INTRODUCTION:

‘‘Delay the first, postpone the second and prevent the third.’’

- Park.K

BACKGROUND OF THE STUDY:

Family is a primary unit in all societies. It is a group of biologically related individuals living together and eating from a common kitchen. The family size plays a very important role in the health and welfare of not only the individual, family and community, but also of the nation as a whole. Family planning is the planning about when to have children, with the use of birth control and other techniques to implement such plans. Family planning is not synonymous with birth control. It includes proper spacing and limitation of birth and advice on sterility. Population explosion is the most serious problem facing our country today. With 16 per cent of the world’s population, India is the second largest populated country in the world.

The nation- wide family planning programme was started in India in 1952 making it the first country in the world. In spite of this, about 56 percent of the couples in India are still unprotected from pregnancy. Population growth affects the size and age composition of population. A growing population is usually the young population. For example, in India, children under 15 years of age constitute nearly 34.33 percent of the total population. A young population is a dependent population. The dependency burden is very high in India in terms of providing social and welfare services like education and health care facilities. Population growth adversely affects our per capita income. Poverty leads to sickness and sickness leads to poverty, this is a cycle prevalent in all developing countries. Population explosion leads to creation of many problems like inadequate schooling, fewer job opportunities, and overcrowding. It also leads to the development of health consequences like high infant mortality rate, maternal mortality rate.

The knowledge and attitudes of people regarding family planning methods is essential to the adoption of family planning measures. It is an essential that both partners have equal responsibility regarding the selection of family planning methods. In India there are many reasons for the need for family planning. Firstly, the economic aspect. If we have more children, we will not able to nourish them and educate them well, as the poor standard of living cannot be raised. Therefore, the main objective of the economy is to plan a family. Secondly, it is also a hindrance in the country’s progress. Lastly, mother’s health is also one of the factors. If she bears more children, her health will deteriorate.

Increase in population leads to various problems, that is, shortage of food, unemployment, lack of civic conditions, housing problem, and inadequate availability of health services. Government is doing its level best to achieve the target of family planning. Family planning devices are distributed to the people without any charges. Mass media and electronic media is used for wide publicity.

Vasectomy is considered as a most reliable permanent family planning methods in males. Pregnancy rate associated with vasectomy is less than 1 percent only. However, vasectomy is considered highly effective and safe². There is a need for motivation of married couples regarding the selection of family planning measures. This is possible only by the constant efforts of health personnel in the community. Health education is the best method regarding this awareness programme. The acceptance of male permanent family planning method is very poor when compared to female methods. Motivating men to accept permanent family planning technique helps in improving the health of women (Panigrahi 2010). Sterilization offers many advantages over other contraceptive methods. It is a one-time method; it does not require sustained motivation of the user for its effectiveness; provides most effective protection for pregnancy, the risk of complication is small if the procedure is performed according to accepted medical standards; and it is most cost effective¹.

Male sterilization or vasectomy being a comparatively simple operation can be performed even in primary health centres by trained doctors under local anaesthesia. When carried out under strict aseptic technique, it should have no risk of mortality. In vasectomy it is customary to remove at least 1cm of VAS after clamping. The ends are ligated and then folded back on themselves and sutured into position, so that the cut ends face away from each other. This reduces the risk of recanalization at a later date. It is important to stress that the acceptor is not immediately sterile after the operation. During this intermediate period, another method of contraception must be used. If properly performed, vasectomies are almost 100% effective. Following vasectomy, sperm production and hormone output are not affected. The sperm produced are destroyed intraluminally by phagocytosis. This is a normal process in the male genital tract, but the rate of destruction is greatly increased after vasectomy. Vasectomy is a simpler, faster, and less expensive operation than tubectomy in terms of instruments, hospitalization, and doctor’s training. Cost wise, the ratio is about five vasectomies to one tubal ligation.¹

OBJECTIVES:

1. To assess the level of knowledge among married men and women regarding No-Scalpel Vasectomy.

2. To assess the effectiveness of planned teaching programme among married men and women regarding No-Scalpel Vasectomy.

3. To find the association between knowledge scores and selected demographic variables.

REVIEWS ON LITERATURE:

A study was conducted about the level of knowledge and attitude of married male workers about vasectomy and the factors influencing the attitude of married men working in Babcock University towards vasectomy. Stratified random sampling technique was used to select 200 participants from the academic and administrative work divisions of university and self-constructed questionnaire was administered and 150 were retrieved and analyzed using both descriptive and inferential statistics. Findings revealed that majority (42.7percent) of the participants were between the ages of 31- 40 years, Christians (97.3percent), of the Yoruba tribe (55.3percent), had a bachelor’s degree (46percent) and were non- academic staff (53.3percent). Majority (38percent) of participants had adequate knowledge and 62.7percent had positive attitude towards vasectomy. There was no association between the participant’s level of education and their level of knowledge and their attitude towards vasectomy. The risk of spouse’s health (54percent) was the major factor influencing positive attitude and the need of more children (41.3percent) was the main factor influencing negative attitude towards vasectomy. There is a need to develop awareness programs in order to equip the population with valid information and thus increase their knowledge about vasectomy¹.

