________________________________________________________________________

ENDORSEMENT

TITLE : A study on knowledge and attitude on birth spacing among reproductive age among married women attending Imadol Health Post..

BY : Nirmala Sapkota

Course : Post Basic Bachelor in Nursing

Area : Imadol Health Post

Accepted by : The Faculty of Medicine Tribhuvan University Lalitpur Nursing Campus

in partial fulfillment of requirement for post Basic Bachelor's Degree in Nursing.

…………….……………..Mrs. Rebecca Sinha Campus chief

Lalitpur Nursing CampusResearch advisor

…………………………… Assistant Campus chiefMrs. Radha Devi Bangdel Lalitpur Nursing Campus

…………………………….Mrs. Ambika Poudel Research advisor

Lalitpur Nursing Campus

…………………………… Research teacherMrs. Sarala K.C.

……………………………. Research teacherMrs. Ranjana Shrestha

............................................. Research teacherMrs. Khagi Maya Pun

............................................. Research teacherMrs. Shova Laxmi Bajracharya

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ACKNOWLEDGEMENT

This descriptive educational research study has been completed with valuable advice, suggestion and guidance and co operation of many people. I would like to express my thanks gratitude to all people who had contributed to this research study.

First of all I would like to express my deep gratitude to Tribhuvan University Institute of medicine , Lalitpur nursing Campus Sanepa for providing me a opportunity to conduct this study as a part of my fulfillments of bachelor Degree in the community Nursing. My heart full thanks go to Campus Chief Mrs. Rebecca Sinha for providing me the opportunity to carry out this study and Mrs. Radha Bangdel, Assistant Campus Chief for providing Valuable suggestions.

I would like to express my express my deep sense of gratitude and appreciation to my research advisor and research teacher Mrs. Ambika Paudel for her constant guidance, Support, Valuable suggestions and encouragement during my study period. Similarly, I would like to give my sincere thanks to co-coordinators of BN 2nd year, Mrs. Khagi Maya Pun research teacher Mrs. Ranjana Shrestha and Faculty members.

I am thankful to Imadol health post incharge, Bhimsen Pant who permitted me to collect data at Imadol health post. Similarly my thanks go to other staffs of Imadol HP, As well as to the participants who involve in my study.

I wish to express my thanks to the Mr. Ron Happ, English teacher for correction of language and Mrs.Rajani Shrestha, liabrian of Lalitpur Nursing Campus, Library staff of Maharajung Nursing Campus as well NHCRC library staff.

My extreme sincere thanks goes to Executive Secretary of LNC, Ujjwal Upadhaya As well as my friend miss Rachana Regmi for help, support cooperation and guidance in computer work.

Finally I would like to thank all my colleagues, who graciously helped and encouraged me throughout the study. So I express my sincerely gratitude to all my friends.

This study had been completed with suggestion, guidance and help of many people. So last but not the least I would like to thanks to all people who had contributed directly and indirectly in the research.

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ABSTRACT

Small Scale descriptive research was conducted as a partial fulfillment of the requirement

for bachelor of Nursing programmed in Imadol HP among 50 respondents. The main

objective of this research was to assess the reproductive age married women Knowledge

and attitude on birth spacing.

Structured and close ended Questionnaire was developed based on related literature and

objective. Face to face interview technique was used to collect information. Simple

descriptive statistatic was used for data analysis such as percentage, frequency and mean

score. After analysis of data findings were presented through tabulation and Pie chart,Bar

graph

The number of respondents were 50.All respondents 50(100%) had heard about family

planning and birth spacing.

In this research study there were 5 knowledge related question, Each Question carry1

mark its full marks was 5.Maximum score of knowledge was5 and minimum score was

2.Mean Knowledge score of illiterate women was 3.84 and literate women mean

knowledge score was 4.64.Respondents were categorized in three groups according to

achieved marks,<70%,>70% to <90 %and >90% inadequate knowledge, Moderate

knowledge and Adequate knowledge respectively. Among 50 respondents 12% had

inadequate knowledge, 20% moderate knowledge and 68% had adequate knowledge.

There were 7 attitude related question each question carried 3 marks. Full marks of

attitude related question was 21.Attitude answer was marked 3,2,1,0 for strongly satified,

Satified, Dissatified and strongly satisfied respectively. In attitude maximum score was

21 and minimum score was 13.Mean Score of attitude related question among literate

women was 18.62 and mean score of attitude among illiterate women was 18.38.

The study shows that most of the women had more knowledge and good attitude on birth

spacing.

