RESEARCH PROPOSAL: KNOWLEDGE, ATTITUDE AND PRACTICE ON FAMILY PLANNING AMONG MEN IN HOSPITAL KULIM AND TAIPING AND

ITS ASSOCIATED FACTORS

INTRODUCTION Introduction

The issues of youth sexuality

The World Health Organization definition is this: Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A womans ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.

Malaysias population on July 2011 is 28,728,607 with the birth rate of 21.08 births per 1,000 population. The growth rate is now slightly higher than the growth rate for 1970-1980. This is due to higher fertility rates as the number of young women who reach the age of marriage is increase. There are various contraceptive methods which are categorized as barrier, chemical, natural or surgical (Weeks 2002). Surgical method includes sterilization (vasectomy and tubectomy) which is a permanent and irreversible method of birth control. The method for contraception that is usually use in Malaysia nowadays are Oral Contraceptives (the pill), nuvaring (vaginal ring), Ortho Evra (patch), Depo-Provera (injectable), Intrauterine Device IUD (Mirena, Progestin-releasing IUD) and Implanon for hormonal type. While for non-hormonal type, there are male and female condom, vaginal spermicides, diaphragm, contraceptive sponge, cervical cap, Intrauterine Device IUD (paragard), fertility awareness and withdrawal technique.
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Attitudes towards fertility regulation, knowledge of birth-control methods, access to the means of fertility regulation and communication between husband and wife about desired family size are essential for effective family planning (Dabral and Malik 2004). Various factors governs the acceptance of contraception e.g., religion (NFHS 1998-99, 2002), number of sons in family (Bhasin and Nag 2002), and education of husband and wife (Bhasin and Nag 2002), etc. Besides, spousal communication also increases the likelihood of contraceptive use (Kamal 1999; Ghosh 2001). Sterilization is usually accepted when the couple is sure that they have completed their family size and gender preference (Bhasin and Nag 2002).

LITERATURE REVIEW Literature Review According to study by Kulsoom et al. (2006) it showed that married woman of reproductive age have some knowledge about family planning but the percentage of users is not as higher. Factors such as socio demographic, low level of education, poor contraceptive delivery system, desire of male child, misconception of religion contribute to the attitude of family planning. Alina et al. (2006) studies showed that Malay women and their husband had inadequate knowledge about family planning as the wives who had have been in closer contact with the health care provider also had inadequate knowledge. The communication with the wives is the main source of family planning and contraception information for the husband. Murad et al. (2003) studies showed that as a whole, the respondents were aware of the need for family planning. Their formal education, surrounding, family and environment contributed to their awareness. However their family planning practise did not always reflect this awareness. This could be due to their family, religious and cultural background. According to the research that conducted entitled knowledge, attitude and practice of family planning methods among women attending antenatal clinic in Jos, North-central Nigeria (1998) it was found that Knowledge (88.1%) and acceptability (75.4%) of family planning methods were high, while modern family planning methods use was 44.0%. More women 39.3% were aware of oral contraceptive pills. Common methods used were male condom (59.5%), oral contraceptive pills (47.0%) and injectables (27.1%) among others. Most of the women (60.0%) received their family planning information in the hospital. Seventy five percent
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of the women agreed that both husband and wife should jointly decide for a family planning method. Sixty eight percent of women would like to use contraceptive methods after delivery of the index pregnancy. The desire for more children accounted for 36.5% among those that refused use of contraceptive method after delivery. So, despite the high educational status, knowledge and acceptability of family planning methods observed in this study, the practice of these methods is still relatively low. Next, according to the study done entitled knowledge, attitude, and practice of family planning among women aged 15-44 in the Yildizeli district of Sivas, (1985) it was indicated that the socioeconomic, educational, and health levels of people surveyed were rather low (even lower educationally for women) when compared with those throughout Turkey. In addition to these, it was found that: 1) in Yildizeli, the small family norm was dominant as it is throughout Turkey; 2) ever married women aged 15-44 in this area did not have sufficient knowledge about family planning; and 3) contraception in the region was being poorly applied. Thus, in conclusion, for a successful reduction of fertility in regions like Yildizeli, it was suggested that the socioeconomic conditions of localities and families and their health levels should be improved by an integrated approach. Besides that, study done in gynaecological outpatient clinic of Fatima Hospital, Baqai Medical University, Karachi, entitled Contraceptive Knowledge, Attitude and Practice Among Rural Women (2005) revealed that out of 100 interviewed women with mean age of 29.7 years, 81(81%) had some knowledge about family planning methods. The media provided information of contraceptives in 52 out of 81 (64%) women. Regarding the usage of contraceptive methods, only 53 (53%) of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 18 (33.9%) and 12 (22.6%) of women had already undergone tubal ligation. The women using injectables and intrauterine contraceptive devices were 10 (18.8%) and 7 (13.2%) respectively. Six were using oral contraceptive pills (11.3%). Positive attitude towards contraception was shown by 76 (76%) of them, while 41(41%) stated their husbands positive attitude towards contraception. So, in the present study, there was a low contraceptive use among women of rural origin despite good knowledge. Motivation of couples through media and health personnel can help to achieve positive attitude of husbands for effective use of contraceptives.

