“A study to assess the knowledge regarding selected aspects of

reproductive health among adolescent girls with a view to develop a

health education package” at B E S College, Bangalore.

By

SOPHIA

Dissertation submitted to the Rajiv Gandhi University of Health Science, Bangalore,

Karnataka.

In partial fulfillment of the requirements for the degree of,

Master of Science in Nursing

in

Obstetrics and Gynaecological Nursing

Under the guidance of

Mrs. Sangeetha, Assoc. Professor

Obstetrics and Gynaecological Nursing

Sarvodaya College of Nursing

Vijayanagar, Bangalore – 79

( Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore )

2005
 RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCE BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation / thesis entitled “A study to assess the

knowledge regarding selected aspects of reproductive health among adolescent girls

with a view to develop a health education package” at B E S College, Bangalore is a

bonafide and genuine research and work carried out by me under the guidance of Mrs.

SANGEETA, Prof. Obstetrics and Gynaecological Nursing.

Date : Signature of the Candidate

Place : Bangalore SOPHIA

ii
 CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A study to assess the knowledge

regarding selected aspects of reproductive health among adolescent girls, with a

view to develop a Health education package in B.E.S. College, Jayanagar,

Bangalore” is a bonafied research work done by Mrs. Sophia, in partial fulfillment of the

requirement for the degree of Master of Science in Obstetrics and Gynaecological

Nursing.

Date : Signature of the Guide

Place : Bangalore Mrs. N. Sangeetha

Asst. Professor
Obstetrics and Gynaecological
Nursing Department

iii
 ENDORSEMENT BY THE H.O.D., PRINCIPAL / HEAD OF THE

INSTITUTION

This is to certify that the dissertation entitled “A study to assess the knowledge

regarding selected aspects of reproductive health among adolescent girls, with a

view to develop a Health education package in B.E.S. College, Jayanagar,

Bangalore” is a bonafide research work done by Mrs. Sophia under the guidance of Mrs.

N. Sangeetha, Asst. Professor in Obstetrics and Gynaecological Nursing.

Seal & Signature of the HOD Seal & Signature of the Principal
Asst. Prof. N. Sangeetha Prof. G. R. Chamnalkar

Date : Date :
Place : Bangalore Place : Bangalore

iv
 COPY RIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health Science, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

Date : Signature of the Candidate

Place : Bangalore Name : Sophia

v
 Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

Praise and thanks to the Lord Almighty for his loving care and special graces

bestowed during this research endeavour.

The investigator, owes a deep sense of gratitude to all those who have

contributed to the successful completion of this study.

My sincere thanks and appreciation are due to :

Mr. Chamnalkar, Principal, Sarvodaya College of Nursing for his support and

guidance suggestion and constructive criticism

Ms. Chitra, Associate professor and the head of the department – Medical

Surgical Nursing, Sarvodaya college of Nursing for her support , guidance and

suggestion.

Mrs. Sangeetha, Assistant Professor and head of the department – Obstetric and

Gynaecological Nursing, Sarvodaya College of Nursing for her keen interest guidance

valuable suggestion and co operation extended to this study as a guide.

I wish to express my heart felt gratitude’s to Mrs. Victorial, Mr.Amal Xeviour,

Mrs. Sugandhi, Mrs. Hilda and other members of Master of Science in Nursing

programme for their constructive criticism and valuable suggestion which contributed

towards completion of this study.

vi
 I would like to extend my deepest gratitude to all the experts who have

contributed in the form of criticism and suggestion to formulate the tool to be practical

and objective.

I am oblige to the participants for sacrificing their valuable time and extending

their co operation to provide the data.

Mr. Ravikumar, Statistician, for his expert guidance and assistance in the

statistical analysis. Throughout my sail on the Academic ship and specially during this

investigation, he has been a continued source of encouragement and help.

I am deeply indebted to my husband Mr. Sundaresan and my brother Celastian

Babu for their co operation and support.

I also extend my gratitude to Mr Bangar Raju and also to the Manager of

Corporatipon Bank for their Kind help for my studies.

I extend my sincere thanks to my dear parents, in – laws , sisters and other family

members who have helped me directly and in directly towards the completion of this

thesis.

All colleagues and friends who have helped me from the beginning from the end

of the study

(SOPHIA)

vii
 LIST OF ABBREVIATIONS USED

E. V = External variable

I.V. = Internal variable

Sc = Science

A = Arts

Ch = Christian

M = Muslim

H = Hindu

WHO = World health organization

STD = Sexually transmitted disease

viii
 ABSTRACT

“A Study to assess the knowledge, attitude and practices regarding aspects of

reproductive health among adolescent girls at B. E. S. College, Jayanagar, Bangalore.”

Objectives of the study

1) To assess the knowledge on selected aspects of reproductive health among

adolescent girls.

2) To compare the level of knowledge regarding selected aspects of reproductive

health between science students and arts students.

3) To determine the relationship between knowledge and selected socio democratic

variables such as subject chosen, mothers education place of residence, source of

information and family income.

4) To prepare a health education package on selected aspects of reproductive health.

The study was descriptive in nature, which was carried out in B.E.S. College,

Jayanagar, Bangalore, 60 adolescent girls were selected by simple random sampling

by lottery method. Among sixty female adolescent belong to Arts group. Semi –

structured interview schedule was held by the investigator to collect needed data,

which has two parts.

PART – I : Comprises socio – demographic variables

PART – II : Deals with knowledge of adolescent girls regarding selected

aspects of reproductive health under four sections. Section – A

ix
 deals with knowledge regarding Anatomy and Physiology of

reproductive system, Section – B comprises knowledge regarding

menstruation & menstrual hygiene, Section – C & Section – D

deals with knowledge regarding pregnancy and care, and family

planning methods respectively.

Collected data was analyzed by using descriptive and inferential statistics.

Result of the study revealed that the adolescent girls knowledge on over all

aspects of reproductive health was average ( 50.6% ). Mean percentage knowledge

score on pregnancy and care ( 58.7% ) was higher and the subject were having less

knowledge regarding family planning ( 42.2% ) than the areas of menstrual hygiene

( 53.7% ) and anatomy and physiology of reproductive health ( 49.7% ).

The study revealed that socio – demographic variables like subject studying,

mother’s education, place of residence, type of family, source of information,

guardian’s occupation and family income are significantly influencing the knowledge

level of adolescent girls. Also present study evidences the need for education and

proper guidance to adolescent girls to promote a positive reproductive health. It is a

part of professional nurses responsibility.

A health education pamphlet is prepared by the investigator for the use of

adolescent girls based on their needs identified. The prepared health education

material handed over to the school library for the students reference.

x
 TABLE OF CONTENTS

Chapter Page
Contents
No. No.

I Introduction 1 – 11

II Objectives 12 – 13

III Review of Literature 14 – 27

IV Methodology 28 – 36

V Results 37 – 55

VI Discussion 56 – 59

VII Conclusion 60 – 64

VIII Summary 65 – 67

IX Bibliography 68 – 71

X Annexure 72 – 134

xi
 LIST OF TABLES

Table Page
Titles
No. No.

SECTION- I

5.1.1 • Distribution of adolescent girls according to

religion 40
5.1.2 • Distribution of adolescent girls according to

place of residence 41

5.1.3 • Distribution of adolescent girls according to

source of information. 42

5.1.4 • Distribution of adolescent girls according to

occupation. 43

5.1.5 • Distribution of adolescent girls according to

monthly income. 44

5.1.6 • Distribution of adolescent girls according to

their mother’s education. 45

SECTION – II

Mean, standard deviation , and mean score percentage

5.2.1
of 4 dimension of reproductive health. 46 - 47

xii
 Table Page
Titles
No. No.

SECTION – III

5.3 ( 1-4) RELATIONSHIP BETWEEN SELECTED

DEMOGRAPHIC VARIABLES AND KNOWLEDGE

SCORE 48

5.3(1a-4) • Mean score of knowledge on reproductive

health by subject of studying. 49

5.3(1b-4) • Mean score of knowledge on reproductive

50
health by literacy status of mothers.

5.3(1c-4) • Mean score of knowledge on reproductive

health by source of income. 51

5.3(1d-4) • Cumulative table showing the statistical

significance of selected socio- demographic

52
variables on knowledge.

5.3.5 • Mean score percentage of knowledge on

reproductive health based on occupational status

53 – 54
and family income.

5.3.6 • Cumulative table showing the statistical

significance of selected socio – demographic

55
variables on knowledge.

xiii
 LIST OF FIGURES

Figure Page
TITLE
No. No.