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TABLE OF CONTENT

Content Page

Endorsement ……………………………….. I Acknowledgement…………………………..... II

Abstract……………………………………… III

Table of content……………………………… IV List of tables………………………………...... V

List of figures…………………………………. VI

Abbreviations………………………………... VII

CHAPTER-I

Introduction1.1 Background of the study……………………1.2 Significance of the study1.3 Statement of the problem1.4 Objective of the study1.5 Hypothesis1.6 Operational definition1.7 Limitation of the study

CHAPTER-IIReview of related literature2.1 Review of related literature2.2 Summary of related review literature

CHAPTER-IIIResearch Methodology3.1 Research design3.2 Study area3.3 Population of study3.4 Sample size of the study3.5 Sampling Technique3.6 Criteria for sample collection3.7 Variables3.8 Data gathering tools3.9 Data collection procedure

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3.10 Validity and reliability of the research

3.11 Pre-test3.12 Ethical consideration3.13 Data analysis procedure3.14 Budget and time3.15 Knowledge scoring procedure

CHAPTER-IVAnalysis and interpretation4.1 The demographic information4.2 knowledge assessment4.3 Hypothesis testing

CHAPTER-VSummary conclusion and Recommendation

5.1 Summary5.2 conclusion5.3 Implication of the study5.4 Recommendation5.5 Strength of the study5.6 Difficulties5.7 Plan for dissemination

BIBLIOGRAPHYAPPENDICESQuestionnaireTime schedulePermission letter

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ABBREVIATIONS

B.N : Bachelor of Nursing

CBS : Central Bureau of Statistics

CPR : Contraceptive prevalence rate

DHO : District Health Office

DHS : Demographic and Health Survey

FP : Family Planning

FPAN: Family Planning Association Of Nepal.

HP : Health Post

IOM : Institute Of Medicine

IMR : Infant Mortality Rate

MMR : Maternal Mortality Rate

NHCRC : National Health Council Research Centre

n : Total Number

TFR : Total Fertility Rate

UNDP : United Nations Development Programme

USF : University of San Francisco

VDC : Village Development Committee

WHO : World Health Organization

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CHAPTER ONE

BACKGROUND Birth spacing is the interval between births that provides the greatest health, social and

economical benefits for family. Enabling couples to determine when they will have

children is vital to safe motherhood and healthy children.

Birth spacing refers to the time interval from one child’s birth date until the next child’s

birth date. There are many factors to consider in determining what an optimal time

interval between pregnancies.However,researchers agree that 2 ½ years to 3years

between births is usually best for the well being of mother and her children.

(Reproductive health programmed)

When births are spaced 2 and ½ years to 3 years apart there is less risk of infant and child

death. There is also higher risk of the baby being underweight. Infants and children under

five years of age, births spaced at least 36 months apart are associated with the lowest

mortality risk. Likewise birth to conception intervals of less than 6 months as well as

abortion, pregnancy intervals of less than 6 months are associated with increased risk of

preterm births, low birth weight and small for gestational age as well as are associated

with increased risk of maternal mortality and morbidity.

(Nortion A2005)

GLOBALLY

Women in Ghana, Kenya, Rwanda, Zimbabwe and Comoros prefer birth interval of up to

4 yrs. (USAID 2005)

A finding from rural North India shows that short birth intervals have been associated

with adverse birth out comes. The figure of still birth were significantly greater among

birth intervals of <18 months, 18 to 35 months compared with intervals of 36 to 59

months.

(Emma Keatl 2008)

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Nepal is land lock country situated between India and China. It has a total population of

23.2 million in an area of 147,181 square kilometer.

Family planning programmed was established in Nepal in 1959 with the establishment of

NGO .i.e. Family planning association of Nepal. Family planning services in 1960s were

limited to the distribution of condoms pills, and insertion of loops .FPAN initiated a

weekly radio program 1968.FPAN program were expanded from 3 districts in 1960s to

15 districts in 1970s and 32 districts in 2004.

It is divided in to three demographic regions; hill, terai and mountain. There are five

development regions. According annual report of the 2062/63 contraceptives prevalence

rate in those development region were; Eastern 48.17%.,Central 48.59%,Western

33.83%,Midwestern 35.04% Far western 30.33% (Annual report 062/63)

According population census 2001, the annual growth rate was 2.24 %(NDHS 20006)

between 1991 and 2001.Almost most An equal number of males and females is recorded

in the census with the sex ratio of 99.8 Population growth continues to be very high on

account of large size of female population in the reproductive age group (49.2) and high

fertility rate (3.1 children per Women) NDHS (2006) due to high unmet demand for

contraception (27.8%) and early marriage of girls before the age of 18yrs.

In Nepal 23% of births occur within 24 months of previous birth and the median birth

interval is 32 months. (DHS 2001)

Couples who spaced their births 3to 5 years apart increase their children’s chances of

survival and mothers are more likely to survive too. Many women want to space births

longer than they currently do. (USAID 2005)

WHO suggest that couples should wait at least 2-3 years between births in order to

reduce the risk of adverse maternal and child health out comes.

There has been high fertility rate among adolescents. About 21% of Adolescent Women

aged (15-19) are already mothers or are pregnant with their first child.(DHS 2001).The

contraceptive Prevalence rate (CRP) is reported to be at 12%only among adolescent

age(15-19) While it is 23.4% among 20-24 age group(DHS 2001)as against 67% and

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15.8% respectively in 1996. This indicates that use of contraceptives by these age groups

is quite low as compared to other countries in the region.

