Behavior of young people regarding family planning.

CONFLICT OF INTEREST: none declared. Family planning is a conscious activity of reproductive age that inclines, not only to regulate the number and timing of birth, but also to have a healthy child and to fulfill all of its role throughout the life cycle. The survey included 1804 students of various generations, which is approximately 9.3% of all students of the University of Montenegro. Instrument of survey was questionnaire with 25 closed type questions. Methods used for statistical data analyses were methods of descriptive statistics and nonparametric methods to analyze significance of differences at the significance p>0.05. The study comprised 53.9% of students aged up to 20 years and 46.1% of students aged from 21 to 26 years. There is statistically significant difference among students regarding sources of knowledge on family planning by age (Chi 2 = 14.54, p<0.05). The students have got information on family planning mostly from parents (46.7%). Out of total number of interviewed students, who stated that abortion is good method of contraception, 12.8% claimed doctors as the source of information, then books, mass media and parents. The most of interviewed students find condom as the best contraceptive method. Students used to get information on family planning mostly often from their parents, and most of them consider that they are well informed. One third of students do not protect themselves from undesired pregnancy, but most of them consider abortion as non adequate method of family planning.

1. INTRODUCTION

Family planning is a conscious activity of individuals and couples of reproductive age that incline, not only to regulate the number and timing of birth, but also to have a healthy child and to fulfill all of its role throughout the life cycle (1). Constitution of Montenegro provides to its citizens the inalienable (indefeasible) right to health care and healthy living by items that ensure protection and promotion of reproductive health. Hence, family planning comprises various aspects– biological, medical, demographic, sociological, psychological, economic, ethical, political, and from the standpoint of carrier, there are three levels: as individual practice, as a movement of social groups and as a family planning program that is brought by government (2). Family planning is a complex process which is related to other aspects of reproductive health. The average age of engaging into the first sexual intercourse has decreasing tendency and it is also associated with a multiple sexual partners during active sex life, and thus an increased risk of acquiring sexually transmitted diseases (3). It is estimated that each year, sexually transmitted diseases (STDs) are diagnosed in more than 400 million adults. Out of that number, approximately 60% of STDs and infections occur in people younger than 25 years. Past experience with young people shows that they get knowledge about sexuality mostly from unreliable sources, such as television, magazines and “experience exchange” with peers and older adolescents (4). Information about “delicate topics” at home is scarce and insufficient, as well as school curricula (5). First sexual experience are rarely planned by adolescents, which is the reason for not using protection, either from ignorance or passivity and passing the responsibility to partner. The sexual behavior of adolescents is complex, and the facts show that even when they are well and accurately informed, they often behave inconsistently in protection of pregnancy and STDs. Growing number of young with different forms of risky behavior demands faster and better managing in early detection and eradication of risk factors, appropriate approach, prevention through contemporary and continuous methods of health education and promotion, counseling and regular preventive and gynecological follow up (6). Effective birth control could allow young couples to achieve individual goals and to plan family, when they want. There are many different types of contraceptive methods. These methods can be physical or traditional and contemporary (7).

Objective of this survey is, primarily, to study knowledge, attitude and behavior of young people regarding family planning, as well as their awareness of sexuality and contraception, degree of motivation for using contraceptives and pattern of sexual behavior.

2. MATERIALS AND METHODS

The survey was conducted from May to December 2009 and it was cross-sectional study, created and coordinated by experts of the Institute of Public Health. The target population was students of the University of Montenegro. The schedule of conducting the survey on faculties was made by random selection and it was agreed by the University of Montenegro. The interviewers were trained for conducting the survey. The general plan was made and precise survey day for each faculty was defined. According to the activity plan, all students, who were present at the faculty on the planned day, were surveyed.