In a community based cross-sectional study it was identified that Promotional activities should focus on bridging the prevailing information gap regarding NSV among the potential clients. The IEC activities including interpersonal communication and group counselling sessions must deal with their apprehensions thereby changing the behaviour of the society. This study was conducted among 340 male members of eligible couples in six randomly selected villages in Singur from September 2017 to February 2018. Each respondent was interviewed using a structured schedule. All ethical issues were addressed. Data entry and analysis was done using SPSS version 16.0. Results: Out of 340 participants, 57.9% have heard of NSV. Around 61% of the participants have heard of the male contraceptives from media. Although 57.8% knew it to be method of permanent male contraception, only 15.7% were aware that NSV does not need hospitalization. The most frequently reported reasons for underutilization of NSV in the community was fear of surgery (51.3%) and loss of earning due to prolonged bed rest (44.2%). Overall, the proportion of male members of the eligible couples who underwent NSV was 0.6%².

Population explosion has been India's major problem since independence. It is a major obstacle to the overall progress of the nation. Adoption of family planning methods is one of the best solutions to tackle this problem. The roots of the factors influencing family planning issues are entrenched in the socio-cultural milieu of Indian society. Uttar Pradesh is the most populated state of the country having population of 199.581 million and TFR of 3.3 (AHS 2012-2013) with high fertile trajectory. Among the family planning methods currently, male sterilization accounts for only 0.3% of all sterilizations in Uttar Pradesh (AHS 2012-2013). A strategy to promote men's involvement in effective birth control is needed to reduce the population growth. The aim of this study is: i) To access the perception of married males towards family planning. ii) To access knowledge about NSV iii) enumerate the causes for low acceptance of NSV. Methods: A cross-sectional study was carried out. Multi-stage random sampling technique was used. In the first stage, two urban slums from each Nagar-Nigam zone was selected randomly. In the second stage, from each selected slum, a sample of 24 eligible households was selected at random to achieve the desired sample size. Results: Female sterilization technique was considered as the most effective family planning method by the male respondents. Socio-cultural barriers were the most important reason for the low acceptance of NSV. Educational status was found to be the most important predictor for these socio-cultural barriers. Conclusion: Measures should be taken to remove misconceptions, to increase uptake of NSV³.

In India, non-scalpel vasectomy (NSV) technique was introduced in 1992 to improve the male participation in family planning, though it has failed to achieve its goal. Hence this study was planned to know the real concern about this condition. This study was carried out to assess the knowledge and attitude about non- scalpel vasectomy (NSV) and practices of any contraceptive methods among married females in reproductive age in an urban slum. Methods: This was a cross-sectional study done in urban field practice area of Institute of Community Medicine, Madras Medical College, Chennai-03, Tamil Nadu in the period July 2014 to August 2014 among Married females of reproductive age group (15-49 years). Specific questions on knowledge, attitude regarding NSV were asked. Data were entered in Microsoft Excel sheet and analysed in SPSS version 20. Results: This is a questionnaire-based study. All (106 participants) were aware of vasectomy. Among them 50% knew that vasectomy is an option for permanent sterilization. About 36% of them knew that cash incentive is given for vasectomy and 30% knew that insurance given for pregnancy and other complications followed by vasectomy. Around 31% of the respondents knew that vasectomy does not affect sexual performance. About 29% knew that vasectomy does not need prolonged bed rest. Only 19% of the participants knew that vasectomy is done free of cost and as an OP procedure and 11.3% knew that vasectomy is done without any incision. Among the participants 81% agreed that limiting family size stabilizes the financial condition of the family. About 48% of the participants agreed that family planning is also a responsibility of males and 56% were willing to recommend vasectomy for others. Only 35% of the females agreed to adopt vasectomy for their spouse. Among the respondents 73.6% were practicing some form of contraception currently. Conclusions: We conclude that there is a need to design and develop a need based behavioural change communication strategy to bridge the existing information gap among the eligible couples about NSV and to improve the male participation in family planning. Involvement of media, community participation and successful stories of males who have adopted NSV would enhance the effectiveness of all the interventions⁴.

