Knowledge, attitudes and practice survey of family planning among South Asian immigrant women in Oslo, Norway



Download 0.98 Mb.
Page9/10
Date conversion04.02.2017
Size0.98 Mb.
1   2   3   4   5   6   7   8   9   10

Education The use of contraception is higher among women with less than 12 years education 107(84.3%) than compared to women with more than 12 years of education women. In descriptive analysis, there is a significant association between contraceptive use and education. In bivariate analysis, contraceptive use is 5.4 times higher among lower educated women compared to higher educated women. After controlling for other variables, education has a significant effect for using contraceptives. This finding is consistent with the study in Bangladesh 2000 (50).

Attitudes towards contraceptives The positive attitudes toward contraceptives have a significant association with use of contraceptives. The majority of respondents are positive towards using contraceptives especially older groups. They share their experience or suggest modern contraceptives use to others who want to stop births. Women 31-45 years are usually giving advice to young couple to have children early and complete their family. Developed infertility by using modern contraceptives is one of the common reasons given by immigrants for not using modern contraceptives. Therefore, most of the women have their first child at their age of 18-24. Before reaching 30 years, most of the respondents want to have their desired family size. The most common reason related to not using modern contraceptives among young women is the fear of side effects from modern contraceptives. Number of children, age and attitudes is significantly related to contraceptive use in this study and is also observed in the study of Bangladesh 2010 12, in Thailand 2007 46.

One-third of study respondents had a history of requesting induced abortion. The most frequently given reasons for termination of pregnancy was wishing to finish education (35.8%), unplanned pregnancy (25.9%), too little birth space (7.4%), and economical reasons (14.8%). This study finding is consistent with the study in Sri-Lanka 2004 and in Sweden in 2000.



    1. Methodological consideration: Do the results of the thesis tell us truth?

There are several possible sources of systematic errors that may influence the validity or the accuracy of the results. These include selection biases, information biases, confounding and sampling bias.

Recruitment rate was 93%. The sample size was not fully achieved from August 2010 to December 2010. The study population was not representative for the population. Data was supposed to be collected from the health centres in the Alna, Stovner and Søndre Nordstrand districts. Due to lack of resources at Alna and Stovner (lack of private room for conversations with participants), the participants were recruited only from health centres of Søndre nordstrand district and Gamle Oslo.

Information on ethnic background, immigration status is valid, but it was difficult to obtain quality information on knowledge, attitude and practice, because, the questionnaire was including both closed and open questions. There was missing information in respondents’ self answered questionnaire. Especially for the unmarried young girls, they choose multiple answers to some questions; it was confusing when the data was entered.

Sexual and reproductive health education is part of the health education of the Norwegian educational system however, the younger , second generation immigrant girl shows according to this study that they have lack of family planning knowledge. It was puzzling when the data analysis was completed.

Knowledge of family planning part only includes the heard of contraceptive methods. Questionnaire should have included questions regarding the benefit of the modern method or when CM should be used etc. Therefore, measure of family planning knowledge was difficult. The measuring tools were not good enough to determine the attitude of family planning by this questionnaire. Some questions needed to be revised by degree of agreement and disagreement with the statement under attitudes part of questionnaire. Though confounding factors for FP knowledge was found, but confounding factors for attitudes toward FP discussion with unmarried young girls was not possible to measure. Prevalence of contraceptive use was not possible to measure here either. In the questionnaire, it was asking ‘are you currently using any contraceptives method’ instead, the questionnaire should be asking ‘are you using any contraceptive methods since last three months’.

This study’s results are only valid for the groups who reside in Oslo, but are not a valid result for the population from where they originate. However, it may be valid for South Asian women who live in other Scandinavian countries. Considering the ethnicity, though women migrated from same country, they are differing in their own community by language, education and understanding of health as a girl who is born and brought up here will be different from others who migrated here after marriage. They are also different by their migration status (e.g. refugees, labour migrants, asylum seekers and skilled migrants).

The author has no idea of the true distribution of the target population and the sample. The author was recruiting study subjects by cluster and snowball sampling. The snowball sampling is sometimes inexact, and can produce varied and inaccurate results. It might be that the initial subjects tended to nominate another to whom she knows well. Because of this, if the nominated subjects share the same traits and characteristics, it could be sampling bias. Therefore this study can’t generalize the all the South Asian immigrants because the representativeness of the sample was not guaranteed.


