Psychosocial correlates of KAP- gap of contraceptive usage amongst slum dwellers

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Title[SW1]: - Psycho-[SW2]socia[SW3]l correlates of KAP- gap of contraceptive usage[SW4] amongst[SW5] slum dwellers


Background: India, despite of being the first country to start National Family Planning programme[SW6] (1952) is expected[SW7] to become the most populous[SW8] country by surpassing[SW9] China by the year 2050.The concept[SW10] of[SW11] “ KAP gap” was first explored[SW12] in 1960’s. Aims: To find out psycho-[SW13]socia[SW14]l reasons of non-usage[SW15] of contraceptives. Material &Methods: A cross sectional[SW16] study was carried[SW17] out amongst[SW18] 716 eligible couples residing[SW19] in slums of Khalapar[SW20], ([SW21]Muzaffarnagar).Results[SW22]: Twenty nine percent of couples were not using contraceptives due to[SW23] psychosocial[SW24] reasons. Majority[SW25] (62.5%) of women were aged less[SW26] then[SW27] 30 years. The commonest reason was husband not interested (9.8%); maximum number of husbands were educated[SW28] junior high school and above (42.9%). While maximum number[SW29] of women who were not interested[SW30] were illiterate (52.9%). Majority[SW31] (60.7%) of couples belong to lower socioeconomic classes (IV &V). Majority (70.6%) of women and 47.6% of men who were not interested[SW32] to use contraceptives belong to lower socioeconomic classes (IV &V).

Conclusion: since a very[SW33] high proportion (29.0 %) of study subjects is nonuser due to[SW34] psychosocial[SW35] reasons it is recommended[SW36] that due attention should be paid[SW37] by planners and it should be dealt[SW38] with strengthening behavior change communication.

Key words: KAP gap, slum dwellers, contraceptive usage[SW39], unmet needs

Introduction: India is the second most populous country and is projected to surpass China by the year 20501. Government of India recognized the threat of population explosion way back in 1952 and formulated National family Planning Programme. The National Population Policy (1976) reiterated the importance of small family adopting a target oriented approach which was later changed to target free approach in National[SW40] Population Policy (2000) 2 along with provision[SW41] of quality- care and informed choice.

The concept of “KAP-gap” was first explored in 1960’s and was replaced by “Unmet need3” in 1977. They were represented mainly in terms of coverage, availability of quality services and lack of information amongst married women of reproductive age group1. The present study is an effort to find out the psychosocial correlates of never usage of contraceptive amongst the women of reproductive age. Since this study is focused[SW42] on intention and behaviour towards contraceptive usage and do not[SW43] covers the issues related to quality of services. Hence the use of older[SW44] term “KAP-gap” seems to be more relevant.

Material & Methods: The study was carried out amongst 806 families residing in the slum area of Khalapar (Muzaffarnagar) under Urban Health Training Centre, Department of community medicine, Muzaffarnagar Medical College, Muzaffarnagar (UP) .

Modified Kuppuswamy4 criteria was[SW45] used for socioeconomic status and the educational status was classified as per Census of India (1991).5

A total of 716 eligible couples, all Muslims by religion with women in reproductive age (15-45) were found living in the area. The Couple Protection Rate was found to be 60.6%, which is similar to rural[SW46] area of Dehradun6. The exclusions were made for 74 couples who stopped using contraceptives due to medical reasons e.g. pregnancy/ lactation, known case of infertility, side effects, menopause and hysterectomy .Only 214 couples were not using contraceptives due to some reasons. Amongst them more than one-fourth (29.0%) eligible couples who never used contraceptives due to psychological and social reasons were studied.

Results and Discussion: There has hardly[SW47] been any study conducted on the psychosocial reasons of[SW48] KAP gap under discussion. It limits the comparative statement about the available data by the author. The only available data was from the city of Delhi7 and it was reported that husbands were not interested to use (8.88%), ignorance 43.70% and fear of side effects contrary to the present study being 37.5%, 12.5% and 10.7%. In more than two-third (67.8%) of couples either of the spouse[SW49] was not interested to use including[SW50] husband (37.5%) not interested to use followed by ignorance (12.5%), fear of side effects (10.7%). Rest 9.0% wanted to have male[SW51] child. Majority[SW52] (62.5%) of women[SW53] were under 30 years of age.

Table 1 shows that 50.0% of the husbands were educated middle and above. Amongst the husbands not interested for contraceptive use, maximum number 9 (42.9%) were educated middle and above contrary to women majority (52.9%) of whom were illiterate. No statistically significant association was found between psychosocial reasons and literacy status of the eligible couples (p>0.05)

Table 2 reveals that majority[SW54] (60.7%) of couples were in lower socioeconomic classes (IV&V). Similar pattern[SW55] of distribution was observed for specific psychosocial reasons.

Conclusion: A significant proportion of eligible couples were found not using contraceptives due to psychosocial reasons that too predominantly due to lack of interest. Since Reproductive and Child Health programme is focused towards delivery[SW56] of quality services the planners and policy makers should give due attention towards these reasons and Behavioral change Communication activities should be strengthened.


