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Family Planning In Siddhi Pur VDC Of Lalitpur Nepal

By Roshan Nath Panta

CHAPTER - I

INTRODUCTION

1.1	Background:

Nepal is a developing South Asian country with population of 23.1 million, which is growing at the rate of 2.25 percent per annum (CBS 2003). The percent of unemployment population is 8.1 per 100 economically active populations (CBS 2003). The present estimated literacy rate is 54.1 percent (CBS 2004), which is however increasing but still much lower to upgrade the pace of development by making optimum use of human resource. Country is facing various challenges that are encountered in the process of socio economic development. Such challenges are poverty reduction, increasing population, unemployment education, health care, transportation etc. The country is divided into three ecological zones: mountain, hill and terai (plains) and is inhabited by more than 100 castes and ethnic groups (CBS, 2003). About 59.61 percent of Nepalese people are dependent on agriculture for their livelihood (CBS 2003). However, agriculture sector contributes only about 38.38 percent of the GDP (CBS, 2004). The GDP per capita remains very low at $241 (CBS, 2004). Inequality of the means of subsistence and income is widespread. Acute underemployment is considered as the principal cause of large-scale poverty. Economic growth of the country has not improved markedly over the years to outstrip the population growth rate. Improvement in the Health Services including the family planning is one the challenges and priority areas for the government. Keeping in view these challenges, efforts are underway to improve quality of the Nepalese people. Population is growing rapidly on one side, and on the other side the per capita food production has not been able to catch up the pace of population growth. Not only this, the population growth has also resulted in forest depletion, causing frequent landslides, floods and soil erosion. We have experienced after the restoration of democracy that the demand of people for better education, health, drinking water and other physical facilities are not easy to provide. The unemployment problem has been severe. Over the course of history, population growth has passed through different stage. The industrialized societies have gone through the major three stages, which are as follows: Ø	First stage is applicable to backward countries where both death and birth rates are high. In these countries agriculture is the main source of income. Ø	During the second stage, economy begins to proceed towards development. Along with industrialization, urbanization starts and transport facilities are provided to the society. Education, food, health and similar other facilities take place. At this stage there is almost population explosion. Ø	At the third stage, living standard improves and along with that there is improvement in the physical standard of the people. There is definite trend towards urbanization and industrialization and birth rate definitely falls down (Hans Raj, 2003). All the countries of the world are passing through these stages. Broadly speaking, some African countries are in the first stage. Asian in the second and European in the third stage. But there is no country in the world which does not pass through all the three stages (Hans Raj, 2003). To restore balance between population growth and the capacity of diverse ecosystems, implementing of family planning program is a must agenda globally. After 1960s, the population in the country has been increasing with a high rate. The population growth rate between 1961 and 1971 was 2.05% per annum. It rose up during 1971and 1981 and reached 2.62%. The population growth rate slightly came down to 2.08% between 1981and 1991. It has been again rising up to 2.25% in 2001(CBS 2003). At present, Nepal’s fertility rate is 4.1 (CBS, 2003). The socio-economic traditions favoring sons, low status of women in the society, low literacy rate are some of the contributing factors for high level of fertility. Almost equal number of males and females is recorded in the census with a sex ratio of 99.8. Population growth continues to be very high on account of the large size of female population in the reproductive age group (49.2%) and high fertility rate (4.1 children per woman) due to high-unmet demand for contraception (27.8%) and early marriage of girls before the age of 18 years (CBS, 2003). Adolescent and youth constitute the largest segment of the population (32.49%) in Nepal (CBS 2003). The adolescents aged 10-19 years constitute 22.3% in 1991 and it is 23.62% in 2001(CBS 2003). This is indicative of the fact that the tendency of young people is on the increase. As Population Census 2001 overview of structure of population and number of household is as follows: Total population:				23, 151,423. Male:						11,563,921. Female:					11,587,502 Percent:					100 Annual growth rate				2.25 Number of households:			4,253,220 Average household size:			5.44 Population density:				157-persons/sq.km  *Source: CBS 2001 census In Nepal, the practice of family planning began since late 1950s through non-governmental sectors. The Family Planning Association of Nepal was established in 1959. Its service was included only for information and education within Kathmandu valley. Later, government supported family planning services started at the beginning of 1968. A huge network from central to the village, including both government and non-governmental organizations has been set up to provide family planning services in the country. A large amount of foreign aid from USAID, WHO, etc has been channeled in this sector to promote adoption of family planning methods.

1.2	Statement of the Problem: Population growth is a global phenomenon. Even though it remains a natural process in the world, population growth has taken the form of problem especially for the developing and underdeveloped nations like Nepal. The problems of unemployment, rise of conflict, lack of opportunities etc., are some of the results of population growth. Growth rate (fertility rate) and mortality rate are the two factors that tend to affect the population growth of any country. In the context of Nepal, due to the advancement in the medical science and better living conditions, the adult mortality rate is decreasing while the fertility rate is on constant rise. The present fertility rate of Nepali is 4.1/1000 women, which is one of the highest rates in the world (CBS, 2003). The fertility rate of Nepali women in urban area is 2.82/1000 women, 4.37 in rural areas, 4.57 in Himalayan regions, 3.77 in Hilly region and 3.64 in Terai region (CBS, 2003) It is believed that the influence of family planning program is correlated with the fertility decline by increasing the number of contraceptive users. In Nepal, the contraceptive prevalence rate is 39.3% (CBS, 2003). In order to reduce the high growth rate of population in Nepal, government has given priority to the health services. Since family planning service has been considered as an effective measure for controlling population and high fertility rate, the government has given an importance on family planning in its periodic plans since 1960s. Since then, we can find that every periodic plan has incorporated the family planning services as an essential program. Various programs like mass awareness campaign on means and methods of family planning, general education about family planning, distribution of contraceptive means, nationwide access to family planning services etc, have forwarded for the top priority in the plans, policies and programs of the government. Despite the good plans, policies and programs of the government, the effectiveness of those programs is very low. The existence of high fertility rate is not only in the rural areas but also in the urban and semi-urban areas. Why despite the valiant efforts the effectiveness of the programs is low? Why haven’t the fertility rate decreased despite the increase in level of awareness? Why has the contraceptive prevalence rate remained in a bleak stage despite the efforts from the government and non-government sectors? The lack of effectiveness of these policies and programs has been a major concern and become a subject of study. In the field of family planning and population control, the major issues, which can be identified, are: ·	Population growth rate (2.25) is high and has not come down even after the efforts and program, which is prioritized (CBS, 2003). ·	Fertility rate (4.1) is still high (CBS, 2003). ·	Greater numbers of population do have knowledge of family planning (99.5%)and Methods available but use of these methods and services (39%) seems to be low (NDHS, 2001). ·	Contraceptive prevalence rate is low in comparison to other developing countries. ·	The effectiveness of the family planning measures is low. Thus, most of Nepalese people know about the methods of family planning. But they do not use those methods. Thus, if clearly seems that the gap among knowledge, attitude and practices exists into different levels. In this context, this study has been proposed to answer the following question: ·	What is the current level of knowledge of family planning methods among the population of Siddhipur VDC in Lalitpur district? ·	What types of family planning methods are practiced among the married men and women in Siddhipur? ·	What are the barriers for not using/practicing the family planning methods? Thus the dissertation will delve into the relationship among knowledge, attitude and practice and analyze the gap (KAP-gap) leading to affect fertility rate, birth control and family planning as a whole. 1.3	Objective of the Study The general objective of this study is to find out knowledge, attitude and practices of family planning among the married population (15-49 years) in Siddhipur VDC. The specific objectives of the study were to: ·	Identify the knowledge on utilization of family planning methods among married couples of Siddhipur VDC, in Lalitpur district. ·	Find out the practice of contraceptives among married men and women. ·	Find out the attitude of the practices on family planning devices. ·	Find out the reasons of contraceptive users and nonusers and their effects. ·	Explore the perception of people on family planning service. 1.4	Rationale of the Study The study provides knowledge, attitude and practice of family planning method used in the community of the selected ward no. 6 of Siddhipur VDC, Lalitpur district. Detailed and analytical information through the study on family planning and practices of contraception use at different locations, ethnicity and particular group is always required to the policy makers, planners, administrators and demographers to develop and design appropriate policy and programs. The use and demand of the family planning means depend on the knowledge, attitude and practices and availability of devices/services of the married population within the range of fertile couple. To achieve the better result from the family planning services, the knowledge, attitude and practices are the most important factors for the others. This study, therefore, will provide little but essential information, which will help to implement the effective family planning programs in related sectors. 1.5	Conceptual Framework In this study, it is assumed that there is a significant bearing of social, economic and culture aspects, which contribute to bring behavioral changes in social framework. There exists a chain of relationship between the knowledge, attitude and use of family planning methods. Socio-economic and environmental variables-including education, number of living children, family structure, quality of health services, social values etc. are some of the contributing factors in the application of knowledge into practices.