    1. Recommendation

  1. Study reveals the knowledge of Chlamydia among South Asian Immigrants remarkably low; therefore, health care providers should inform about Chlamydia and its long- term consequences.

  2. To encourage for using modern contraceptives among immigrants there is need of available information about the benefits of these modern contraceptives.

  3. The study reveals that one-third respondents had a history of requesting abortion. To identify the relevant cause for not using contraceptives in relation to unplanned pregnancy further studies are needed.

  4. This study had a time constraint. Therefore, more in depth knowledge about the cultural beliefs and social norms related to family planning discussion with regard to unmarried women further research should be carried out by qualitative research.

  5. Reproductive health relevant service and information should be delivered to newly arrived immigrants with consideration towards their native tongue.

  6. Health care providers should reflect on the difficulties among immigrants reproductive health that is related to language and cultural differences.

  7. Health care staffs need to be empowered in order to manage culturally sensitive issues related to immigrants health.

Chapter 7. Conclusion

There was a difference in family planning knowledge among immigrants living in Oslo, Norway. Most important significant predictors for good FP knowledge are age 20-30 yrs., education and being a Indian women. Compared to second generation immigrant women, first generation immigrant women have 2 times higher family planning knowledge. The family planning knowledge was 3 times higher among women from India compared to women of Bangladesh origin.

Family planning discussions with unmarried youth is not common in societies where the respondents originate. There is a significant association between received FP knowledge before marriage and immigration status.
Over two-third of the immigrants are using any of contraceptives. The most important statistical significant demographics related to use of contraceptives was age, education, number of children and attitude towards modern contraceptives. Fear of side effects (63.3%) was the most common reason related to not using modern contraceptives..

.


For family planning services, only 17.5% of the women preferred to visit health centre, while 27.7% respondents would not to go anywhere. The language barrier is one of the difficulties related to seeking family planning service among 18.7% immigrants.

Positive attitude towards family planning knowledge can promote a good reproductive health and well being. This study reveals that education is one of the significant confounding factor to increase the knowledge and practice of family planning among immigrants. However, further research is needed to explain the observed difference in family planning knowledge, attitude and contraceptive uses (e.g. age groups, ethnicity) among immigrants.


Reference List



  1. http://www.who.int/topics/family_planning/en/

  2. http://en.wikipedia.org/wiki/Family_planning

  3. http://www.familyplanning.org.nz/

  4. United Nations Population Division. World Contraceptive Use, 2009. Wall chart. New York: United Nations, 2009.

  5. Pachauri S, Santhya K.G, Reproductive Choices for Asian Adolescents: A Focus on Contraceptive Behavior, Intern Family Planning Perspectives 2002, 28: (4), 186-195.

  6. Sheikh B Tasneem, Rahim S Tariq Assessing knowledge, exploring needs: A reproductive health survey of adolescents and young adults in Pakistan Eur J Contracept Reprod Health Care 2006;11(2):132–137.

  7. http://en.wikipedia.org/wiki/Immigration

  8. Population statistics. Immigrant population, 1 January 2011. Statistics Norway.2011, http://www.ssb.no/emner/02/01/10/innvbef/

  9. J. Mao: Knowledge, Attitude and Practice of Family Planning: A Study of Tezu Village, Manipur (India) . The Internet Journal of Biological Anthropology. 2007 Volume 1 Number 1

  10. A study of knowledge, attitude and practice (KAP) of family planning among the women of rural Karachi, Kulsoom kazi, social work, 2006

  11. Shah NA, Nisar N, Qadri MH. Awareness and pattern of utilizing family planning services among women attending Urban Health Care Center Azizabad Sukkur. Pak J Med Sci 2008; 24(4): 550-5.

  12. Perera J, De Silva T, Gange H. Knowledge, behaviour and attitudes on induced abortions and family planning among Sri Lankan women seeking termination of pregnancy. Ceylon Medical Journal 2004; 49: 14-7.

  13. SK Ferdousi, MA Jabbar, SR Hoque, SR Karim, AR Mahmood, R Ara, NR Khan. Unmet Need of Family Planning Among Rural Women in Bangladesh, J Dhaka Med Coll 2010; 19(1) : 11-15

  14. http://en.wikipedia.org/wiki/Sex_education




  1. Mehta, Suman, Riet Groenen and Francisco Roque (1998). “Adolescents in changing times:Issues and perspectives for adolescent reproductive health in the ESCAP region”, in ESCAP, Asia-Pacific Population Policies and Programmes: Future Directions, Asian Population Studies Series No. 153 (United Nations publication, Sales No. E.99.II.F.4), pp. 167-194.

