Family Planning Knowledge, Contraceptive Practice and Unmet Need among Married Women of Reproductive Age in Urban and Rural Areas of Karimnagar, Telangana:

Author

Atul Gopal Agrawal, Ankita Agrawal

Abstract

 Background: Family planning allows individuals and couples to decide freely and responsibly on the number and spacing of their children. Knowing about contraception does not automatically lead to its use; method preferences, fear of side effects, access, partner communication and counselling quality all play a part.

Objective: To compare family planning knowledge and contraceptive practice between urban and rural married women of reproductive age in Karimnagar, Telangana, and to identify factors associated with current modern contraceptive use.

Methods: A community-based cross-sectional study was conducted from October 2023 to May 2024 in the urban and rural field practice areas of a tertiary care hospital. Of 452 eligible married women aged 18–49 years, 400 were interviewed (response rate 88.5%; 200 urban, 200 rural) using a pretested structured questionnaire. Groups were compared with chi-square (continuity-corrected) or Fisher’s exact tests and t-tests; proportions are given with Wilson 95% confidence intervals. Factors associated with current modern method use were examined by multivariable logistic regression.

Results: Awareness of at least one modern method was 96.8% overall, but current modern method use was 60.5% (95% CI 55.6–65.2), and a further 10.5% used traditional methods. Modern method use did not differ between urban (61.0%) and rural (60.0%) women (p = 0.919), although urban women had higher awareness and knowledge scores (mean 7.1 vs 6.5; p < 0.001). Unmet need (simplified definition) was 21.5% (95% CI 17.8–25.8). The commonest barriers among non-users of modern methods (n = 158) were fear of side effects (41.8%) and desire for pregnancy (36.7%). In the adjusted model (AUC 0.73), parity ≥2 (aOR 2.59; 1.18–5.68), secondary education or above (2.39; 1.42–4.04) and not wanting a child within two years (3.62; 2.00–6.56) were associated with modern method use, whereas adequate knowledge was not (0.93; 0.56–1.54).

Conclusion: High awareness coexisted with moderate use and substantial unmet need, a knowledge-to-practice gap driven more by fertility intention, parity and education than by knowledge itself. Programmes should pair awareness with individualised, non-coercive counselling that addresses side-effect concerns and involves partners, while respecting autonomy.

Keywords

Family planning; contraception; unmet need; knowledge–practice gap; reproductive health; cross-sectional study; Karimnagar; Telangana; India.

Full Text:

Download Paper PDF

References

1. International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019–21: India. Mumbai: IIPS; 2022.
2. International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019–20: Telangana fact sheet. Mumbai: IIPS; 2021. Available at: https://dhsprogram.com/pubs/pdf/OF43/OF43.TG.pdf
3. Sundaran S, Darivemula SB, Bala S, Tondare DP, Kumar SA, Molagara S. Prevalence of unmet need for contraception among married women aged 15–49 years in urban and rural areas of Telangana. Indian J Health Sci Biomed Res KLEU. 2024;17(2). doi:10.4103/kleuhsj.kleuhsj_595_23
4. World Health Organization. Medical eligibility criteria for contraceptive use. 6th ed. Geneva: WHO; 2025. Available at: https://www.who.int/publications/i/item/9789240115583
5. Bradley SEK, Croft TN, Fishel JD, Westoff CF. Revising unmet need for family planning. DHS Analytical Studies No. 25. Calverton, MD: ICF International; 2012.
6. Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368(9549):1810–1827.
7. Starbird E, Norton M, Marcus R. Investing in family planning: key to achieving the Sustainable Development Goals. Glob Health Sci Pract. 2016;4(2):191–210.
8. Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659–673.
9. Senderowicz L. Contraceptive autonomy: conceptions and measurement of a novel family planning indicator. Stud Fam Plann. 2020;51(2):161–176.
10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457.
11. Ministry of Health and Family Welfare, Government of India. Annual Report 2024–25. New Delhi: MoHFW; 2025. Available at: https://www.mohfw.gov.in/sites/default/files/Final%20Printed%20English%20AR%202024-25.pdf
12. Devaraj K, Gausman J, Mishra R, Kumar A, Kim R, Subramanian SV. Trends in prevalence of unmet need for family planning in India: patterns of change across 36 States and Union Territories, 1993–2021. Reprod Health. 2024;21:48. doi:10.1186/s12978-024-01781-6
13. Muttreja P, Singh S. Family planning in India: the way forward. Indian J Med Res. 2018;148(Suppl):S1–S9.
14. Senderowicz L, Maloney N. Supply-side versus demand-side unmet need: implications for family planning programs. Popul Dev Rev. 2022;48(3):689–722. doi:10.1111/padr.12478
15. Singh P, Singh KK, Singh P. Factors explaining the dominion status of female sterilization in India over the past two decades (1992–2016): a multilevel study. PLoS One. 2021;16(2):e0246530.
16. Yadav K, Agarwal M, Shukla M, Singh JV, Singh VK. Unmet need for family planning services among young married women (15–24 years) living in urban slums of India. BMC Womens Health. 2020;20:187. doi:10.1186/s12905-020-01010-9
17. Rahaman M, Singh R, Chouhan P, Roy A, Ajmer S, Rana MJ. Levels, patterns and determinants of using reversible contraceptives for limiting family planning in India: evidence from National Family Health Survey, 2015–16. BMC Womens Health. 2022;22:124. doi:10.1186/s12905-022-01706-0
18. Singh I, Shukla A, Thulaseedharan JV, Singh G. Contraception for married adolescents (15–19 years) in India: insights from the National Family Health Survey-4 (NFHS-4). Reprod Health. 2021;18:253. doi:10.1186/s12978-021-01310-9
19. Pillai VK, Nagoshi JL. Unmet family planning need globally: a clarion call for sharpening current research frameworks. Open Access J Contracept. 2023;14:139–147.
20. United Nations, Department of Economic and Social Affairs, Population Division. World Family Planning 2022: Meeting the changing needs for family planning: Contraceptive use by age and method. New York: United Nations; 2022.
21. Moreira LR, Ewerling F, Barros AJD, Silveira MF. Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys. Reprod Health. 2019;16:148.
22. Holt K, Dehlendorf C, Langer A. Defining quality in contraceptive counseling to improve measurement of individuals’ experiences and enable service delivery improvement. Contraception. 2017;96(3):133–137.
23. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17(8):857–872.
24. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.
25. Wemakor A, Garti H, Saeed N, Asumadu O, Anyoka B. Prevalence and determinants of unmet need for contraception in North Gonja District, Ghana. BMC Womens Health. 2020;20:222. doi:10.1186/s12905-020-01077-4