Socio-economic and cultural setup:n	Educationn	Economic statusn	Religion n	 Patriarchal valuen	Service Availability and AccessibilityDemography:n	Agen	Number of Children

1.6 Organization of the Study This study consists six chapters. The first chapter deals with the background of the study, covers the overview of population growth and family planning service and its effectiveness in Nepal. It also deals with statement of the problem, rationale of the study, objectives of the study, conceptual framework and organization of the study. The second chapter presents literature review. The literature review gives general overview of population growth, introduction of family planning methods reducing fertility rate. The specific review of literature deals with different socio-economic aspects, which are major contributing factors for population growth and effective implementation of family planning services. Third chapter is about selection of research topic, research methodology, which includes research design, selection of the study area, universe and sampling, sources of the data collection, technique of data collection, analysis of data and limitations of study. Chapter four provides background characteristics of household population, which includes demographic and socio-economic status of the population. Chapter five deals about the interpretation and explanation of data collected from ward no. 6, Siddhipur VDC of Lalitpur and explains the utilization pattern of family planning devices It also describes about the reasons of using and non-using of family planning methods. Finally, in chapter six, summary, conclusions and recommendations are presented. CHAPTER - II LITERATURE REVIEW In the modern over populated world, population has become a threatening burden for every country in the world. So to check the rapid increment in population, family planning has been believed to be a final means to be exercised. Its further studies and researches have become the towering field to be searched and delved into. In the context, there are a number of researches done in the field of family planning. This chapter describes such researches; national and international, printed and electronic, published and unpublished products based on knowledge, attitude and practice of family planning. All the associated literatures on the research, knowledge, attitude and practice of family planning are discussed and analyzed critically. 2.1	General Literature Overview People are intensely seemed to be engaged in different activities of family planning. Birth control and reduction in fertility rate should be continued to decrease overloaded population. People's knowledge is the product of the society, culture and level of education, etc. Thus their attitude is also influenced by those factors. And then the positive attitude originated from them increases the rate of family planning service. Similarly, education can increase the use of contraceptive. "There is s strong positive association between educational attainment of women and their contraceptive use" (Aryal, 1998: 90). Education and contraceptive use should be linked together. Here the word 'education' should not be taken vast. It is the element of life that changes the view of the clients like the information of contraceptive change the attitude and performs in practice. Education in term of knowledge broadens the mind of the client, which helps them to have informed choice. So the crucial thing for the practice of contraceptive is knowledge. So the rate of literacy is high in urban area whereas it is low in rural area. Consequently the rate of contraceptive use is high resulting in low fertility rate in urban area whereas the contraceptive use is low in rural area resulting in high fertility rate. Similar kind of view can be found in the Theory of Social Capillarity. In this theory, Dumont said, Birth rate in the cities is also low because cost of bringing up is very high and there is keen desire to go up as quickly and speedily as possible. On the other hand, in the village birth is high because there is orthodoxy, rigid caste system, lack of vigor, poverty and illiteracy. He was convinced that poverty in itself is not the cause of high birth rate but it is because of ignorance and lack of vigor (quoted in Hans Raj, 2003:184). In this way, both writers believe that knowledge is the core element for the rapid increase of family planning contraceptive. Knowledge can strengthen the attitude and assist clients to choose the appropriate method of family planning. “Literacy has a positive impact on the level of contraceptive knowledge. Overall contraceptive knowledge increases steadily with an increase in the respondent's literacy level” (MOH, 1981:82). While providing knowledge, most of the researches opine that the health teaching or information about family planning method can be given effectively by female. Similar kind of the view can be traced out in the article, Using Socio-cultural Information to Improve Health Planning of the book, Policies, Plans and People. “This approach was justified on the grounds that in many countries, Nepal among them, women could be more effective than men in providing maternal and child health care and family planning”(Justice, 1986:140). But this view does not seem to be justified because female cannot be suitable for every context, in the context of male and female. It is already accepted that female service provider can be suitable for the female but not for the male. If it is said that the same sex can be accepted the suitable service provider but not for all. Population growth around the world affects each one of us through its impact on the economy, the environment, safety and health, and the habitability of the world children will inherit. Experts agree that the cumulative evidence is strong that current rates of population growth pose significant and interacting risks to human well being. The population growth has brought much adverse impact on socio–economic fronts as well as resulted in forest depletion, causing frequent landslides, floods and soil erosion. We have experienced that along with the population growth the demand of people for better education, health, drinking water and other physical facilities have also increased and  have created so many problems. Therefore, to address all the problem of population growth, measure to control the birth rate, it was considered very essential to promote modern family planning Method. Family planning is more important in the under-developed world where there is always scarcity due to demand than the available supply for almost everything. Promoting spousal discussion of family planning has frequently been advocated as a viable policy tool for narrowing the gender gap in partners’ fertility intentions in developing countries. Discussion between spouses is expected to increase contraceptive use, because a sizable minority of women cited that their husband’s disapproval of contraception as the reason for nonuse, despite having never discussed family planning with their husband. 2.2	Specific Literature Review The level of knowledge of family planning methods; about the contraceptive: Depo-Provera, Pills, Condom, Norplant, Sterilization facilitates attitude and ultimately supports people to perform practice or use them. Success of the family planning programs depends on the level of knowledge. So the relationship among knowledge, attitude and practice is directly proportional to the success of family planning programs. In this way, there are many researches and many studies done on family planning but the issue that has been focused here in this research has been lacked. Likewise the chapter deals with different literatures that share similar kind of findings. Firstly, a journal, Asian-Pacific Population Journal published from Bangkok by Nations Unies presents a research done in eighteen less developed countries and states: The challenge which remains for the family planning program is to develop an IEC strategy which would effectively address these reasons for nun-use and reduce the KAP- Gap by persuading substantial proportions of unmet – demand population to practice contraceptive" (Shrestha, Stoeckel & Manandhar, 1991:36). Thus the research further shows the problem that the incidence rate is low and at last concludes that the service of family planning should be increased and provided qualitatively. But it ignores the insight that KAP (knowledge, attitude and practice) - Gap decreases the incidence rate of contraceptive users. Although the research points out the reason for non-use of family planning among women in Nepal who want to space or limit the birth of their children or decrease fertility rate. Then the term "spacers" that means un-pregnant woman having the desire to have more children and are not using any means of family planning and "limiters" that means that the un-pregnant woman, having the knowledge of family planning, no desire of additional child but are not using any contraceptive currently. Now the objective of this research is to find out the reason of why the limiters do not use family planning and tries to supports that KAP-gap is the influencing factor of the reason. "Knowledge of contraceptive is nearly universal in Nepal" (MOH, 1997:49). It means that the knowledge about means of family planning is known to all. But the same survey reports, "Current contraceptive uses in the central Hill (43%) and mid-western Terai (40%) sub regions and lowest in the western Mountain sub region (11%)" (MOH, 1997). Sum up, the average current user of Nepal becomes 31.3%. Now the question can be raised that why there is a big gap between the level of knowledge and the practice in term of use. So the gap suggests that the difference is originated only from the gap among knowledge, attitude and practice. Similarly the report opines that most women feel that their husbands also approve of family planning; 70 percent women report that their husbands approve of family planning. While 15 percent say that their husbands disagree (MOH, 1997). It means that the attitudinal understanding seems to be compulsory for the use of contraceptive. So it tries to clarify that the couple's knowledge assists attitude and ultimately increases it practice. "In general, proportion of wife and husband approving family planning has been found to decrease at old ages" (MOH, 1993:125). This survey adds similar kind of idea that some of the couple do not agree for the method of family planning. It also clarifies that the level of approval decreases on rate of declining age. When they become old, the husband approves in less degree. Further the study points that the level of approval depends on the basis of geographical region and level of literacy of the couple. However, it accepts that education is the key factor to affect family planning. So the strategy of information and education should be strictly implemented in family planning. Similar kind of finding can be traced out in the research, done every five years by Family Health Division, the Ministry of Health, realizes the finding. In this research every respondent was asked to name one of the eight methods of family planning: pills, condom, IUD, injectable, implants, vaginal tablets and male and female sterilization. "Acquiring knowledge of contraceptive methods is an important precondition toward gaining access to and then using a suitable contraceptive method in a timely and effective manner" (MOH, 2001:67). It states obviously that the knowledge about family planning is essential and preconditions to flourish the program. Similarly the research further reports its findings that the most widely known modern contraceptive methods between both ever-married and currently married women are female sterilization (99%), male sterilization (98%), injectable 97%), the Pills (93%) and condom (91%) (MOH, 2001). Likewise, NDHS Survey shows there was a fivefold increase between 1976 and 1986 in current users of contraceptive and a two fold increase between 1986 and 1996.Over last five years modern contraceptive use is increased by 35 percent from 29 percent in 1996, to 39 percent in 2001(MOH, 2001). This indicates the gap between knowledge and practice. Practice is more or less oriented and guided by attitude. So knowledge of family planning does not seem to be completely converted into practice. In the national five-year survey, 18 percent women were found using periodic abstinence. Among them, only one–third were (MOH, 2001) able to tell correctly about menstrual physiology in case they could save themselves from unplanned or unexpected pregnancy. This data shows that there are people or women who are using methods of contraceptive although they are far from the knowledge of family planning. But the practice of any family planning contraceptive cannot be hundred percent successful and effective without adequate knowledge or information about family planning. Likewise, in the same report, it is reported that 8 percent women or men regretted sterilization (MOH, 2001). Among them, 4 percent regretted operation because of its side effects, 2 percent did so because of their want or need of another child and one percent regretted it because of the death of their one child. Now this report gives thrilling information because one –half of regretted rate is due to side effect. It seems that the four percent customers are not counseled properly. They performed practice without proper knowledge of family planning. If they were informed properly and had chosen it by knowing from their heart, they would not regret sterilization. The above survey disclosed that 43.6 percent agreed that using condom reduces men’s pleasure. According to the survey, 22.6 percent men agreed that women who were sterilized might become promiscuous whereas 71.5 percent men disagreed so. These data prove that attitude towards family planning is highly required need for the success of family planning. Men play significant role in the reproductive life of women. Family planning is an important component of reproductive health. So the attitude of men should be positive to achieve successful reproductive life. 43.6 percent people have negative attitude towards condom because they believe that it reduces sexual please. Similarly 22.6 percent men believed that women become promiscuous when the latter are sterilized. This belief is a biggest barrier to have performance or practice of family planning. This negative attitude towards sterilization hinders the practice of family planning and increases the gap of KAP. Informed choice is an important tool for monitoring the quality of family planning services. All providers of sterilization must inform potential user that the operation is a permanent irreversible method; potential users must also be informed of other methods that could be used (MOH, 2001:88). This suggests that informed choice should be implemented to provide qualitative service and only then the discontinuation rate can be decreased. Informed choice is the client's volunteer selection of family planning by knowing all information about the methods. In the information, the knowledge of indication, side effect, contraindication, and what to do if something seriously happened, are included. After that the heath worker or counselor only should assist the client to choose the best one. It checks the discontinuation of family planning method. Similarly, the informed choice is focused on the training of family planning. Informed choice is defined as, "Pariwar niyojanko sabai sadhan bare purna jankari prapta garikan kunai byaktile gareko nirnya nai susujit chanaut ho” (The decision of what to take among different means of family planning after getting complete information about them is called informed choice) (MOH, 2003:1-2). It deserves the quality of the extreme level of satisfaction, important policy of reproductive health, human right to choose, etc. The most important point is that it prepares client for any side effect that might happen in future. At last it increases the level of knowledge, creates positive attitude and prepares for the service of family planning. But the national survey of 2001 depicts that only 37.5 percent clients were informed about side effects and problems of used method. 