  2. Hussain, R., Bittles, A.H. Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan. J.Biosocial Science 1999.31, 121-138.

  3. Fariyal F. Fikree, Amanullah Khan, Muhammad Masood Kadir, Fatima Sajan and Mohammad H. Rahbar,What Influences Contracepfive Use Among Young Women In Urban Squatter Settlements of Karachi, Pakistan? International Family Planning Perspectives, 2001, 27(3):130-136

  4. Malin, M, gissler.M: Induced abortion among immigrant women in Finland, Finish journal of ethnicity and Migration,2008,3(1),www.etmu.fi

  5. Saxena, S; Copas, AJ, Mercer, C, Jhonson, AM. Fenton, K, Erens, B, Nanchahal, K, macdowall, W, Wellings, K: Ethnic variation s in sexual activity and contraceptive use: National cross-sectional survey, Contraception 2006, 74(3):224-233

  6. Wilson E, McQuiston C. Motivations for pregnancy planning among Mexican immigrant women in North Carolina. Maternal and Child Health Journal 2006; 10(3):311-20

  7. Remennick IL, Amir D, Elimelech Y, Novikov Y. Family planning practices and attitudes among former Soviet new immigrant women in Israel. Social Science & Medicine 1995; 41(4):569-577S.

  8. Comerasamy H, Read B, Francis C, Cullings. The acceptability and use of contraception: a prospective study of Somalian women's attitude. J Obstet Gynecol 2003; 23(4):412-5.

  9. Eskild A, Nesheim BI, Busund B, Vatten L, Vangen S. Childbearing or induced abortion: the impact of education and ethnic background. Population study of Norwegian and Pakistani women in Oslo, Norway. Acta Obstet Gynecol Scand 2007; 86:298–303.

  10. Helström, L., Odlind, V., Zetterström, C., et al.’Abortion Rate and Contraceptive Practices in Immigrant and Native Women in Sweden,’ Scand J Public Health 2003; 31 (6): 405–410.

  11. Eskild A, Helgadottir LB, Jerve F, Qvigstad E, Stray-Pedersen S and Loset A Induced abortion among women with foreign cultural background in Oslo. Tidsskr Nor Laegeforen 2002; 122, 1355–1357.

  12. Barrett, G, peacock, J, Victor, CR: Are women who have abortions different from those who do not?, A secondary analysis of the 1990 National survey of Sexual attitudes and life styles, Public health 1998,112(3):157-63

  13. Rasch V, Knudsen LB, Gammeltoft T, et al. Contraceptive attitudes and contraceptive failure among women requesting induced abortion in Denmark. Hum Reprod 2007; 22:1320–1326.

  14. Helström, L., Zetterström, C., Odlind, V. ‘Abortion Rate and Contraceptive Practices in Immigrant and Swedish Adolescents,’ J Pediatr Adolesc Gynecol 2006; 19 (3): 209-213.

  15. Vangen S, Eskild A, Forsen L. Termination of pregnancy according to immigration status: a population-based registry linkage study. BJOG 2008;115:1309-1315

  16. Wiebe, E. R, Sent, L. Fong, S. Chan, J: Barriers to use of Oral contraceptives in Ethnic Chinese women presenting for abortion, Contraception,2002,65(2):159-63.

  17. Rademakers. J: Abortion in Netherlands 1993-2000: Annual reports of the Dutch Abortion clinics Foundation, StiSAN, Heemstede, 2002.

  18. Rademakers, J. Mouthaan, I, de Neef, m.: diversity in sexual health: Problems and dilemmas, European Journal of Contraceptive and reproductive Health care, 2005, 10:207-11.

  19. Evan G. DeRenzo, Joel Moss (ed). Writing clinical research protocol: ethical considerations. Elsevier Academic press 2006.Book.

