases systematically with an increase in age. Women’s age
their partners or spouses. Meanwhile, a husband’s education had no was a significant variable to contribute positively to contraceptive use
significant effect on his wife’s current contraceptive use [13]. Women’s [22]. From Table 7 results show that the knowledge of family planning
education also played an important role in relation to contraceptive use, methods increases constantly with the increase in age of the women.
as literate women were more likely to use contraceptives than illiterate The overall contraceptive use rate was 55.28 per cent; this rate is 52.48
women[14,15].They have more awareness and opportunities to have per cent were in the age group of 15-24 years, 55.82 per cent were among
information about the contraception in order to have birth control. 25-34 years, which is the most crucial period in the reproductive span
Increase in the education raised the likelihood to use contraception and 66.47 per cent of the age group of 35-44 years used contraceptive.
than did those without education[16], because low education level In the present study, contraceptive acceptors are maximum in the
associate with lack of awareness and acceptability of family planning higher age group (35-44 years) of CMW. For instance, the highest
and these affects on the usage of contraceptives[17]. The level of percentage of awareness (98.93 per cent) and use of contraception
education is positively and significantly associated with knowledge (56.47 per cent) have been found in the age group of 35-44 years. The
and adoption of family planning methods. Literacy, particularly female proportion of users declined slightly among the lower age group (15-
literacy is seen to influence awareness level and acceptance of family 24 years). It appears that adoption of methods for spacing between
planning method in this study. children increase with age, but as the respondents reach at the age of
35 years or above, they achieve their desired family size and a large
The study showed that a lack of formal education was identified
number of them adopt the terminal methods or decide to adopt other
as a key factor in use contraceptives. Out of the (2587) total women
methods of family planning. Low acceptance of contraception in the
of the present study, 1224 (47.31per cent) was illiterate. Among the
age group of 15-24 years might be due to the desire of newly married
women who are illiterate, 97.71 per cent are aware of family planning
couples to prove their fertility first since contraceptive use is associated
methods as against 29.33 per cent users. Similarly, among the literate
with side effects.
female respondents, more than 90 per cent are aware in comparison to
only 72 per cent users (Table 4). The proportion of users is significantly An analysis of the family type shows that about 74 per cent
higher among the literates as compared to illiterate respondents. The respondents are of simple families and remaining 26 per cent belong
study demonstrates the positive relationship between education level to complex families. Level of knowledge and adoption of the family
of women and use of spacing methods. Other study/investigators planning methods is higher among the nuclear families as compared
[18,19] have also reported similar findings and NFHS-2 results are to those who come from the complex families. Almost 98.80 per cent
of similar tune. This indicates that not only the literacy but economic female respondents from simple families as compared to 97.62 per cent
affordability of contraception may be a more important factor than
knowledge. Reversible family planning methods like tubal ligation are Knowledge Adaptation
 
heavily subsidized under the National Population Control Program No. Per cent No Per cent
in India which makes them much more affordable for women across Yes 2553 98.69 1430 55.28
economic groups. No 34 1.31 1157 44.72
Total 2587 100.00 2587 100.00
There is a clear-cut relationship between economic conditions
and knowledge and adoption of family planning methods. Higher Data Source: Based on Field Survey by the Researcher, 2010
monthly income is consistently associated with higher knowledge and Table 2: Knowledge and Adoption about Family Planning Methods in Rural Areas
adoption of family welfare methods among the females of this study. of Malda District, 2010.
The respondents having monthly income below Rs. 2000 have only
YES
98.06 per cent have knowledge and 47.92 per cent acceptance whereas Source of Knowledge
No. Per cent
those having income Rs.2000-5000 per month showed 98.53 per cent
Radio 965 67.48
knowledge and 50.26 per cent acceptance rate (Table 5). The acceptance
TV 996 69.65
of family welfare methods is observed to be directly proportional to the
Paper 312 21.82
monthly family income of the acceptors in the study area. The highest
Film 84 5.87
rate of acceptance of family planning observed among highest income
Family 261 18.25
group (above 15000). The finding is supported by another study
Gov. Employees 397 27.76
where the acceptance rate was highest in the higher income groups
NGO 213 14.90
[20]. Socio-economic status is thus seen to have a definite impact on
Other 965 67.48
acceptance of methods of contraception.
Data Source: Based on Field Survey by the Researcher, 2010
Occupation often influences the decision making for practicing
Table 3: Sources of Knowledge about Family Welfare Methods in Rural Areas of
contraceptives among women [21]. The employment factor increased Malda District, West Bengal (2010).