SIGNIFICANCE OF THE PROBLEMS

Birth Spacing is the gap between the births of one child to next pregnancy. Healthy time

spacing and pregnancy can reduce the risk of neonatal death by as much as 3.2 times;

lessen the post neonatal death as much as by 3 times (DHS analysis 2005). For improve

maternal and child health a couple should wait least two years or more after a birth before

attempting to become pregnant again.

Average Nepali women give birth to 3.1 (2006 DHS) children during her reproductive

age and the contraceptive prevalence rate were 48%for any method (2006 DHS). In

Nepal 23% of birth in occur within 24 months of previous birth (DHS 2001).

This study will be helpful for women as they will be able to know their existing

knowledge of birth spacing.

This study will be also helpful for spouse and other member of respondent’s family

because they will also be able to share obtain knowledge on birth spacing.

Researcher is interested on this topic because of the following reason:

Most of the Nepali women don not make decision on family planning,

Their husbands take decision on family planning,

Higher fertility rate i.e. 3.1

Population growth rate 2.24%.

Contraceptive prevalence rate is also low in our country and 23% of Nepali

women give birth within 24 months of previous birth.

This study also helps to assess the knowledge and to identify the attitude on birth

spacing on the reproductive age married women.

Findings help to conduct awareness program on birth spacing to reproductive age

married women who come at Imadol HP.

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STATEMENT OF THE PROBLEM

A study on knowledge and Attitude on birth spacing among reproductive age married

women attending Imadol Health Post.

OBJECTIVE OF THE PROBLEM

GENERAL OBJECTIVE

The general objective of this study is to assess the knowledge and to determine attitude

on birth spacing among reproductive age married women attending Imadol Health Post.

SPECIFIC OBJECTIVE

To assess the knowledge of birth spacing on reproductive age married women

attending Imadol health Post.

To identify attitude of birth spacing.

To provide education on birth spacing for knowledge deficits women.

HYPOTHESIS

Literate reproductive age married women may have more knowledge good attitude on birth spacing, than those of illiterate women.

OPRATIONAL DEFINATION

Knowledge : Information and understanding about birth spacing.

Attitude : Away of feeling, beliefs and behavior on birth spacing.

Literate : Those respondents who can read and Write.

Illiterate : Those respondents who can’t read and write.

Birth spacing : Gap between births of one child to the birth of next child.

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CHAPTER TWO

LITERATURE

Review of related literature.

A research process cannot imagine without reviewing related literatures. Review of the

literature refers to broad, comprehensive, in-depth, systematic and critical review of

published and unpublished data based literature and conceptual literature.

Materials found in print or non-printed forms. It gives depth knowledge in selected topic.

The literature were reviewed from research and non research area, journals, articles,

reports, documents, books and some abstract received from internet search. The aim of

literature review is to extend the knowledge and find out evidence which support the

study.

Emma .K etal (2008) Examined in their study “Birth Interval and Risk of stillbirth or

Neonatal Death: Findings from rural north India “that short birth intervals have been

associated with adverse birth outcomes. The figure of stillbirth were significantly greater

among birth interval of < 18 months, 18-35 months and >59 months compared with

intervals of 36-59 months.

Bhalotra S.etal (2008) mentioned in their study “Birth spacing, Fertility and neonatal

mortality in India :Dynamics, frailty, and fecundity” that on 30,000 childbirths in India

while analyzing causal effects of birth spacing on subsequent neonatal mortality, they

found that for every neonatal death,0.37 additional children are born, of whom 0.30

survive. they further said that birth intervals explain only a limited share of the

correlation between neonatal mortality of successive children in a family.

Dahal,GP.eatl(2008) concluded in the study “fertility-limiting behavior and

contraceptive choice among men in Nepal” that 41% of men who wanted no more

children said they never communicated with their spouses about FP,and 25%said they

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frequently did so. large majority (82%) reported that they alone made decisions about

their wives health care. third of men had no exposure to family planning in the mass

media in the last few month, while about four in ten had been exposed to messages

through either radio, TV or Newspaper. The most common family composition among

those who did not want more children was two sons and daughter (15%) only 3% had no

living sons. Generally men who wanted more children tended to have rather small

families or had more daughters than sons.

Vera,D (2007) stated in a study “Birth spacing perceptions of rural filipion’s that analysis

of ethnographic data produced the following meaning, Factors Influencing Birth spacing,

and six categories (a) gender relations,(b) religion and catholic church,(c)Contraceptive

technology,(d)media,(e)family and friends and (f)family planning education.

Understanding the factors influencing birth spacing in different cultures may provide

health care providers with a broader scope for providing culturally competent care.

Stubblefield,G (2007)mentioned in the article :Inter pregnancy interval and pregnancy

outcome” it is important to determined whether inter pregnancy interval is truly a

significant independent biological risk factors for adverse pregnancy events since

educated women have some control over the spacing of their pregnancy and thus could

potentially reduce their risk of such outcomes.

USF news 2007 march

A study by four University of San Francisco Nursing students recommends that Mother

wait two and a half to three years between babies to avoid risks to their own health and

that of their children.

According to their study problems associated with having babies too close include

increased risk of miscarriage and premature birth and maternal health complications.