1.1 Conceptual framework based on health promotion model 10

4.1 Schematic representation of the research design of the study 30

5.1.1 Distribution of adolescent girls according to Religion 40

5.1.2 Distribution of adolescent girls according to place of residence 41

5.1.3 Distribution of adolescent girls according to Source of

Information. 42

5.1.4 Distribution of adolescent girl’s Guardian according to their

Occupation. 43

5.1.5 Distribution of adolescent girls according to family Income. 44

5.1.6 Distribution of adolescent girl’s mothers according to their

Education. 45

5.2.1 Mean Score percentage of Knowledge on four dimensions of

reproductive health. 47

5.3 (1-4) Mean score of knowledge on reproductive health based on

subject studying, mother’s educational status, place of

residence, source of information. 48

5.3.5 Mean score of knowledge on reproductive health based on

Occupational status and family income. 53

xiv
 1. INTRODUCTION

“ How beautiful is youth ?

How bright at gleams

With it illusions

Aspiration and dreams

Book of beginning , story

With out end

Each maid a heroine

Man a friend”

-H .W. Long

In India it is estimated that 1/3rd of the total population is under the age group of

20 and adolescent are at the high risk of sexual and reproductive health problems. More

than 15 millions girls aged 15-19give birth every year. The adolescent girls who get

pregnant before 18 may be upto 5 times more likely to die, than a women aged 20-28.

This is also a concern for health care providers.

Each country has its own legal age for having sex. The child marriage –Restrains

Act of 1978, in India raises the legal age at marriage from 15 years to 18 years for girls

and 18-21 years for boys. The law is there to protect from an unplanned pregnancy and

other reproductive health problems. But half of the women in India are married before the

legal age of 18 years.

 The survey conducted by MCH, family planning. Ministry of health and family

welfare in India reported that the fertility rate of rural and urban adolescence in the age

group of 15-19 years is 97% and 57.2% respectively. In the early adolescent years a girl

is still growing and her pelvis has not reached as adult size. Pregnancy increases the

nutritional demands of adolescents. Along with growth demands, nutritional demand

reduces the total growth of adolescent, so pregnant adolescent is more likely to suffer

from obstructed labour if her pelvis is not in full size. Girls who become pregnant in

their teens are less likely to seek prenatal care compared to women of adult hood. Thus

pregnant adolescent are likely to have health problems like Eclampsia, than women over

20 years. Studies in several countries have shown that the risk of death during child birth

higher among adolescent than adult women. So knowledge regarding pregnancy care is

important for adolescents.

The data about contraceptive used by adolescents in India is not well documented.

Available data reveals 90.4% of 15 to 19 age groups have heard of one method

contraception, 90.2% knows about modern methods and 79.95% know where to obtain

the contraceptives. The main source of information on contraceptives was radio (17.9% )

television ( 42.2% ) and ( 14.6% ) got from both the sources.1

Studies on adolescence sexual behaviour in different parts of the world show that

adolescence premarital sexual encounters are generally unplanned, in frequent and

sporadic.2 Adolescence related health problems are important issues which have not

received the attention in our country especially in the context of the girl child. So good

reproductive should include freedom from the risk of sexual diseases, the light to regulate
once own fertility with full knowledge of contraceptive choices and ability to control

sexuality.

Reproductive health strategies includes education for responsible and healthy

sexuality, safe and appropriate contraception and service for pregnancy, delivery and

abortion. Therefore reproductive health must be protected and restored by social as well

as educational interventions across the lifespan of individual particularly adolescence

girls by using the “Lifespan approach”. 3

Many poets describe Adolescence period so glamorously. Adolescence is period

of transition from childhood to adulthood which encompasses puberty, the period where

secondary sexual characteristics begin to develop. Puberty is the process of change, that

takes place as the girl grows up and become physically matured and capable of having

children. As a result of hormonal influence many changes takes place in human beings

during adolescence. Adolescence is a complex period of myriad of physiological as well

psychological changes. This is a time for them to prepare for making responsibilities, a

time of exploration and widening horizons and a time to ensure healthy all around

development.

According W H O “Adolescence is a period of a life between 10 to 19 years”.

THE CHANGES GIRLS EXPERIENCE DURING PUBRETY :

• Slight change in body odour .

• Hips gets wider

• Increase in height and weight

• Broadening of the pelvic bone to prepare a room for a baby to be carried safely

• Some pubic and armpit hair appear

 • Nipples gets darker

• Breast becomes full

• Menstruation occurs about 2 ½ years after onset of puberty

Boys experience increase in height, weight, muscle mass, pennies and testicles

size increases, face and body hair growth and voice deepening occurs during this periods.

Onset of spontaneous emission of seminal fluid is an overt sign of puberty analogous to

menarche in girls.4

Along with this physical changes many psychological and psychosexual changes

also takes place in the Adolescence. They need to be aware of this changes and should be

able to cope with not only to physical changes but also with the psychological and

psychosexual changes. In order to make them competent to adopt positively to such

change knowledge of reproductive health is essential.

Need for the study

Adolescent girls lack knowledge regarding reproductive health problems etc. leading

to depression, mental stress and seeking of advice from quacks and incompetent persons

for knowledge on the subject which is undesirable. Moreover the routine health services

do not provide adequate care of the adolescent health problem which exaggerates the

problems further. Understanding their awareness about related issues will help us in

giving education based on need.

If adolescent period is given due attention, more confident and healthy adulthood

emerges. They are the citizens of the tomorrow on whom the future of the nation

depends. The status of women and girls in society is a crucial determinant of their

reproductive health. Education opportunity for girls decide their status, the control they
have on their own lives, their health and fertility. So female education is an important

step and essential element for health. 5

In line with the 1994 international conference on population and development,

reproductive health care is defined as the constellation of methods, techniques and

services that contribute to reproductive health and well being by preventing and solving

reproductive health problems.

In the world’s population about 19% are in the age group of 10 to 19 years. In

another study it was estimated that 25% of the Indian population lies in the age group of

15 to 25 accounting for 138 million persons. He also noted that adolescent girls between

the age of 10 – 19 years comprise about 22% of the female population in India.6

The goal of achieving health for all which, India is committed to, would certainly not

be feasible without priority to the vulnerable group in which the future of any society

depends upon the character of competence of its youth.7

Ideally a well informed parent who communicates well with an adolescent girl can

provide this information. But in our culture still parents hesitant to talk these matters

with children’s.

Considering the above factor the investigator felt there is a need of preparing a health

education package, on the reproductive health which is most important to the adolescent

girls and this will help to know about free from the risk of reproductive disease, the light

to regulate once own fertility with the knowledge of contraceptive choices and the ability

to control sexuality.
Statement of Problem

“ Study to assess the knowledge, attitude and practices regarding aspects of

reproductive health among adolescent girls at B. E. S. College, Jayanagar, Bangalore.”

Hypothesis

H0 :- There is significant association between demographic variables and knowledge of

reproductive health.

H1 : - There is significant association between subject selected by the adolescent girls.

H2 : - Their is significant association between literacy status of the mother and

knowledge of reproductive health among adolescent girls.

H3 : - There is significant association between source of information and knowledge of

reproductive health.

H4 : - There is significant association between place of residence and knowledge of

reproductive health.

H5 : - There is significant association between occupation of parents, family income and

knowledge of reproductive health.

OPERATIONAL DEFINITIONS

1. Knowledge : Refers to awareness and understanding of

adolescent girls in the areas of anatomy and

physiology of reproductive system, menstrual

hygiene, pregnancy and care and family planning

method.

2. Adolescent girls : Refers to unmarried females in the age group of

16 – 19 years.
3. Reproductive health : In the present study reproductive health is the health

of adolescent girls related to the knowledge on

anatomy and physiology of reproductive system,

menstrual hygiene, pregnancy and family planning

methods.

4. Health Education : Information regarding the health aspects & healthy

practices.

Assumption

1) It is assumed that adolescents may not have adequate knowledge about

reproductive health.

2) It is assumed that science students have more knowledge than arts students

regarding reproductive health.

3) It is assumed that socio demographic variables will influence the knowledge level

of adolescent girls regarding reproductive health.

Criteria for Sample :

Inclusion Criteria :

• Un married adolescent girls between 18 to

20 Years.

• Only those who attended menarche.

• Only those who give consent for the study.

Exclusion Criteria :

• Married adolescent girls are excluded.

• Student who have not given consent for the

study.
 CONCEPTUAL FRAMEWORK

The conceptual framework of study is based and designed on the concept of

“Health Promotion Model” proposed by Pender.8 This model describes the causal

mechanisms that explain and predict the health promoting components of life style.