Some faculties refused to participate in the survey, while some others were unable to participate because of earlier completion of school year due to new influenza pandemic. Some students did not want to take part for various reasons. The rate of faculties’ response was 90%, whereas the rate of students’ response (their consent to survey) was 87%. It was planned to involve 10% of all students in Montenegro, and considering that there are 19325 students at the University of Montenegro, number of students included in the study had to be 1933 with the rate of students’ response 90%. Regarding aforesaid, plan of number of students to be interviewed was prepared on each respective faculty. But since the number of students, who refused to participate in the study, differed from faculty to faculty, the planned number of interviewed students was not reached. Namely, the survey included 1804 students of various generations, which is approximately 9.3% of all students of the University of Montenegro. For the purpose of results interpretation, only students aged up to 26 years have been taken into account. Furthermore, some questions from the survey were intended only for sexually active female students. The experts of the Institute of Public Health had defined the questionnaire used for the survey and its adequacy was tested on the fifth year students of the Medical faculty of the University of Montenegro. The questionnaire was consisted of 25 closed type questions but only answers to questions, which were related to the topics of this work, were analyzed. The following methods for statistical data analyses were used: methods of descriptive statistics (frequencies distribution of qualitative characteristics and relative numbers) and nonparametric methods (the χ2 test) for analyzing significance of correlation between responses and knowledge of students about family planning, as well as attitude and knowledge about family planning and sexual behavior of students, at the significance p<0.05. The statistical package SPSS v. 13.0 was used for data analyses.

3. RESULTS

The study comprised 53.9% of students aged up to 20 years and 46.1% of students aged from 21 to 26 years. Out of total number of participants, 67.6% were female. It is observed that more than a third of participants were first year students, more than a quarter second year, around 20% third year, 15% fourth year, 2% fifth year and 0.7% sixth year students. There is not statistically significant difference among students regarding sources of knowledge on family planning by gender (χ2 = 7.66, p>0.05), but it appears by age (χ2 = 14.54, p<0.05). The students have got information on family planning from parents (46.7%), mass media (27.5%), books and school (23.6%) and at least from doctors (2.2%) (Graph 1). Out of total number of interviewed students, who stated that abortion is good method of contraception, 12.8% claimed doctors as the source of information about family planning, then books (12%), mass media (9%) and parents (5.5%). Out of total number of male students 11.2% considers abortion as good method of contraception, while among female students this percentage is 5.8%. There is statistically significant difference among interviewed students by gender (χ2 = 16.02, p<0.01). Attitude that abortion is a good method of family planning was commonly found in sexually active female students who reported that only their partners make decision on contraceptive methods (9.5%), then those who reported that they choose contraceptive methods themselves (9.3%). There were 5.3% of female students who consider abortion as a good family planning method among them who do not use any contraception, while this attitude was stated by 4.9% of female students who make decision on contraceptive methods with their partners (Graph 2).

More than a quarter of female students (28.6%), who had more induced abortions and 14.3% of female students, who had one induced abortion, consider abortion as a good method of contraception. Among female students, who consider abortion as a good method of contraception, majority received information about family planning from doctors, followed by those whose source of information were books. Mass media as the source of information was on the third place, and then information received in the school, and at the last place there were information received from parents (Table 1). There was statistically significant difference in students’ responses (χ2 = 15.230, p<0.05). The most of interviewed students find condom as the best contraceptive method, then pill, contraceptive coil, calendar-based method, and interrupted sexual intercourse, and at the end local contraceptives. Thereby, there is statistically significant difference regarding the source of information about family planning (c2 test = 39.74, p<0.05). There is statistically significant difference among students in estimating their own knowledge about contraception (χ2 = 32.25, p<0.05). The most of students estimate their knowledge as sufficient, then as very good, excellent, insufficient and at the end only 3.4% of students state that they have no knowledge about contraception. The students, who have estimated their knowledge as excellent, stated the sources of knowledge by following order: books (21.1%), mass media (18.3%), school curricula (18.1%), doctors (17.9%) and parents (13.4%).

Table 1.

