Family Planning Knowledge and Current Use of Contraception Among the Mru Indigenous Women in Bangladesh: a Multivariate Analysis
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Open Access Journal of Contraception Dovepress open access to scientific and medical research Open Access Full Text Article Original RESEARCH Family planning knowledge and current use of contraception among the Mru indigenous women in Bangladesh: a multivariate analysis M Rakibul Islam1 Background: This article aims to understand the family planning (FP) knowledge and current Gunnar Thorvaldsen2 use of contraception and its predictors among women of the Mru people – the most underprivi- leged indigenous community in Bangladesh. 1Bangladesh Agricultural University, Bangladesh; 2Norwegian Historical Methods: In this study, 374 currently married Mru women were interviewed and selected Data Centre, University of Tromsø, purposively from three upazilas (administrative subdistricts) of the Bandarban area, where most Norway of the Mru people live. The association between the variables was assessed in bivariate analysis using the Chi-square test and binary logistic regression models were employed to explore the predictors of FP knowledge and current use of contraception among the Mru women. Results: Only about 40% of respondents had ever heard FP messages or about FP methods – two-fifths of the national figure (99.9%). The current use of contraception was much lower (25.1%) among the Mru people than at the national level (55.8%). Among both modern and traditional methods, the contraceptive pill ranked first. About two-thirds (66.0%) of married women used this method – more than two times than the national figure (28.5%). On the other hand, the prevalence of male methods was comparatively lower than at the national level. Logistic regression models revealed that place of residence, religion, age, school atten- dance, husband’s school attendance, service provided in the community, distance to the service center, and exposure to mass media had significant effects on knowledge of FP and on use of contraception. Conclusion: Education for mothers and vernacular language-based doorstep FP programs with special emphasis on awareness are suggested for the community. Keywords: family planning, contraceptive use, the Mru, logistic regression, Bangladesh Introduction In recent years, knowledge of family planning (FP) and contraceptive use have acceler- ated in Bangladesh and are playing a remarkable role in controlling fertility, particularly in reaching the replacement level of fertility. In this regard, both government and non- governmental organizations (NGOs) have been employing various strategies. Many researchers believe this is an impressive achievement within Bangladesh, a Muslim country where different familial, socioeconomic, cultural, and religious taboos still prevail.1 Almost all married women in Bangladesh (99.9%) have heard of at least one Correspondence: M Rakibul Islam FP method. The use of contraception among married women has increased from 7.7% Department of Rural Sociology, in 1975 to 55.8% in 2007. Although the overall knowledge of contraceptive methods Bangladesh Agricultural University, Mymensingh-2202, Bangladesh is high in Bangladesh, the prevalence of use of these methods is not high.2–4 Tel +88 017 12221677 Contraceptive use declined from 58.1% in 2004 to 55.8% in 2007, but this change Fax +88 091 61510 2 Email [email protected] has taken place mostly in the use of traditional methods. Modern methods are now submit your manuscript | www.dovepress.com Open Access Journal of Contraception 2012:3 9–16 9 Dovepress © 2012 Islam and Thorvaldsen, publisher and licensee Dove Medical Press Ltd. This is an Open Access article http://dx.doi.org/10.2147/OAJC.S25185 which permits unrestricted noncommercial use, provided the original work is properly cited. Islam and Thorvaldsen Dovepress more used than traditional methods. Traditional methods New religion: the Crama (namely, periodic abstinence and withdrawal) are difficult to Before the 1950s, the Mru people believed in animism use consistently. They require strong spousal communication, and Buddhism. Since then, some Mru have converted to discipline, and understanding, and have a high rate of failure.5 Christianity. Nowadays, the majority of the Mru people Men do not have sufficient knowledge about traditional belong to a new religion: Crama. Man Ley Mru, the founder methods in Bangladesh.6 Clinical methods used by men are of Crama, started disseminating religious and moral messages significantly rarer than non-clinical methods.7 Condom use is to the Mru in the 1980s. In 1985, when he was 19 years old, he disparaged for aesthetic reasons and because it is a frustrating arranged a meeting of the Mru people and announced that he method – condoms are embarrassing to obtain, difficult to had created a new religion for them, since they did not have store, clumsy to use, and nuisance to dispose of.5 then a distinguishing religion. He also created the alphabet In Bangladesh, oral contraception is popular and is for the Mru language. The Reyung Khiti (“good