The model focuses on the following three areas :

ƒ Cognitive perceptual factors ( individual perception )

ƒ Modifying factors ( demographic and social )

ƒ Participation in health promotion behaviours ( Likelihood of action )

Individual Perceptions :

The individual perceptions, “The primary motivational mechanisms of health

promoting behaviours” are said to exert a direct influence on health promoting behaviour.

Of all the cognitive – perceptual factors, perceived control of health, perceived self

efficacy and perceived health status are among the strongest determinants of health

promoting behaviours.

In the present study, the individual perceptions considered are need for knowledge

about selected aspects of reproductive health including anatomy and physiology of

reproductive system, menstrual hygiene, pregnancy care, family planning methods, and

perceived barriers such as lack of understanding and knowledge.

 CONCEPTUAL FRAME WORK
Health Promotion Model

Cognitive Perceptual Factors Modifying Factors Participation in health

Promotion behaviour

Knowledge about selected aspect of Demographic characters such as Likelihood of taking action to
reproductive health including anatomy parent’s education, occupation, income, improve the knowledge about
and physiology of reproductive system, subject chosen. menstrual hygiene,
menstrual hygiene pregnancy care and Pregnancy care, family
family planning methods. planning methods by
Interpersonal influences – peer group, attending group education,
reference group, group pressure and consulting medical persons
Perceived barriers such as lack of health seeking patterns when need arises, practicing
understanding and knowledge healthy behaviours, avoiding
Situational factors – like place of unhealthy behaviours.
residence ( rural and Urban )
Cues to Action

ƒ Mass media
Behavioural Factors – Practices ƒ Attending group
influencing reproductive health, education
knowledge influencing reproductive ƒ Health Professionals
health ƒ Parents
ƒ Teachers
ƒ Self Observation
ƒ Conversations with
friends

Conceptual Model Modified from Pender’s Health – Promotion Model ( 1996 )

Modifying Factors

Modifying factors consists of demographic characteristics, interpersonal

influences, situational and behavioural factors.

Pender states that according to the “health promotion model”, modifying factors

exert their influence through the cognitive – perceptual mechanisms that directly affect

behaviour.

Characteristics included in this study are parents education, occupation, income,

subject chosen, place of school, peer group, reference group, health seeking patterns,

practices and knowledge influencing reproductive health.

Participation in Health – Promotion behaviour

Cognitive : Perceptual factors constitute the exclusive source of all the

connections between the modifying factors and participation in

health promoting behaviours.

Cues to action : Is the last part of the health promotion model and consist of

activating cues or triggers that spark of health promotion activity

such as mass media, attending group education, information from

health professionals, parents, teachers, self observations,

conversations with friends. Interventions to improve knowledge

about menstrual hygiene, pregnancy care, family planning

methods, includes emphasis on attending group education,

consulting medical persons when need arises, practicing healthy

behaviours and avoiding unhealthy behaviours.

25
26
 2. OBJECTIVES

1) To assess the knowledge on selected aspects of reproductive health among

adolescent girls.

2) To compare the level of knowledge regarding selected aspects of reproductive

health between science students and arts students.

3) To determine the relationship between knowledge and selected socio democratic

variables such as subject chosen, mothers education place of residence, source of

information and family income.

4) To prepare a health education package on selected aspects of reproductive health.

27
28
 3. REVIEW OF LITERATURE

Review of literature is a broad systematic and critical collection and evaluation of

the important scholarly published literature as well as unpublished scholarly print

material, it serves an evidence and essential back ground for any research.

Review of literature is critical summary of research on a topic of interest generally

prepared to put a research problem in context to identify gaps and weakness in prior

studies so as to justify a investigation9. In order to accomplish the goal of present study,

an attempt has been made to review and discuss the literature which shall covers the

fallowing area

• Literature related to anatomy and physiology of reproductive system,

menstruation, pregnancy and care, and family planning methods.

• Studies related to menstruation, pregnancy care and family planning methods.

REVIEW RELATED TO ANATOMY AND PHYSIOLOGY OF

REPRODUCTIVE SYSTEM

• Indian journal of maternal and child health, states " human life has been

divided into periods. The period of adolescence extends from puberty to last year

of second decade(late teens) in females”.10

• “Adolescence is an important stage in developmental milestone which starts from

10 years of age and goes up to 14 years later it was extended up to 19 years”.

Growth and development of the child during this stage encompasses, two closely

related maturation phenomena which includes :

29
 ¾ Puberty : The process of physical growth and development

¾ Adolescence : The process of cognitive and physiological growth

and development. Both the phases are important and

extra attention and care.11

• In the text book of “ Maternity Nursing” states that Puberty as the age at which

the internal reproductive organs reach maturity, the age puberty varies between

10- 14 years and number of physical and psychological changes takes place”.12

• The text book of “Maternal Child – Health Nursing” defines adolescence as the

passage from childhood to maturity. Adolescence begins with appearance of

secondary sex characteristics and ends with cessation of growth. Puberty is the

onset of physical maturity. At puberty secondary sex characteristics begins

develop and capability of sexual reproduction is attained. The events leading

puberty is initiated with secretions of gonad hormones and development of the

secondary sexual characteristics.13

• “ Essentials of community health nursing” states adolescent as the developmental

task and it’s the state of Identity versus role confusion in the developmental

phase. It is also the premise of emotional maturity and independence. It means

that, the adolescent must detach herself from current relationships to be able to

grow and develop a new, productive adult identity.14

30
REVIEW RELATED TO MENSTRUATION AND MENSTURAL HYGIENE

• The text states “Menarche is the beginning of the menstrual function or the onset

of the first menstrual period as result of the hypothalamic- pituitary-ovarian axis

and age of menarche from 9 to 17 years”.15

• The Journal states “menstruation is the periodic discharge of the blood mucus

and epithelial cells from the uterus. It usually occur monthly in through out the

reproductive period, except during pregnancy and lactation, when it is usually

suppressed”. Accordingly the span of years during which child bearing is

possible that is about ages 12 – 45, corresponds to the period during which

ovulation and menstruation are closely interlinked, and because no process of

nature is purposeless, menstruation must play some vital and indispensable role in

child bearing. Menstruation represents the abrupt termination of a process

designed to prepare lodging for a fertilized ovum. It for cents the break down of

bed that is not needed because the “border” does not maternalize. Thus, its

purpose is to clear away the old bed so that a new and fresh one may be created

the next month. The average age at which menstruation occurs between 12 and

14 years of age . there are wide variations in the same women about the intervals

of menstruation cycle this has been the subject of several studies on normal

young women. This has been the subject of several studies on normal young

women. These investigations show that the majority of women of even 10 days

are not uncommon and may occur with out apparent detriment to health. 16

31
• In the text Maternity and women’s health, mentions “menarche occurs in

adolescent females about 3 yrs of the growth spurt and occurs in about half of

girls when they are about 12 ½ years old, but may occur as early as 16 yrs or as

late 16yrs”.17

• The text book of maternity nursing states “Historical literature contains many

references about myths related to menstruation as its recurring nature and

similar sequence, menstrual cycle were thought to be under the control of moon,

some behavioral changes falsely attributed to menstruating women such as, if

menstruating women walking through a farmer’s field crops of the field would

not grow and get flowers. In many culture menstruating women is kept in a

separate place , then following a realized cleaning the women joins her

family”.18

LITERATURE RELATED TO PREGNANCY AND CARE

• “Pregnancy is a time of great changes and adaptation for women”. These changes

affect her physical well being, self esteem interaction with others daily activities

and future plans. So early prenatal care is essential aspects, which presents

benefits to the client, her partner and her family. Numerous teaching

opportunities arise, especially regarding normal physiological changes

Psychological concerns and pregnancy care, thus avoiding stress and undue

concern for clients.19

• Adequate care during pregnancy, particularly in the early stages of pregnancy,

reduces the incidence of neonatal mortality, congenital malformation or other

32
 birth defects, maternal mortality and pre maturity. Many studies showed that

women in the younger age group tend to receive care later than in the other age

groups (National center for health statistics-1990). This may be owing to the fact

that the highest rates of illegitimacy are in the youngest age groups, young

mothers tend to be late comers to prenatal care. In this context the maternity

nurse has a crucial role to play several studies have indicated that the nurse can

perform roles involving the receiving and giving of information to concerned

person far more effectively than physicians.

