Determinants of Knowledge Regarding Family Planning Among Reproductive-Age Women Attending Rural Immunization Clinics in Karnataka, India: A Cross-Sectional Analytical Study

Abstract

Background: Family planning is central to reducing maternal and neonatal mortality, yet 270 million of the world's 1.1 billion women with a need for family planning have an unmet need, and rural Indian women continue to lag behind national averages in comprehensive contraceptive knowledge despite near-universal awareness of at least one method. Simple bivariate comparisons cannot identify which socio-demographic factors independently drive knowledge once correlated variables, such as a woman's own and her husband's education, are accounted for.
Objectives: To assess the level of knowledge of family planning among reproductive-age women attending rural immunization clinics; to identify socio-demographic factors bivariately associated with knowledge; and to determine independent predictors of knowledge using multivariable logistic regression.
Methods: This cross-sectional analytical study included 100 married women aged 18-49 years attending immunization sessions at two rural Primary Health Centres (Adargunchi and Noolvi), Hubballi, Karnataka, between 15 September and 15 November 2023. A pre-tested, interviewer-administered questionnaire captured socio-demographic characteristics and family planning knowledge. Bivariate associations were tested with the chi-square test (Fisher's exact test where expected cell counts were below 5); variables significant at p<0.10 were entered into a binary logistic regression model, yielding adjusted odds ratios (AOR) with 95% confidence intervals (CI).
Results: Only 52% of women were aware of family planning, and only 42% attained a “good” composite knowledge score (≥4 of 5 items); 52% scored “poor.” Only 8% had heard of emergency contraception, and 53% could not describe the underlying concept of family planning. On bivariate analysis, women's own education (χ²=16.587, p=0.002), husband's education (χ²=11.740, p=0.019) and occupation (χ²=5.160, p=0.023) were significantly associated with awareness. The multivariable model was statistically significant overall (omnibus χ²=20.436, df=7, p=0.005; Nagelkerke pseudo-R²=0.247), but only pre-university/diploma-level education in the woman herself remained an independent predictor (AOR=4.03, 95% CI 1.12-14.48, p=0.033); husband's education and occupation, despite their bivariate significance, did not retain independent significance after adjustment.
Conclusion: Awareness and depth of family planning knowledge remain low in this rural Karnataka cohort. A woman's own education, rather than her husband's education or occupation, emerged as the sole independent, modifiable determinant of knowledge once these inter-correlated factors were adjusted for one another. Health education strategies should therefore engage women directly, rather than assuming that a husband's schooling adequately proxies for household-level reproductive health literacy.