Background

Adolescence is critical period for reproductive health of girls with long term implications. There are not many community-based studies about rural adolescent girls’ reproductive life. 

Objectives 

Community based study was conducted to know about planned family concepts and practices of married adolescent girls of rural tribal communities

Material Methods 

Descriptive study was done in140 villages over one year. Randomly 10 to15married girls’ of≥14 to ≤20 years of age willing to be part of the study in context of objective of study were enrolled.

Results 

Majority of girls did not favor small family. Many, not all were willing to listen and understand importance of small family.  Not only illiterate but more girls who had some education, also had their first child in first year of marriage in nuclear families compared to joint or extended joint families. Around 53% girls were aware about contraceptives, irrespective of early or late adolescence. In all the age groups, around 50% of girls were using used contraceptives. Barrier contraceptives (condom) was the most commonly used method, irrespective of education. Contraception usage was more in casual laborers (100%) and shopkeepers (85.4%) compared to homemakers (43.8%) and agricultural laborers (59.0%).

Conclusion 

Present study revealed that not only young adolescent rural girls were married but had children too by 20yrs. Many did not believe in small family. Around 50% had awareness of contraceptives. Awareness did not lead to practice Many had first child within first year of marriage, more so in nuclear families.  A lot is needed in health system for awareness and counselling.

Adolescence is a critical period for reproductive health of girls with implications on their health and well-being, not only during adolescence, but their future lives and lives of their children too with impact on society at large. The most significant factors which affect adolescents' health are the choices they make and the opportunities they use for their health-enhancing or health-compromising behaviors. Unfortunately, very young age marriages of girls continue to be common in rural communities around the world (1, 2, and 3). Marriage at young age is often followed by adolescent pregnancy, which has enormous harmful effects on the health of adolescent girl as she is neither physically nor psychologically fit for pregnancy.   There are not many community-based studies about rural adolescent girls about reproductive life.

Objectives

Community based study was conducted to know about planned family concepts and practices of married adolescent girls of rural tribal communities.

After taking ethics committee’s approval, information about perceptions and practices of married adolescent girls, regarding planned family (PF) was collected by interviews using a predesigned tool with some questions for yes or no answers and others short answers. After consent girls were interviewed in villages at mutually convenient places. Information was recorded on the hard tool. No one was given the tool to fill.   

Study setting- Total 140 villages near the village with health facility (study center) in a remote, forestry and hilly region.

Study design – Descriptive study.

Study period–One year.

Inclusion criteria -Randomly 10to15married girls’ of≥14 to ≤20 years of age, who were willing to be part of the study by responding to questions in context of objective of the study were enrolled as study participants.

Exclusion criteria-Those <14>20 years, not willing to give responses, however no one refused. 

Sample size-The sample size was calculated using a free online statistical calculator (statulator) [4]. The calculated sample size was rounded to 2000 with 95% confidence, and 2?solute precision. Participants were randomly included from each village using a random number table to attain the desired sample size.

Of girls of 14-15yrs (681), only 266(39%) said it was good to have small family and 46.6% of these 266, said small family was good for women and children.  However, of 415 young girls who did not favor small family, 73.7 %were willing to listen and understand. In girls of 16 to 17yrs, (960), 362(37.7%) favored small family and of these 362 girls 45.35% said it was good for women and children. Of the 598 girls of 16 to17 yrs, 76.8% were willing to get information in this context, not all. Of girls of age 18to <20yrs>

Table II shows relationship between marriage and first birth interval in context of type of family and other variables. In nuclear families, more than 50% girls had their first child within first year of marriage. Of the illiterate girls, who had their first child in first year of marriage, 65.9?longed to nuclear family, significantly more than ,19.9?longing to joint/ extended family(p value 0.01).In girls who had some education, also majority had their first child in first  year of marriage in  nuclear families ,in primary educated,49.1%, secondary/ higher secondary educated, 46.0%, graduates, 45.9%and joint/ extended family (primary 26.7%, secondary/ higher secondary 27.5%, graduate 18.9%),again statistical difference (p value 0.01). Other variables also affected marriage first child birth interval as depicted in table II (Table II). Table III shows the relation of contraceptive awareness with various variables.   Around 53% girls were aware about contraceptives, irrespective of early or late adolescence and education. However, numbers out of casual laborers and shopkeepers were signifantly more than home makers (P value0.01) Also signicantly more of upper class had awareness than low economic class (p value0.05). More girls were aware of Intrauterine contraceptive device (IUCD), compared to Hormonal (injection and oral contraceptives pills) (20%) and barrier method (14%). No one talked of dual method. (Table III), In all the age groups, around 50% of girls were using contraceptives. Barrier contraceptives (condom) was the most commonly used method (14-15 yrs, 47.6%, ≥16-17yrs 53.3%, ≥18-20 yrs- 32.6%) irrespective of education. Contraception usage was more in casual laborers (100%) and shopkeepers (85.4%) ( P Value <0.5 compared to middle and lower classes with barrier contraceptives being the most common. Table IV shows the relationship contraceptive use with various variables, (Table IV)

Table 1: Awareness of Planned Family Concept

*Small Scale, (Food, Shoes Making, Bamboo Items) Industry, Welding Workshop, Brick Furnace

Table 2: Family Type and Marriage First Birth Interval

*Small Scale, (Food, Shoes Making, Bamboo Items) Industry, Welding Workshop, Brick Furnace

*Small Scale, (Food, Shoes Making, Bamboo Items) Industry, Welding Workshop, Brick Furnace

IUCD Intrauterine contraceptive device 

                                                                               Table: 3 Awareness about contraception 

Table 4: Contraceptive Used

*Small Scale, (Food, Shoes Making, Bamboo Items) Industry, Welding Workshop, Brick Furnace