Rasheed, P (2007) concluded in the study “Birth interval; perceptions and practices

among urban based Saudi Arabian Women” that education and employment status were

predictors of birth spacing preferences .About half were not aware of the physical benefit

associated with longer birth interval. Only 26.3%had mean birth interval <2 years. Age

and employment status were significant positive predictors of longer birth interval.

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Norton,M (2008) stated in” Global Health technical briefs” that spacing births three to

five years apart associated with the lowest risk for neonatal ,infant, child and under five

mortality, Birth spacing should included in the mortality reduction strategies.

Conde, A.A (2006) Concluded in the study” Birth spacing and risk of adverse perinatal

outcomes” that both short and long inter pregnancy intervals have been associated with

an increased risk of adverse perinatal out comes .He further concluded that inter

pregnancy intervals shorter than 18 months and longer than 59 months are significantly

associated with increased risk of adverse perinatal out comes .These data suggest that

spacing pregnancies appropriately could help prevent such adverse perinatal out comes.

USAID (maternal and children health) 2005 August

Recent research found that birth intervals of 3 to 5 years are safer for mothers and babies

compared to birth intervals of two years or less. Children born 36 to 41 months after their

next older sibling have a lower risk of neonatal, infant and under five death as well as

lower risk of shunting as being underweight then children born 24 to 29 months apart.

Mothers benefit as well as longer birth intervals. Birth intervals of 27 to 32 months place

women at a decreased risk of maternal death, third trimester bleeding, premature rupture

of membrane, puerperal endometritis and anemic compared to birth spaces 9 t0 14

months apart.

Sarahl. b (2007) mentioned in the study “family planning advice and postpartum

contraceptive use among low income women in Mexico” that providing information

about FP as apart of prenatal care is an important means of increasing postpartum

contraceptive use in urban Mexico. Relatively low levels of methods use in this setting

may be addressed by increasing the proportion of providers who offer family planning

advice during prenatal care, and strengthening their capacity to advice about the safety

and efficiency of hormonal methods. These findings may be relevant in other settings that

are considering ways to integrate family planning advice and counseling into general

health services

Thapa S. etal (2001) Stated in their study that women in Nepal desire a family size,

especially those living in urban areas. Although significant numbers of women practice

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contraception, induced abortion is also used primary to control family size and for birth

spacing. Increased promotion and use of contraceptive methods are needed to decrease

the number of abortions, especially those that are high risk and unsafe.

WHO(2005) suggest “birth spacing –report from a WHO technical consultation “that

individuals and couples should wait at least 2-3 years between births in order to reduce

the risk of adverse maternal and child health out comes .

Almaie S (2003) found in the cross sectional study “The pattern and factors associated

with child spacing in eastern Saudi Arabian” that the most of important variables to be

significantly correlated with the birth intervals were maternal age ,level of education,

family size and breast feeding.

DHS analysis 1999 Guatemala

Alack of knowledge about methods and about source of methods continues to hamper

women from spacing their children. For the instance in the Bolivia 1998 DHS 27% of

women under 30 indicated that they lacked knowledge of methods. In Guatemala in 1999

the rate was 28.1% in Nigeria in 1999 it was 15.6%

Johns Hopkins University Bloomberg school of public health 2002

Many more women need to space births longer to realize the health benefits. Even in

Indonesia, where median birth intervals are longest at 45 months, 36% of women have

birth intervals shorter than 3 years. In Zimbabwe, with the second-longest median birth

interval at 40 months, 40% of women have birth intervals shorter than 3 years. (The

median is the exact “middle” birth interval of a country, with half of women having

longer birth intervals and half having shorter intervals than the median.

Rutsteins study 2000

Recommends birth intervals of three years or longer. Births should be spaced at least 36

months (three years) apart to achieve greater improvements in child survival.

Malnutrition is an underlying factor in more than half of all under five deaths. Rustein

found that the risk of chronic or long term malnutrition decreases with longer birth

intervals.

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New ERA 2001

Unmet need for family planning, currently married non pregnant women of reproductive

age who say that they do not want any more children or they want to wait at least for two

years before having another child but are not currently using any contraception are

considered to have unmet need for family planning.

The percentage of met and unmet needs for family planning as of the demographic and

health survey 2001.the total demand for family planning was 67.1% of the MWRA of

which 39.3% was met and 27.8%of need not met yet of which11.4% of MWRA want for

spacing and 16.4% for limiting.

Therefore, out of the 67.1% of the MWRA requiring FP service the demand has been

stratified for 58.5% of these couples. Nepal’s family planning programmed is directed to

ward reaching couples with unmet needs and towards reducing the proportion of women

expressed no demand through information and awareness activities.

Rutstein 2002

A 2000 study using DHS data from 18 countries and assessing the out comes of more

than 430,000 pregnancies found that children born 3years or more after previous birth

are healthier at birth and more likely to survive at all stages of infancy and childhood

through age 5.

When compared with children born less than two years after a previous birth .children

born after three to four year interval were found to be

1.5 times more likely to survive in the first week of life.