34 percent clients were only informed what to do if any side effect is experienced. And 28.5 percent clients were only informed about other means of family planning (MOH, 2001). This means that more than sixty percent clients were not given an opportunity to have informed choice. This data might decrease the level of knowledge and increase the chance of discontinuity of the service. The survey reports, "The majority of women (55%) and men (66%) have heard a family planning message recently on the radio. Only 22 % women and 32 % men have heard family planning message on television. Two-fifth of women and more than one fourth of men had not been exposed to family planning message in any media source." (MOH, 2001:93). This extract clarifies that the fundamental source of providing knowledge about family planning to both man and woman is radio. The next important clarification is about two-fifth or 40% woman and one-fourth men or 25% men are far away from any kind of information about family planning. Do they not need any means of family planning? The answer really comes positively. So if they do, what will happen if they are not completely informed? This data shows that some people need the accessibility of media and information of family planning. It makes us conclude that information, education and communication are the minimum requirements for successful or effective means of family planning. Respondents residing in the terai region show higher proportion of ever use of female sterilization (10.3) while higher percentage of ever use of male sterilization has been observed in the mountainous region (10.5) followed by the hill (6.0) and terai (4.4). This is expected in view of the fact that most of the female sterilization camps are organized in the terai area while most of the vasectomy camps are organized in the mountainous and hill regions (MOH, 1986:113). This suggests that the achievement of male sterilization in hills and female sterilization in terai is higher comparatively because the higher rate of conducting male sterilization camp in hills and female sterilization camp in terai... How can it be possible? While providing one service of family planning, the counselor has to assist the clients to have informed choice. So the means of family planning can be changed. According to the HMG policy of family planning service, informed choice should be taken. So this proves that the service in that time was not provided with the modern policy of informed choice. In this way, how communication plays a significant role in spreading knowledge, strengthening attitude and performing performance. Here the meaning of communication is to provide information about the methods of family planning. A deliberate discussion should be done for the effective flow of knowledge about family planning. Communication can spread knowledge, values, and social norms. Such knowledge includes the idea of fertility control itself as well as knowledge about specific methods of contraception and how they are used. For example, communication can convey the advantages and disadvantages of smaller families or the beneficial and harmful consequences of specific contraceptive (Piotow, Kincaid.et al, 1997:2-3). This emphasizes on the importance of the communication before taking family planning service. Detail discussion with the client can provide enough knowledge. Although this USAID sponsored survey did uncover some differences in knowledge, use, attitudes and decision-making practices between men in Cairo and in Upper Egypt, these differences were not sufficient to account for the difference in contraceptive use. Indeed, they often contradicted conventional culturalist expectations. Nonetheless, the report concluded that prevailing traditional social norms in urban and rural upper Egypt influence men's decision making role in family planning and may be responsible for the difference in contraceptive use. Thus, statistical anomalies were forced to fit the culturalist paradigm (Ali, 1997). In this research, Ali views that there might not be any difference in different geographical locations but opine that difference exists between knowledge, attitude and practice. He moreover adds that the gap of KAP varies according to cultural paradigm. For example, the Muslim culture hardly follows the methods of family planning. In Indian context, the experts believed that population of India are increasing rapidly. So their program seems to be very hurry. So their first trial is to extend family planning all over India. They also say that religious groups of India are very active but they do not show any kind of intensity to provide family planning knowledge and change religious attitude. Then they can be successful. Their action does not match with their policy. Similarly in India there are many religious leaders who have openly opposed family planning program. of course, Hinduism does not oppose family planning, yet producing children is considered a religious duty of every Hindu. In rural India even today for the Hindus the child is the gift of God and abortion a sin (Hans Raj, 2003: 133). Further more he suggests, "family planning facilities should be provided not only in big hospitals but also in big industries, factories, etc" (Hans Raj, 2003:135). It is not clear in the sense that how the program can be famous if the negative attitude of different religious leaders does not support the program. So only putting family planning means in industries cannot be the solution for birth control. Even Muslims are much strict. Thus firstly, the attitude of Indian people should be changed by providing differential knowledge or information towards different methods of family planning. According to the data of India, In 1968 about 10 crore persons who were in reproductive age and out of that only 8% were using family planning method (Hans Raj, 2003). The data shows the KAP gap and suggests that information about different methods of family planning should be provided adequately and people's attitude towards this program should be changed into positive. Otherwise the program cannot be run successfully. Knowledge or information about the methods of family planning cannot be sufficient to conduct the family planning program successfully. It is because that people have knowledge but their attitude has not been changed. So they do not take the service timely. Similar kind of the case and report can be found and reported. Those who felt a vasectomy would compromise the strength of the husband argued for female sterilization while others used the same rationale to argue for male sterilization. In general, most informants perceived the laparoscopy as more threatening to strength because it involved internal body parts (Dahal, & Fricke, 1998: 65). It revealed that the difference in knowledge and attitude creates negative belief as showed in the previous extract. The people who have misconceived belief on some methods of family planning advise for next family planning. So it is because of negative attitude created while primary information was provided to them. The belief that having done vasectomy means the compromise of strength is attitudinal problem that should be solved to run the family planning program successfully. The research further philosophies that fertility rate of those Tamang villages could not be controlled because they believe in might is right. Having many children means having more manpower to rule over and to serve the parents. But they do not think over the result of planned family. In this way, the research depicts the incensement in family planning service but people of those villages went for service after having more than six children. It was the cause that the fertility rate could not be controlled. So all these activities are directly originated by KAP-gap. Absolute improvements in education are impressive in all regions, and in almost all countries (see Table 10, columns 1-3). With such large changes, we would expect that education would make a substantial contribution to declines in adolescent fertility, because in general, educated women have lower levels of adolescent child bearing (Blanc & Way, 1998:129). This extract shows that education plays dynamic role in different aspects. For example, the adolescent fertility rate has been decreased due to the rise in education. So education affects all sides of human life. Among them, one component is family planning, education clears concept, changes the attitude towards family planning and increases the practice of family planning. Complete knowledge in form of consent can only be attained when the client is educated. As a whole, the program is facilitated with education. A report shows that increase in educational status in China and India affected in the rise of methods of family planning. However like other methods, the prevalence of sterilization is unevenly distributed in the world; China and India, the two most populous countries, gave more than half of the world's users of this method. In general, female sterilization is far more common than male sterilization and the gap between two countries to widen. (WHO, 1992: 8) This extract clarifies that female sterilization has been excessively used in both China and India. The region behind it is that the people of those countries were educated. So, they could perceive the need of family planning. Even need of any thing only can be felt by the light of education. But one thing that is to be observed is that why only female sterilization but not male sterilization has been increased, Among many reasons, it may be that although technically male sterilization has smaller operation and less difficult than female sterilization, men believe that the operation done while sterilizing makes weak and inactive after sterilization. So they compel their wives to attain the sterilization. In this way male dominated world, female sterilization becomes the final means of permanent family planning. The belief seems to be the product of ill belief towards the method of family planning. They do have knowledge of family planning but do not have positive attitude of family planning. At national level, the overall number of male VSC has decreased from 20,894 in FY 2059/60 to 19,521in 2060/61.Considereable efforts will be needed to increase the number of male VSC in the future, as the government is committed to the recommendations of the International Conference on Population and Development (ICPD) to increase male participation in the national RH/FP programme (MOH, 2005:81) This citation also proves that the decreasing number of male VSC will be increased to insure male participation in reproductive health and family planning program. “Governmental efforts to increase contraceptive use among poor women need to focus on changing attitudes toward smaller family size and family planning” (Shoemaker, 106). This study pointed that governmental effort is not sufficient to change the public attitude towards fertility rate and family planning. In Indonesia, different people viewed differently that two or three or four number of children can be ideal number. This finding proved that the level of knowledge was low. In that research it was found that about 40% of woman (both poor and better off) cited reasons related to fertility rate, which in most cases meant that women did not consider themselves at risk of pregnancy because they did not have sex regularly. They were not informed that even irregular sex in ovulation period can be dangerous. They lacked the knowledge of family planning as a whole. Some of them reported that due to fear of side effect, they did not use any means of family planning. Thus, it was found that knowledge about family planning was universal but complete knowledge was scarcely found. So without complete knowledge, the KAP gap will be widened and will not be in favor of family planning program to be universal. CHAPTER - III RESEARCH METHODS 3.1	Rational of the Study Area Selection This study is focused to ward no 6 of Siddhipur in Lalitpur district. The selection of Siddhipur VDC is six kilometers away on the southeast direction of Lalitpur Sub-Metropolitan. Access to information, exposure and opportunities seems to be higher than other VDCs of Nepal, which are very much deprived of health care and family planning services. The study, thus, would be useful to determine the relation of proximity between urban and semi-urban area in knowledge, attitude and practice towards family planning. Similarly the research will be differentiating Knowledge, attitude and practice of family planning of that community in term of a gap among them. Moreover the VDC is very close to Lalitpur Sub- Metropolitan and shines with some effects of globalization but deserves the backwardness in some respects like the farthest VDC of Lalitpur. So this research on Siddhipur will be special blend of rural and urban area as well. 3.2	Research Design This study includes the descriptive and explanatory research design as it was intended to examine knowledge of family planning methods and the practices of contraception among the fertile couple of study area. The basic approach of the study was to find the overall knowledge, attitude and practice of family planning in the study area. 3.3  Sources and Nature of Data Both primary and secondary data were collected for the objectives of this research study and research design. But the study has been based on the primary data collected basically through field survey as an interview with targeted respondent by administering questionnaire and doing some case observations of the target population. The secondary data were collected from relevant books, research papers and reports, informative articles and published documents. Both qualitative and quantitative data were collected for this study. 3.4	Sampling Process Siddhipur is one of the VDCs out of 41 VDCs of Lalitpur district, Kathmandu valley, which is adjoined to Lalitpur Sub-Metropolitan. It consists a total population of 5,277 with 936 households. For the purpose of the study, ward no. 6 of the VDC was chosen as a study area on a convenient and purposive basis that consists of 387 people from70 households among them, comprising of 110 populations of 15-59 years. (DDC Profile, Lalitpur 2004). In order to select the sample size for the purpose of the study, all married population between the ages 15-49 was taken. The total number of respondents between the age of 15-49 were 80 comprising 47 females and 33 males. All were selected for this study. The unit of analysis in this study is individual respondent 3.5	Data Collection Techniques Various techniques and methods were used to obtain required data and information for this study. For collecting primary data, field visit and filling up of the questionnaire from respondents and interview schedules were administered. A well-structured interview schedule containing multiple choices and open and close-ended questions were prepared and applied while administering the questionnaires. Some follow-up questions were also asked for getting additional information from the respondents. In course of administering the questionnaire, the researcher had approached each individual respondent of the target ward no. 6 of Siddhipur VDC. The purpose of study was informed before filling out the questionnaire and asking of the questions. The respondents were assured for maintaining confidentiality of the personal information and were informed that the information will be only used for academic purpose. So in the beginning of any interview respondent verbal consent was taken from each respondent. 3.5.1	Interview Schedule In order to collect primary data, the interview schedule (questionnaire) was the main instrument, which was basically designed in two parts. The first part was used to obtain information on personal details, social, economic and their professional status and the second part was more specific for obtaining the information on knowledge attitude and practice of family planning methods. 3.5.2	Key Informants Interview The key informants of this study were the government health workers, family planning service providers and private practitioners. A checklist was also developed and used to collect the relevant information. A total of 5 key informants were included in this study. Maternal Child Health Worker (MCHW), Assistant Health worker (AHW), Female Community Health Volunteer (FCHV) and local leaders were selected purposefully as they were knowledgeable people on utilization of family planning devices. 3.6	Data Analysis The study was mainly based on primary data, which were collected through the field survey involved 80 respondents of ward no. 6 of Siddhipur VDC of Lalitpur. The collected data from the field survey were tabulated and processed forward by using SPSS software and excel, and other statistical tool and techniques. Frequency tables and cross tables were used to analyze and describe the basic characteristics of the respondents. Simple and statistics such as frequency counts, percentage, mean value, ratio analysis were used as necessary tools to explain and interpret the data and overall findings. Comparison was made with different variables. The independent variables used in the analysis were socio-economic and demographic variables. Socio-economic variables include occupation, level of education, land ownership and income level. The demographic variables include age, age of first pregnancy, number of children, number of family of the respondents. All the information was edited for checking the consistency. 3.7	Limitations of the Study Every research has some sort of limitations under which the researcher has to work in. In the same way, the research is not the exception of the above-mentioned feature of research. This study also has some limitations, which are the followings: Ø	Any country or area or specific location is affected by various socio-economic factors and demographic variables such as education, employment, age at marriage, number of living children and traditional culture. But in this study only some of the socio-economic and demographic factors, like occupation, level of income, education, age group, etc have been taken into consideration Ø	This study is confined to ward no 6 of Siddhipur Village Development Committee, Lalitpur, Nepal. This is a micro-level study. Thus, the research represents the utilization situation of the study ward among the married couple of 15-49 years and can be compared with the national situation but is not expected to reflect the exact situation of Nepal. Ø	The study has been confined only among the married men and women between the ages 15 to 49. Ø	The whole study is focused only on knowledge and attitude towards the practice of family planning.