J Community Med Health Edu Volume 1 • Issue 1 • 1000102

ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

Page 5 of 9

Knowledge Using Not using Total

  Educational Status
No Per cent No Per cent No Per cent Women
Illiterate 1196 97.71 359 29.33 865 70.67 1224
Below Primary 234 98.73 139 58.65 98 41.35 237
Primary 516 98.85 411 78.74 111 21.26 522
Middle 249 99.20 207 82.47 44 17.53 251
High School 263 100.00 231 87.83 32 12.17 263
Intermediate 48 100.00 44 91.67 4 8.33 48
Graduation and Above 42 100.00 39 92.86 3 7.14 42
Total 2548 98.49 1430 55.28 1157 44.72 2587
Data Source: Based on Field Survey by the Researcher, 2010

Table 4: Education wise Response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

Knowledge Using Not using Total

Income Group
No Per cent No Per cent No Per cent Women
Below 2000 353 97.78 173 47.92 188 52.08 361
2000-5000 937 98.32 479 50.26 474 49.74 953
5001-10000 905 98.69 531 57.91 386 42.09 917
10000-15000 241 98.77 166 68.03 78 31.97 244
Above 15000 112 100.00 81 72.32 31 27.68 112
Total 2548 98.49 1430 55.28 1157 44.72 2587
Data Source: Based on Field Survey by the Researcher, 2010

Table 5: Income wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

Knowledge Using Not using Total

Occupational Status
No Per cent No Per cent No Per cent Women
Farmer 47 97.92 32 66.67 16 33.33 48
Agri. Labour 252 96.92 159 61.15 101 38.85 260
Non-Agri Labour 168 97.67 118 68.60 54 31.40 172
Business 18 100.00 15 83.33 3 16.67 18
HHBW 404 99.26 271 66.58 136 33.42 407
Service 98 100.00 88 89.80 10 10.20 98
Marginal Worker 799 99.01 449 55.64 358 44.36 807
House Wives 762 98.07 298 38.35 479 61.65 777
Total 2548 98.49 1430 55.28 1157 44.72 2587
Data Source: Based on Field Survey by the Researcher, 2010

Table 6: Occupation wise response of Knowledge and Use of Contraceptive in Rural Areas of Malda District, West Bengal (2010).

females from complex families had the knowledge of family planning
methods and 55.64 per cent of the women from the simple families
and 54.24 per cent from complex families are the acceptors of family
planning practices (Table 8). It has been observed that the respondents
of simple families had higher percentage of family planning acceptance
than that of complex families, this may probably due to the greater
freedom and privacy. The use is higher in nuclear families than in
joint families. The structures of joint Indian family constitute of more
members and as the parents are hardly bothered about the responsibility
of their children. It is the joint responsibility of head of the family and
this is one of the reasons that use of contraception is low.
As India is a country of great diversities of religion. Various studies
have been conducted to know the contraceptive practices in different
regions of the states and country also. Social development levels-
notably educational levels and health patterns along with different
familial systems and gender hierarchies have been argued to explain
differences in reproductive behaviour [23-26]. It is also argued that
reproductive behaviour is strongly influenced by the insecurities
associated with minority-group status [7]. Religion is one of the most
important factors responsible for determining the social and personal
behaviour of the individual within the family. The association of
religion with contraceptive behaviour had been documented in various
other studies [27-29]. Religious groups in Malda district are not
against the principle of family planning, as it can be seen from Table
8. Data shows that percentage of women knowing the any methods
of contraception is higher among non-Muslims compared to Muslim
women. However, from this result it cannot be firmly confirmed
that non-Muslim CMW have higher knowledge, because here other
factors are not taken into consideration. The main reason behind
this difference is more involvement of non-Muslim women as family
planning workers such as ASHA and Aganvadi workers that are more
familiar to their own society, that’s why they successfully spread more
awareness in their own community. This study is confirmed to previous
studies which have indicated that Hindus have higher awareness and
adoption level than Muslims [30,31]. Also, the prevalence of illiteracy
among Muslim women is only aggravated their condition of not using
the contraception.
Differential use of contraception also prevails across castes groups.
The female of general castes showed higher knowledge and adoption
of family welfare methods than the respondents of other castes. It
is found that highest percentages of women (56.73 per cent) from
general/forward caste are current users of family planning, followed
by OBC (55.08 per cent) and SC/ST (49.17 per cent) women. It is
because women from forward castes are mostly better educated, have

