Introduction:
Family planning is regarded as one of the most important public health advancements which primarily focusses on women to attain the desired number of children and determine the spacing of pregnancies. Family planning can serve as an important step to reduce the health related risks for women and death due to early child bearing. According to World Health Organization, 2018 a woman's ability to choose if and when to become pregnant directly impacts her health and well-being. In terms of Sustainable Development, the SDG is considered as a blueprint ensuring healthy lives and promoting well-being with a more sustainable future for all. Sustainable Development Goal (SDG) 3 pertains to Maternal Health where the target is to reduce the Maternal Mortality Ratio (MMR to be less than 70 per 100,000 live births by 2030). Target 3.7 of the Sustainable Development Goals (SDGs) calls on countries “by 2030, ensuring universal access to sexual and reproductive health-care services, including information and education, family planning, and the integration of reproductive health into national strategies and programmes”.[1]
In order to influence the key interventions for reducing maternal and child mortality & morbidity, The Ministry of Health & Family Welfare launched RMNCH+A (Reproductive, Maternal, New- Born, Child and Adolescent Health). For the RMNCH+A program, IEC (Information, Education, and Communication) plays an indispensable role in disseminating key information to the community and aims to bring about change in the attitude, belief, knowledge, and behavior of the target population.[2] IEC (Information, Education, and Communication) is considered as important health promotion and intervention program to bring about change in the target audience with a prime focus on specific issues and health-related problems. IEC activities employ a range of instruments that operate at three levels, first is the individual level constituting interpersonal communication methods like home visits, one to one conversations, personalized services, etc. Second at the group level including community group discussions, workshops, lectures, demonstrations, etc. Finally, the third at the mass level consisting of mass media channels (TV, radio, social media, audio-visual spots, street theatre and folk methods); print media channels (newspapers, magazines, posters, brochures, pamphlets, leaflets, FAQ booklets, etc.).[3] Since the rural population is unaware of various health services provided by the Government, IEC helps in understanding the various health-related issues more simply and directs the program to the path of success. On the basis of providing facilities to women, India has three cadres of Community Health Workers (CHWs). The first is the Auxiliary Nurse-Midwife (ANM), working at sub-center who are expected to be multi-purpose health workers. The second is the Anganwadi Worker (AWW), who works solely in her village and carry out work related to providing health and nutrition education to families and also educating parents about child growth and development. The most recently created cadre is the Accredited Social Health Activist (ASHA), trained as health educators and promoters working solely in her village and they focus on the promotion of MCH, including immunizations and institutional-based deliveries, for which they receive a performance-related fee.[4]
The provision of Information, Education, and Communication (IEC) is considered as a key component of family planning programs and serves two major programmatic objectives: to inform people of the existence of family planning methods and to educate family planning acceptors on the proper use of methods to ensure correct and continued contraceptive use.[5] Interpersonal communication along with various sources of mass media like radio, television, posters, and movies acts as a medium for educating and counselling the patients to promote family planning program.[6] Communication researchers have long recognized that exposure to mass and small media can generate interpersonal communication.[7] To provide health-related facilities and disseminating information regarding health awareness, Community health workers (CHWs) role come into play. Community Health workers are local inhabitants trained to serve the people of their respective communities for basic public health and nutrition services. These CHWs, generally are working under the administrative and financial control of the Ministry of Health.[8] Community Health Workers play a key role in health assessment, providing community resources and providing health education for better health-related services and awareness among masses.
Family planning includes the planning to have children and use of contraceptive methods and other techniques to regulate these plans fostering healthy life. In terms of a better understanding of family planning various key dimensions serves a critical role among which is the use of contraceptives. The prevalence of contraceptives worldwide has increased from 54.8% in 1990 to 63.3% in 2010.[9] It is important to explore various sources of media messages and its impact on individuals to have a better understanding of various efficient ways to promote family planning. Taking into consideration the impact of mass media and interpersonal communication in creating awareness, the present study explores its effectiveness in terms of family planning.