2.2 times more likely to survive the first 28 days.

2.3 times more likely to survive the first year.

2.4 times more likely to survive to age 5.

Conde Agudelo and Belizan 2002

2002 research on Latin America, Using data from 1,080,650 pregnancies found that birth

intervals of 20 months or less were associated with increased risk of early preterm

delivery, fetal deaths, low birth weight, early neonatal death and low agar score.

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W.Jansen, University of North Carolian 2002

Among married women who are 29 years or younger, the portion of the total demand for

family planning for birth spacing reasons varied from about 66% to over 90% in 12 to 17

countries examined. In the over five countries demand for birth spacing represented at

least 50% of the total demand for family planning among women who were less than 30

years old. (17 counties: - Bangladesh, Benin, Bolivia, Egypt, Ghana, Guatemala,

Indonesia, Kenya, Mali, Nicaragua, Peru, Philippines, Tanzania, Togo, Uttar Pradesh,

Yemen, Zimbabwe)

Summary of Literature Review

Birth Spacing Plays vital role in the reduction of maternal and infant mortality rate. Birth

spacing also promotes better health of child and mother. Spacing birth three to five years

apart is associated with the lowest risk for neonatal, infant, child and under five mortality.

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CHAPTER III

RESEARCH METHODOLOGY

1. Research design: A simple descriptive research design was used for this study.

2. Research area: Imadol Health Post

3. Study Population: All reproductive aged married women i.e. 15-49 years attending Imadol Health Post.

4. Sample of the study: 50 women of reproductive age those who came “Imadol Health Post”.

5. Sampling technique: Purposive sampling method was used for collection of data.

6. Inclusion criteria: Reproductive aged married women attending Imadol Health Post. The clients who were willing to participate in this study.

7. Data gathering tools: Semi structured interview schedule with the close-ended and open-ended question was used to collect data from the respondents.

8. Data collection procedure: Before collecting data formal and informal permission was obtained from health post in charge. Data was collected by interview method.

Respondents were selected by purposive method; 15-20 minutes was taken from each respondent.

Researcher used Nepali language.

9. Validity and reliability of the instrument: To measure the validity of the instrument the questionnaire were shown to the advisor, research teacher and other teacher of BN faculty of Lalitpur Nursing Campus.

Necessary modification of the questionnaire was done according to their guidance and suggestion.

10. Pre test: The developed questionnaires were tested with 10% of the final respondents prior to the study and necessary modification was made on the question.

11. Data analysis procedure: Collected data were analyzed and interpreted on the basis of different statistical calculation like percentage, using table, pie chart, Bar chart.

12. Variables

I. Independent variables: education, occupation, husband's education, and permanent address, media exposure.

II. Dependent variables: knowledge and attitude about birth spacing.

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13. Ethical consideration

Verbal and written permission was obtained from the Imadol health post in charge

Verbal permission was taken from the respondents.Purpose of the study was explained.Privacy, confidentiality was maintained.

14. Budget

Self finance

15. Time schedule

5 weeks according to curriculum.

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CHAPTER FOUR

4. DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of data obtained from

questionnaire. All the collected data were checked and rechecked for their accuracy and

completeness at the end of the day.

All the obtained data were analyzed on the basis of the objective and hypothesis of the

study and displayed using different tabulation, graphic presentation. The findings of the

study are presented in three parts.

1. Demographic information.

2. Knowledge regarding birth spacing on reproductive age married women.

3. Attitude on birth spacing on birth spacing among reproductive age married women.

PART I

Demographic information

Table 4.1 Distribution of respondents according to their demographic variable. n= 50

S.nVariables Frequency percentage

Ethnic group1. Chhetri/Brahmin 26 522. Tamang/Magar 10 203. Newar 5 104. Chaudhary 3 65. Nepali 2 46. Majhi 2 47. Rai 1 28. Muslim 1 2

Age1. 15-24 22 442. 25-34 23 463. 35-49 5 10

Religion1 Hindu 37 74%2 Buddhist 10 20%3 Christen 2 4%4 Muslim 1 2%

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Occupation1 House wife 43 86%2 Daily wedges 5 10%3 Business 2 4%

Above table 4.1 showed that majority of respondents 26(52%) were Brehaman/chhetri.this may be due to Imadol is the locality of brahaman and chhetri.Maximum respondents 23(46%) were age group of (25-34) years. Most of the respondents37 (74%) were Hindu. Most of the respondents 43(86%) were house wife.

Table 4.2 Distribution of respondents Demographic data. n=50

SN Education Frequency Percentage1 Illiterate 13 262 Literate 37 74

Primary 19 38Secondary 13 26Heigher.Secondary 5 10

Type of family1 Nuclear 40 802 Joint 10 20

Age of marriage1 Below 20 yrs 30 60%2 Above 20 yrs 20 40%

Gravida and Para1 Primipara 30 60%2 Multi Para 20 40%

Husbands education1 Uneducated 25 502 Educated 25 50

Address1 Temporary at Imadol 38 762 Permanent at Imadol 12 24

Above table 4.2 showed that majority of respondents 37(74%) were literate.40 (80%)

respondents lived in nuclear family. 30(60%) respondents married below the age of 20

years.

