_______________________________________________________________________

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 Campus
Research advisor

…………………………… Assistant Campus chief

Mrs. Radha Devi Bangdel Lalitpur Nursing Campus

…………………………….
Mrs. Ambika Poudel Research advisor
Lalitpur Nursing Campus

…………………………… Research teacher

Mrs. Sarala K.C.

……………………………. Research teacher

Mrs. Ranjana Shrestha

............................................. Research teacher

Mrs. Khagi Maya Pun

............................................. Research teacher

Mrs. 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

Introduction
1.1 Background of the study……………………
1.2 Significance of the study
1.3 Statement of the problem
1.4 Objective of the study
1.5 Hypothesis
1.6 Operational definition
1.7 Limitation of the study

CHAPTER-II
Review of related literature
2.1 Review of related literature
2.2 Summary of related review literature

CHAPTER-III
Research Methodology
3.1 Research design
3.2 Study area
3.3 Population of study
3.4 Sample size of the study
3.5 Sampling Technique
3.6 Criteria for sample collection
3.7 Variables
3.8 Data gathering tools
3.9 Data collection procedure
3.10 Validity and
reliability of the research
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3.11 Pre-test
3.12 Ethical consideration
3.13 Data analysis procedure
3.14 Budget and time
3.15 Knowledge scoring procedure

CHAPTER-IV
Analysis and interpretation
4.1 The demographic information
4.2 knowledge assessment
4.3 Hypothesis testing

CHAPTER-V
Summary conclusion and Recommendation

5.1 Summary
5.2 conclusion
5.3 Implication of the study
5.4 Recommendation
5.5 Strength of the study
5.6 Difficulties
5.7 Plan for dissemination

BIBLIOGRAPHY
APPENDICES
Questionnaire
Time schedule
Permission 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)

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

13. Ethical consideration

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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.

CHAPTER FOUR
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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
Variables Frequency percentage
S.n
Ethnic group
1. Chhetri/Brahmin 26 52
2. Tamang/Magar 10 20
3. Newar 5 10
4. Chaudhary 3 6
5. Nepali 2 4
6. Majhi 2 4
7. Rai 1 2
8. Muslim 1 2
Age
1. 15-24 22 44
2. 25-34 23 46
3. 35-49 5 10
Religion
1 Hindu 37 74%
2 Buddhist 10 20%
3 Christen 2 4%
4 Muslim 1 2%
Occupation
1 House wife 43 86%
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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 Percentage

1 Illiterate 13 26
2 Literate 37 74
Primary 19 38
Secondary 13 26
Heigher.Secondary 5 10

Type of family
1 Nuclear 40 80
2 Joint 10 20
Age of marriage
1 Below 20 yrs 30 60%
2 Above 20 yrs 20 40%

Gravida and Para

1 Primipara 30 60%
2 Multi Para 20 40%
Husbands education
1 Uneducated 25 50
2 Educated 25 50

Address
1 Temporary at Imadol 38 76
2 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.

4.3Distribution of respondents knowledge on source of family planning suppliers.

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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.

Part II
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Knowledge Assessment

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

Correct Incorrect
S.n. Items No. of No. of
% %
respondents respondents
Family planning devices are
1 freely available in government 38 76% 12 24
services
Birth spacing is gap between
2 the birth of one child to the 50 100% 0 0
birth of next child
More than two years is good
3 48 96% 2 4
for birth spacing
The Sources of family
planning supply are health
4 47 94% 3 6
post, PHC, Sub-health post,
Hospital and dispensary.
For mother’s and babies health
5 it is necessary to keep birth 44 88% 6 12
spacing

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.

Knowledge related question

4.5Distribution of respondents regarding temporary family planning method

n=50
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100%

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.

4.6Distribution of respondents who heard about types temporary family

planning method.
n=50
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D is t r ib u t io n o f r e s p o n d e n t s lis t e n n u m b e r o f f a m ily p la n n in g m e t h o d

16
14
12 o n e m e th o d
10 T w o m e th o d
15 16
N u m b e r o f r e 8s p o n d e n t s 14 T h r e e m e th o d
6 F o u r m e th o d
4 F iv e m e t h o d
4
2
1
0
o n e m e t h To wd o m e t hT oh dr e e m e Ft hooudr m e t hF oivd e m e t h o d

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

4.6Distribution of respondents, Used family planning method.

n=50
_______________________________________________________________________
_

Distribution of respondents used

family planning method

25

20
respondents

15

10

0
Depo No any Natural Pills Condom
methods of family planning

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.

4.7 Distribution of respondents source of knowledge on temporary family

planning.
_______________________________________________________________________
_

n=50

Distribution of respondents source of knowledge

of FP

20
20
15
15
11
No of
10
respondents
4
5

0
Friends Health Media/ Family
worker Books members

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.

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

22%

a
b

78%

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
_______________________________________________________________________
_

D is trib u tio n o f res p o n d en ts kn o w led g e o n b irth

s p a cin g

50

40
Respondents knowledge

A bove 5y rs
30 A bove 4y rs
20 A bove 3y rs
A bove 1y rs
10

0
A b ove 5 y rs A bove 4y rs A bove 3y rs A bove 1y rs
B irth in te rva l

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

D istribution of respondents on num ber of

C hildren

50
40

No. of 30
re sponde nts20
S eries1
10
0
O ne Two Three Four
children children children children
No. of childre n

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

35

30
Number of Respondents

25

20

15

10

0
0 1 2 3 4 5 6
Know le dg e S core

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
5
4.5
4
3.5 3
Respondents 3
Knowledge 2.5 2
Score 2 Literate Respondents
1.5
Illiterate Respondents
1
0.5
0
1 2
Maximum Score Minimum
Score

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

Inadequate
Moderate knowledge Adequate knowledge
knowledge
Respondents
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.

Positive attitude Negative attitude Total

S.n Items No. of No. of No. of %
% % respondents
respondents respondents
Married reproductive
age women should use
1 temporary family 49 98% 1 2% 50 100
planning method for
birth spacing
Sex determine the size
2 43 86% 7 14% 50 100
of the family
No. of children
3 determine the size of 43 86% 7 14% 50 100
family
It is good to keep birth
100
4 spacing for mothers 50 0 0% 50 100
%
health
Birth spacing reduces
5 46 92% 4 8% 50 100
maternal mortality
It is good to keep birth
100
6 spacing for children 50 0 0% 50 100
%
health
Birth spacing reduces
7 47 94% 3 6% 50 100
children mortality
93.7
Total 328 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
_______________________________________________________________________
_

6%

Positive attitude score

Negative attitude score

94%

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
_______________________________________________________________________
_

20
18
Number of respondents 16
14
12
10
8
6
4
2
0
10 12 14 16 18 20 22
Attitude Score

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
_______________________________________________________________________
_

5%

Positive attitude
Negative attitude

95%

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
_______________________________________________________________________
_

90
Respondents answer 80
70
60
50
84 Negative attitude
40
Positive attitude
30
20
10 7
0
Positive Negative
attitude 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

Mean score
Educational
Frequency Percentage
status
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.
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_
 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