The present study is a sub-part of a broader study which aims to determine the efficacy and effectiveness of Information, Education and Communication activities on Health Awareness and Promotion among women in Rajasthan. According to geographical location the state of Rajasthan lies on the north-western side of India and is the largest state. As a result of the revamped efforts, according to the latest released SRS data (Sample Registration System, 2018), India observed a significant drop of 28% in the Maternal Mortality Ratio between 2013 and 2016 with the ratio declining from 167 to 130. This impressive figure reflects the focus of government on low performing states, termed Empowered Action Group (EAG) which contributed the most decline (23%, from 246 to 188). While Maternal Mortality Ratio (MMR) dropped for each state, Rajasthan which forms a part of EAG states having high MMR, saw a lower drop rate from 244 to 199. Against this background, the present study explores understanding the role of various mass media sources and interpersonal communication in creating awareness regarding family planning in rural Rajasthan.
Methodology
Objective- The present study aims to explore the reach of various communication channels including mass media sources, interpersonal communication in promoting family planning among women in rural Rajasthan.
Sample Selected- Two-stage area sampling is used in the present study. In the first stage out of 33 districts of Rajasthan 7 administrative divisions are identified in order to be surveyed. These divisions include Ajmer, Jaipur, Bikaner, Bharatpur, Jodhpur, Udaipur and Kota. Further blocks in which the headquarter of the selected districts lie were identified. In the second stage all the PHCs of each of the selected block were identified and final sample of PHCs were randomly selected from the list. A total of 275 respondents were selected using Cochran’s formula to have an estimated representative sample size of the study. The following data sources were put to use to determine the sample area: PCA data district maps from the District Census Handbook (Census of India, 2011) and updated list of PHCs as obtained from Swasthya Bhawan, Jaipur.
Age Range- A total of 275 women in the age range 15-49.
Tools and technique- The present study is a sub-part of a detailed study conducted to determine Efficacy and Effectiveness of Information, Education and Communication activities for health awareness and promotion among women in Rajasthan- towards a HOPE approach. A planned structured questionnaire was administered on the sample selected on the following theme: Nutrition, Sanitation, Family Planning & Reproductive Health, Maternal Health Services, and Communicable and Non-Communicable disease. Women responded to the questions upon their consent. The present paper focusses on awareness of family planning and as a result, this broad objective is used for interpreting the results. Stata 15 software is used for analysing the data and all the data entry along with variable coding and variable labelling.
Results
A total of 275 women were included in the study in the age group 15-49. For analysing the results using descriptive statistics, Stata 15 software was used. Table 1 shows the size of the sample district/division wise. The data obtained shows sample size distribution from various districts. Among 275 women in the study group, the majority of women belonged to the age group 35-49 years (38.6%), followed by age group 26-34 (26.6%), 21.1% of women belong to the age group 20-24 and 13.8% of women belonged to the age group 15-19. Out of them, almost 80% of women were currently married. (Table 2).
In terms of educational attainment majority of them were not literate 70 (25.6%), only 49 women received secondary education (17.9%) while 15% of them attained education till middle school. Only 27 women (9.9%) received education till graduation while only 15 women (5.5%) received education up to post-graduation and above. Literacy is understood as the ability to read and write, results reveal that majority of women were able to read the whole sentence (59.9%), while 30.7% of women were not able to read at all, while around 8% women were able to read-only parts of the sentence. On the basis of occupation of the respondent it was noticed that the majority of women are housewives (59.1%), around 13.5% of women are self-employed and only 1.1% of women work in government services. (Table 3)