Relation of students who mentioned abortion as a good method of Contraception and source of information on family planning

Abortion is a good mode for family planning
You receive information on family planning from:	Yes		No		Total
	No	%	No	%	No	%
media	43	32.8	436	27.0	479	27.5
books	28	21.4	206	12.8	234	13.4
school	10	7.6	167	10.4	177	10.2
parents	45	34.4	769	47.7	814	46.7
doctors	5	3.8	34	2.1	39	2.2
TOTAL	131	100.0	1612	100.0	1743	100.0
(χ2 = 15.230, p<0.05)

The contraceptive method, that is being used, is considered by the largest number of students as partially safe, then as completely safe, followed by those, that use no protection at all and at the end students who find their method unsafe. The largest number of students, who use protection occasionally, considers their contraceptives as partially safe, while the most of students, who use protection regularly, find their method completely safe. Students that use protection occasionally prevail in group, which finds their method unsafe (Table 2). There is statistically significant difference in students’ responses (χ2 = 257.62, p<0.01).

Table 2.

Relation of attitude on safety of contRaception and frequency of usage

Safety of contraception	Protection aginst pregnancy						Total
	Do not protect		Protect partially		Protect completely
	No	%	No	%	No	%	No	%
Do not use contraception	75	68.2	14	11.2	45	9.0	134	18.3
Not safe	6	5.5	12	9.6	10	2.0	28	3.8
Partially safe	11	10.0	73	58.4	212	42.5	296	40.3
Completely safe	18	16.4	26	20.8	232	46.5	276	37.6
TOTAL	110	100.0	125	100.0	499	100.0	734	100.0
(χ2 = 261.81, p<0.01)

4. DISCUSSION AND CONCLUSIONS

The early engaging in sexual intercourse, with other forms of risky behavior such as sexual intercourse under influence of alcohol or other abuse substances, leads to multiple sexual partners and danger from sexual abuse, prostitution and crime (8). On the other hand, society became more tolerant toward behavior and attitude of individuals and groups. There are less forbiddances and opinions which constrain young people and their behavior, so this tolerance could be seen in their sexual life. But, source of information for young about family planning and reproductive health, in general, is considerable problem (9). Students are informed insufficiently about family planning, according to their own statement. In fact, there is still awkwardness, when talking on this subject. More than a half of young people in Serbia have said that they do not have enough information about new contraception, although two-thirds of them consider sex as very important in their relationship, according to survey conducted by the Association for Reproductive Health among young people in Belgrade last year (10).

The results of other surveys confirmed that there was trend of engaging in sexual activities at very young age with incomplete and insufficient knowledge about it. One of the characteristics of modern societies is the increase of sexual activities among young people, especially the first sexual experience in early adolescence period. Consequently, there are increased risks related to sexuality of young people, proved by epidemiological researches in that area. At the same time students are not fully informed, which result in inappropriate behavior. The young people are getting informed about sexuality through mass media or from peers and through school curricula on a biology class in elementary and secondary school. Nowadays, parents are too busy, many of them are uninformed, and often it is “taboo” in family (11). The research in other countries confirmed the same experience about awareness and knowledge on reproductive health of young people from sources of various values (12). However, results obtained in our study show that respondents dominantly received information by competent sources. The particular research shows changing in family relationships and that the young people talk more often to their parents on this topic. They are entitled to open access to verified and accurate information concerning their sexuality, reproductive health and rights. Knowledge is the power. The more young people know the more control they have over their lives. The results of this survey show that all sexually active students do not use contraceptives. It is very similar with results of surveys on young people behavior conducted in Serbia. These surveys show that the most of them stated that they use contraceptives always, while a quarter of participants stated that they use contraception often and one in five stated rarely or never. These surveys also showed that condom is the commonly used contraceptive, and contraceptive pills were on the second place. The most of interviewed makes decision about using contraception together with partner whereas almost half of them stated they make decision alone (13). The results of survey conducted among students in Serbia showed that two-thirds of female students and more than a third of male have sexual intercourse. More than a half of sexually active students do not use contraception. The most used contraceptive methods are the interrupted sexual intercourse and calendar-based method, then pill, local contraceptives, diaphragm and contraceptive coil (14). The family planning is one of the basic human rights and freedoms. The goal of the family planning is having healthy and wanted child, and responsible and conscientious parenthood.