Family planning plays a pivotal role in reducing maternal and infant mortality and in achieving sustainable population growth. [1] Contraceptive methods empower women to control their fertility, plan pregnancies, and participate fully in social and economic life. [2] However, despite widespread availability of modern contraceptive options, their uptake remains low among certain populations, particularly in tribal communities. [3]

India is home to over 104 million tribal people, constituting about 8.6% of the total population. [4] These communities often inhabit remote and rural areas with limited access to healthcare services, education, and socio-economic development programs. [5] The National Family Health Survey (NFHS-4) reported significant disparities in contraceptive use between tribal and non-tribal populations, with tribal women demonstrating lower knowledge and utilization rates. [6] Several factors contribute to this gap, including illiteracy, poverty, patriarchal social structures, and cultural taboos surrounding contraception. [7]

In many tribal societies, fertility is closely tied to cultural identity, with larger families viewed as symbols of prosperity and security. [8] Furthermore, decisions about family planning are often male-dominated, limiting women's autonomy over reproductive choices. [9] Health workers have reported that tribal women frequently express fear of side effects, religious concerns, or misinformation related to sterilization or hormonal contraceptives. [10] These attitudes reflect the urgent need for culturally sensitive, community-based education strategies. [11]

Previous studies conducted in tribal areas of central and eastern India have highlighted a wide variation in knowledge and practice of contraceptive methods. [12] For instance, a study in Madhya Pradesh revealed that while 60% of tribal women had heard of family planning methods, only 35% used any contraception. [13] Similarly, in Odisha, lack of access to health facilities and low female literacy rates were associated with poor contraceptive prevalence. [14]

Additionally, health infrastructure challenges, such as understaffed primary health centers (PHCs), limited outreach, and inadequate counselling services, further restrict access to modern contraception in tribal belts. [15] The government has introduced several schemes under the National Health Mission to target vulnerable groups, yet implementation remains inconsistent across districts. [16] Furthermore, language barriers and a lack of trust in healthcare providers often discourage tribal women from seeking reproductive health services. [17]

Understanding the knowledge, attitude, and practices (KAP) of tribal women toward contraceptive use is crucial for designing interventions that address not only access but also sociocultural barriers. [18] By identifying these gaps, healthcare policymakers and providers can tailor strategies to improve awareness and enhance service delivery in tribal regions. [19] Effective family planning among tribal populations can significantly contribute to improved maternal health, child survival, and women’s empowerment. [20]

This study was undertaken to assess the KAP regarding contraceptive methods among reproductive-age women in a tribal community in Sambalpur district situated in western part of Odisha. The findings aim to inform targeted interventions to increase awareness and acceptance of contraception in similar underprivileged populations. [21]

This was a community-based cross-sectional descriptive study conducted in a tribal-dominated areas of Sambalpur district in western India between November 2022 and December 2023. The region comprises primarily rural and remote areas with limited access to healthcare services. The study focused on assessing the knowledge, attitude, and practices (KAP) related to contraceptive methods among women of reproductive age residing in tribal communities.

Study Population

The study population included women aged 15–49 years who were currently residing in the selected tribal areas for at least six months prior to the survey.

Sampling Technique

A multistage random sampling method was employed. First, three blocks were randomly selected from the district. Then, two villages from each block were randomly chosen. In each village, systematic random sampling was used to select eligible women until the sample size was achieved

Sample Size

A sample size of 384 was calculated using the formula:

                                                          n = Z²pq/d²

(Assuming a prevalence (p) of 50%, 95% confidence interval (Z = 1.96), and margin of error (d) of 5%)

As a multistage random sampling method was employed the calculated sample size was multiplied by 2 (Design effect), so that the sample remains representative and the results are statistically valid.

So Total Sample size =384*2 = 768

After addition of probable non responder of 5% the absolute sample size was: 806(rounded to 810)

After data collection 785 response were found complete in all respect and hence these 785 were included in the analysis.