CHAPTER- IV STUDY AREA AND THE PEOPLE 4.1	Geographical Setting Siddhipur is one of the VDC out 41 VDCs of Lalitpur District. It is situated about six kilometers away to the Southeast of district headquarters, Patan. It is surrounded by Lubhu on east, Imadol on west, Tikathali on north, and Harisiddhi on south. The size of the VDC is comparatively small with respect to its neighboring VDCs, which covers about 225.75-hector land area. Godawari River flows along its eastern boarder and which is a perennial source of irrigation (DDC Profile, 2004). 4.2	Socio-economic and Cultural Setting of the Study Area 4.2.1	Population According to the CBS report of 2001, the total population of Siddhipur VDC is 5277 out the total population, 2666 are male and 2611 are female. The total number of number of house household in the VDC is 936. The total population of the study area Tadhanani (ward no 6) is 387. The number of households is 70 (DDC Profile, 2004). 4.2.2	Caste and Ethnicity Newar is the major ethnic group in Siddhipur VDC. The study area Tadhnani.Ward no - 6 is dominated by the Maharjan of Newar ethnic group. Percent of Newar population in the VDC is 88.93. There are different caste groups in the village. Guvaju, Maharjan, Nemkul, Shrestha, Amatya, Jyapu, Nau and Jugi are the main caste groups of the VDC. (DDC Profile, 2004). 4.2.3	Health and Sanitation There is a sub-health post in Siddhipur VDC under District Public Health Office, Lalitpur. A family planning clinic, run by Nepal Family Planning valley branch and five medical stores are in the village. Nine FCHVs providing good volunteer services are at the ward level. There is one Doctor and 10-health assistant working in the village (DDC Profile, 2004). 4.2.4	Occupation Agriculture is the main occupation of Siddhipur. Paddy, Wheat and seasonable vegetables are the main crops. There are traditional cottage industries like pottery, textile and straw production such as basket, shoes and sukul (mat) knitting. Sukul knitting (Hand knitted straw mat) is one of the popular and traditional occupations of the village people. Recently, significant portion of population have been engaged into service activities within the country and aboard (DDC Profile, 2004). 4.2.5	Educational Status of the VDC The educational status of Siddhipur is lower compared to national average. Only 29 percent female and 42 percent male are literate. The history of formal educational institution is not very long. In 2012 BS, Sidhimangal Primary School was established with joint effort of local teachers and government. Now it has been changed in to higher secondary school. Moreover, there are two primary schools (Private & Public), four lower secondary schools from private sector and one public high School. (DDC Profile, 2004). CHAPTER-V KNOWLEDGE, ATTITUDE AND PRACTICE OF FAMILY PLANNING The main objective of the study is to identify the level of knowledge, attitude and practice of family planning and to analyze the relationship between various factors. Therefore the data collected from the field survey were analyzed on the basis of age, sex, level of education, occupation, social value, number of children, religion etc. to find out the relationship between knowledge, attitude and practice of family planning. 5.1	Socio-economic Status of Respondents In this section, social aspects of respondents have been analyzed as per the data and information obtained from the field survey. Table 1:Respondents by Sex Sex	Frequency	Percentage Male	33	41.25 Female	47	58.75 Total	80	100 Source: Field Survey, 2006

Out of the total respondents, 58.75% were female and 41.25% were male. The overall ratio of male and female in the research are27a is nearly 1: 1.5. With the gender perspective this is a good combination of the sample size. Obviously, the ratio of male was found to be less in comparison of the ratio of female because by the field survey it was found that most of the male were aboard for employment. This was found universal in the whole community. Table 2: Respondents by Age Group Age	Female	Male	Total	Percentage 15-19	0	0	0	0.00 20-24	2	1	3	3.75 25-29	15	6	21	26.25 30-34	7	9	16	20.00 35-39	15	8	23	28.75 40-44	5	5	10	12.50 45-49	3	4	7	8.75 Total	47	33	80	100 Source: Field Survey, 2006

It is seen from the table no. 2 that the highest percentages of the respondents were from the age groups of 25-29 (26.25 %), 30-34 (20%) 35-39 (28.75 %) whereas the second lowest age group was 20-24 (3.75 %). No one was from the age group of 15-19. Out of the total respondents, 75 % were from the age group of 25-39. After contemplating the data, it is found that in fertile age group, 20-39, the number of male is lesser than the number of the female because the male go abroad but the ratio of male and female in the age group 40-44 is 1:1 because the age group is inactive in comparison of the above. The same table is represented in the form of Chart 1 & 2 on frequency and percentage wise respectively. Table 3: Respondents by Religion Religion	Frequency	Percent Hindu	79	98.75 Christian 	1	1.25 Total	80	100 Source: Field Survey, 2006 The above table clearly shows that the majority of population (98.75 %) is Hindu and a very small percentage (1.25%) is Christians. The entire communities of ethnic Newar are followers of Hindu religion.