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ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

Page 6 of 9

desire for lesser number of children etc. Among SCs 96.91 per cent, methods of contraception, its use is 19.77 per cent, whereas among
among OBCs 98.87 per cent and among general caste 99.06 per cent others it is above 50 per cent. If the CMW have one son and knowledge
have knowledge of contraception. Compared with various castes, of contraception increase to 98.49 per cent of women, its use is as high
percentage of tribal women having knowledge of contraception is quite as 79.63 per cent, however, when CMW have two or more sons. The
low, and very low level of use of contraceptives which indicates that knowledge and use of contraception is sharply increased among the
the message of family planning methods even after about five decades women when they have one son. Of course this result may be due to
of its advocacy could not reach tribal population in India. Therefore, the very small cell count. However, from this result it can be inferred
planners and policy makers should scrutinize earlier programs, and that along with number of living sons, knowledge of contraception has
rectify and modify accordingly so that tribal women could have full a great role in its practice. Hence, women without son(s) should be
choice of contraception. motivated to use contraception for their better reproductive health,
Jayaraman[21] and Ojakaa [32] found that the number of living not from fertility reduction per se. Because decision regarding fertility
children is important factor affecting the current use of contraception. is personal matter and everyone has the right to decide how many
It has been observed from Table 11 that among the CMW when they children (sons) to have, provided they are not eliminating daughters.
do not have any child, about 5 percent uses contraception, when they
The women were asked whether they have ever used family
have one child its use is 13 per cent, it increases to 22 per cent when
planning methods or not, of 2587 currently married couples, the
they have two children and further increases to 27 percent when they
level of knowledge and approval of family planning were high, 98.69
have three or more children. Close observation into the result reveals
per cent and 55.28 per cent respectively. Although 55.28 per cent of
that there is a huge difference in contraceptive use between women
women have ever practiced one form of family planning methods
who knows all modern methods of contraception and those who knows
only some of them. Among the women who knows all the modern and 44.72 per cent have never practiced family planning methods
methods of contraception, even if they do not have child, 7 per cent during their life. However, the actual practice of family planning
are using contraception, it increases to 19 per cent when they have one methods was found to be low where only 38.3 were using any family
living child, it rises to 24 per cent when they have two living children planning method at the time of the survey.
and goes as high as to 48 per cent when they have three or more
living children. On the other hand, among CMAW who do not know Age Group
Knowledge Using Not using
Total Women
all the modern methods of contraception, when they have no living No Per cent No Per cent No Per cent
child, contraceptive use is about 4 percent, 7 per cent when they have 15-24 571 97.61 307 52.48 278 47.52 585
one living child, 20 per cent when they have two living children, and 25-34 1143 98.62 647 55.82 512 44.18 1159
increases to 22 per cent when they have three or more living children. 35-44 834 98.93 476 56.47 367 43.53 843