From the data, it can be seen that a total of 132 women belonged to other-backward caste constituting 48.4% followed by general caste (78 women, 28.6%). A majority of women were Hindu (89.8%) followed by Muslims (6.6%) & Christian (1.1%). (Table 4)
Table 1: Sample Size |
Districts |
No. of Respondents |
Percent |
Ajmer |
48 |
17.5 |
Bharatpur |
37 |
13.5 |
Bikaner |
40 |
14.6 |
Jaipur |
32 |
11.6 |
Jodhpur |
40 |
14.6 |
Kota |
41 |
14.9 |
Udaipur |
37 |
13.5 |
Total |
275 |
100 |
Table 2: Distribution of sample on the basis of age and marital status |
Age in years |
Percent |
Marital status |
Percent |
15-19 |
13.8 |
Never Married |
18.6 |
20-24 |
21.1 |
Currently Married |
78.9 |
26-34 |
26.6 |
Widowed |
1.5 |
35 & above |
38.6 |
Divorced/Separated |
1.1 |
Table 3: Educational qualifications, literacy status and occupation of the selected sample |
Educational attainment |
Number |
Percent |
Illiterate |
70 |
25.6 |
Literate without formal education |
1 |
0.4 |
Below Primary |
8 |
2.9 |
Primary schooling |
37 |
13.5 |
Middle school |
41 |
15 |
secondary |
49 |
17.9 |
Higher secondary |
24 |
8.8 |
Diploma/certificate |
2 |
0.7 |
Graduate |
27 |
9.9 |
Post Graduate or above |
15 |
5.5 |
Literacy status |
|
|
Can't read at all |
84 |
30.7 |
Able to read only parts of the sentence |
22 |
8 |
Able to read whole sentence |
164 |
59.9 |
Language not known |
4 |
1.5 |
Occupation |
|
|
House wife |
162 |
59.1 |
Self Employed |
37 |
13.5 |
Government Services |
3 |
1.1 |
Others |
72 |
26.3 |
Table 4: Sample based on caste and religion |
Caste |
Number |
Percent |
Scheduled caste |
52 |
19.1 |
Scheduled Tribe |
11 |
4 |
Other Backward caste |
132 |
48.4 |
General |
78 |
28.6 |
Religion |
|
|
Hindu |
246 |
89.8 |
Muslim |
18 |
6.6 |
Christian |
3 |
1.1 |
Jain |
2 |
0.7 |
No Religion |
1 |
0.4 |
Do not wish to answer |
4 |
1.46 |
| Table 5: Showing knowledge about government advertisement on health awareness |
| Source of health awareness |
Almost Everyday |
At least once a week |
Less than once a week |
Not at all |
Newspaper |
17.52 |
13.87 |
9.49 |
59.12 |
Magazine |
2.92 |
3.28 |
2.55 |
91.24 |
Television |
24.09 |
13.87 |
5.84 |
56.2 |
Radio |
5.84 |
4.01 |
2.19 |
87.96 |
Internet |
14.96 |
7.66 |
1.82 |
75.55 |
Smartphone |
15.69 |
6.93 |
1.82 |
75.55 |
Cinema hall |
1.46 |
1.46 |
5.47 |
91.61 |
Hoarding/Wall painting |
18.61 |
20.07 |
12.41 |
48.91 |
Public transport |
12.77 |
13.5 |
14.96 |
58.76 |
Media helps in enabling people to have access to different sources of information. Results below show the dissemination of information and knowledge about government advertisement on health awareness. The results obtained indicate that the main source of information in terms of government advertisement for health awareness is Television (24.09% almost every day), wall-paper and hoarding (18.61%) followed smartphone (15.69%) almost every day. The least contributing sources in terms of knowledge about health awareness were cinema hall (1.46%), magazine (2.92%) and radio (5.84%). (Table 5)
Since family planning impacts women’s health by providing universal access to sexual and reproductive healthcare services and counselling information, the present study revealed a high percentage of awareness of family planning methods (97.09%) (Graph 1). Results further show that 71% of women were aware of suitable age for bearing first child after marriage (Graph 2) and the main source of information regarding this were others (including community, friends, and relatives), ASHA workers (44.44%) followed by Television (39.68%) as mass media source (Graph 3). Around 89.89% of women were aware of spacing between two children (Graph 4) and the main source of information were ASHA workers (42.92%), others (including community, friends, and family) and Television (37.5%) as a mass media source (Graph 5).
In our study, some questions were based on the awareness of various contraceptives methods among women. Results revealed that around 89.14% of women were aware of tubectomy, 80.52% knew about contraceptive pills and 75.28% of women were aware of Vasectomy. Women were also aware of some other methods of including using injectable (74.53%), the male condom (68.16%), copper T (59.18%) and female condom (29.59%) (Graph 6). Data was also collected and analysed to identify the various sources if information for all the contraceptive methods, Graph 7 shows that ASHA workers, others (community members, family and friends) along with Television are the main source.