Inclusion Criteria

• Women aged 15–49 years
• Residents of the selected tribal villages for at least 6 months
• Willing to provide informed consent
• Currently married (as contraceptive use was assessed in the context of marital status)
• Exclusion Criteria
• Women who were severely ill or mentally challenged at the time of the survey
• Pregnant women (to prevent bias in assessing current contraceptive use)
• Those unwilling to participate or unable to communicate effectively

Data Collection Tool

A structured and pretested questionnaire was used to collect data. The questionnaire was developed in English and translated into the local tribal dialect, ensuring clarity and cultural appropriateness. It comprised four sections:

1. Socio-demographic details (age, education, occupation, family type, number of children, etc.)
2. Knowledge of contraceptive methods (awareness, sources of information, types known)
3. Attitude (beliefs, perceptions about safety, effectiveness, social acceptability)
4. Practices (use of contraception, reasons for use or non-use, method used)

The tool was validated through a pilot study in a non-study tribal village, and modifications were made based on feedback.

Data Collection Procedure

Data were collected by trained female health workers under supervision. House-to-house visits were conducted, and face-to-face interviews were carried out after obtaining informed consent. Privacy and confidentiality were strictly maintained. Each interview took approximately 30–40 minutes

.

Ethical Considerations

Ethical clearance was obtained from the Institutional Ethics Committee. Participants were informed about the purpose of the study, and verbal and written consent was obtained. Participation was voluntary, and respondents could withdraw at any point without any consequences.

Data Analysis

Collected data were entered into Microsoft Excel and analyzed using SPSS version 22. Descriptive statistics such as percentages and means were used to summarize the data. Chi-square test was used to assess associations between socio-demographic variables and contraceptive practices. A p-value < 0.05 was considered statistically significant.

A total of 785 women were interviewed. The findings have been categorized into socio-demographic characteristics, knowledge, attitudes, and practices related to contraceptive methods.

Table 1: Socio-Demographic Profile of Participants (n=785)

Table 1 describe the socio-demographic characteristics of the respondents. Majority (44%) of women were in the 25–35 age group, 30% and 26% respondents were belonged to 35-49 yrs, & 15-25 years of age group respectively. Most (48.9%) of the respondents were studied up to middle school certificate, followed by 17.5% were having only primary education. Only 10.3% were found to have completed intermediate/Diploma/ITI. Out of the 785 respondents only 10.7% were found not having any formal education. Out of the 785 respondents 68.9% were housewife not engaged in formal income generating activities. Only 23.9% were found engaged in elementary occupation followed by 6% who were engaged in craft related activities. Around 93.2% respondents were belonged to lower socio-economic class family as per the modified Kuppuswamy classification followed by 6.6%, who were in Upper Lower socio-economy class family category. Most of the respondents were Hindu (42.5%) followed by Christian (26.4%) and Muslims (10.1%). There were 21% respondents who hesitate to share their religious practices. There were 8.8% respondents having no living children at the time of survey, followed by 15.8%,30.7%, 36.2% were having 3(three), 1(One), 2(Two) numbers of living children respectively. 8.5% were found having more than 3 living children. Most (67.9%) of the respondents were married. Whereas 18.9%, 7.5%,5.5%, 0.3% were single, widowed, separated, Divorces respectively. While 5% respondents were not married at the time of survey, 33.1% were having married for 10 & more years. 22.8% were having married in the last 1 year. Around 54.4% respondents were living in three generation family that is along with her in laws and children, followed by 26% & 19.6% living in nuclear and joint family respectively.

Table 2: Awareness about Contraceptives among women of reproductive age group (n=785)

According to Table 2 out of the 785 respondents 675 (86%) had awareness regarding contraceptives practices.

Table 3: Knowledge about contraceptives among women of Reproductive age group (n=675)

 ^1,2,3,4 Multiple responses allowed for the respondents.