Table 4: Respondents by Family Size Family Members	Frequency	Percent 2	2	2.50 3-5	51	63.75 6 and more	27	33.75 Total	80	100 Source: Field Survey, 2006 The table no.4 shows that the average family size of the study area is 5. Out of the total respondents 63.75% have 5 or less than 5 members in the family. In assumption that a family has one father and one mother, the average number of children in each family is 3. But 33.75% family had 6 or more than 6 family members. The reason behind that perhaps may be the gap among knowledge, attitude and practice of family planning, which is the subject of the research. Table 5: Respondents by Family Type Family Type	Frequency	Percent Nuclear	50	62.50 Joint	30	37.50 Total	80	100 Source: Field Survey, 2006 Table no. 5 shows that majority of the respondents (62.5 percent) live in a nuclear family whereas 37.5 percent have joint family. This indicates that people now preferring to live in a nuclear family. Table 6: Respondents by Occupation Occupation	Frequency	Percent Agriculture	53	66.25 Service (Domestic/Abroad)	15	18.75 Business	12	15.00 Others	0	0.00 Total	80	100 Source: Field Survey, 2006 The above chart shows that two-third (66.25%) of the total respondents are engaged in agriculture. Production of vegetables is chiefly the main source of income for people around Kathmandu and as the research area is easily accessible to the main market of the capital which is one of the main reasons that agriculture is the main occupation of the research area. 18.75% respondents are engaged in service and 15% are involved in business. Table 7: Respondents by Land Holding Land Holding	Frequency	Percent Yes	75	93.75 No	5	6.25 Total	80	100 Source: Field Survey, 2006 The above table clearly indicates that majority (93.75%) of the respondents are landholders. However the data shows that the area of land possessed by the majority of the respondents is 1-3 ropanies, which is presented, in the following table no. 8. Table 8: Respondents by Land Size Land area (Ropanies)	Frequency	Percent <1	4	5.33 1-3 	39	52.00 3-5	25	33.34 5 and more	7	9.33 Total	75	100 Source: Field Survey, 2006 Table 8 indicates that 90.66% of respondents own a land area of less than 5 ropanies whereas the rest 9.33% respondent own more than five ropanies. Therefore, it further suggests that the respondents cultivate vegetable or other cash crops. Although the majority of the respondents’ occupation (66.25%) has agriculture but majority of the respondents (52%) has 1-3 ropanies of land that does not seem to be sufficient for agriculture. Table 9: Respondents by Annual Income Annual Income (Rs)	Frequency	Percent < 30000	5	6.25 30000- 40000	20	25.00 40000- 50000	4	5.00 50000- 60000	8	10.00 60000- 70000	12	15.00 > 70000	31	38.75 Total	80	100 Source: Field Survey, 2006

It shows that 55 percent respondents’ annual income range is between Rs 30,000— 70,000. Also shows that 38.75% of the respondents earn Rs.70,000 or more, which is good indication for standard livelihood. Whereas the annual income of 6.25% respondents is less then Rs 30000. Table 10: Respondents by Level of Education Level of Education	Frequency	Percent Illiterate	18	22.50 Literate	22	27.50 Primary	9	11.25 Lower Secondary	5	6.25 Secondary	15	18.75 Higher Secondary and above	11	13.75 Total	80	100 Source: Field Survey, 2006

. The above chart shows that 22.5 percent respondents are illiterate; 27.5 percent of total respondents can just read and write. Similarly, 11.25 percent have received primary education, 6.25 percent have lower secondary education and 18.75 have secondary education while remaining 13.75 percent have received higher secondary education or higher degree. It is surprising even if the study area is in Kathmandu valley. The percentage of illiterate people (22.5%) is significantly high. So the level of illiteracy helps to widen the gap among knowledge, attitude and practice of family planning. Table 11: Respondents Having Children Respondents with Children	Frequency	Percent Yes	76	95.00 No	4	5.00 Total	80	100 Source: Field Survey, 2006 Table 11 shows that 95 percent of the respondents have children. It is highly unlikely in Nepalese society to be married couples without children. Therefore, only a few couples are found to have no child. The reason behind having no child was not specifically traced out. Table 12: Number of Children No. of Children	Total Zero 	One 	Two  	Three 	Four and above Son	None	4	10	4	4	2	24 One 		8	19	16		43 Two 			9		2	11 Four 					2	2 Total	4	18	32	20	6	80

Daughter	None	4	8	9			21 One 		10	19		2	31 Two 			4	16		20 Three 				4	2	6 Five 					2	2 Total	4	18	32	20	6	80 Source: Field survey, 2006 The table shows the number of respondents having combination of son and daughter. For example, there were 32 respondents having two children. Among them, 19 respondents had one son and one daughter, 9 respondents had two sons only and 4 respondents had two daughters only. Similarly, there were 6 numbers of respondents having four or more than four children. Among them, two had five daughters only, two had 2 sons and three daughters and two had 4 sons and one daughter Table 13: Age of First Pregnancy Age of First Pregnancy	Female Respondents	Percent 15-19	20	44.44 20-24	21	46.67 25-29	3	6.67 30-34	1	2.22 Total	45	100 Source: Field survey, 2006 Table 13 shows that 91.1 percent of female became pregnant before the age of 25. Among them 44.44% female respondents got their first child before 20 years of age whereas 46.67% female respondents did so before 25 years of age. This data presents that 44.44% respondents had earlier got married and received their first child. So they might not get the knowledge of family planning or have positive attitude or might not have practiced any means of family planning. As a whole the data widens the gap among knowledge, attitude and practice of family planning. Further more the second data of 46.67% respondents received their first child on standard age. 5.2	Respondents’ Knowledge of Family Planning Table 14: Knowledge of Family Planning Knowledge of F.P.	Frequency	Percent Yes 	79	98.75 No	1	1.25 Total	80	100 Source: Field survey, 2006 It shows that 98 .75 percent of the respondents have knowledge of Family Planning. Almost all respondents have heard about any means of family planning. Even in national surveys, it has been found that almost 99 percent people between the age group of 15-49 are aware of family planning (NDHS 2001). So similar to the national level, the knowledge about any means of family planning is universal. Table 15: Knowledge of Family Planning Methods (n=79) Known F.P Methods	Frequency*	Percent Condom 	63	79.75 Pills 	59	74.68 IUD 	19	24.05 Cream/Jelly 	13	16.46 Vasectomy 	56	70.89 F. Sterilization 	51	64.56 Injectable	73	92.41 Implants 	24	30.38 Source: Field survey, 2006 . There is a overlap in the frequencies in table-15 & Chart -8 due to the more than one response by the respondents. It shows that relatively higher percent of the respondent have knowledge of Injections, Condoms and Oral Pills. Among them, injectable means of family planning was more famous than any other because it is widely used in Nepalese society for its efficacy, durability, easiness and least failure rate. Most of the key informants said that Depo provera (injectable method) is widely used because of its long-term action of three months and easy to have. Table 16: Source of Information (n=79) Source of Information	Frequency*	Percent Friend 	25	31.65 Neighbor 	19	24.05 Spouse 	10	12.66 FP Worker/FCHVs 	54	68.35 Radio 	34	43.04 TV/Cinema 	32	40.51 Newspaper 	19	24.05 NGOs 	17	21.52 Poster 	13	16.46 Others (VDC, Drug Shop)	6	7.59 Source: Field survey, 2006 The above chart shows that 68.35% respondents view that the popular source of information about family planning method was FP Workers/FCHVs. There is a overlap in responses relating to other sources of information. However 43.04 and 40.51 percent of the respondent viewed Radio and TV/Cinema as other significant source for information 31.65% view that friends are also important sources of information. Table 17: Knowledge of Family Planning Service Center Knowledge of FP Center	Frequency	Percent Yes	78	97.50 No	2	2.50 Total	80	100 Source: Field survey, 2006 The above table shows that 97.5 percent of people know about the places where Family planning counseling or service is given. It is a good indication that people have heard about the places where FP service is provided.
 * Multiple responses
 * Multiple responses

Table 18: Known Place for Family Planning Counseling and Service (n=78) Places for FP Service/counseling	Frequency*	Percent FP Center	64	82.05 Hospital	24	30.77 FP worker/FCHVs/TBA	41	52.56 Drug Retailing Shop	6	7.70 Others	0	0.00 Source: Field survey, 2006 The chart no. 10 shows that most of the respondents (82.05 %) prefer go to FP center and consider it appropriate for family planning counseling and services. More than 52.56 percent of respondents were familiar with the work of FP workers, FCHVs and TBA. From the survey, it is also found that FCHVs are more effective to counsel and help female in the subject of Family Planning. 30.77% respondents were found visiting hospital for family planning services. There is overlap in the respondents’ preferences, so the frequency and the percentage are higher than the number of respondents. Table 19: Distance of Service Center Time to reach FP Center	Frequency	Percent Less then 5 minutes	36	46.15 5 to 10 minutes	42	53.85 Total	78	100 Source: Field survey, 2006 Table 19 indicates that it takes less than 10 minutes, respondents, to reach FP service centers. During the field visit and observation, it was found that a health center was found on the center of the ward and so FP service can easily be received by the respondents. 5.3	Respondents’ Attitude towards Family Planning Table 20: Practice of Family Planning Counseling/Services Response	Frequency	Percent Yes	64	80.00 No	16	20.00 Total	80	100 Source: Field survey, 2006 Table 20 shows that majority of the respondent (i.e. 80 percent) was found taking Family planning counseling/services whereas the 20 % respondents do not go for FP Service. Table 21: Choice for Appropriate Family Planning Service Center (n=64) Preferred place for FP counseling/service	Frequency*	Percent FP center 	49	76.56 Hospital 	26	40.63 FP worker/FCHVs/TBA 	28	43.75 Drug Retailing Shop 	5	7.81 Others	0	0.00 Source: Field Survey 2006 The table no. 21 shows that 76.56 percent of respondent go to FP center for counseling and FP services. 40.63 and 43.75 percent of respondents, who prefer to go to hospital and FCHVs are also significant. From that data, it is found that FP center e.g. health post seems to be more reliable and effective service center for family planning and people do not look for better center rather they take the service wherever it is accessible. There is overlap in the respondents’ preferences, so the frequency and the percentage are higher then the number of respondents. Table 22: Ideal Number of Children Ideal No. Of children	Total One	Two	Three	Four & above Ideal No. of son	None		2	1		3 1 son	1	51	8		60 2 son		5	8	1	14 3 son				1	1 4 son				2	2 Total	1	58	17	4	80
 * Multiple responses
 * Multiple responses