Knowledge of the pregnancy care and risk factors has increased dramatically in

the 10-15 yrs. In 1991 the perinatal mortality and morbidity estimated to be 8.5

per 1000 and recorded to low in (1994). A better understanding of human

reproduction has greatly reduced maternal morbidity and mortality.20

• The study results of Attitude of girls towards marriage & Planned family states

that “to prevent and manage high risk pregnancy, conditions that cause poor

pregnancy, can be reduced by proper education. And it is important to transfer the

antenatal information and patient’s risk status in order to assure appropriate intra

partum and new born care. 21

LITERATURE RELATED TO FAMILY PLANNING METHODS

Today couples choosing contraception must be informed about prevention of

unintended pregnancy as well as protection against sexually transmitted disease.

• The study states that “Oral contraceptive are used more frequently than any other

method among 15 – 19 years old women. The condom is the second most

33
 frequently used method. Adolescence frequently misuse and misunderstand the

rhythm method. This method is often less effective for adolescence who have

irregular menstrual cycle. Teenagers should also be taught safe sexual practice

which include the use of family planning methods”.22

• Adolescence who are sexually active often do not use contraceptives consistently

and correctly. Research indicated that those who more reliable use contraceptives

are more likely to have friends who use contraceptives.

Hacker and more stated in the title “Essentials of obstetrics and gynecology”

under the headlines of “Birth control counseling in adolescence” that unplanned

pregnancy remains one of the principal concerns for teenaged women, in spite of

the availability of effective contraceptive technology.

Teens tend to delay contraceptive use for several months after the onset of sexual

activity and younger teens are likely to delay longer than older girls. Risk taking

is commonplace in adolescence, in large part from a sense of invincibility. So any

teenager needs careful counseling to ensure that she knows how to use it, how to

deal with any errors in use and has had her questions about mode of action and

possible side effects answered.

Parents may not involve themselves in sexuality education for several reasons

1. They may not have adequate information

2. They may be uncomfortable with the topic of sex. In addition adolescents may be

uncomfortable when parents discuss sex. Parent’s refusal to discuss sexual

activity a secret and may interfere with the adolescent’s efforts to seek help.

34
 National surveys to parents reveal greater support for the inclusion of comprehensive

sex education in school curriculum and at earlier ages for today’s youth.

Sexuality education programs should begin before puberty and provide adolescents

with experience in personal sexual decision – making and practice in applying these

information to their lives.

Health education at the primary prevention level includes the provision of

information about good hygiene, the prevention of STDS / and contraceptive use. Health

education strategies need to be creative and developmentally, culturally, educationally

and linguistically appropriate.

Nurses should promote school – based sexuality education fro early ages. In addition,

because teachers, report a lack of training in sex education, nurses should take a more

active role in teaching sexuality concepts in school.23

STUDIES RELATED TO REPRODUCTIVE HEALTH

A recent study was conducted by Revathi ( 1996 ) “To determine the knowledge an

attitude of adolescent girls regarding reproductive health before and after a structured

teaching programme at Vellore in 150 high school girls”. The study showed that there

was a significant difference in the knowledge score between the pretest and posttest.

STUDIES RELATED TO MENSTRUATION AND MENSTUAL HYGIENE

Abioye – Kuley EA (1999) conducted “ a study on menstrual knowledge and practice

among secondary school girls in Nigeria” among 352 randomly selected healthy Nigerian

school girls revealed that 187 ( 53.1% ) had attained menarche, 40% of subjects were

35
deficient in knowledge about menstruation and menstrual knowledge was higher in post

– menarcheal girls.

• Singh MM, Devir (1999) conducted “ a study on awareness and health seeking

behaviour of rural adolescent school girls on menstrual and reproductive health

problem” among 130 students ages 13 – 17 years in Haryana revealed that,

menstrual problem was dysmenorrhoea ( 40.7%) followed by irregular menses

( 2.3%). Out of which 5.3% consulted a doctor and 22.4% took over the counter

medications from the chemist shops, most of the girls knew about menstrual

hygiene and medical examination during pregnancy. The major sources of

information were Television ( 73.1% ) radio ( 37.1% ) and parents ( 36.1% )

• Mbizvo MT, Kasule J, Gupta V. (1997) conducted “ a study on effects of a

randomized health education intervention on aspects of reproductive health

knowledge and reported behaviour among adolescent in Zimbabwe”, results

showed as a significant increase in correct knowledge about aspects of

menstruation in intervention as compared with control schools.

• Mary J. (1995) Conducted “an exploratory study on the socio – cultural and

health related problems of unmarried adolescent girls in selected slum at

Bombay”. Revealed that majority of the adolescent girls (94.29% ) expressed fear

at menarche and 68.57% did not have any knowledge about menstruation. Also

71.43% had menstrual problems, like heavy bleeding and irregular menstruation.

• Mibizo et al. (1995) conducted “a study on reproductive biology, knowledge and

behaviour of teenagers is East, central and Southern Africa at Zimbabwe” that

36
 was misconceived as an illness. Peers followed by magazines were the first

sources of information on various aspects of reproductive biology both of which,

might not provide the correct first hand information. The findings point to the

need for targeting the adolescent pupils for information on reproductive health

and increased awareness on the risk of pregnancy, STDs and HIV.

• Koffe. Rierdan J. (1995) conducted “a study on adolescent girls understanding of

menstruation” among adolescent girls, revealed that girls viewed themselves as

prepared for menarche and claimed that had discussed it with their mothers. Their

explanations of menstruation reflected as they are having incomplete knowledge

and more typically a variety of misconception or ignorance.

• Ludwing (1994) revealed in a study on “menarche” that it is one of the most

important biologic signals in the life of a women and he further stated that

education for the understanding of menstruation should stress that of primary

express feminity and should avoid depicting menstrual bleeding as a reproductive

nuisance.

• Morse, J.M. (1993) conducted “ a study regarding the attitude of adolescents

towards menstruation among 860 pre and 1013 post menarcheal girls from 49

randomly selected schools in a Canadian City” related that post menarcheal girls,

the self report of menstrual symptoms gives insight into the prevalence of

symptoms and the perception of symptom severity.

• Anjali J. (1992) in a “descriptive co – relational survey, in two selected schools,

one central government school and the other private school in Bathinda City of

Punjab state” related that adolescent girls, on the whole had inadequate

37
 knowledge of menstrual hygiene. But the convent school girls had higher

knowledge than the central school girls. The girls from a higher socio-economic

background and mothers who had better education were having better knowledge

than others.

• Sveins dottir H (1990) conducted “a study about the attitudes towards

menstruation among 178 Nursing students” revealed that the students view

menstruation as natural not very predictable or debilitating, even though they do

not deny that menstruation can effect behaviour in some way.

• Dashiffc (1987) conducted “a study regarding hygiene in children and

adolescents” revealed that feminine hygiene in concern not only in the

reproductive years, but should be observed through out life. Thus proper

education and guidance of little girls are essential.

• Havens B (1986) conducted “a study regarding menstruation perception and

preparation among female and adolescents among 8th and 10th grade students

attending a private girls school in Hawaii” revealed that 80% had already started

menstruating. Many were first informed their mothers when they started

menstruating. Surprise, fear and embarrassment were common initial reactions,

rather than strong negative or positive emotions.

• Mittag, J.E. (1986) conducted a study in German “regarding personal hygiene and

sex education of young girls” reveals that sexual education of young girls and

guidance for their personal hygiene are closely related”.

• Clarke, A.E. ( 1985 ) conducted a study among 54 adolescent girls “about young

adolescent beliefs concerning menstruation” the result showed that pre

38
 menarcheal girls had less negative evaluation of menstruation than post

menarcheal girls.

STUDIES RELATED TO PREGNANCY AND CARE

• Inhabra et al ( 1998 ) conducted a survey between January 1990 and December

1994, found that 7515 deliveries took place in the obstetrics and gynecologic

departments of Mahatma Gandhi Institute of Medical Science, in India. Out of

which about 1.25% of all women who gave birth had eclampsia and 3% of all

who had abortions were admitted with severe sepsis due to damaged uterus.

Factors responsible for still births and neonatal death were obstructed labour,

early pregnancy, eclampsia and abnormal presentations.

• Kannan ( 1995 ) stated that over 50% of the world’s population is under 25 yrs in

which one in 3 persons were aged between 10 & 24 years. He further concludes

that in India adolescent girls ages 10 to 19 comprise about 22% of female

population and they have special health needs during ante, intra – and postnatal

period of child bearing age.

• Bang et al (1989) found 92.2% to be suffering from gynaecologic or sexual

disease. 55% of them symptomatic and 44% asymptomatic in our area 51.1%

symptomatic and 41.2% asymptomatic rural women and gynaecologic disease in

1994.

• WHO (1992) reported that every day at least 1600 women die of the

complications of pregnancy and childbirth in developing countries. In addition to

these 585,000 maternal deaths occur each year and further a 50 million women

suffer from acute complications, 18 million of these women suffer from long term

39
 disability and only 65% of women received antenatal care in the developing

countries.