Total 2548 98.49 1430 55.28 1157 44.72 2587
The results clearly indicates that there is constant increase in
Data Source: Based on Field Survey by the Researcher, 2010
contraceptive use with the increase in number of living children, but
its increase is much faster when they have knowledge of contraception. Table 7: Age group wise response of Knowledge and Use of Contraceptive in Rural
Areas of Malda District, West Bengal (2010).
However, we also need to examine this fact from other angle. As, son
preference in India is well established fact, so only having the larger
Knowledge Using Not using Total
number of children is not sufficient ground for contraceptive use. Type of Family
No Per cent No Per cent No Per cent Women
Hence we shall examine the relationship between number of living Simple Family 1893 98.80 1066 55.64 850 44.36 1916
sons and knowledge of contraception with its use. Women who did Complex Family 655 97.62 364 54.25 307 45.75 671
not desire additional children were more likely to use contraception Total 2548 98.49 1430 55.28 1157 44.72 2587
than those who desired additional children. Interestingly, those who
Data Source: Based on Field Survey by the Researcher, 2010
wanted more children were more likely to use but were less likely to
use a long-term method than those who did not want more children. Table 8: Family type wise response of Knowledge and Use of Contraceptive in
Rural Areas of Malda District, West Bengal (2010).
As far as living children wise knowledge and adoption is concerned, it
is found that the percentage of acceptance increases with an increase Knowledge Using Not using Total
in number of living children, especially an increase in number of male  Religion
No Per cent No Per cent No Per cent Women
children, thus showing a strong son preference. Table 12 shows that Non-Muslim 1228 98.16 743 59.39 508 40.61 1251
the acceptance rate is higher among women having 2 or more children. Muslim 1325 99.18 687 51.42 649 48.58 1336
But it is surprising to note that both knowledge and acceptance rate Total 2553 98.69 1430 55.28 1157 44.72 2587
decreases rapidly with increase in number of children above five. The
Data Source: Based on Field Survey by the Researcher, 2010
reason attributable to this fact may be no requirement of contraceptive
methods after achieving a target for desired number of children. Table 9: Religion wise response of Knowledge and Use of Contraceptive in Rural
Areas of Malda District, West Bengal (2010).
In the study area, due to strong son preference, contraceptive
practice depends not mainly on number of living children, but heavily Knowledge Using Not using Total
Castes
on the number of living son(s). Here results (Table 11 and Table 12) No Per cent No Per cent No Per cent Women
show that among the CMW who are not having any son, about 20 per General 1795 99.06 1028 56.73 784 43.27 1812
cent of the couple are contraception, it increases to 48.64 per cent when OBC 350 98.87 195 55.08 159 44.92 354
they have one son and it further increases to 66.09 per cent when they SC/ST 408 96.91 207 49.17 214 50.83 421
have two finally it further increases to 80 per cent when they have two or Total 2553 98.69 1430 55.28 1157 44.72 2587
more sons. However, despite having desired number son(s), knowledge Data Source: Based on Field Survey by the Researcher, 2010
of wide range of contraception is must for its use. From the results it Table 10: Caste wise response of Knowledge and Use of Contraceptive in Rural
is quite clear that even if CMW do not have any son, if they know any Areas of Malda District, West Bengal (2010).