ethics”) is gradually increasing its share in the current methods mix.5 the central religious book of Crama. This book is comprised Nevertheless, studies have revealed that discontinuation of of messages taken mostly from Christianity, Buddhism, and the oral pill is common among women in Bangladesh, with Hinduism. Religious rituals are conducted by congregation side effects considered a possible factor for this.8,9 members. At age twelve, a boy or a girl is sent to a prayer Although fertility rates in Bangladesh have declined and room (Kiyang Ghar) for religious purification, which is the prevalence of contraception use has increased through conducted by a priest, and is taught the rules, regulations, extensive FP programs, this development has spread dispro- and messages of the religion.14 portionately among different indigenous, non-indigenous, and cultural groups. The Mru indigenous community is pre- Family planning and reproductive dominantly untouched by the startling development of FP and health use of contraception in Bangladesh. Systematic research on In general, FP services for the Mru society are inadequate, FP and contraception has not been conducted in this commu- due to the non-existence of local service centers and the need nity before. Thus, the purpose of this paper is to understand to travel long distances to get to other centers. Only a few the FP knowledge and current use of contraception and its villages have access to FP suggestions and contraceptives determinants among the Mru women in Bangladesh. from centers a short distance away.14 Small-scale outreach projects have been recently started by NGOs in some areas of Ethnography of the Mru Lama and Thanchi but Alikadam has not yet been included.15 The Mru are the largest small indigenous group in Bangladesh However, most of these projects are general health awareness and the most underprivileged. They live among hilltops, programs, rather than initiatives to provide contraceptives to ravines, cliffs, and deep forest areas of the Bandarban villagers. A recent study showed that nutrition among mothers district. Although the Mru now live in the southern part of is poor in the Mru society. After delivery, a mother is given the Chittagong Hill Tracts (CHT), they originally came to this only salted rice and she sits beside a fire from 9 to 30 days, region several hundred years ago from the state of Arakan in depending upon village practice. Their visits to antenatal and Mayanmar, owing to a blood feud with the Khumi tribe.10,11 postnatal care are few compared with mainstream society Linguistically and culturally, the Mru categorize themselves due to cultural issues, distance, lack of infrastructure, and into five distinctive groups: the Anok (meaning “West”), low socioeconomic status. Furthermore, mothers mostly who live in the south of Bandarban; the Tshung (“Mountain depend on traditional village healers (TVHs) and traditional People”), who have joined the Anok living in the southern midwives, rather than going to hospitals.15 part in the upper Sangu valley; the Domrong (“Lowlands”), who live in the north of Matamuhuri river; and the Dopreng Methods and materials and Rumma (“Forest People”) who live in the far south and The Bandarban district has seven upazilas (administrative in the Arakan.10 The Mru live in 356 villages (paras), com- subdistricts), three of which were selected for this study: prising 5398 households.12 In a census conducted in 1995 by Alikadam, Lama, and Thanchi. There were four reasons the Mru Social Culture, the total population was estimated why these were selected as study areas and these have been at 59,748.13 The male to female education ratio is 2.6 to 1.6. discussed elsewhere.15 A total of 374 currently married Mru Ninety-three percent of villages are more than one mile away women, comprising 133 from Alikadam, 170 from Lama, and from a primary school.12 71 from Thanchi, who had at least one child aged 5 years or 10 submit your manuscript | www.dovepress.com Open Access Journal of Contraception 2012:3 Dovepress Dovepress Family planning and contraception younger were included in the study. Women whose children Chi-square tests. Multivariate analyses were conducted in had died were also selected for face-to-face interviews. Only terms of binary logistic regression analysis. Some variables married women were included in this study so that their situ- used in the bivariate analyses were excluded in the final ation could be compared with those of mainstream society regression models because they were concentrated in one as premarital sex is socially prohibited in Bangladesh (the category of independent variable. Bangladesh Demographic and Health Survey also does not include unmarried women). Results A questionnaire was used for the collection of primary Sample characteristics information, which included both closed- and open-ended Among the survey respondents, 45.5% were from Lama and questions. Since the Mru have a distinct language and are 35.6% were from Alikadam. The remaining respondents unable to communicate in the Bengali language, seven (19.0%) were from the Thanchi subdistrict.