• Agarwal et al (1989) identified in their study “the nutritional status of rural

pregnant women in Bihar and Uttar Pradesh by anthropometric measurement like

weight, height, mid – aim skull circumference and hemoglobin” results revealed

that 81% of women in Bihar and 87% in Uttar Pradesh were anemic with

hemoglobin level either 11gm/dl. or less than this.

STUDIES RELATED TO FAMILY PLANNING METHODS

• Bhaka V and Swami H.M. ( 2000 ) conducted “a study on adolescent girl in

school of Chandigarh regarding knowledge on fertility control methods”. This

study involved 389 students from rural and urban areas, revealed that 51.9% of

girls were aware of fertility control methods, out of which 39.7% of the girls from

rural areas and 54.7% from urban areas were having awareness about

contraception.

• Aemstrong K ( 1994 ) conducted a study “to achieve a goal to encourage earlier

use of family planning services and effective birth control for teens”. Result

revealed that the use of condom is more common in reducing conception rate and

incidence of STD.

• WHO ( 1993 ) reported that sexuality is to taboo subject in most societies and

young adolescents frequently have little knowledge about the basic facts of

contraception. So they are unsuccessful in avoiding unwanted pregnancy.

• Singha B ( 1991 ) had done a “study to assess the adolescents attitude towards

family planning” in a sample of 50 Hindu and 50 Muslim undergraduate students

40
 in Bihar and confirmed that Hindu students had more positive attitudes than

Muslim students.

• Brabin N. conducted a “Study on knowledge and attitudes towards reproductive

health issues in the government schools and Anganwadi premises of three

villages, of the primary health centers, in Hariyana”. This study revealed that all

the girls were knew the legal age of marriage. Early marriage was preferred by 19

( 7.6% ) and 84.3% girls were of the small family norm.

41
42
 4. METHODOLOGY

For any research work the methodology of investigation is of vital importance.

Research methodology is a way to solve the problems. It is a systematic procedure in

which the researcher starts from initial identification of the problems to final

conclusions.24

This chapter includes research approach, setting, sample, sampling technique,

development and description of tool, pilot study, data collection and plan for data

analysis.

RESEARCH APPORACH

Research approach is an umbrella that covers the basic procedure for conducting

research.

The research approach adopted for this study is an descriptive survey. It is used

to explore knowledge regarding anatomy and physiology of reproductive system,

menstrual hygiene, pregnancy and care and family planning methods with the help of

semi-structured interview schedule.

Descriptive research studies collect detailed description of existing variables and

use the data to justify and assess current condition.25

REASEARCH DESIGN

Research design is the plan, structure and strategy of investigations of answering

research questions. It is the over all plan or blue print the researcher selects to carryout

the study.26

The research design adopted for the present study is depicted in figure.

43
ACCOUNTABLE SAMPLE & SAMPLING VARIBLES DATA COLLECTION PLAN FOR
POPLUTION TECHNIQUE TECHNIQUES ANALYSIS

B E S College
I V
* Frequency and
• Subject chosen percentage
Students studying 1ST B A 1ST B Sc • Mother’s education
in 1st year BA • Monthly income
and 1st year Bsc 17-19 yrs 17- 19 yrs • Source of * Mean, mean
at BES college information percentage and
jayanagar standard
Bangalore- deviation.
S.R.S Semi- structured
DV interview schedule
By Lottery method
using Questionnaire * Co efficient of
Knowledge on selected
aspects of reproductive correlation
Health including anatomy
and physiology of
30 30 reproductive system, * t – test
menstruation, pregnancy
care,& family planning
method
60

S.R.S. = SIMPLE RANDOM SAMPLING D.V = DEPENDENT VARIABLE I. V = INDEPENT VARIABLE

FIG. RESEARCH DESIGN FOR THE STUDY

44
VARIABLES UNDER STUDY

A Variable is any phenomena or characteristic or attribute understudy. Variables are the

measurable characteristics of a concept and consist of a logical group of attributes.

The variables in the study are subject chosen, mother’s education, monthly income,

source of information, knowledge on selected aspects reproductive health, including

anatomy and physiology of reproductive system, menstruation, pregnancy care & family

planning method.

SETTING OF THE STUDY

The study was conducted in B E S college Bangalore , among the 1st year B.A &

B Sc students.

POPULATION

The target population for the study includes adolescent girls of 1st year B A & B.Sc.

students . The total number of students was 100.

SAMPLE & SAMPLINNG TECHNIQUES

States that sampling refers to the process of selecting the portion of population to

represent the entire population.27

The sample for the study comprised of 60 students, 30 from arts and 30 from science

group. By simple random technique the samples were selected.

45
CRITERIA FOR SELECTION OF SAMPLE

Inclusion criteria :
• Un married adolescent girls between 18 – 20 years

• Only those who attended menarche

• Only those who give consent for the study
Exclusion Criteria :
• Married adolescent girls are excluded
• Student who have not given consent for the study
• More than 20 years

DEVELOPMENT OF TOOL

The instrument is a vehicle that could best obtain data pertiner to the study and at

the same time add to the body of general knowledge in the discipline.

The investigator developed semi-structured interview schedule to fulfill the

specific need of the study.

DESCRIPTION OF THE TOOL

TOOL – 1 (Part I)

Demographic data

The first part of the tool consists of thirteen items for obtaining information about

the selection background factors such as name, age, sex, religion, mother’s education,

father’s occupation etc.

PART – II

Questionnaire regarding selected aspects of reproductive health.

46
 ™ SECTION A : Questionnaire to asses the knowledge on anatomy and

physiology of reproductive system consisting of 18 items.

Total score is 25.

™ SECTION B: Questionnaire to asses the knowledge on Menstrual

hygiene consisting of fourteen items. Total score is 17.

™ SECTION C : Questionnaire to asses the knowledge on pregnancy care

consisting of twelve items. Total score is 23

™ SECTION D: Questionnaire to asses the knowledge on family

planning methods consisting of seven items. Total score

is 9.

The knowledge level has been divided in to three categories based on the girls

score in the semi – structured interview schedule.

o Below average : Below 50% score

o Average : 50 to 70% score

o Excellent : Above 70% score

CONTENT VALIDITY

Validity refers to the degree to which an instrument measures what it is supposed

to be measuring. Content validity refers to the degree to which the items in an instrument

adequately represent the universe of content.28

Experts comprising 5 nursing educators, and 4 doctors established the content

validity of the tool.

47
There were 100% agreement on 17 items of the Knowledge questionnaire were retained,

4 items which had 80% agreement were modified as per exports opinion. The 3 items that

had less than 70% agreement were discarded.

Based on their suggestion

PART-I

Previously there are only 11 items in the socio demographic variables and number of

items in Part – I is increased to 13 items as per suggestion given by experts.

PART-II

Previously Section - A consists of 19 items , but on expert suggestion (question 7)

is eliminated. In Section – B ( question 32 -33 ) are changed and new questions were

included. Section C and Section – D were cent percent accepted by experts.

PART – I 14 ITEMS

PART – II Section – A there are 18 items

Section – B there are 14 items

Section – C there are 12 items

Section – D there are 7 items

RELIABILITY

Reliability of an instrument is the degree of consistency with which it measures

the attribute it is supposed to be measuring.

48
 The reliability of tool established by collecting data from 6 students of BES

College. The reliability was found by split half method using Spearman Brown Prophey

formula. Reliability score (r) was 0.76. So the tool was considered highly reliable for

this study.

PILOT STUDY

Pilot study is a small scale version of trial run for the major study.

A study was conducted on 5 – 8th December at B E S college. Administrative

approval was obtained for conducting the pilot study. The tool was found to be

comprehensible, feasible and acceptable. There was no identified need for any further

change. There fore the investigator decided to carry out the actual study process with out

making any changes.

DATA COLLECTION PROCESSES

The data collection was scheduled for the month of march 2005. Before the data

collection the investigator obtained the formal permission from the principle to conduct

the study. The Investigator visited the college on the given date and was introduced to

the students by the class co-coordinator. The purpose of the study was explained to the

students. The questionnaire was introduced to the students. The students took 45 min to

completed the tool. After collecting the completed questionnaire the correct answer were

discussed according to the students interest and doubts were clarified.

49
PLAN FOR DATA ANALYSIS

The data were analyzed in terms of the objectives of the study using descriptive

statistical and inferential static’s.