  20. Varkervisser C, Prathmanathan I, Browlee A. Designing and conducting Health Systems Research. Projects: proposal Development and field work. http://www.idrc.ca/en/ev-33011-201-1-DO_TOPIC.html

  21. Miller LW, Crabtree BF. Clinical research: A multimethod Typology and qualitative Road map. In: Crabtree BF, Miller LW, editors. Doing qualitative research. London: Sage publications;1999

  22. Tshetsanyana Alla Kgakole Moya: HIV/AIDS related knowledge, attitudes and practices among Barsawa adolescents school in Ghana districts, Botswana. UIO.2003(7)

  23. Zewditu Kebede Tessema: Husband – wife communication about family planning in Assosa town(Ethiopia).UIO.2002:(5)

  24. Bhopal R. Is research into ethnicity and health racist, unsound or important science? MBJ1997; 314: 1751-1756

  25. Bhopal R. Ethnicity and race as epidemiological variables: centrality of purpose and context. In: Machbeth H.Shetty P(ed) Health and ethnicity. London: Taylor and Francic, 2001:21-40.

  26. Siri Vangen: Perinatal health among immigrants: UIO: 2002

  27. Austrida Gondwe: Reaching adolescents in rural areas: exploratory study on factors contributing to low utilization of family planning services among adolescents in Mangochi district- Malawi. UIO.2008:(6)

  28. Loeber O, Oost R, Arnhem, The Netherlands Sexual and reproductive health issues of Turkish immigrants in the Netherlands Eur J Contracept Reprod Health Care 2008;13(4):330–338.

  29. A.J.Gagnonetal, South Asian migrant women and HIV/STIs: Knowledge, attitudes and practices and the role of sexual power, Health & Place 2010; 16 (1): 10–15.

  30. Annika Lauiaia, How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi: Anthropology matters 2009; 11(1)

  31. Huguette Comerasamy, Bela Read, Christine Francis, Sarah Cullings and H. Gordon: The acceptability and use of contraception: a prospective study of Somalian women’s attitude: J Obstet Gynecol: 2003;23,4,412-415

  32. Serena Donati, Rawia Hamam, Emanuela Medda: family planning KAP survey in GAZA: Social science and medicine; 2000(3) volume 50, 6:841-849.

  33. Contraceptive use among mainmar migrant women of reproductive age in Phang NGA province, Thailand,MS Htoo htoo kyaw Soe, year 2007.

  34. David P. Lindstrom and Coralia Herrera Hernández. Internal Migration and Contraceptive Knowledge and Use in Guatemala, International Family Planning Perspectives, 2006, 32(3):146–153.

  35. BK Onwuzurike, BSC Uzochukwu: Knowledge, Attitude and Practice of Family Planning amongst Women in a High Density Low-Income Urban of Enugu, Nigeria, Afr J Reprod Health 2001; 5(2): 83-89.

  36. Barkat-e-khuda, Roy NC, Rahman DM: Family planning and fertility in Bangladesh. Asia Pac Popul J. 2000 Mar;15(1):41-54.

  37. Parveen,SS. Factors affecting contraceptive use among married female adolescents in Bangladesh, Master’s thesis, Institute for Population and Social Research, Mahidol University. 2000.ISBN-974-664-667-2

  38. Alex Chika Ezeh: The Influence of Spouses Over Each Other's Contraceptive Attitudes in Ghana, stud fam plan. 1993 May-Jun;24(3):163-74

  39. Ikechebelu JI, Joe Ikechebelu NN, Obiajulu FN. Knowledge attitude and practice of FP among Igbo women of south eastern Nigeria. Journal of Obstetrics and Gynaecology. 2005; 25(8): 792–795.

  40. Islam, M., Kane, T.T., Khuda, E.B., Hossain, M.B. and Reza. M.M. Determinant of contraceptive use among the young and newly-wed couples, Reproductive Health in Rural Bangladesh, (1997). Vol.1, ICDDRB, Dhaka, Bangladesh.

  41. Lasee, A. and Beakur, S Husband Wife communication about family planning and contraceptive use in Kenya. International Family Planning Perspectives, (1997). 23: 15-20 & 33.

  42. Nguyen Ngoc C, Ellertson Y, Surasrang L Loc. Knowledge and attitudes about emergency contraception among health workers in Ho Chi Minh City, Vietnam. International Family Planning Perspectives 1997; 23 : 68–72.

  43. Sundby J, Svanemyr J, Maehre T. Avoiding unwanted pregnancy--the role of communication, information and knowledge in the use of contraception among young Norwegian women. Patient Educ Couns. 1999 Sep;38(1):11-9.

  44. Mubita-Ngoma C, Kadantu MC. Knowledge and use of modern family planning methods by rural women in Zambia. Curationis. 2010 Mar;33(1):17-22.