Ideal No. of daughter	None	1	5			6 1 daughter		51	8	2	61 2 daughter		2	8	1	11 3 daughter			1	1	2 Total	1	58	17	4	80 Source: Field survey, 2006 The above table shows that almost all respondents desire to have more than one child. From the data, it can be easily seen that the combination of one boy child and one girl child is the desired number of children wanted by the respondents. Moreover 58 respondents believed that they take two children can be an ideal number. Among them, 51 respondents believed that one son and one daughter can be ideal numbers; five replied that 2 sons only could be ideal number and 2 respondents replied that 2 daughters only could be ideal number but this expectation does not match with the actual condition of their children numbers, which is depicted in Table no. 12. Table 23: Consent for Prevention and Termination of Pregnancy Consent to Prevent Pregnancy 	Frequency	Percent Yes	66	82.50 No	14	17.50 Total	80	100 Source: Field survey, 2006 The table shows that 82.5 percent of respondents have consent for prevention and termination of pregnancy by using any method of family planning. This shows that consent is high because most of the respondents have positive attitude toward family planning and reveal the desire to terminate pregnancy. Table 24: View on the Reasons for Prevention of Pregnancy (n=66) Reasons for Consent	Frequency*	Percent Better Economic Condition of Family 	21	31.82 Good Health for Mother and Child 	23	34.85 Proper Education for Child 	14	21.21 Better Opportunities for Employment 	12	18.18 For Happy Life 	61	92.42 Others	0	0.00 Source: Field survey, 2006 Table 24 overlap in the frequencies and so the number of respondents seems high. The table shows that 92.42% respondents viewed, happy life is the most important factor for prevention of pregnancy. They do have the belief of less number of child and better life. But it does not suffice to practice the method of family planning. So they argue that above mentioned factors affect them to use the means of family planning. Most of respondents’ occupation is agriculture. So prevention of pregnancy is not generally believed responsible for employment opportunities. There are some concerns for the health of mother and child, which is also a secondary reason for prevention of pregnancy. Better economic condition of family is also important. Table 25: Reasons for Avoiding Family Planning Services Reasons 	Frequency	Percentage Spousal Disapproved 	1 0	71.43 Against Religion	4	28.57 Total 	14	100 Source: Field survey, 2006 Table 25 indicates that spousal disagreement is the main reason for not preventing pregnancy. 71.43 % respondents believed that they did not consent for the prevention of pregnancy by using of family planning method. Its reason of the disapproval of their spouse can be the misunderstanding or the lack of proper knowledge of family planning or the gap among knowledge, attitude and the practice of family planning. Table 26: Respondents Religious Belief Against FP FP against Religion	Frequency	Percent Yes	9	11.25 No	64	80.00 Don't Know	7	8.75 Total	80	100 Source: Field survey, 2006 The above table indicates that majority (80 percent) of respondents do not see family planning against religion. It should be noted that more than 98% of population is Hindu) and there is no clear objection on family planning in Hindu culture. But 11.25% respondents believed that using any method of family planning is against religion. It reveals that the societal belief restricts the practice of family planning. In such case, the profound knowledge and positive attitude can be the best tools to fight with the belief against the use of family planning. Table 27: Belief on Salvation Salvation with Son	Frequency	Percent Yes	25	31.25 No	53	66.25 Don't Know	2	2.50 Total	80	100 Source: Field Survey, 2006 The above table shows that 66.25% do not believe that salvation is not possible without son whereas 31.25% believe that having son is necessary for salvation. Salvation is spiritual belief that can be internalized by every respondent but the program of family planning might be troubled by the belief that only son can give salvation. By the belief, people wait for son and meanwhile they get many daughters without using any means of family planning. In that context, people might have knowledge, but the attitude towards family planning seems to be negative. So, better IEC (information, education and communication) can change the attitude of salvation only with son. Table 28: Desire of Son for Continuation of Generation Desire of Son for Continuation of Generation	Frequency	Percent Yes	25	31.25 No	50	62.5 Don't Know	5	6.25 Total	80	100 Source: Field Survey, 2006 The table shows that even though majority of respondents (62.5%) don’t view that male child is required for continuation of generation. However, significant number of respondent (31.25 percent) still view that male child is necessary for continuation of generation. It is also found that 6.25 percent of respondents did not confirm of the necessity of male child for continuation of generation. So 31.25% respondents wait for son to continue their generation. They believe that male child not the female child of the same spouse only can forward further generation. This attitude delays to use the means of family planning. One key informant told that the spouse who has only female children could wait for male child because they believe that on their old age only male child can help and serve them. So the belief towards looking after them on old age was the barrier for the program of family planning. So it recommended that effective IEC can be provided and counseling can be given intimately to remove the belief by the argument that there is no difference in the context of looking after. In that society, a keen observation suggests that the female can serve more than the male because the latter live abroad that is one of the findings of table no. 6. Another key informant told that the female served their parents more because maximum of the female are married in the same village. They can be together with their parents and serve them. So why they should wait for the male child and not to have any means of family planning.
 * Multiple responses

Table 29: Opinion on Side-effect from Family Planning Side-effect of Family Planning device	Frequency	Percentage Yes	7	8.75 No	58	72.50 Don't Know	15	18.75 Total	80	100 Source: Field survey, 2006 The above table shows that 72.50 percent of respondents do not think that family planning has any side-effects to their health. Further, 18.75 percent of respondents are unaware of or did not want to reveal the impact of family planning. 8.75% believed that contraceptive is hazardous to health can one of the barriers for the program of family planning. The reason behind the belief can be wrong information about the means of family planning. So proper counseling can be interrogated. So appropriate counseling is required to remove this kind of belief and the clients should be informed about the minor side effects of contraceptive. 5.4	Respondents’ Practice of Family Planning Table 30: Utilization of Family Planning Methods/Devices Ever Used FP method	Frequency	Percentage Yes 	59	73.75 No	21	26.25 Total	80	100 Source: Field survey, 2006 It is found that 73.75 percent of respondents have used FP methods whereas 26 .25 percent have not. It was found in Table No.12 that 26 respondents (20.8%) had three or more than 3 children. It shows that most of the respondents had ignored the means of family planning. Even the above table shows that 26.25% have never used any FP method. But the Table No.15 shows that 92.41% have the knowledge of injectible contraceptive. Thus there is a huge gap between the knowledge and practice of family planning. Then reason behind it was found that of misconception. They had enough knowledge but did not have positive attitude towards any method of family planning. Table 31:Types of Contraceptive Use (n=59) Contraceptives	Frequency*	Percentage Condom 	13	22.03 Pills 	23	38.99 Inject able 	35	59.32 Implants 	2	3.39 Cream /jelly	0	0.00 IUD	0	0.00 Others	0	0.00 Source: Field survey, 2006 . The table no. 31 & Chart -13 show the frequency of respondents overlapped. There were some respondents who used more than one method of family planning. So the number of the respondents is recounted in different means of family planning. From the above chart it was found that injectable method is the most common FP method in use by female respondents followed by oral pills. It shows that the use of condom is relatively low. It indicates high percent of female use FP Method than the male. One key informant viewed that the male do not want to use condom and pressurize the female to use any method of family planning. It is the reason that the method for the female seems to be higher the method of the male. The knowledge of FP to some extent varies with the practice of family planning. It is because the knowledge of injectable is higher versus the practice of family planning. One of the key informants told that female were not found interested in using implants and IUD because these are kept inside of the body part and there is a fear that these may cause physical problems and harm to health. Table 32: First Use of FP Methods and Variable Number of Children Number of Children	Total No children	1 children	2 children First time use F P method 	10	44	5	59 First time use F P method (Percent)	16.9	74.6	8.5	100 Source: Field survey, 2006 The above table indicates that majority (74.6 percent) of respondents used FP methods after the birth of first child. Only 16.9% of respondents used FP method before the birth of first child. It indicates that the least percentage of the respondents have used any method of family planning which indicates that they have some sort of planning of life, which is one of the objectives of family planning. Table 33: Reasons for Using Family Planning Method. (n=59) Reasons of Using FP methods	Frequency*	Percent Desired Family Size 	12	20.34 Birth Spacing 	48	81.36 Economic Burden	3	5.08 Others (Education for children)	2	3.39 Don’t know	0	0.00 Source: Field survey, 2006 . The table no. 33 & Chart -14 indicate overlapping in frequencies. It sows that the majority of the respondents view that the use of FP method is to promote birth spacing. The desire of ideal number of children is also one of the major reasons for using FP method that is indicated by 20.34 percent of respondents. 81.36% respondents argued that they use method of family planning for birth spacing. The percentage of birth spacing is the highest rate, which is good indication for the program of family planning. But the rate does not help the program because some of the respondents were found to use the method of family planning for birth spacing. But those respondents had a number of children by giving the birth of many children up to old age. So birth spacing cannot stop the excessive number of children. The highest rate of birth spacing only can be positive or supportive when they do that for ideal number of children and plan for the reproductive life. Table 34: Duration of use of Family Planning Methods Duration	Frequency	Percent Less then 1 year	7	11.86 1-2 years	5	8.48 2-3 years	5	8.48 3-4years	13	22.02 4-5 years	2	3.39 5-6 years	6	10.17 6-7years	5	8.48 7-8 years	5	8.48 8-9 years	4	6.78 9-10 years	0	0.00 10 years and above	7	11.86 Total	59	100 Source: Field survey, 2006
 * Multiple responses
 * Multiple responses