Above table shows that majority of respondents 76% have temporary address at Imadol

and 24% have Permanent at Imadol.

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4.3Distribution of respondents knowledge on source of family planning suppliers. n=50

SN Source of F.P. Suppliers Number Percentage

1 Knows the source 47 94%

2 Don’t Knows source 3 6%

Above table 4.3 showed that maximum respondents 47(94%) respondents knows the

source of family planning supplies, this may be due to media exposure. and minimum

respondents 3(6%) doesn’t know the source of family planning supplies.

Among 50 respondents, 30(60%)of respondents were primigravida and 20(40%) were

multi gravida.

Among 20 respondents, 15(75%)kept birth spacing and 5(5%) did not kept birthspacing .

Among 5(25% ) respondents 3(13%) respondents did not knew the source of family

planning supplies so they did not kept birthspacing.and 2(12%) respondents did not kept

birthspacing due to careless.

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Part II

Knowledge Assessment

4.4 Distribution of respondents based on their knowledge on birth spacing.

S.n. ItemsCorrect Incorrect

No. of respondents

%No. of

respondents%

1

Family planning devices are

freely available in government

services

38 76% 12 24

2

Birth spacing is gap between

the birth of one child to the

birth of next child

50 100% 0 0

3More than two years is good

for birth spacing48 96% 2 4

4

The Sources of family

planning supply are health

post, PHC, Sub-health post,

Hospital and dispensary.

47 94% 3 6

5

For mother’s and babies health

it is necessary to keep birth

spacing

44 88% 6 12

Above table 4.4 showed that all (100%) respondents had known birth spacing And most

of the respondents 24% do not had knowledge on family planning devices were freely

available in government services.

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Knowledge related question

4.5Distribution of respondents regarding temporary family planning method n=50

Above Pie chart 4.5, showed that 100% respondents had heard about temporary family

planning method’s.This may be due Imadol Health post is near Lalitpur Municipality, So

most of the people were literate and familiar with FP methods.

100%

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4.6Distribution of respondents who heard about types temporary family planning method. n=50

14

15 1416

0

2

4

6

8

10

12

14

16

Number of respondents

one method Two method Three method Four method Five method

Distribution of respondents listen number of family planning method

one method

Two method

Three method

Four method

Five method

Above bar graph 4.5showed that majority of respondents have good knowledge on

temporary family planning .16(32%) of respondents have heard five method of temporary

family planning and 1(2%) of respondents have heard one method of temporary family

planning method. All respondents had heard about at last one method of family planning

it may be due to assibility of health service

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4.6Distribution of respondents, Used family planning method. n=50

Distribution of respondents used family planning method

0

5

10

15

20

25

Depo No any Natural Pills Condom

methods of family planning

resp

on

den

ts

Above bar graph 4.6 showed that majority of respondents 20(40%) used depo for birth

spacing and 2(4%) use condom for birth spacing.Depo may be the most desirable method

for birth spacing.

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4.7 Distribution of respondents source of knowledge on temporary family planning. n=50

20

15

11

4

0

5

10

15

20

No of respondents

Friends Healthworker

Media/Books

Familymembers

Distribution of respondents source of knowledge of FP

Friends Health worker Media/ Books Family members

Above bar graph 4.7 Showed that majority of respondents20 (40%) source of knowledge

about family were Friends and minimum respondents 4(8%) source of knowledge were

family members. Most of respondent’s source of knowledge of FP service was Friends it

may be due with friends every one can discuss openly in any subject.

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4.8 Distribution of respondents knowledge on family planning services are freely available in government services. n=50

respondents knowledge on free free supply of family planning method by

government services

78%

22%

a

b

a. Did not knew about free supply of family panning devices by government

b. Knew about free supply of family planning devices by government.

Above pie chart showed 4.8 that (22%) 11 respondents did not knew that family planning

supplies were freely available in government services. and (78%) 39 respondents knew

that family planning Supplies were freely available in government services

Most of the respondents knew free supply of family planning it may be due to assibility

of health service. And Imadol VDC is near Lalitpur district.

________________________________________________________________________

4.9 Distribution of respondent’s opinion on child spacing. n=50

Distribution of respondents knowledge on birth spacing

0

10

20

30

40

50

Above 5yrs Above 4yrs Above 3yrs Above 1yrs

Birth interval

Res

pond

ents

kno

wle

dge

Above 5yrs

Above 4yrs

Above 3yrs

Above 1yrs

Above figure 4.9 showed that Maximum respondents 41 (82%) wants more than five year

birth interval and minimum respondents 1 (2%) wants above one year birth interval. It

may be due to Most of the respondents were media exposure and lived near Lalitpur

district.

________________________________________________________________________

4.10 Distribution of respondent’s knowledge on number of children needed for ideal family. n=50

0

10

20

30

40

50

No. of respondents

Onechildren

Twochildren

Threechildren

Fourchildren

No. of children

Distribution of respondents on number of Children

Series1

Above figure 4.10 showed that maximum respondents42 (84%) wants two children for

ideal family and minimum respondents 1 (2%) wants four children for ideal family. It

may be due to most of the respondents were literate and media exposure.