The plan of data analysis was as follows : -

1. The percentage analysis will be carried out for socio-demographic variables.

2. Descriptive static’s such as Mean, Standard deviation, and Mean score Percentage
for Four Dimensions of reproductive Health.

3. Inferential statistics especially independent “t” test to find out the relationship of

knowledge with selected demographic variables such as subject chosen, literacy

status of mother, place of re3sdence, source of information and “ANOVA” to find

out the relationship of knowledge with family income and occupation of guardian.

The significant findings will be presented in tables, figures, and graphs.

SUMMARY

This chapter dealt with research approach and design, variables, setting and sampling.

It includes the preparation and pre testing of the tools. This chapter also dealt with the

pilot study, data collection procedure and plan for data analysis.

50
51
 5. RESULTS

This chapter deals with analysis of data collected from 60 female adolescents

regarding selected aspects of reproductive health.

Analysis is described as “Categorizing , ordering, manipulating and summarizing

the data to obtain answer to research questions. The purpose of analysis is to reduce the

data to an intelligible and interpretable form so that the relation of research can be

studied”.29

Objectives of the study

1) To assess the knowledge on selected aspects of reproductive health among

adolescent girls.
2) To compare the level of knowledge regarding selected aspects of reproductive
health between science students and arts students.
3) To determine the relationship between knowledge and selected socio democratic
variables such as subject chosen, mothers education place of residence, source of
information and family income.
4) To prepare a health education package on selected aspects of reproductive health.

Organization of Findings

The data is organized, analysed and presented under following section.

SECTION –1

The percentage analysis was carried out for the socio- demographic variables.

SECTION – II

Descriptive statistics such as Mean, standard Deviation and Mean score

percentage were calculated for four dimensions of reproductive health.

52
SECTION –III

Relationship between selected socio demographic variables such as subject

chosen, Mother’s education status, source of information, guardian’s occupation, income

of the family and knowledge score.

53
 SECTION – I

SOCIO DEMOGRAPHIC VARIABLES

Table – 5.1.1 Distribution of adolescent girls according to Religion

Religious status Subject(60) Percentage %

Hindu 53 88.3
Muslim 2 3.3
Christian 5 8.4

3.3% 8.4%

Hindu
Muslim
Christian
88.3%

Figure – 5.1.1 Distribution of adolescent girls according to Religion

Table – 5.1.1 Shows that among all the subjects studies, 88.3% were Hindus, 8.4% were

Christians and rest of the 3.3% were Muslims.

54
Table – 5.1.2 Distribution of girls according to place of residence

Place of Residence Subject Percentage

Urban 36 60

Semi urban 24 40

Rural 0 0

70

60 %
60

50

40 %
40

30

20

10
0%
0
Urban Semi - Urban Rural

Figure – 5.1.2 Distribution of girls according to place of residence

Table – 5.1.2 presents that more than half of the girls ( 60% ) were residing in urban area

and remaining 40% were from rural area.

55
Table – 5.1.3 : Distribution of adolescent girls according to source of information

Source of information Subject Percentage

Teachers & Friends 41 68.4

Parents 14 23.3

Mass media 5 8.3

8.3%

23.3%
Teachers & Friends
Parents
Mass media

68.4%

Figure – 5.1.3 : Distribution of adolescent girls according to source of information

Table – 5.1.3 depicts that 41 (68.4%) girls gained knowledge on reproductive health

through teachers and friends, 14 (23.3%) gained knowledge through parents and 5 (8.3%)

from mass media.

56
Table – 5.1.4 : Distribution of adolescent girls according to guardians occupation

Guardian’s occupation Subject Percentage

Daily wages 14 23.3

Monthly income 23 38.4

Business 14 23.3

Self employment 9 15.0

45
40 38.4 %

35
Percentage

30
25 23.3 % 23.3 %

20
15 %
15
10
5
0
Daily Wages Monthly Income Business Self Employment

Source of Information

Figure – 5.1.4 : Distribution of adolescent girls according to

guardians occupation

Table – 5.1.4 depicts that among 60 female adolescents, 23 (38.4%) of the adolescent

girl’s mothers were having monthly income, proportion of parents ( 23.3% ) were found

in occupation of daily wages and business and rest of them 9 (15% ) were self

employment.

57
Table – 5.1.5 : Distribution of adolescent girls according to monthly income of the

family

Family income
Subject Percentage
(per month)

< 1000 19 31.7

1001 – 3000 22 36.7

3001 – 5000 13 21.6

> 5000 6 10

10%
21.6% 31.7%
< 1000

1001-3000

3001-5000

> 5000

36.7%

Figure – 5.1.5 : Distribution of adolescent girls according to monthly income of

the family

Table – 5.1.5 depicts that among 60 adolescent girls 22 (36.7%) of them belong to

income of 1001 – 3000 , 19 ( 31.7% ) were belong to below 1000, 13 ( 21.6% ) of them

belong to 3001 – 5000, and 6 ( 10% ) were belong to more than 5000.

58
Table – 5.1.6 : Distribution of adolescent girls mother’s according to their
Education

Education Subject Percentage

Illiterate 10 16.7

Primary school 8 13.3

High school 21 35.0

Higher secondary 19 31.7

Degree 2 3.3

40
35%
35 31.7 %
30
Percentage

25

20 16.7%
15 13.3%

10

5 3.3%

0
Illiterate Primary High School Higher Degree
School Secondary

Mother's Education

Figure – 5.1.6 : Distribution of adolescent girls mother’s according to their

Education

59
 SECTION – II

Mean, Standard deviation, and mean score Percentage of four

dimension of reproductive health.

Table – 5.2.1 : Mean, Standard deviation, and mean score Percentage of four
dimension of reproductive health.

Maximum Mean
Areas Mean S. D
score score%
Anatomy & physiology
20 9.93 4.02 49.7
of reproductive system

Menstrual hygiene 18 9.66 2.19 53.7

Pregnancy and care 24 14.10 4.18 58.8

Family planning 29 12.25 3.43 42.2

Over all knowledge 91 46.1 10.32 50.7

60
 70
58.8%
60 53.7%
49.7%
Percentage
50
42.2 %
40

30

20

10

0
A B C D
Mean Score

A = Anatomy & physiology of reproductive system

B = Menstrual hygiene

C = Pregnancy & care

D = Family Planning

The Figure revels that Mean , S.D. and Mean score percentage of Knowledge on

reproductive health over 4 dimensions. Findings shows that mean score percentage of

over all Knowledge in the area of reproductive health was (50.7%). Among these 4

dimension more knowledge was found to be in the area of pregnancy and care (58.8%).

The mean score percentage of menstrual hygiene is 53.7% and in the area of

anatomy & Physiology of reproductive health was 49.7%. The least Knowledge score

was about family planning which was about 42.2%

61
 SECTION – III

Relationship between selected socio-Demographic variables and

Knowledge score

Figure – 5.3 ( 1-4) : Mean score of knowledge on Reproductive health by selected

Socio – Demographic Variables.

60 52.7 51.1
49.8
45.3 47.7
50 39.4
43.4 44.6
Mean Score

40
30
20
10
0
Subject Mother's Place of Source of
Studying Educational Residence Information
Status

Demographic Variables

Science Arts
Illiterate Literate
Urban Rural
Teachers, Friends Parents

Figure – 5.3 ( 1 – 4 ) : Mean score percentage of knowledge based on subject studying,

mother’s educational status, place of residence, source of

information.

62
Table 5.3 ( 1a – 4 ) : Mean score of knowledge on reproductive health by subject

studying

Subject
Mean S.D t – value Result
studying No

Science 30 52.7 9.1

6.03* Significant
Arts 30 39.4 6.5

* Significant at . 1% level ( i.e . p< 0.001)

That is the score of subject those who are studying science was found to be 52.7

which is comparatively more than the mean score f students those who are chosen Arts

as a subject 39.43 .Independent ‘t’ test was used assessing the statistical significance and

found to be significance at 0.001 level ( i.e . p< 0.001). It authenticates that subject

studying is influencing the knowledge on reproductive health.

63
Table – 5.3 ( 1b – 4 ) : Mean score of knowledge on reproductive health by

Literacy status of mothers

Literacy status No Mean S.D t- value Result

Illiterate 12 45.3 4.7

2.50*
Literate 48 49.8 5.7 Significant

* Significant at 2% level ( i.e . p< 0.02)

The relationship between knowledge on reproductive health and literacy status of

mother is portrayed in the table. Those with illiterate mothers and a mean of 43.3 and

those with literate mothers had a Mean 49.8. The statistical significance in mean score of

knowledge over the literacy status was out by the application of independent ‘t’ test and

it was found to be significance at 2% level (i.e. p< 0.002). The result showed a clear

gradation of knowledge over their mother’s educational status. This was high and also

statistically significant.