Table 3 describe the knowledge of Tribal women of reproductive age group on contraceptive methods and their side effects. Out of the 675 respondents who had any awareness about contraceptives, 68% & 66% were heard about OC pill & condoms respectively. Followed by Sterilization (57%), IUCD (52%), Natural;/ Traditional methods (32%). Respondents were least (only 21%) aware of Injectable contraceptives. When asked about the availability (where to get) of contraceptives, 82.3%, 71.4%, 65.8% were responded with MPHW(F), ASHA, Government hospital respectively.  At the same time 30.7%, 28.7%, 11.2% were mentioned that contraceptives were available at AWWS, Chemists, & Private hospitals respectively. When inquired about the “Ideal spacing period”, 43.8%, 36.6% were responded with 3-4 years & 1-2 years respectively. Followed by 9.3%, who were no knowledge on Ideal spacing period. When asked about the “Fertile period” 25.8% responded with “immediately after menstruation” followed by 19.7%, who “didn’t have knowledge” on fertile period. Whereas 19.2% responded with “during Menstruation”, 9.3% answered that “anytime during the period”. Most (65.1%) of the respondents labelled Irregular menstruation is the most common side effects of using contraception followed by Heavy menstruation (39.2%), Dizziness (33.1%), Vomiting (22.5%), Cessation of Menstruation (18.3%), Weight Gain (16.4%, Increased vaginal discharge (5.9%), Headache (4.2%). Most of the knowledge on contraceptive practices along with usages, availability, side effects, failure rate were from ASHA/ ANM workers (66.2%), followed by Friends / relatives. Mass media like Television/ radio/ internet acts as a reliable source of information for 34.9% respondents.

Table 4: Attitudes Toward Contraceptive Use

In table 4, Most (60.4%) of the respondents believed that contraceptives are safe for use but at the same time 24.7% were of the opinion that use of contraceptives causes infertility. A majority (81%) believed that husband’s approval was essential for using of contraceptives. 16.1% women opined that use of contraceptives is against their cultural norm. 54.7% of the women responded that they are satisfied with the currently using contraceptives and will recommend the same to their friends & family. 

Table 5: Practice of Contraception

      ^*Multiple response allowed to the respondents

Table 5 described about the current practice of the surveyed population, regarding the uses of contraception. Out of the total 675 respondents who had some knowledge on contraception 61.1% were had ever used any type of contraception. Condoms were found to be the most (78.8%) commonly used methods followed by Oral pills (55.6%). Other methods like Female Sterilization, IUCD, Other natural methods were practiced by 17.8%, 15.6%, & 2.2% respectively. Only 23.8%, out of 675 were found currently using any type of contraceptive methods. Among the current users Condoms (53.6%), followed by Oral pills (31.1%) were found the most preferred methods. Other methods like Female sterilization, IUCD is practiced by 15.6%, 2.2% of the respondents. Injectables, Traditional methods, any other barrier methods were used by 1.9% each respondent. 24.3% of the respondent shared that they faced problem while using contraception. As per the respondent IUCD (94.8%), Injectables (52.9%) were the most common contraception causing problems, followed by condoms (34%) and OC pills (29.9%). Problems associated with Female sterilization, Male sterilization, and any other barrier methods were limited to 17.3%, 11.8%,12.3% respectively.

Table 6: Reasons for not using Contraceptives currently (n=514)^*

^*Multiple answer allowed to the respondents

Table 6 describe the reasons for currently not using any type of contraception. While 51.4% share their reservation of using contraception due to fear of side effects like infertility, irregular bleeding, heavy menstrual bleeding and other health problems. Followed by cultural taboo/ religious beliefs (23.5%), incomplete family (22.8%), Opposition from partner (20.6%), indecisiveness (18.9%), No knowledge/Awareness (10.9%), for not using contraception currently.

Table 7: Association of Knowledge on contraception with socio-demographic parameter.

As per the table 7 it was found that  knowledge on Contraception among tribal women of reproductive age group was found significantly associated with socio-demographic factors like age (χ²= 12.94, p value 0.0015), Education of the respondent (χ²= 96.415, p value 0.001), Occupation of the respondents(χ²= 57.69, p value 0.001), Socio-economic status of the family of the respondent (χ²= 9.262, p value 0.009), Religion (χ²= 138.721, p value 0.001), Number of living Children (χ²= 4.055, p value 0.001), Marital status (χ²= 111.803, p value 0.001).

Table 8: Association of Contraceptives Practices with other socio-demographic Parameters.

