Contraceptive usage patterns among residents of Shivamoggaslums-cross sectional study

Introduction

The UNESCO defines a slum as a contagious settlement where the inhabitants are characterized as having inadequate housing and basic services.¹ Slums are compact settlement with a collection of poorly built tenements, mostly of temporary nature, crowded together usually with inadequate sanitation and drinking water facilities in an unhygienic conditions.² Slums can be of two types notified and non notified, areas notified as slums by the respective municipalities, corporations, local bodies or development authorities are treated as notified slums. A compact area of at least 300 people or about 60-70 households of poorly built, congested tenements, in unhygienic environment usually with inadequate infrastructure and lacking in proper sanitary and drinking water facilities are considered as a non notified slums.^3,4 Unprepared for such a rapid growth, the cities lack infrastructure and basic services that poses the slum dwellers to the challenges related to health, education, livelihood, climate change and natural hazards.⁵ Informal settlements that result from unplanned growth offer unique opportunities for city planners to achieve improvements in both climate and health. There is an urgent need to identify and reduce health inequities, particularly for the most vulnerable populations, such as people living in urban slums or informal settlements.⁶ Health is a major economic issue for slum residents. The unhealthy physical environment leads to sickness, demanding medical treatment, which results in the reduction of workdays, followed by economic loss. Economic loss leads to inability to invest in a clean environment. The vicious cycle continues. Slums have frequently been conceptualized as social clusters that produce a distinct set of health problems. The poor environmental condition coupled with high population density makes them a major reservoir for a wide spectrum of adverse health conditions.⁷ In India the proposed NUHM (national urban health mission) aims to improve the health status of the urban population particularly slum dwellers and other vulnerable sections by facilitating equitable access to quality healthcare with the active involvement of the urban local bodies.^8,9 In Karnataka a total of 179.86 lakh people are living in urban area. As per the survey conducted by Karnataka slum development Board there are 2804 slum areas in state, of which 2397 are notified and 407 are non notified. It is estimated that the population of the slums in the State is about 40.50 lakhs, which works out to 22.56% of the State’s urban population.¹⁰ these slums have limited access to basic amenities and at the same time living conditions are unhygienic. People in these slums are living with poor housing conditions, overcrowded environment, poor sanitation, and lack of knowledge regarding disease transmission and health care facilities available for them. This has led to outbreaks of several diseases (diphtheria outbreak) in the recent past. Hence this study was taken up for health need assessment of the slum dwellers meanwhile trying to educate them regarding healthy ways of living which in turn will help in betterment of health among these people. This study would help in better implementation of National urban health mission which is mainly meant for health among slum dwellers.

Materials and methods

A Community based cross-sectional study was conducted in selected urban slums in Shivamogga town after obtaining ethical clearance from the Institutional Ethics Committee (Ref. No. SIMS/ IEC/282/2016-17), Shimoga Institute of Medical Sciences, Shivamogga, during the period of January 2017 –June 2017

Inclusion criteria:

All the households whose head of the family was willing to take part in the study.

Exclusion criteria:

Households whose head of the family is not willing to take part in the study and houses which were found to be locked in the both the visits

Data collection and analysis

A list of all slums and the number of households therein was collected from City Municipal Corporation Shivamogga. A list of slums with the minimum of 50 households was made and 10 slums were selected by simple random sampling all the households in the selected slums were included in the study. Quantitative data were collected from the households of selected slums after taking informed consent using a pretested semi-structured questionnaire. The questionnaire contained items to collect socio-demographic details and family planning methods they adopted. Information was cross checked by looking into the available medical records. Locked houses in the first visit were revisited, and those houses which were found to be locked in the second visit were excluded from the study. Data analysis was done using measures of central tendency, standard deviation, proportions. SPSS software was used for data entry and analysis.

Results:

Socio-demographic profile of slum dwellers the background characteristics of the head of the household were as follows. The mean age of head of the household was 44 years, 79.9% of the households were headed by males and 20.1% of the households by females. The education and occupation of the head of the household are depicted in figure 1 and figure 2. It was observed that most of the head of the households were educated below high school Results 23 (49%) and were daily wage workers (59%) by occupation. The other socio-demographic details of households are represented in table 1.

Among 854 households studied it was found that 733(85.8%) of the households had eligible couple and they were asked about the contraceptive method being used. About 36.2% of them were not using any form of contraceptives. The percentage distribution of households based on the contraceptive method used is as follows tubectomy 54%, oral contraceptive pills 17%, intrauterine devices 14% and condom was used by 14%. The same is shown in figure 1.

Discussion:

Among 854 households studied it was found that 733(85.8%) of the households had eligible couple and they were asked about the contraceptive method being used. 53.8% of them reported that they used some form of contraceptives 36.2% of them were not using any form of contraceptives. Similar findings were seen in a study done by Kumar et al¹¹.

Interpretation and Conclusions:

There is a need for increasing awareness regarding different family planning methods and benefits of family planning on socioeconomic development. The findings of our study provides data to plan services and programmes for betterment of people living in slums, further help in creating felt needs of health services for the slum dwellers which will enable to decrease common preventable disease and better utilization of health facilities among them.