 IUCD: - Intrauterine contraceptive device 

Large gaps remain in meeting family-planning needs among adolescents globally. There are obvious benefits to having a small family like child receives more parental attention, educational advantages, higher school and personal achievement levels than do children of larger families. The financial costs of maintaining a household are lower. It is easier for both parents to combine careers with family life. The general stress level is lower because there often are fewer conflicts and less rivalry In the present study amongst adolescent girls in rural tribal communities, only little more than one third perceived family should be small and those who did not favour small families around 70%, not all were willing to listen and try to understand, irrespective of variables.  A Cross-sectional survey (5) was conducted in a PHC of Pune, Maharashtra, India, 75% were aware about any contraceptive method. Female sterilization was most commonly known method. Most common source of information was media 53% followed by family members 48%. Another hospital-based study in northern India (6) it was revealed that awareness regarding contraceptive was very poor. In another study (7) prior to an evidence-based health education program in which students in 10th grade health class in two low-to-middle income rural schools completed surveys Contraception focused interventions in rural communities should address modifiable protective factors, such as self-efficacy and parent connection. Interventions need to be trauma-informed and language accessible. Researchers (8) compiled a comprehensive dataset of family-planning indicators among women aged 15-19 from 754 nationally representative surveys among 300 million women aged 15-19 years in 2019, 29.8 million (95% UI 24.6-41.7) use any contraception, and 15.0 million (95% UI 12.1-29.2) have unmet need for family planning. Population growth and the postponement of marriage influence trends in the absolute number of adolescents using contraception or experiencing unmet need. Large gaps remain in meeting family-planning needs among adolescents. The proportion of the need satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 59.2% (95% UI 44.8-6

Data (9) come from the 2018 Healthy Youth Survey, including N = 3757 sexually active, rural-based adolescents contraception use disparities were observed for rural-based youth identifying as Black, Asian, Indigenous, and Latino/a/x/e; lesbian, gay, bisexual, and questioning their sexual identity (LGBQ); and those experiencing poverty. In these models, LGBQ status remained negatively associated with contraception use. The evidence on sexual and reproductive health and rights (SRHR) of adolescent girls in low and middle-income countries (LMIC) in the light of the policies, programs and commitments made at the International Conference on Population and Development (ICPD), progress since 1994 (1) challenges and opportunities for protecting marriages under the age of 18 years continue.   Need to enhance sex education in the school and college to reduce teenage pregnancy and to select the choice of contraception as they need in future   in the present study more girls who had nuclear families had their first childbirth within first year of marriage and so also girls from low economic class and those who were illiterate.  Committee on Adolescent Health Care in United States (10) reported that the birth rate among adolescents was 22.3 per 1,000 women. The American College of Obstetricians and Gynecologists (11) supported the access of adolescents to all contraceptives approved by the U.S. Food and Drug Administration.  It has been opined that in the absence of contraindications; girl’s choice should be the principal factor in prescribing any contraceptive. Dual method uses, (condoms in combination with more effective contraceptive) to protect against (STDs) as well as unwanted pregnancy was believed to be the ideal contraceptive for adolescents, with access to the full range of contraceptives, including long-acting reversible contraceptives. They should be able to plan family, decline and discontinue any method on their own, without barriers. More research is needed to determine which programs are more effective and which programs do not work. Continued efforts are integral to further advance positive trends. Enuameh et al (12) did a study about family planning (FP)needs of adolescents in predominantly rural communities in the central part of Ghana and reported that knowledge of contraceptives was high (87.7% women), but use was low (17.9% women). More than half study participants viewed F P as important to their health and wellbeing (59.6%women). Some adolescents had the perception that contraceptive use was the responsibility of solely women (41.1% women); others said that the use of contraceptives could lead to promiscuity in among women (43.8% women ) In the present study around 53 % were aware,  around 35?out  hormonal and condom .Yarger et al (13) did a study to compare awareness and use of FP services by rural and urban adolescent girls before participation in the federal Personal Responsibility Education Program in California. Overall, 61% of participants had heard of an F P provider in their community, only 24% had visited an F P service provider. Awareness and use of FP services were lower among rural than urban. Findings suggested that adolescents in rural areas faced greater barriers to accessing FP services than adolescents in urban.  In the present study 53% used contraception 3% already had sterilization    Barla et al (14) did a study and reported that in Jharkhand of India. 38% girls’ attitude for timing on practicing FP methods were after two children to limit further births and they were less aware about temporary methods of limiting family. In rural areas traditional remedies were also used for planning family (PF). It was found that awareness and acceptance of FP methods was attributed to poor health infrastructure and services. Empowering adolescents with the right knowledge and instilling the right attitude during adolescence would lead to lesser vulnerabilities and better future health outcome in their future. However, the existing social norms also discourage contraceptive use and this was attributed to misconceptions that contraceptive caused infertility, and the persisting taboo of having sex without the intention to reproduce. Women perceived the use of modern contraception as unfeasible because regular contraceptive use was difficult, given the lack of privacy in the family setting. In contrast, traditional methods of contraception, complemented by induced abortions, were considered feasible and the best available means of reproductive control. Women had lack of knowledge of contraceptive methods and did not always differentiate between medical abortion and contraception. Paul et al (15) reported that tribal women of 20-24 years, 25-29 years and 30-34 years were about two times more likely to use any contraceptive than adolescent girls. The study revealed that having extensive knowledge about FP did not promote the use of contraception.

Present study revealed that not only young adolescent rural girls were married but had children too by 20yrs. Many did not believe in small family. Around 50% had awareness of contraceptives. Awareness did not lead to practice Many had first child within first year of marriage, more so in nuclear families.  A lot of is needed in health system for awareness and counselling.