The above chart shows that only 22.02 % respondents using FP method for 3-4 years. The duration of using FP method is varied ranging from less than 1year to above 10 years. It is clear that respondents’ use of FP method for particular duration of time was basically for birth spacing. 11.86% respondents seemed to be using the method of family planning for ten or more than ten years. On the one hand, it is certain that they might not have felt any major effect of FP method. Otherwise they might have discontinued. But according to Table no 29, 8.75% respondents viewed that FP method can be hazardous to health which is justified by the long term use of contraceptive for ten or more than ten years by 11.86% respondent of the above table. On the other hand, it is obvious that 11.86% has used FP method for along time but they have not used long acting method of FP like IUD. It is supported by the data of Table No. 31 that only 3.39% respondents have used Implant and 0% for IUD, which work for 7 years and 12 years respectively. It means that they might not have counseled properly or might not have received enough information about informed choice that provides differential knowledge of all methods of family planning. Moreover, if they were satisfied with their number of children, then they should use permanent sterilization whereas the number of clients for female sterilization was found to be only three and the number of male sterilization was zero. It means that they were not properly counseled for permanent sterilization. Table 35: Current Users of FP Methods (Interview time) Reply for Current Use of FP method	Frequency	Percentage Yes	40	50.0 No	40	50.0 Total	80	100.0 Source: Field survey, 2006 The above table shows that 50% are using FP method currently. The remaining 50 % are not using FP method for different reasons. It will be advantageous to pay attention on different reasons for not using any methods of family planning, which are given below. Table 36: Reasons for not Using Family Planning Methods Currently Reasons of not using FP method at current	Frequency	Percentage Want for baby	5	12.50 Fear of side effect of the method 	5	12.50 Disagree of spouse 	11	27.50 Religious reason 	2	5.00 Spouse away 	12	30.00 Unavailability of method in time	0	0.00 Other (Menopause) 	5	12.50 Total	40	100 Source: Field survey, 2006

The above chart shows that majority of respondents (30%) are not using FP method due to their spouse being away from home followed by 27.5 % respondents who are not using FP method due to the disagreement of spouse. Desires of child and fear of side effective of FP methods are also the reason of not using FP method. A very low percent (5%) are found not using for religious cause. Thus it is clear from the table that most of the respondents (27.5) have been disturbed by the disagreement of their spouse. The data reflects the dominating role of the male in patriarchal society. It does not mean that all of those respondents might be only female who complains the disagreement of male spouse but it is certainty of being the majority of the female. Like other affair of couple life, male is more important and should be counseled properly because they play decision-making role in every step of life. So for the program of family planning, it cannot be exception. It can be noted that no one respondents gave the reason of not using contraceptive due to the unavailability of family planning method in time. 5.5	Respondents’ Suggestion Promoting FP Practices Table 37: Suggestions to Promote Family Planning (n=59) Suggestion for increase FP	Frequency*	Percent Campaign 	28	35.44 TV/ Film show 	30	37.97 Effect motivation 	10	12.66 Easy access of services 	31	39.24 Treatment of side effects 	12	15.19 Regular follow up services 	5	6.33 Others (Economic benefit) 	1	1.27 Source: Field survey, 2006
 * Multiple responses

The table no. 37 & Chart no.17 show that, different respondents suggested so different ideas. So the frequency for the repeated ideas will be overlapped. The table 37 shows that 39.24 % respondents gave suggestions for easy access of FP services, 37.97% said TV/Film show and whereas 35.44% expressed view on enhancing awareness by raising campaigns for the effective promotion of family planning methods. But one striking rate of the suggestion for the treatment of side effect indicates that the respondents might not have been treated while they might have suffered with side effect. It is recommended that the clients should be looked after properly and informed choice should be compulsorily provided while providing the service. 5.6	Respondents’ Knowledge, Consent and Practice of FP Method by Annual Income Table 38: Knowledge, Consent and Used of FP Methods by Annual Income Annul Income Rs	Knowledge of F.P.	Consent to use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No Less then 30000	5		5		3	2	5 30000- 40000	19	1	15	5	15	5	20 40000-50000	4		3	1	3	1	4 50000-60000	8		8		8		8 60000-70000	12		9	3	9	3	12 More then 70000	31		26	5	21	10	31 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 Table 38, shows that respondents with income range of 60,000-70,000 was more inconsistent or irresponsive in respect to knowledge, practice and attitude towards family planning. Majority of respondents who come under 30,000- 40,000 income range are found well-motivated and regular using FP methods. The percent of respondent who fall within the income range of less than 30,000 was only 6.25 and were inconsistent in terms of knowledge and practice of family planning. It can clearly infer that respondent with higher income were the less frequent user of FP methods and practicing family planning. It can be speculated that with higher income, the family can afford more children then the ones with lower income. 5.7	Respondents’ Knowledge, Consent and Practice of FP Method by Education Table 39: Knowledge, Consent and Use of FP Methods by Education Education	Knowledge of F.P.	Consent to Use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No Illiterate	17	1	13	5	11	7	18 Literate	22		13	9	13	9	22 Primary	9		9		7	2	9 Lower Secondary	5		5		5		5 Secondary	15		15		13	2	15 Higher Secondary & above	11		11		10	1	11 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 The table - 39 shows that literacy or education is a key component for social change as well as adoption of modern methods of family planning. Majority of the respondents (77.5 %) fall under the literate and educated group. Those respondents who fall in the literate group have knowledge about family planning but the attitude of those people is not positive while using FP methods. It is seen that almost all respondents from primary to higher level of education do have knowledge and positive attitude towards FP methods but there is a slight variation in the practice. It can be said that education, which develops ones ability for analytical thinking, does counts on the attitude and practice of family planning as well. Further, the above table does illustrate that with the increase on the education level, there is gradual positive improvement towards the practice of family planning.

5.8	Respondents’ Knowledge, Consent and Practice of FP Method by Occupation Table 40: Knowledge, Consent and Use of FP Methods by Occupation Occupation	Knowledge of F.P.	Consent to use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No Agriculture	52	1	40	13	33	20	53 Service	15		15		15		15 Business	12		11	1	11	1	12 Total	79	1	66	14	59	21	80 Source: Field Survey 2006

Chart 18: Total Number of Respondents 80 Chart 18 shows that out of the total respondents 66.25% are agriculture occupation. It was found that out of them 98.11% do have knowledge about family planning but they have very poor attitude towards adopting family planning methods. The respondents who have knowledge of FP method, out of them, 76.92 % do have positive attitude and 63.46 % use FP methods. It indicates that, there is big variation between knowledge, attitude and practice of family planning. In other occupation, there is no significant difference between knowledge, attitude and practice. There are various reasons for the prevalence of gap between knowledge, attitude and practice among the respondent engaged in agriculture but one of the reasons is misunderstanding about of family planning methods that the use of FP methods have health hazards and it make physically weak and can not work as usual. Other reasons are desire of more children, son preference, lack of proper awareness and spousal disagreement. As a whole, it can be inducted that knowledge cannot be sufficient to promote practice of family planning. The important element of the program is the attitude that should be positive in any respondent to use any method of family planning. So if any solution is searched, then the strong grip of FP service can be the best step to change the negative attitude. 5.9	Respondents’ Knowledge, Consent and Practice of FP Method by Age Table 41: Knowledge, Consent and Use of FP Methods by Age Age	Knowledge of F.P.	Consent to use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No 20-24	3		3		2	1	3 25-29	22		22		19	3	22 30-34	19		17	2	16	3	19 35-39	19		13	6	13	6	19 40-44	11		8	3	8	3	11 45-49	5	1	3	3	1	5	6 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 Table 41 shows that nearly all respondent do have knowledge of family planning in the study area. It was found that there is gap between knowledge, attitude and practice between the different age group. It is quite clear that the population between the age group 25-34 which represents 51.25% of the respondent is more active in the use of contraceptives and family planning methods. There is a consistency between knowledge, attitude and practice among the age group. It further shows that even if the respondents of age group 35-49 have knowledge but there is a variation in attitude use of family planning methods. According to the key informant attitude of both, male and female was found poor with regard to sterilization. Most of them expressed fear of side effect with sterilization. During the field survey it was found out of the 80 respondents only 3 female respondents told that they had undergone for sterilization. 5.10	Respondents’ Knowledge, Consent and Practice of FP Method by Belief of Salvation without Son Table 42: FP Knowledge, Consent and Use, and Respondent having Belief of Salvation with Son Salvation with son	Knowledge of F.P.	Consent to Use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No Yes	24	1	14	11	11	14	25 No	53		51	2	47	6	53 Don't Know	2		1	1	1	1	2 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 Table no.42 shows that 25 (31.25 percent) believe that salvation is impossible without son. Among them, 24(96%) have the knowledge of family planning whereas 14(56%) have consented to use FP and lastly11 (44%) have ever used any FP method. The data reports the gap between knowledge, consent (attitude) and ever use of practice. This indicates that still a significant percent (31.25) people are motivated by patriarchal value and strongly believe having son is necessary for salvation. Whereas 66.25 percent of respondents are in the view that son is not necessary for salvation. 5.11  Respondents’ Knowledge, Consent and Practice of FP Method by Belief, Son for Continuation of Generation Table 43: FP Knowledge, Consent and Use, and Respondents having Belief of Son to Continue the Generation Belief of Generation Continuation	Knowledge of F.P.	Consent to use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No Yes	24	1	14	11	11	14	25 No	50		50		46	4	50 Don't Know	5		2	3	2	3	5 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 Table 43 shows that respondents have mixed responses on the necessity of son for the continuation of generation. It is analyzed from the table that 25 (31.25 %) respondents strongly believe that son is necessary for continuation of generation; whereas majority 50 respondents (62.5 percent) are not in favor of son for continuation of family generation. Out of 25 respondents, 24 respondents (96%) had the knowledge of FP whereas only 14 respondents (56%) had the consent to use FP and only 11 respondents (44%) had ever used any method of family planning. There is a variation in the practice and attitude among the respondents those who are in favor of son and who are not in favor of son. 5.12	Respondents’ Knowledge, Consent and Practice of FP Method by Number of Children Table 44: FP Knowledge, Consent and Use Versus Respondents’ Number of Children No. of Children	Knowledge of F.P.	Consent to use FP	Ever used FP method	Total Yes	No	Yes	No	Yes	No No children	4		4		2	2	4 One children	18		18		15	3	18 Two children	32		32		30	2	32 Three children	20		12	8	12	8	20 Five children	5	1		6		6	6 Total	79	1	66	14	59	21	80 Source: Field Survey 2006 Table no. 44 gives interesting findings that most couples desire two children preferably one of each sex (Table 22). In respect to knowledge, attitude and practice in terms of demographic variable corresponding to number of children, it is found that almost all respondents with two children are consistent with approval and use of family planning methods. It is also found that respondent with five children neither approves family planning nor ever used family planning methods. The reason behind it varied. After all, such respondents had only five children and were found to be waiting for son without having any method of family planning. A female respondent having 5 daughters replied that she was waiting for one son when she was asked why she was not using any method of family planning. She added more that she still hoped to get one son when she was advised that there is no any certainty to get son in next time. She viewed that her son will feed her in her old age. One thing that is more remarkable that the female seemed to be more excited to get at least one son but not the male.