  45. Chen J, Liu H, Xie Z. Effects of rural-urban return migration on women's family planning and reproductive health attitudes and behavior in rural China. Stud Fam Plann. 2010 Mar;41(1):31-44.

  46. Naqvi S, Hashim N, Zareen N, Fatima H. Knowledge, attitude and practice of parous women regarding contraception. J Coll Physicians Surg Pak. 2011 Feb;21(2):103-5

  47. Yusuf F, Siedlecky S, Byrnes M, Yusu F [corrected to Yusuf F. Family planning practices among Lebanese, Turkish and Vietnamese women in Sydney. Aust N Z J Obstet Gynaecol. 1993 Feb;33(1):8-16.

  48. Joesoef MR, Baughman AL & Budi Utomo,Husbands Approval of Contraceptive Use in Metropolitan Indonesia: Program Implications, Studies in Family Planning 1988;19,3:162-168

  49. Wasileh Petro-Nustas, Men’s Knowledge and Attitude towards Birth Spacing and Contraceptive Use in Jordan, International Family Planning Perspectives, 1999; (25) 4:181-185

  50. Mbizvo M T and Adamchak D J, Family Planning Knowledge, Attitudes, and Practices of Men In Zimbabwe, Studies In Family Planning, 1991;22,1:31-38

Annexure: 1 Informed consent form for youth groups (young girls)

Dear Participant

I am a doctor from Bangladesh and my name is Asma Abedin. I am pursuing a Master of philosophy at the University of Oslo. I am very interested in family planning especially sexual health and contraceptive knowledge among young girls in Oslo.

The purpose of the study is to know whether young girls have knowledge about sexual health and contraceptive methods, and whether they are interested in discussion family planning before getting married.

This interview will only be used for research purposes. The questions are about your menstrual cycle, and your knowledge and attitude towards sexual health and contraceptive methods and where you should go to get the information and service.

The interview time will take about 10- 15 minutes and the questionnaire is anonymous that is your name will not be asked for and no identification number will be used to identify you. If you agree to participate in this survey, all of the collected information will be kept in confidential. If you decide to withdraw yourself from this survey, all of the information will be destroyed. So, participation is entirely voluntary.

I would really appreciate your valuable time for this interview because your opinions are very important to me as a doctor and researcher. The findings of this study will be made available to you. If you have any questions before, during, or after the study please feel free to contact me by telephone 46 84 53 73.

I declare that oral and written information has given as well as the declaration of consent to the participant.

Date: _________ Signature: _________________________

For participant:

I hereby confirm that, after receiving the above information, both by talking and by writing, I agree to participate in this survey. My information will only be used for research purposes by the Asma Abedin (researcher). I am informed that participation is voluntary, and that I can withdraw my participation at any time.

Date: _________ Signature: __________________________

Annexure 2: Informed consent form for women

Dear Participant

I am a doctor from Bangladesh and my name is Asma Abedin. I am pursuing a Master of philosophy at the University of Oslo. I am very interested in family planning especially sexual health and contraceptive knowledge among women in Oslo.

The purpose of the survey is to increase our knowledge about family planning and different contraceptive methods in women from your country. This interview will only be used for research purposes. You will ask about your reproductive history and your attitude towards information and discussions of different family planning method. You will also ask about where you go to get the service.

The interview time will take about 15- 20 minutes and the questionnaire is anonymous that is your name will not be asked for and no identification number will be used to identify you. If you agree to participate in this survey, all of the collected information will be kept in confidential. If you decide to withdraw yourself from this survey, all of the information will be destroyed. So, participation is entirely voluntary.

I would really appreciate your valuable time for this interview because your opinions are very important to me as a researcher. The findings of this study will be made available to you. If you have any questions before, during, or after the study please feel free to contact me by telephone 46 84 53 73.

I declare that oral and written information has given as well as the declaration of consent to the participant.

Date: _________ Signature: _________________________



For participant:

I hereby confirm that, after receiving the above information, both by talking and by writing, I agree to participate in this survey. My information will only be used only for research purposes by the Asma Abedin (researcher). I am informed that participation is voluntary, and that I can withdraw my participation at any time.

Signature or mark of the Subject: Date: _________

This questionnaire is entirely anonymous and confidential: please answer as truthfully as possible. Write and tick possible answer


1   2   3   4   5   6   7   8   9   10


The database is protected by copyright ©dentisty.org 2016
send message

    Main page