Though nonscalpel vasectomy (NSV) technique was introduced in India in 1992 to increase male participation in family planning, it has failed to get adequate momentum and to achieve its goal. We conducted a cross-sectional questionnaire-based survey to get insight into apathy of men towards NSV. The study included 428 respondents. Most of the respondents (97.4%) were aware of NSV as a method for permanent male sterilization. The majority of them (97.2%) knew that NSV is done without any charge and cash incentive is given to the NSV client after the procedure. Though 68.0% respondents agreed that permanent sterilization is a possible option for them, only 34.1% respondents were willing to adopt NSV as a method of family planning. Fear of surgical procedure (40.7%), permanent nature of procedure (22.2%), and religious belief (19.0%) were the common reasons for unwillingness to adopt NSV. We conclude that there is a need to design and develop need-based information, education and communication (IEC) strategy to bridge the existing information gap among the eligible couples regarding NSV to improve its adoption. Involvement of community leaders and satisfied clients and utilization of television and radio would enhance the effectiveness of such interventions.⁵

Uttar Pradesh is the most populated state of the country having population of 199.581 million and total fertility rate of 3.3 (annual health survey [AHS] 2012–2013) with high fertile trajectory. Currently, female sterilization accounts for about 18.4% and male sterilization for 0.3% of all sterilizations in Uttar Pradesh (AHS 2012–2013). A strategy to promote men's involvement in effective birth control is needed to reduce the population growth. Since no scalpel vasectomy (NSV) is an easy method but still not being utilized; hence, the purpose of this research is to ascertain various factors of nonutilization of NSV. Objectives: The objective of the study is (i) to determine the barriers among married males for adopting NSV as a method of family planning, (ii) to determine the awareness about NSV, (iii) to suggest measures to increase uptake of NSV by the people. Methods: A cross-sectional study was carried out. A two-staged multistage random sampling technique was used. Lucknow is divided into eight Nagar Nigam zones. In the first stage, two urban slums from each geographical zone were selected randomly. In the second stage, from each selected slum a sample of 24 eligible households was selected at random to achieve the desired sample size. Results: It was observed that among the study participants maximum 89.2% perceived Sociocultural barriers, while 0.6% of the participants perceived service delivery barriers. However, 14% of the participants also perceived procedure-related barriers as the most important cause for not accepting NSV. Conclusion: Measures should be taken to remove these barriers, and increase uptake of NSV.⁶

MATERIALS AND METHODS:

Pre-Experimental, one group pretest and posttest design was used, 60 men and women who have married and not undergone permanent family planning methods were selected for the study. Purposive sampling technique was used. Modified open system model is used for conceptual framework. Structured questionnaire was prepared as two sections. Section I which contain demographic data which included age, gender, religion, education, occupation, family income, types of family, number of children, age at marriage, previous history of infertility, acceptance of temporary family planning methods, previous awareness about No- Scalpel Vasectomy, number of relatives undergone permanent family planning methods and Section II consists questions on the knowledge of family planning methods. Teaching programme included the Permanent family planning method for men Vasectomy definition, Types of vasectomy, Criteria for undergoing No-Scalpel Vasectomy, Post -operative advices after No-Scalpel Vasectomy and its Complications. After 7 days of Planned Teaching Program, the same structured questionnaire was used to conduct the post test. The data obtained were analyzed by both descriptive and inferential statistics, on the basis of objectives and hypothesis of the study.

RESULTS AND DISCUSSIONS:

SECTION I: PERCENTAGE DISTRIBUTION OF DEMOGRAPHIC VARIABLES:

The frequency and percentage distribution demographic variable of the sample according to the age, religion, education, occupation, previous history of infertility, previous history of temporary family planning method followed and number of relatives undergone permanent family planning methods. Majority 44(73.3%) of the respondents were in the age group of 20- 40 years, 53 (88.3%) of the respondents belonged to Hindu religion, 48 (80%) of the respondents had completed primary education, 53(88.3%) of the respondents were working as coolie, all 60(100%) respondents had no previous history of infertility, all the 60 (100%) respondents were using temporary family planning methods and 57 (95%)of the respondents relatives had not undergone any permanent methods of family planning methods.

SECTION II: PRE TEST KNOWLEDGE LEVEL ON NSV AMONG MARRIED MEN AND WOMEN

Tab 1: Pretest Knowledge level on NSV among Married men and women N=60

Knowledge level	Category	Respondents
Knowledge level	Category	Number	Percent
Inadequate	≤ 50 % Score	37	61.7
Moderate	51-75 % Score	23	38.3
Adequate	> 75 % Score	0	0.0
Total		60	100.0

The table 1 indicates that 61.7% of the respondents had inadequate knowledge and 38.3% of the respondents had moderate knowledge in the pre- test.