As per the table 8 it was found that  practices on Contraception among tribal women of reproductive age group was found significantly associated with socio-demographic factors like age (χ²= 30.559, p value 0.001), Education of the respondent (χ²= 111.98, p value 0.001), Occupation of the respondents(χ²= 25.82, p value 0.001), Religion (χ²= 175.72, p value 0.001), Number of living Children (χ²= 198.14, p value 0.001), Marital status (χ²= 186.62, p value 0.001).

This study explored the socio-demographic profile, knowledge, attitudes, and practices regarding contraceptive use among tribal women of reproductive age in a tertiary care setting. The findings highlight significant gaps in both awareness and utilization of contraceptive methods, despite reasonable levels of knowledge among those exposed to health services.

A majority of the women (44%) were in the 25–35 years age group, with a high rate of unemployment (68.9%) and low educational attainment—only 4.3% being graduates. This demographic pattern is consistent with previous studies conducted in tribal and rural populations of India, where limited education and occupational opportunities are known barriers to reproductive health service utilization (Patel et al., 2011; Singh & Kaur, 2014) [22,23].

Awareness of contraception was relatively high at 86%, similar to NFHS-5 data which reports awareness rates above 80% among rural Indian women. [24] However, the actual use was lower: only 61.1% had ever used contraceptives, and just 23.8% were current users. The gap between knowledge and practice is consistent with previous research by Rajaram and Rashmi (2010), who observed that while tribal women may be aware of methods like condoms and pills, sociocultural norms and myths hinder actual usage. [25]

Among those who had knowledge, condoms (66%) and oral pills (68%) were the most known and used methods—reflecting national trends. However, awareness of long-term or less-visible methods such as injectables (21%) and IUCDs (52%) was considerably lower. This aligns with findings from Puri et al. (2007), who noted that fear of side effects and lack of trust in newer methods limits uptake among tribal and less educated groups. [26]

The study revealed a strong reliance on community health workers like ASHAs and MPHW(F) for contraceptive knowledge. ASHAs were cited as sources by 66.2% of respondents—supporting earlier reports by Bhatnagar et al. (2015), which emphasized the pivotal role of ASHAs in family planning outreach in rural areas. [27] Mass media played a minor role (24.5%), indicating underutilization of broader IEC (Information, Education, Communication) strategies in tribal zones.

Attitudinally, while 60.4% believed contraceptives to be safe, 24.7% still associated them with infertility—a common myth also documented by Kumari and Sachdeva (2015). [28] Importantly, 81% of women felt the husband's approval was necessary, pointing to significant male dominance in reproductive decision-making—echoing studies from tribal belts in Odisha and Jharkhand (Gupta et al., 2013). [29]

Barriers to current usage were primarily fear of side effects (51.4%), cultural/religious beliefs (23.5%), and partner opposition (20.6%). Similar barriers were identified in studies by Dasgupta et al. (2012) and Baruah et al. (2014), which suggested that improving community sensitization and male involvement can enhance contraceptive uptake. [30,31]

Statistically significant associations were found between contraceptive knowledge/practice and factors like age, education, religion, marital status, and number of children—mirroring findings by Pandey et al. (2018) and Deshmukh et al. (2020). [32,33]

In conclusion, while awareness is high, actual contraceptive use remains low among tribal women, driven by socio-cultural, informational, and gender-related barriers. Tailored interventions focusing on education, debunking myths, and enhancing male participation are crucial. Strengthening the role of frontline health workers and integrating mass media campaigns could further bridge the gap between knowledge and practice.

This study demonstrates that although a considerable proportion of tribal women in the reproductive age group are aware of modern contraceptive methods, the actual practice remains significantly lower. Socio-cultural factors such as male-dominated decision-making, myths, and low educational attainment serve as major barriers to contraceptive use. The strong influence of community health workers as sources of information highlights an opportunity for targeted interventions. Increasing female education, enhancing community-based awareness programs, promoting male involvement, and delivering culturally sensitive reproductive counselling through trained personnel can improve family planning practices in tribal communities. Addressing these gaps is critical for improving maternal and child health outcomes and achieving national reproductive health goals.

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