CHAPTER -VI SUMMARY, CONCLUSION AND RECOMMENDATIONS The study has been conducted to examine the k utilization pattern of family planning devices among the married men and women of ward no. 6, Siddhipur VDC, Lalitpur. The finding of the study is mainly based on the data obtained from the field study. Information obtained from the survey has been analyzed with the use of different statistical tools and methods. The study provides various information regarding knowledge, attitude and practice of family planning adopted by the people of the study area. 6.1	Summary of the Findings The total number of respondents for the study was 80. The size of the respondents was selected through the census basis sampling. Out of the total respondents, 58.75% were female and 41.25% were male. The overall ratio of male and female in the research area is nearly 1: 1.5. With the gender perspective this is a good combination of the sample size. Highest percentages of the respondents come from the age groups of 25-29 (26.25 %), 30-34 (20%) and 35-39 (28.75 %) whereas the lowest is 20-24 (3.75 %). No one was found from the age group of 15-19.Out of the total respondents, 75 % are from the age group of 25-39. The average family size of the study area is five. Out of the total respondents 66.25% have 5 or less than 5 members in the family. It is assumed that a family has one father and one mother and the average number of children in each family was 3. 22.5 percent respondents are illiterate; 27.5 percent of total respondents can just read and write. Similarly, 17.5 percent have received primary or lower secondary education whereas remaining 32.5 percent have received secondary, higher secondary and above level education. 95 percent of the respondents have children. It is highly unlikely in Nepalese society to have married couples without desire for children. Therefore, only few married couples are found to have no child. The finding is that 91.1 percent of female become pregnant before the age of 25. This is directly related to mean marriageable age in Nepalese society. There is a slight trend of planning the birth of first child, which may be one of the reasons that 8.9 percent of female respondents had their first pregnancy after the age of 25. Majority of the respondents expressed that the most popular and accessible source of knowledge about family planning methods is village health worker followed by radio, TV/cinema and friends. Majority of the respondents have two children. Respondents were found aware about birth spacing. The study gives quite encouraging information about almost all respondents of the study area that they had heard about modern family planning methods. The main contributing factor for high awareness and knowledge could be the increasing of heath services, better counseling, opportunity to have informed choice, massive awareness campaign through various means, increased service of community health workers, promotion of family planning and health care services by government and INGO/NGOs. It was found that 98 .75 percent of the respondents have knowledge of Family Planning. Higher percent of the respondent have knowledge of Injections, Oral Pills and Condoms. Nation-wide family planning campaign and advertisement of products (condom, injection and pills) by different media has certainly helped to aware people on these family planning methods. The most prominent source of information about family planning method was FP workers/FCHVs/TBA. 68.35% respondents viewed that family planning workers, FCHVs and TBA are important source of information. There was variation in responses relating to other sources of information. At least 43.04 percent of the respondent viewed Radio, TV/cinema and Friends as other significant source for information. There is repetition in the responses, some respondents have indicated more than one sources. Majority of the respondents (98.75%) desire to have more than one child. There is no significant difference in the desire for male or female child. From the data, it can be easily seen that 72.5% viewed the combination of one male child and one female child is the desired to be an ideal number. Majority of the respondents were in favor of having less number of children and wish using family planning methods. The respondents, who did not use FP methods at the time of survey, told many reasons for not using contraceptive. Some of the reasons were desire of son, want of additional child, spouse staying out of home, no consent of spouse etc. It has been found that 82.5 percent of respondent wish to have consent for prevention of pregnancy through family planning. It has been found that 73.75 percent of respondents have used contraceptives whereas 26.25 % have not used contraceptive. Respondents with income range of 50,000-60,000 were more consistent in respect to knowledge, practice and attitude towards family planning. Literacy and education were found to be important factors that have impact on adoption of modern methods of family planning. With the increase in education level, there is gradual positive improvement towards the practice of family planning. Big variation was found towards knowledge, attitude and practice of family planning among the respondents who are from agriculture occupation. In other occupation there is no significant difference between knowledge, attitude and practice. It was found that there is gap between knowledge, attitude and practice between the different age groups. The population between the age group 25-39 which represents 75% of the respondent is more active in the use of contraceptives and family planning. The finding was to support that the respondents believed that most important factor to prevent pregnancy was to desire for happy life with less number of children. Other factors to do so were found to be the health of mother and child, which is also a secondary reason for prevention of pregnancy. Spousal disagreement is the main reason for those respondents who were not using FP method for preventing pregnancy. The majority (80 percent) of respondent do not see Family Planning against religion. It should be noted that more than 98% of population is Hindu and there is no clear objection on family planning in Hindu culture. The majority of respondents (66.25%) don’t view that male child is required for salvation or continuation of generation. However, significant number of respondent (31.25 percent) still view that male child is necessary for salvation. Injectable (59.32%) is the most common FP method in use by female respondents followed by oral pills. 74.6 % of respondents used FP methods after the birth of first child. Only 16.9% of respondents used FP method before the birth of first child. The finding was that 50% respondents are using family planning methods currently. The remaining 50 % are not using family planning methods for different reasons. The respondents, who were using family planning methods, told many reasons for adopting family planning practice. According to them, the reasons for adoption of contraception are-improve economic condition, better care of children, happy and small family. 6.2	Conclusion The study gives quite encouraging information that about 98.75% of the respondents of the study area had heard about modern family planning methods. The main contributing factor for high awareness and knowledge could be the increasing of heath services, massive awareness campaign through various means, increased service of community health workers, promotion of family planning and health care services by government and INGO/NGOs. Knowledge, attitude and practice of family planning were found varied in terms of age group, sex, occupation, education and income. The respondents, who did not use contraceptive methods at the time of survey, told many reasons for not using contraceptive. Some of the reasons are desire of son, want of additional child, spouse staying out of home, no consent of spouse etc. The respondents were found to be using Depo- provera (injectable) followed by pills, condoms, and implants at the time of survey. Out of the total respondents only three female have undergone for sterilization. The respondents who were using contraceptive and accepting family planning methods, told many reasons for adopting family planning practice. According to them, the reasons for adoption of contraception are to improve economic condition, better care of children, happy and small family size, etc. 6.3	Recommendations 1.	This study is confined to utilization pattern of family planning devices. It has tried to explain about the level of knowledge and attitudes and practice of family planning methods among the married men and women of this particular ward of Siddhipur VDC of Lalitpur. Only few variables have been taken to analyze the relation and gap between knowledge, attitude and practices. So there are so many other factors that could be taken into consideration by other researchers. The findings of the study are very useful and quite relevant for reference and further research. 2.	Many of the respondents, even with the knowledge of family planning had not adopted the FP methods. Social values, desire of more number of children and misconception about family planning method are found some the reasons of not adopting FP method. Therefore, these factors should be taken into consideration. 3.	Based on these findings, appropriate interventions and effective implementation of program are needed. If the program designed appropriately and applied, that can make significant improvements in the practices of FP methods not only in study area but also in the other parts of the VDC. 4.	Knowledge, attitude and practice (KAP) of Family Planning are interdependent upon education status. In order to raise the KAP of family planning educational programs emphasizing the importance and benefits of family planning should be conducted at grass-root level. 5.	The finding suggests that son preference is still prevailing among the respondents. This type of traditional concept should be challenged through educational intervention and counseling. 6.	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