64
Table – 5.3 ( 1c – 4 ) : Mean score of knowledge on reproductive health by

place of residence

Place No Mean S.D t- value Result

Urban 36 47.7 7.4

2.81* Significant
Semi urban 24 43.4 6.1

* Significant at 5% level ( i. e . p < 0.05)

Table revels that Mean score 47.7 of adolescent girls residing in urban is found to

be comparatively more Knowledge than the student residing in semi urban area 43.4 .

Independent ‘t’ test was used for assessing the statistical significance and it was found to

be significant at 5% level (i.e. p< 0.005). It authenticates that the place of residence is

influencing the knowledge on reproductive health.

65
Table – 5.3 ( 1d – 4 ) : Mean score of knowledge on reproductive health by source

of information

Source of
No Mean S.D t- value Result
information

Teachers, 46 44.6 7.4

friends
2.39* Significant
Parents 14 51.1 8.6

* Significant at 0. 01% level ( i.e . p< 0.01)

Table represents the relationship between the knowledge on reproductive health

and source of information, those who have gained information through their parents had a

mean of 51.1 and through other source of the information received through parents is

comparatively more than the other sources. To find out the statistical significance the ‘t’

test was carried out and was found to be significant at 1% level (i.e. p< 0.01). It

confirmed that the sources of information influencing the knowledge score3.

66
Table – 5.3.5 : Mean score of knowledge on reproductive health based on

occupational status and family income

Knowledge score
Variables/ categories No. F – ratio Result
Mean S.D
1. Occupational status
™ Daily wages 14 41.78 13.18

™ Monthly income 23 43.44 6.64 7.50 P<0.001

Significant
™ Business and self
employment 23 52.53 9.38

2. Income
™ <1000 19 39.94 10.23 P<0.001
6.53 Significant
™ 1001-3000 22 48.72 8.91

™ 3000 19 50.68 9.35

60 52.53 50.68
48.72
50
41.78 43.44
Mean Score

39.94
40
30
20
10
0
Occupation Income
Demographic Variables

Figure – 5.3.5 : Mean score percentage of knowledge based on occupational status

and family income.

67
Table 5.3.5 presents the Mean score of knowledge on reproductive health over the

different categories of occupational and income status of the family. The girls those who

have better knowledge than the parents engaged in daily wages for their income.

To assess the significance of mean score of knowledge over the three categories

of occupation, ANOVA ( Analysis of variance ) was worked out and it was found to be

significant at 0.001 level ( P < 0.001 ). This implies that knowledge is significantly

increases with the occupational status.

To assess the significance of mean score of knowledge over the three categories

of income, ANOVA ( Analysis of variance ) was worked out and it was found to be

significant at 0.001 level ( p <0.001). This implies that the knowledge score of the girls

significantly increases with family income.

This shows that the guardian’s occupation and family income are significantly

related to knowledge of the girls on reproductive health.

68
Table – 5.3.6 : Cumulative table showing the statistical significance of selected socio
demographic variables on knowledge.

Selected Socio Demographic

Sl. t – value p – value Result
Variable

1. Subject studying 6.03 P<0.001 Significant

2. Literacy status of mothers 2.509 P<0.02 Significant

3. Source of information 2.39 P<0.001 Significant

4. Place of residence 2.817 P<0.05 Significant

Variables F - ratio P-Value Result

5. Guardian’s Occupation 7.50 P<0.001 Significant

6. Family Income 6.53 P<0.001 Significant

Table 5.3.6 envisage the summary of results related to the statistical significance of the

selected socio – demographic variables with the knowledge on reproductive health.

Results of significance were tabulated at different exact probability level. All the

variables were significant to the maximum critical level of 5% ( i.e. 0.05). But, among

these socio – demographic variables, subject studying, source of information, guardian’s

occupation and family income were highly significant (i.e. P<0.001). Literacy status of

mothers were moderately significant and place of residence was significant at only 5%

level ( i.e. P <0.05). It shows that subject studying, source of information, guardian’s

occupation and family income were highly influencing the knowledge on reproductive

health.

69
70
 6. DISCUSSION

An descriptive study was conducted to assess the knowledge of reproductive

health among the adolescent girls at B.E.S. College, Jayanagar, Bangalore.

Data were collected from 60 students, by using semi – structured interview

schedule. Collected data was analyzed and presented in the form of tables and graphs.

Independent “t” test to find out the relationship of knowledge with different demographic

variables i.e. subject studying, literacy status of the mother, place of residence, source of

information. And ANOVA to find out the relationship of knowledge with family income

and occupation of guardian.

This chapter attempts to discuss the findings of study.

The findings are discussed under the following headings.

1. Demographic characteristics of the sample.

2. Land of knowledge of adolescent girls on reproductive health.

3. Association between knowledge of reproductive health to family income and

parent’s occupation.

1) Demographic Characteristics of the sample :

Analysis revealed that most of the adolescent girls were Hindus ( 88.3% ) when

compared to other religious. It might be associated with the national figure as in India

the percentage of Hindus are more than any other religion.

With regard to the place of residence most of them ( 60% ) are residing in Urban

and 40% are residing in semi – urban.

71
 Regarding the source of information on reproductive health, reveals that 68.4% of

adolescents girls gained knowledge from teachers and friends and 23.3% gained

knowledge from parents and only 8.3% gained knowledge from mass media.

Distribution of adolescent according to guardian’s occupation, reveals that

majority of the parents ( 38.4%) earning monthly and 15% are self employed, 36.7% are

earning < Rs.3000/- and 10% are earning < Rs.5000/-.

The analysis also reveals that 35% of the girls mother’s are studied upto high

school and only 3.3% completed degree.

2) Land of knowledge of adolescent girls on reproductive health :

Mean knowledge score was highest 14.10 + 4.18 for the area “Pregnancy and

care”. That is about 58.8%. Mean knowledge score of menstrual hygiene was ( 9.66 +

2.19 ) about 53.7%. Mean knowledge on A/P of reproductive health shows ( 9.93 + 4.02)

mean & S. D. of score which is around 49.7%. Mean knowledge score on family

planning shows ( 12.25 + 3.43 ) mean & standard deviation of score, which is around

4.22%.

However, the total mean knowledge score regarding the reproductive health

shows ( 46.1 + 10.32 ). Mean and S. D. of score which is around 50.7% of the total

score.

3) Association between knowledge of reproductive health to family income and

parent’s occupation :

To assess the significance of mean score of knowledge over the three categories

of occupation, ANOVA ( Analysis of variance ) was worked out and it was found to be

significant at 0.001 level ( P < 0.001 ). This implies that knowledge is significantly

increases with the occupational status.

72
 To assess the significance of mean score of knowledge over the three categories

of income, ANOVA ( Analysis of variance ) was worked out and it was found to be

significant at 0.001 level ( p <0.001). This implies that the knowledge score of the girls

significantly increases with family income.

This shows that the guardian’s occupation and family income are significantly

related to knowledge of the girls on reproductive health.

All the variables were significant to the maximum critical level of 5% ( i.e. 0.05).

But, among these socio – demographic variables, subject studying, source of information,

guardian’s occupation and family income were highly significant (i.e. P<0.001). Literacy

status of mothers were moderately significant and place of residence was significant at

only 5% level ( i.e. P <0.05).

73
74
 7. conclusion

Education can generally change people from their wrong and unhealthy

perceptions and practices. A major goal to Nursing practices is to encourage the healthy

practices.

The following conclusion were drawn from the present study

• The adolescent girls have average knowledge

Overall knowledge score of adolescent girls regarding selected aspects of

reproductive health was average ( 50.6% ). The study also showed that socio –

demographic variables such as subject chosen, mother’s educational status, type of

family, place of residence, source of information, guardian’s occupations and family

income are significantly related to the knowledge level of the adolescent girls.

This indicates that an effective programme of health education must be instituted

in school / college with a view to make the adolescents knowledgeable about different

aspects of reproductive health, which help to promote a positive attitude, and healthy

practices of reproductive health.

Nursing Implications

The findings of the study Nursing education, Practice, Research and Nursing

administration.

Nursing Education

Basic education of nursing should include their aspects of education of

adolescents with a special focus on teaching about puberty and the accompanying

change. The primary task is to help the nurse to master at basic level and evaluate the

update content as an ongoing future.

75
 The result of the study enables the nurses to prepare themselves to give health

education more effectively based on culture and social background of the people. The

proper dissemination of information on sexual matters is essential to help children and

adolescent to develop correct and healthy attitude towards sex.