SECTION III: POST TEST KNOWLEDGE LEVEL ON NSV AMONG MARRIED MEN AND WOMEN

Table 2: Classification of Respondent based on overall Posttest Knowledge level on No- Scalpel Vasectomy. N=60

Knowledge Level	Category	Respondents
Knowledge Level	Category	Number	Percent
Inadequate	≤ 50 % Score	0	0.0
Moderate	51-75 % Score	21	35.0
Adequate	> 75 % Score	39	65.0
Total		60	100.0

The table 2 indicates that 35% of the respondents have moderate knowledge and 65.0% respondents have adequate knowledge in post- test

SECTION IV: ASPECT WISE KNOWLEDGE SCORES OF RESPONDENTS ON NO-SCALPEL VASECTOMY IN PRETEST

Table 3: Classification of respondent based on aspect wise Pre test knowledge level on No- Scalpel Vasectomy

Sl. No	Area wise	No: of Items	Max Score	Pretest Knowledge
Sl. No	Area wise	No: of Items	Max Score	Mean	SD	Mean (%)	SD (%)
I	Introduction and Types	4	4	2.07	0.6	51.7	14.3
II	Definition	3	3	1.82	0.8	60.6	26.2
III	Pre procedure	7	7	3.02	1.0	43.1	13.9
IV	Procedure	4	4	1.67	0.8	41.7	21.2
V	Post procedure	10	10	5.27	1.0	52.7	10.5
VI	Complication	2	2	1.10	0.6	55.0	31.2

Table 3 depicts aspect wise pretest mean knowledge scores of respondents on No- Scalpel Vasectomy. The pretest mean percentage knowledge scores of respondents on No- Scalpel Vasectomy were as follows: introduction and types were 51.7% with SD % 14.3, definition were 60.6% with SD % 26.2, pre procedure were 43.1% with SD% 13.9, were procedure 41.7% with SD% 21.2, were post procedure 52.7% with SD% 10.5 and complication 55% with SD% 31.2.

SECTION V: ASPECT WISE KNOWLEDGE SCORES OF RESPONDENTS ON NO-SCALPEL VASECTOMY IN POSTTEST

Table 4: Classification of Respondent based on aspect wise Posttest Knowledge level on No- Scalpel Vasectomy. N=60

No.	Knowledge Aspects	State-ments	Max. Score	Respondents Knowledge
No.	Knowledge Aspects	State-ments	Max. Score	Mean	SD	Mean (%)	SD (%)
I	Introduction and Types	4	4	3.30	0.7	82.5	16.6
II	Definition	3	3	2.52	0.5	83.9	16.7
III	Pre procedure	7	7	5.57	0.9	79.5	12.9
IV	Procedure	4	4	3.15	0.8	78.8	19.8
V	Post procedure	10	10	8.22	0.9	82.2	9.3
VI	Complication	2	2	1.57	0.5	78.3	24.8

The posttest mean percentage knowledge scores of respondents on No- Scalpel Vasectomy were as follows: introduction and types were 82.5% with SD% 16.6, definition were 83.9% with SD% 16.7, pre procedure were 79.5% with SD% 12.9, procedure were 78.8% with SD% 19.8, post procedure were 82.2% with SD% 9.3 and complication were 78.3 with SD% 24.8.

SECTION VI: COMPARISON OF PRETEST MEAN AND POSTTEST MEAN SCORES OF THE RESPONDENTS

Table 5: Comparision of pretest and posttest knowledge scores of the respondents

Aspects	Max. Score	Respondents Knowledge				Paired ‘t’ Test
Aspects	Max. Score	Mean	SD	Mean (%)	SD (%)	Paired ‘t’ Test
Pre test	30	14.93	1.7	49.8	5.7	28.86*
Post test	30	24.32	1.8	81.1	6.2	28.86*
Enhancement	30	9.38	2.5	31.3	8.4

* Significant at 5% level, t (0.05,59 df ) = 1.96

The table above (Tab No: 5) shows the overall mean posttest knowledge scores (81.1%) of respondents who were exposed to planned teaching programme is significantly higher than the overall mean pretest knowledge scores (49.8%) and the mean difference is 31.3%.

The computed ‘t’ value (t=28.86) was higher than the table value (table value = 1.96) at level of significance. Therefore, the findings of the study revealed that planned teaching programme was effective in increasing the knowledge on No-Scalpel Vasectomy among married men and women residing in a selected rural area, Coimbatore

Demographic Variables	Category	f	Knowledge Level				Chi- square value	P Value
			Inadequate		Moderate
			f	%	f	%
Gender	Male Female	26 34	12 25	46.2 73.5	14 9	53.8 26.5	4.67*	P>0.05
Educational Level	Primary High school	48 12	31 6	64.6 50.0	17 6	38.04 50	0.86 NS	P<0.05