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ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102

Page 7 of 9

As shown in Table 13, for the women who used contraception, health. Method related reasons like health concerns, fear of side effects
the most popular means of birth control is the sterilization operation, and lack of access/too far, too much costs and health care provider
which was used by 25.41 of all women and another 1.97 per cent who bias accounted for 32.4 per cent of non-utilizations of family planning
have husbands who are sterilized. This predominance of the female services. The method related reasons were mainly health (17.9 per
sterilization method is similar to findings from Karnataka and other cent) followed by fear of side effects (6.7 per cent), lack of access (3.5
Indian states. Because sterilization is irreversible, only women who per cent), health provider bias (2.4 per cent) and cost of contraceptives
are certain that they do not want any more children are likely to use (1.8 per cent). The knowledge and sources of family planning methods
it. Sterilized women tend to be substantially older than other women, were other important factors for non-utilization of family planning.
but age alone does not account for their large family size. In every age This was mainly due to respondents lack of knowledge on the type
group, sterilized women have substantially more children than women of method or they did not know the source of family planning
who use temporary methods. The difference is particularly pronounced methods. Lack of knowledge of family planning methods accounted
among young women. or in other words out of total married couples 6.5 Per cent while lack of sources of family planning method was also
27.37 per cent have adopted a permanent method whereas remaining reported by 4.4Per cent of non-users.
27.51 per cent are using temporary contraceptive methods (Table 13).
Use of temporary methods is very low in India, both in absolute and Conclusion
relative terms. The second most popular method of family planning This study has examined the pattern of contraceptive use and
was birth control pills, which was used by 13.41 per cent of women. choice of methods among 2587 married women of reproductive age in
Thus 27.51 per cent females are effectively protected against conception rural areas of Malda district of West Bengal with a particular focus on
by one or the other family planning methods. The adoption percentage the extent to which demographic and socio-economic characteristics
by each method is 9.63 per cent (condoms), 13.41 per cent (i-pill), 1.78 influenced the practice of contraceptive use. The results show that
per cent (loop) and 4.36 per cent (for both safe period and self restrain
method). No. of living Knowledge Using Not using Total
Children No Per cent No Per cent No Per cent Women
The present study reveals that the majority of the females of the
0 0 167 96.53 81 46.82 92 53.18
study area are adopting terminal methods such as sterilization. But
1 1 360 98.90 188 51.65 176 48.35
in the case of temporary methods, oral pill and condom is the more
2 2 732 99.19 419 56.78 319 43.22
common than other methods. This study suggests that the favorable
3 3 568 98.27 328 56.75 250 43.25
attitude towards permanent family planning methods among the
4 4 378 98.69 217 56.66 166 43.34
women is a welcome trend towards the promotion of family planning
5 5 224 97.82 128 55.90 101 44.10
programme. Besides the permanent methods, temporary family
5+ 5+ 119 97.54 69 56.56 53 43.44
planning methods are also given due weightage in order to strengthen
Total Total 2548 98.49 1430 55.28 1157 44.72
the programme. Lack of complete knowledge and some side effects
thereof about the temporary family planning methods are the reasons Data Source: Based on Field Survey by the Researcher, 2010
for their less propagation and use among the women. This clearly Table 11: Living children wise response of Knowledge and Use of Contraceptive in
shows the close association between knowledge and attitude formation Rural Areas of Malda District, West Bengal (2010).
towards behavioural change.
No. of living Knowledge Using Not using Total
Reasons for non-acceptance of family planning methods son(s) No Per cent No Per cent No Per cent Women
0 511 97.15 104 19.77 422 80.23 526
For non-users, reasons were asked for non-utilization. The reasons
1 654 98.49 333 50.15 331 49.85 664
for the non-utilization of family planning methods among women
2 798 98.76 525 64.98 283 35.02 808
varies by the CMW for those families having less than or equal to three
2+ 585 99.32 469 79.63 120 20.37 589
and more than five living children in their families. Significantly high
  2548 98.49 1431 55.32 1156 44.68 2587
proportion (21.5 per cent) of the families who are having more than
four living children in their families have expressed old age as one of Data Source: Based on Field Survey by the Researcher, 2010
the reasons and are confident that they won’t get children. About 16.4 Table 12: Living Son (s) wise response of Knowledge and Use of Contraceptive in
Rural Areas of Malda District, West Bengal (2010).
per cent respondents account for health hazards, side effects and fear
of operation as potent reasons for their non-acceptance of sterilization
Knowledge Using
compared to the families which are having less than or equal to three Methods of Contraceptive
No Per cent No Per cent
living children. The desire for son and daughter is an important reason
Not Using 34 1.31 1157 44.72
for non acceptance revealed by the majority of the females who are
Male Sterilization 1457 57.18 51 1.97
having less than or equal to three living children in their families. This
Female Sterilization 1969 77.28 657 25.40
clearly reflects various reasons expressed by the non-acceptors of less
Oral 1861 73.04 347 13.41
than or equal to three living children as well as more than four living
Condom 1842 72.29 249 9.63
children in their families.
Loop 1354 53.14 46 1.78
Fertility related reasons were the most reported reasons that affected Safe Period 1792 70.33 32 1.24
the family planning services utilization among participants. Among Withdrawal 907 35.60 22 0.85
fertility related reasons, abstinence was the highest husbands/partners. Other 872 34.22 26 1.01
Religious opposition has also appeared to be important barrier to non- Total 2587 100.00
use of family planning methods which accounted for 7.6 per cent of the Data Source: Based on Field Survey by the Researcher, 2010
non-users. Sometimes potential family planning users prefer not to use Table 13: Methods wise use of family welfare methods in Rural Areas of Malda
more reliable methods due to misperceptions and concerns about their District, West Bengal (2010).