  1. K. Park (2000): Park's Textbook of Preventive and Social Medicine, (16th Ed.), M/s Banarasidas Bhanot, Jabalpur, p. 327.
  2. Govt. of India (2000), National Population Policy 2000.Ministry of family welfare New Delhi.
  3. France Donnay. Children in the tropic. Controlling fertility 1991,193-194
  4. Mishra D. and Singh H. P., Kuppuswamy’s Socioeconomic status scale – A Revision, Indian Journal of Pediatrics, Vol. 70, March 2003,
  5. Census of India: Provisional population Total (paper 1991) Registrar and Census commissioner for India, New Delhi 1991.
  6. Kansal A. (2004): Epidemiological correlates of fertility and contraceptive prevalence in rural population of Dehradun District. Thesis submitted for MD Community Medicine to H.N.B. Garhwal University (Unpublished).
  7. Khokar A. and Gulati N. A study of never users of contraception from an urban slum of Delhi, Indian Journal of Community Medicine, Vol.XXV,No.1,Jan-Mar.2000.

Table-1: Psycho social reasons in relation to education



Education of Husband

ill. pri. mid.&above

Education of Wife

ill. pri. mid.&above


Husband not interested (21)

8(38.1) 4(19.0) 9(42.9)

6(28.6) 10(47.6) 5(23.8)


Women not interested (17)

5(29.4) 4(23.5) 8(47.0)

9(52.9) 5(29.4) 3(17.6)


Ignorance (7)

2(28.6) 1(14.3) 4(57.1)

2(28.6) 4(57.1) 1(14.3)


Scared of side effects (6)

1(16.6) 1(16.6) 4(66.7)

1(16.6) 4(66.7) 1(16.6)


Want male child (5)

1(20.0) 1(20.0) 3(60.0)

0(00.0) 4(80.0) 1(20.0)




17 11 28

(30.4) (19.6) (50.0)

18 27 11

(32.1) (48.2) (19.6)

X2 ( ill. Vs. lit.) = 0.1357, df = 1, p>0.05

Figures in parentheses are percentage

Table-2: Psychosocial reasons in relation to socio-economic[SW57] status

S. N.


Socio-economic [SW58]class




Husband not interested

2(9.5) 4(19.0) 5(23.8) 7(33.3) 3(14.3)



Women not interested

1(5.9) 1(5.9) 3(17.6) 6(35.3) 6(35.3)




1(14.3) 0(0.0) 2(28.5) 1(14.3) 3(42.8)



Scared of side effects

0(0.0) 1 (16.6) 0(0.0) 3 (50.0) 2(33.3)



Want male child

0(0.0) 0(0.0) 2(40.0) 1(20.0) 2(40.0)



4(7.1) 6(10.7) 12(21.4) 18(32.1) 16(28.6)


Figures in parentheses are percentages


[SW1]1Statistics: Dr.Pawan Kumar Goel.doc, 1,098 words

Original, 01 Jun 2014 16:55

Bog Index 92 Poor

Average Sentence Length 15.8 Excellent

Passive Index 55 Fair

[SW2]1Psycho- Hyphen Help

Usually written as one word, for example: psychokinesis


[SW3]1Psycho-social Difficult Words

Difficult or specialist. Consider revising.

[SW4]1usage Complex Words

use (except when referring to language)

[SW5]1amongst Complex Words


[SW6]The National Family Planning programme

[SW7]1is expected Passive Verbs

Prefer active verbs

[SW8]1populous Confused Words

populace = (noun) the public, the people

populous = (adjective) densely inhabited

[SW9]1surpassing Confused Words

supersede = supplant, replace

surpass = excel, outdo, exceed

superseding or keep surpassing

[SW10]1concept Abstract Words

Don't overuse - be specific or edit out

you can often use idea

or DELETE concept

[SW11]1The concept of Wordy Phrases

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DELETE The concept of

[SW12]1was first explored Passive Verbs

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[SW13]1psycho- Hyphen Help

Usually written as one word, for example: psychokinesis


[SW14]1psycho-social Difficult Words

Difficult or specialist. Consider revising.

[SW15]1non-usage Hyphen Help

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[SW16]1cross sectional Hyphen Help

Usually hyphenated


[SW17]1was carried Passive Verbs

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[SW18]1amongst Complex Words


[SW19]1residing Complex Words

living, staying, remaining

[SW20]1Khalapar Spellchecker

Suggest: Jhalawar

[SW21]1, ( Questionable

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There should be no comma before an opening bracket

[SW22]1Muzaffarnagar).Results Spellchecker

No suggestion

[SW23]1due to Misused Words

due to = expected to, or caused by

- do not use if you can substitute 'because of'

because of

[SW24]1psychosocial Difficult Words

Difficult or specialist. Consider revising.

[SW25]The majority

[SW26]1less Confused Words

fewer = used of things that can be counted individually

less = used of bulk or volume


[SW28]1were educated Passive Verbs

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[SW29]The maximum numbe

[SW30]1were not interested Passive Verbs

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[SW31]The Majority

[SW32]1were not interested Passive Verbs

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[SW33]1very Overwriting

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[SW34]1due to Misused Words

due to = expected to, or caused by

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because of

[SW35]1psychosocial Difficult Words

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[SW36]1is recommended Passive Verbs

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[SW37]1be paid Passive Verbs

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[SW38]1be dealt Passive Verbs

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[SW39]1usage Complex Words

use (except when referring to language)

[SW40]The National Population Policy

[SW41]The Provision


[SW43]Do not cover

[SW44]The older term

[SW45]Were used

[SW46]Rural areas

[SW47]Have hardly been




[SW51]A male child

[SW52]The majority

[SW53]The women

[SW54]The majority

[SW55]Similar patterns

[SW56]The delivery