According to study done entitled Knowledge, Attitude And Practice Of Family Planning Among Women In Basrah City South Of Iraq (2011) revealed that the current prevalence of contraceptive use (any method) among 900 non-pregnant women was 53.7%, use of modern methods was 37% and traditional methods was 16.7%. The use of traditional methods of contraceptives was significantly associated with older age, higher educational level. The main cause for not using contraceptives was health reasons. Husband's objection and cost of contraceptives also had role in non use of contraception methods. So as conclusion, the rate of use of contraceptives was low for both any method and for modern types. The pill was the most popular method of contraceptives and the next more popular method was the withdrawal method. The study reveals good knowledge about family planning.

Apart from that, there was a study entitled Knowledge, Attitude and Practice (KAP) of Family Planning among Married Women in Banteay Meanchey, Cambodia (2008) and the results showed that knowledge of modern contraceptives among the respondents is universal, with 99% of women being aware of at least one modern method of contraceptive. The respondents and stakeholders showed a positive attitude in their support of family planning programs, and more than half of the respondents knew where to obtain contraceptive methods. Around 56% of the women were practicing family planning at the time the survey was conducted, with their main reasons being fertility desire despite the side effects of some methods, and to maintain their standard of living. Study conducted by Birhan Research & Development Consultancy entitled Knowledge, Attitudes, and Practices in Family Planning in Amhara, Oromia, SNNPR and Tigray Regions of Ethiopia (2004) revealed that a considerable proportion of women in urban centers are illiterate and those with a secondary and above level of education are negligible. This calls for assisting and encouraging young girls to pursue education, especially at higher levels. Next, although knowledge of any method of contraception is high in the population, knowledge of
specific methods is very low - particularly of long-term and permanent methods of contraception. Therefore, there is need to broaden the knowledge of such methods of family planning. The survey also indicated that married women aged 15-24 have a high unmet need for spacing births. Focus has to be made to reach these specific groups to satisfy their contraceptive demand for spacing. On the other hand, unmet need for limiting was higher among older women, particularly those residing in
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urban areas. Intensive promotion of long-lasting or permanent methods of family planning could be made available for these women, as their intention is to stop childbearing. Most commonly, family

planning programs are designed to reach women only and in most cases do not involve men. But, in countries like Ethiopia, where men play a dominant role in the household decision making, programs may not be effective without men's involvement, and hence, an effort has to be made towards this end.

PROBLEM STATEMENTS High fertility rate and inadequate spacing between births, can lead to high maternal and infant mortality. An estimated 600 000 maternal deaths occur worldwide each year; the vast majority of these take place in developing countries. WHO estimates that 13% of these deaths are due to unsafe abortion. Worldwide, where approximately 50 million women resort to induced abortion, frequently results in high maternal morbidity and mortality. Thus, family planning and spacing among births are one of the methods to avoid these deaths. Promotion of family planning and contraceptive use is highly adopted by the international community as one of the strategy to reduce the maternal mortality and to reach the Millennium Development Goals. In 1994, World Health Organization (WHO) defined reproductive health as a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life, without any diseases or discomfort. Reproductive health is a basic precondition for a good life, and also for the health of future generations. General strengthening of reproductive health and of family planning services has repeatedly been stated as a priority for reducing maternal mortality and improving maternal and child health. So far, little systematic research has been done to assess reproductive and family planning history, knowledge and needs in the low-income population. This population is likely at higher risk of health problems. In spite of greater needs, they may receive less health services. Therefore, a better understanding of reproductive health service use and needs within this
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population is crucial for improving services and subsequently for improving health, whether through private or governmental action. Since Kulim is a sub urban area, the level of knowledge may vary from the population in urban area. The level of knowledge may not correspond to the attitude and practice of family planning. The objective of this study was to better understand knowledge, attitude and practice on family planning among men in Hospital Kulim and Taiping and its associated factors. Specifically, we want to investigate mens reproductive and family planning history, knowledge, needs, and their suggestions for improving their own reproductive health.