J Community Med Health Edu Volume 1 • Issue 1 • 1000102

ISSN: JCMHE, an open access journal
Citation: Hussain N (2011) Demographic, Socio-Economic and Cultural Factors Affecting Knowledge and Use of Contraception Differentials in Malda
District, West Bengal. J Community Med Health Edu 1:102. doi:10.4172/jcmhe.1000102
there are significant relationships with contraceptive use. Considerable
differences in Knowledge and Use of Contraception according to
women’s literacy and educational status, income and occupation, age,
family type, religion and caste, mass media exposure and living children
and son(s) experience by mothers were found in the study. The study
revealed the knowledge and favourable attitude of rural women towards
contraception. In the study area even after about five decades of family
planning programme, only 1.51 per cent of CMW do not have any
knowledge of any methods of contraception. This high knowledge with
low utilization rate is mainly because of different barriers to decision on
use of contraceptives. Therefore, there is a need to impart knowledge
about the family planning methods among the CMW so that it will help
women to choose suitable and affordable method, enable them to lead
a burden and danger free and healthy reproductive life, enable couples
to decide when to and whether to have child, and thereby facilitate
fertility decline in the study area. May be with increasing education,
the women understand their contraceptive better and practice it
more intensely. As level of education is significantly associated with
the contraceptive usage among women. Religious communities show
differential use of contraceptives. Among the religious communities the
use of contraception is low among Muslims and lower castes women.
A couple’s working status also had a significant effect on contraceptive
use. The improving employment opportunities for women will increase
the prevalence of contraception thus, hopefully, lower the birth rate
[21]. Electronic media, government employees and organizations
can play a positive role to impart knowledge and overcome the gaps
arising thereof between knowledge and practice. Regarding methods
of contraception, female sterilization is the most popular permanent
method and is used by majority of females.
Throughout the world, mass media have influenced knowledge,
attitudes, and behavior regarding the use of contraception [33].
Our study also found that mass media exposure (Radio/TV) has an
important effect on reproductive behavior. It could be because radio
and television programs and the values they disseminate are transmitted
directly into the home, they have the potential to directly affect every
member of the household, even those with little or no schooling [34]
[35]. The role of mass media in changing both patterns of contraceptive
use and notions of ideal family size could be another reason for low
fertility among those exposed to mass media [36].
The evidence in support of the religiosity hypothesis is also modest.
While Muslim women are less likely to be currently using contraception,
the percentage using modern contraceptive methods are much higher
than that of Christians. In addition, a very small percentage of Muslim
women cited religious prohibition or husband’s objection as reasons
for their non-use of contraception.
Despite the legal restrictions against marrying at a young age, early
marriage is common in the country in general and in the study area
in particular. Therefore, programs should focus on creating awareness
of the marriage law and the disadvantages of early marriage and large
family size. Similarly, more emphasis needs to be place on messages
conveyed via the mass media, addressing the advantages of small
family size and family planning. Mass media can present a wider range
of knowledge and lead to adopting contraception. Furthermore, long-
running programs focusing on increasing literacy status and wealth
status are essential to improve the reproductive health status of women.
Above all, period of emergency proves that force full
implementation of Family Planning Programme (FPP) will not be
possible in a country like India. In India people’s relation with the
state, i.e. at the order of law, in these arenas comes only next to society.
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Page 8 of 9
The state norms are appreciated as long as they assist the masses into
which the reproductive and familial domains function. The state need
to bring more amendment in the FPP keeping in mind all the cultural
complexities of gender and reproductive political economy dimensions.
Then only the desire of the state to progress in the economic frontier
by achieving small family size norm which is the only hidden agenda of
FPP could be achieved as our study suggest.
Acknowledgements
This research work was sponsored by UGC DRS-II Programme. The
authors thus, would like to express his heart felt gratitude to Prof. Farasat Ali
Siddiqui, Chairman, Department of Geography, Aligarh Muslim University, for his
Constructive support.
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