 |
 |
Graph 1 Frequency of awareness about family planning among women. A total of 97.09% women were aware about family planning. |
Graph 2 The graph depicts percentage of women who were aware that it is not advisable to have children within first year of marriage |
 |
Graph 3 The figure depicts percentage of various sources of information among women who were aware that it is not advisable to have children within first year of marriage |
 |
 |
Graph 4 The graph depicts percentage of women who were aware about spacing between two children |
Graph 5 The figure depicts percentage of various sources of information among women who were aware of spacing between two children |
 |
Graph 6 The figure indicates total percentage of women aware about various contraceptive methods |
 |
Graph 7 Indicate sources of information on contraception method |
Discussion
The study aimed to explore the reach of various communication channels in promoting family planning among women in rural Rajasthan. A Family planning includes the planning to have children and use of contraceptive methods and other techniques to regulate maternal health & well-being. Having a lack of knowledge in terms of family planning prevents couples from effectively managing their childbearing. Interpersonal communication serves as a key in disseminating information among the masses. A study concluded interpersonal communication as an important aspect of health care quality.[10] Communication in terms of mass media including television, radio, newspaper, hoardings, wall-paper helps in targeting large group of people in providing information. In the present study data was collected from a total sample of 275 women and it was observed that the majority of women (97%) were aware of family planning. Since the Government is promoting at central as well as state-level regarding the right time to have children after marriage, results show that 71% of women were aware that it is not advisable to have children within the first year of marriage and the main source of information were others (community, friends, and relatives), ASHA workers (44.44%), while television is the main source in terms of mass media. After bearing the first child, another factor which affects the reproductive health of women is the spacing between children, results revealed that majority of women (89.89%) were aware of spacing between two children and the main source of information being others (community, friends, and relatives), ASHA workers (42.92%) and television as the main source in terms of mass media. Studies have indicated that healthcare workers under the IEC program act as a reliable and trusted source of information for the community members. Researchers in their study concluded that through the use of IEC program correct knowledge and information regarding different components of fertility can be disseminated among couples.[11]
The knowledge about various contraceptive methods among women was also explored which revealed that 89% of women were aware of tubectomy as a method of contraception followed by contraception pills (81%). Around 75% of females were aware of vasectomy and injectable. Females were also aware of male condom (68%) and copper T (59%) and only a small percentage of women (30%) were aware of the female condom. The main source of information regarding the various source of contraceptive methods are ASHA workers, others (community members, family and friends) and Television. One of the study concluded that people living in the rural areas of India do not possess knowledge barriers in terms of family planning, as nearly three-quarters of the non-users were aware of at least one modern method of family planning and about at least one source from where it could be obtained.[12] Around half the women were aware of spacing methods and a higher acceptance of these methods was observed from the districts where women had knowledge of these methods. A study stated that health workers were more effective in disseminating information related to public health as compared to mass media sources.[8]
Conclusion
The purpose of our study was to identify the reach of various communication channels in disseminating information related to family planning in rural Rajasthan. Information from the responded was gathered by administering a pre-planned questionnaire on family planning. Data analysis and interpretation was done on the basis of response obtained through the administration of the questionnaire. Inferring from the data obtained, it was observed that the majority of women were aware of family planning and the source of information among them were ASHA workers, others (community discussion, friends, and relatives) while Television was the main source in terms of mass media. In our study women are the only stakeholders we sought responses from, while other stakeholders like family members or community members were not included in the study. Further studies can thus focus on taking into account the responses of other stakeholders to have a better understanding in terms of family planning. The use of various other sources of media like radio, newspaper, and wallpaper/hoarding is still limited in terms of family planning. Strategies can be developed and worked upon to expand various sources of mass media for spreading information.
Acknowledgement:
Our deepest gratitude to the officials of Swasthya Bhawan, Health Ministry, coordinators of the State Institute of Health & Family Welfare (SIHFW) Rajasthan for implementing the study in several districts of the State. We would also like to acknowledge the cooperation provided by Community Health Workers (CHWs) of the studied districts for sharing their enriching experiences and wealth of information about the entire project. Finally, special appreciation is reserved for the Indian Council of Medical Research (ICMR) for sponsoring the research project.
References
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- Coeytaux FM, Kilani T, McEvoy M. The role of Information, Education and Communication in family planning service delivery in Tunisia. Stud Fam Plan. 1987;18(4):229-234.
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- Hasan T, Zia A, Anjum IA. A Comparative Study of Health Education Strategies in Family Planning. Pak J Med Res. 2019;58:77–82.
- Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013;381(9878):1642–1652
- Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K, Levy K, Schmittdiel J, Lee J, Schillinger D, Steinauer J. Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynaecol. 2016;215:78.e1-78.e9.
- Jha SN, Baur B, Haldar A, Dasgupta U. A study on fertility perception: an experience from West Bengal, India. Int J Prev Med. 2014;5(1):16-20.
- Chandhick N, Dhillon BS, Kambo I, Saxena NC. Contraceptive knowledge, practices and utilization of services in the rural areas of India (an ICMR task force study). Indian J Med Sci. 2003;57(7):303–310.
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