OBJECTIVES To measure the knowledge, attitudes and practices towards family planning among men To determine the method of contraception preferred Hypotheses There is no significant association between awareness of men and their knowledge, attitude and practice towards family planning. To identify factors which influence the practice of family planning

METHODOLOGY

The methodological framework for the study is as below:

STUDY BACKGROUND The study will be conducted in Kulim and Taiping, Malaysia.

STUDY DESIGN This research will be using cross-sectional study. Universal sampling will be carried out and a scoring system which already being authorized will be used to evaluate the knowledge of our respondents.

INCLUSION CRITERIA All men age above 18 years old to 50 years old who give consent and good cooperation.

EXCLUSION CRITERIA Patients who are less than 18 years old and more than 50 years old and those who do not want to participate.

TOOLS Questionnaire for Respondents:

A questionnaire will be framed for the men to elicit information on several parameters of family planning. The areas of the questionnaire: Family profile, Awareness of family planning, Sources of information regarding contraceptives, Use of contraceptives, Different contraceptives used by respondents.

SAMPLE SIZE All consecutive patients that meet the inclusion criteria will be eligible for the study.

DATA ANALYSIS Data will be analysed by using SPSS 19.0

RESEARCH ETIQUETTE Verbal and written consent will be taken from the patients regarding the use of their personal demographic for research. The patients were also provided with an information sheet with information concerning the research.

REFERENCES 1. Malaysian Journal of Public Health Medicine, 2006, Vol 6, Alina T1, Norbanee TH, Hashin MH, Zaki NM, Knowledge on family planning among women who delivered at HUSM Kelantan and their husband 2. Murad AZ, Harlina Siraj, Hazim WA, 2003 : A survey on knowledge, attitude and practice towards family planning among married women in a sub-urban area of Klang Valley, The International Medical Journal ( eIMJ), volume 2, Number 1. July 2003 , electronic version . http://www.e-imj.com/ 3. Diaz S. 1998, Contraceptive technology and family planning sevices. Int J Gynecol Obstet 4. 1998;63 suppl (1):S85-S90. 5. Bernstein P.S., Rosenfield A. Abortion and maternal health. Int J Gynecol Obstet 1998;63 suppl (1):S115-S122. 6. G. Rama R, K. Moulasha and S. Sureender. Knowledge, attitude and practice of family planning among fishermen in Tamil Nadu. The J of Family Welfare 1993;39(3):50-54. 7. Attia ZT. A pilot study on family spacing, attitudes and practices in rural Gezira, Sudan. Contraception1991;43(4):353-59. 8. Donati, S. Hamman, and R. Medda. Family planning: A knowlwdge, attitude and practice survey in Gaza. Social Science and Medicine 2000; 50(6):841-49.
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9. Susan N. Improving contraceptive practice and delivery. National Institute of Child Health and Human Development 2001. (http: www.nichd.nih.gov/). 10. Rasliza Ramli. A survey on knowledge, attitudes and practices towards family planning among general practitioners in Klang Valley. Obstetric & gynaecological case record and commentaries for part II master examination UKM 2000: 320-356. 11. Cardwell B & Barkat -e-Khuda. The first generation to control family size: a microstudy of the cause of fertility decline in rural area of Bangladesh. Stud fam plan 2000; 31(3): 239-51. 12. Cassen, Robert, Visaria et al. India: Looking ahead to one and half billion people. BMJ 1999;Vol 319(7215): 995-97. 13. Spenelli, Talamanca and Lauria. Patterns of contraceptive use in 5 European countries. Am J Public Health 2000; Vol 90(9): 1403-08. 14. Steiner, Markus J. Contraceptive effectiveness: What should the counselling message be? Jama 1999; Vol 282(15): 1405-000. 15. Wong CM, Fifydani S & KY. Womens knowledge, attitudes and perception towards contraceptive education- a questionnaire survey. Malaysian Journal of Obstetrics & Gynaecology 2001; Vol 7(2): 75. 16. Agha, S. Is low income a constrain to contraceptive use among the Pakistani poor? J of biosocial Science 2000; 32(2): 161-175. 17. Kannappan Palaniappan. Antenatal contraception counseling in Muar- is there adequate importance? Malaysian Journal of Obstetrics & Gynaecology 2001; Vol 7(2): 76.

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APPENDICES

SEPTEMBER

NOVEMBER

DECEMBER

FEBRUARY

OCTOBER

JANUARY

AUGUST

MARCH

APRIL

JULY

JUNE

Making proposal Presentation to department Submission to ethical board Approval by ethical board Start distribute the questionnaires / Collecting data Analysis data Research presentation

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MAY

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