________________________________________________________________________

4.11 Distribution of Attitude score in relation to no of respondents regarding birth spacing.

n=50

0

5

10

15

20

25

30

35

0 1 2 3 4 5 6

Knowledge Score

Num

ber

of R

espo

nden

ts

Above figure 4.11 showed that majority of respondents 33(66%) had maximum

Knowledge score 5,10(20%)respondents had 4 score,5(10%)respondents had

3 score, and 1(2%) had 2 score. Majority if respondents had maximum score it may be

due to most of respondents were literate and lives near Lalitpur Municipality.

________________________________________________________________________

4.12 Distribution of despondence knowledge score in relation to their education level. n=50

5 5

3

2

00.5

11.5

22.5

33.5

44.5

5

Respondents Knowledge

Score

1 2

Maximum Score Minimum Score

Literate Respondents

Illiterate Respondents

Above figure 4.12 shows that the Literate and Illiterate respondents, both have same

maximum level of knowledge i.e. 5 ,the Minimum Score of literate respondents was 3

and minimum Score of illiterate respondents was 2 both literate and illiterate respondents

had same maximum level score it may be due to both type pf respondents are equally

media exposure. And lived at Imadol VDC near Lalitpur District.

________________________________________________________________________

4.13 Distribution of respondents Knowledge on birth spacing. n=50

Respondents

Inadequate knowledge

Moderate knowledge Adequate knowledge

Frequency % Frequency % Frequency %

50 6 12 10 20 34 68

Key

Above table 4.13 showed that most of the respondents 34(68%) had adequate knowledge

on birth spacing and 10(20%) respondents had moderate knowledge and 6 (12%) had

inadequate knowledge on birth spacing Most of the respondents were literate and media

exposure

So they had adequate knowledge on birth spacing.

________________________________________________________________________

Part III

Attitude Assessment

4.14 Distribution of respondents according to their attitude regarding birth spacing.

S.n Items

Positive attitude Negative attitude Total

No. of

respondents%

No. of

respondents%

No. of respondents

%

1

Married reproductive

age women should use

temporary family

planning method for

birth spacing

49 98% 1 2% 50 100

2Sex determine the size

of the family43 86% 7 14% 50 100

3

No. of children

determine the size of

family

43 86% 7 14% 50 100

4

It is good to keep birth

spacing for mothers

health

50100

%0 0% 50 100

5Birth spacing reduces

maternal mortality46 92% 4 8% 50 100

6

It is good to keep birth

spacing for children

health

50100

%0 0% 50 100

7Birth spacing reduces

children mortality47 94% 3 6% 50 100

Total 32893.7

%22 26.3% 350 100

Above table 4.14 showed that majority of the respondents have positive attitude on

bithspacing ie,100% and 26.7% negative attitude on birth spacing.

________________________________________________________________________

4.15 Distribution of respondents Negative and Positive attitude on birth spacing. n=50

94%

6%

Positive attitude score

Negative attitude score

Above pie 4.15 charts showed that among Total attitude question (350). Respondents

Negative attitude answer 22(6%) And Positive attitude answer328 (94%).Most of the

respondents score higher positive answer, it may be due to most of them were media

exposure and literate.

________________________________________________________________________

4.16 Distribution of respondents Attitude Score

n=50

0

2

4

6

8

10

12

14

16

18

20

10 12 14 16 18 20 22

Attitude Score

Nu

mb

er o

f re

spo

nd

ents

Above figure 4.16 shows that Majority of respondents 3(6%) had maximum Knowledge

score 21,19 (38%) respondents had 20,8(16%) respondents had 19 score,5 (10%)

respondents had 18 score,9(18%) respondents had 17 score,2(4%) respondents had 16

score,3(6%) respondents had 15 score,1(2%) respondents had 13 score. Most of the

respondents had 20 score it may be due to most of the respondents were literate, and lived

near Lalitpur district.

________________________________________________________________________

4.16 Distribution of Literate women Positive and Negative attitude on birth spacing. n=37

95%

5%

Positive attitude

Negative attitude

Above figure 4.16 Among 50 respondents there were 37(74%) literate women there

were 350 attitude related question. Among these 350 questions literate women gave

247(95.36%) positive answer and 12(4.63%) negative answer. Among literate women

most of them gave positive answer this may be due to they can read pamphlet and poster

and gain knowledge.

________________________________________________________________________

4.17Distribution of Illiterate women attitude on birth spacing.

n=13

84

70

10

20

30

40

50

60

70

80

90

Res

po

nd

ents

an

swer

Positiveattitude

Negativeattitude

Negative attitude

Positive attitude

Above figure 4.17 Among 50 respondents, there were 13 (26%) illiterate women. There

were 350 attitude related question. Among illiterate respondents Positive answer was 84

and negative answer was 7

This may be due to illiterate respondents also exposed to media.

________________________________________________________________________

Hypothesis testing

Hypothesis No. 1

Educated reproductive age married human may have more knowledge good attitude on

birth spacing then those of uneducated human.

The hypothesis was tested in simple statically method that is by using mean score

Educational status

Frequency

Mean score

Percentage

Knowledge Attitude

Literate 13 4.46 18.62 26%

Illiterate 37 3.84 18.38 74%

Above table shows that the respondents who are educated had higher mean knowledge

score 4.46 and also had higher mean attitude score 18.62, regarding birth spacing then

that of uneducated respondents. So, that this hypothesis was accepted.

________________________________________________________________________

CHAPTER V

Summary, Conclusion and Recommendation.

This chapter presents the Summary of significant findings and conclusion of the study .In

these chapter recommendations are also included to improve the existing situation and

further studies.

5.1 Summary of the findings of the study

Related demographic information

Out of 50 respondents 46 %( 23) were age group of 25-34 years.

Out of 50 respondents 86 %( 43) were house wife.

Out of 50 respondents74 %( 37) were literate.

Out of 50 respondents 74 %( 37) were Hindu.

Out of 50 respondents60 %( 30) were Primi gravida.

Out of 50 respondents 76%(38) were temporary residual at Imadol HP

Related to Knowledge.

Majority of respondents100 %( 50) had heard about temporary family planning.

Majority of Respondents 100 %( 50) had heard about birth spacing.

Most of the respondents 40 %( 20) use depo for birth spacing.

Among total respondents 40 %( 20) score of knowledge of FP was friends.

Most of the respondents 82 %( 41) want birth spacing above 5 years.

68 %( 34) respondents had adequate knowledge on birth spacing.

Among 50 respondents 60 %( 30) multi gravida, 75 %( 15) kept birth spacing and

25% did not kept birth spacing.

Mean score of literate respondents 4.64.

Mean score of illiterate respondents 4.61.

Related to attitude

Attitude means score of literate women was 18.62.

________________________________________________________________________

Attitude means score of illiterate women was 18.38.

Among 37 literate women ,positive attitude score was 95.36%

Among 13 illiterate women Positive attitude score was 92.30%

5.2 Conclusion

The study has given general view about the respondent’s knowledge and attitude on birth

spacing .The study reveled that literate respondents mean knowledge

Score was 4.64 and illiterate respondents mean knowledge score was 3.84.

Literate respondents mean attitude score was 18.62 and illiterate respondents mean

attitude score was 18.38.It means knowledge and attitude score of literate respondents are

greater than that of illiterate.

5.3 Implication of study

This study would be beneficial to the investigator regarding the further study of

related topic.

This study will be helpful for the further researcher to do in large scale.

This study motivates the respondents to get more knowledge and change in

attitude.

The findings help in planning further in-service education on birth spacing.

5.4 Recommendation

Can be studied in large scale sample in different parts of the country so findings

can be generalized.

Comparative study can be carried out between urban and rural women.

DHO should take initiation to promote and strengthen FP programmed through

integration with safe mother hood for improvement of status of birth Spacing.

Ministry of education should provide Non formal education for illiterate women

of the community.

Formal education should be provided to all by respecting education is right of

people through providing incentive to the schooling children especially for girls

child.

________________________________________________________________________

5.5 Strength of the study

This study was concluded by maintaining anonymity and confidentiality and also

by protecting the right of the respondents.

This study may be helpful for women to plan number of child.

The questionnaire items were based on objective of the study and literature.

The study will be helpful to carry out farther research in future.

5.6 Difficulties faced during the study.

Researcher faced problems on searching relevant recent literature in the context of

Nepal.

Because of inexperience researcher faced difficulties in scoring, analysis and

interpretation.

5.7 plan for dissemination

Research advisor

Library of Lalitpur Nursing Campus

Imadol health post.

BIBLIOGRAPHY

Nepal demography and health survey (.2001).

Emma k, eatl(2008)”Birth intervals and risk of still birth or Neonatal Deaths,

Findings from rural north India.

Nortion A (2005)”Need of birth spacing for improving newborn, infant, child and

maternal health.

Codane A.A,(2006)Journal of American Medical Assocation:Birthspacing and risk of adverse perinatal outcomes,295;1809-1823.

Almaie,S.(2003)Journal of Royal Society for the promotion of health; The pattern and factors associated with child spacing in eastern Saudi Arabia 123(4)217-221.

Norton M.(2008)International Journal of Gynecology and Obstratic;Global Health Technical Brief 89;1-6

________________________________________________________________________

Rasheed,P(2007)Eastern Mediterranean Health Journal; Birth Interval; perception and practices among Urban-based Saudi Arabian women13(4);881-892.

Vera,D(2007)Journal of Trans cultural Nursing; Birth spacing perceptions of rural Filipions 18(3);238-246.

Dahal,Gp.eatl International Family planning perspective(2008)34(1):6-14. Internet Sources www.uptodate.com/patients www.google.com www.health library.net www.healthnet.org www.usaid.gov/ourwork/global health/pop/teachers/service access