Nursing Practice

Nurses as women and competent professionals have responsibility to promote

health information and practice among women and girls in the society.

It is necessary to have guidance in the school, consisting of school health nurse,

teachers and mothers, so that they can provide guidance to the girls from their pre

adolescent period itself.

Generally, the adolescents are shy and resistant to speak about sex and sex related

matters with mother or family members. So there is a need to take – up an awareness

programme with school teachers to guide them and keep them in a right track. Also most

of the parents have a negative attitude towards reproductive education. Nurses can ply a

major role in changing their attitude about these aspects.

So the provision of information to the mothers have an influence on knowledge of

girls regarding reproductive health since they are the first source of information.

As the teachers are the key personnel in imparting, knowledge to students there is

a need to have a special training programme for the teachers regarding reproductive

health, so that they are equipped with adequate knowledge to guide their students. This

helps in proper dissemination of information since teachers are the major source of

information.

76
 Nursing service department can have a health education cell with a bunch of

adequately prepared nurses. Nursing personnel should be given in service education

regarding the importance of reproductive health. Carefully prepared health education

programme as part of mass education will be useful in creating, awareness among general

public. Nurses have a crucial role in educating the public through such programmes.

Research

The study also revealed that there is knowledge deficit regarding reproductive

health. Compared to other aspects of health there is a need for extended and intensive

nursing research on the areas of reproductive health among adolescent girls using better

methods of teaching and effective teaching materials. At the same time awareness about

the importance of conducting research in the area of reproductive health can be created

among the nurses those who are working in the clinical area. It will help the future

generation to become healthy.

Nursing Administration

Nursing personnel should be prepared to take leadership role in educating school

teaching in reproductive health. They should inculcate interest in educating these

teachers during their school visits and disseminate information on areas of reproductive

health. Nurses should take up responsibility to publish more information booklets and

other health education packages to teachers.

LIMITATIONS

1) Data were obtained using on the semi – structured interview schedule.

2) Effectiveness of information booklet was not assessed.

77
RECOMMENDATIONS

1) A similar study may be replicated using a large sample, thereby findings can be

generalized.

2) A similar study can be conducted on all area of reproductive health ( AIDS,

Teenage abortion, STD, Sex education ).

3) A Study can be conducted to find out the attitude of parents, teachers and students

towards reproductive health.

4) Experimental study can be conducted with structured teaching programme on

knowledge.

5) A longitudinal study may be conducted to assess sexual behaviour of adolescent

girls.

6) A study can be carried out to determine the cost effectiveness of reproductive

health programme.

7) Educational programme on reproductive health can be conducted by the public

health department.

8) Comparative study can be conducted among the urban and rural adolescent girl’s

knowledge regarding reproductive health.

9) Public health nursing students can be instructed to conduct the health education

programme in their school health units.

78
79
 8. SUMMARY

A descriptive study was adopted and the study was conducted in B.E.S. college

Jayanager Bangalore. Data was collected from 60 adolescent girls by using semi-

structured interview schedule

The findings of the study can be summarized as follows:

1) Findings related to Sample characters

ƒ The most of the subject’s mothers ( 35% ) were found to be literate.

ƒ Majority of the subject’s ( 60% ) were residing in urban area.

ƒ A majority of the study subject’s ( 68.4% ) gained knowledge on reproductive

health through teachers and friends.

ƒ Major portion the study subject’s guardians were employees drawing monthly

income ( 38.4% ).

ƒ Majority of girls ( 36.7% ) family income was 1001 – 3000 per month.

2) Finding related to knowledge scoring of Adolescent girls :

ƒ In present study the mean percentage of knowledge of anatomy and physiology of

reproductive health was 49.7%.

ƒ Mean score knowledge of study subjects regarding menstrual hygiene was 53.7%.

ƒ Most of the study subjects had more knowledge ( 58.8% ) in the area of

pregnancy and care.

ƒ Minimum number ( 42.2% ) of the subjects had knowledge in the area of family

planning.

ƒ Over all mean core knowledge of adolescent girls on the selected aspects of

reproductive health were ( 50.7% ) and Standard deviation was 10.32.

80
3) Findings regarding the relationship between selected Demographic variables and

knowledge level of adolescent girls

ƒ There exists a significant relation between the knowledge on selected aspects of

reproductive health and subjects have chosen science as their core subject. It was

found to be significant at .1% ( P < 0.001).

ƒ There is a significant relation between the knowledge on reproductive health and

source of information. Independent ‘t’ test was worked out to determine the

statistical significance of the mean score, it was found to be significant at 1% i.e.

( P <0.01).

ƒ The knowledge of the subjects residing in urban area ( 47.7% ) significantly

higher than the rural residing subjects ( 48.4% ) and it was confirmed at 5% level

( P < 0.05 ). It authenticated that the type of residence in influencing the

knowledge on reproductive health.

ƒ There is a significant relation between the knowledge of students on reproductive

health and type of family. Independent ‘t’ test was carried out to find out the

statistical significance and there is a significant difference between the mean

score on knowledge over family type at 2% level ( i.e. P < 0.02 ).

ƒ The study also showed that there is a significant relation between the knowledge

on reproductive health and mother’s education, which was significant at 2%

( P < 0.02 ).

ƒ Guardian’s occupational status and family income are significantly related to the

knowledge level of the adolescent girls regarding reproductive health.

81
82
 9. Bibliography

1. Rajkumari S. Attitude of girls towards marriage & Planned family, The Journal

family welfare. 1985; (31):36 – 38.

2. World Health Organization. Expanding options in Reproductive Health Geneva

UNDP / UNFPA / WHO / World Bank special programme of Research,

Development and Research Training in Human Reproduction. Geneva : 1992.

3. Varghese Mini. Reproductive child health in the context of women’s Health.

Health for the millions. 1998; 24:16 – 17.

4. Dawn C.S. Text book of Gynaecology and contraception. Calcutta : Dawn

books.1985;13 – 15.

5. Thaneja P.N. The girl child in India. Journal of Indian pediatrics. 1990; (7) : 1041.

6. Khanna J. et al. Challenges in reproductive health. WHO:1994; (4): 12 – 13.

7. Sharma. The why and how of reproductive education in India. Indian Journal of

Maternal and Child health. 1997;(8): 69 – 71.

8. Marriner Ann. Nursing Theorists and their work. Toronto; C.V. mosby company.

9. Polit Denise F. & Bernadette P. Hungler. Nursing Research Philadelphia, J.B.

Lippincott company.1995.

10. Sharma. The why and how of reproductive education in India. Indian Journal of

Maternal and Child health.1997; (8) 69 – 71.

11. Rao A. R. The challenge of adolescent health. Health for the millions.1995; ( 21)

26 – 38.

12. Bobak, Irene. Maternity nursing. Phildelphia : Mosby year book. 1994. 20-23.

83
13. Pillitteri Adele. Maternal Child – Health Nursing. Philadelphia : J.B. Lippincot

company.1992; 45-46.

14. K. Park. Essentials of community health nursing. 3rd Edition. Jabalpur :

Banarsidas publication, 2000. 198 – 200.

15. K. Katharyn, A. May. Comprehensive maternity nursing. 2nd Edition.

Philadelphia: lippincott company. 1999; 98-101.

16. Susan. The experience of menarche. Journal of Nurse Midwifery.1985; 3 – 9.

17. Bobak and Lowder milk. Maternity and women’s health care. Phildelphia :

Mosby year book. 1996; 20-23.

18. Boback Irene et al. Essentials of Maternity Nursing. The Nurse and the

childbearing family. Toronto C.V., Mosby Company. 1987.

19. Bennet, Ruth, India Brow. Myles text book for midwives. 12th Edition. England :

ELBS. 1995; 118 - 141.

20. James, D.K. High risk pregnancy. 2nd Edition. Philadelphia : W.B. Saunders,

1999; 9 –11.

21. Rajkumari S. Attitude of girls towards marriage & Planned family, The Journal

family welfare. 1985; (31):52-54.

22. Kannan A.T. Adolescent Health issues and concerns in India. Health for

Millions.1995; ( 21) 29 – 30.

23. Smitha, M.V. A study to assess the knowledge, attitude and practices regarding

Premarital sex and contraception among adolescent students of selected Pre-

University colleges of Mangalore. 2004.

84
24. Kothari, C.R. Research methodology and technique. Hyderabad : Willey eastern

publications. 1990 ; 68 – 69.

25. Chin & Jacob. Nursing research methods of critical appraisal and utilization.

Philadelphia : Mosby year book, 1994; 228.

26. Polit, Denise F., Hungler, B.P. Nursing Research, Principles and methods.

Philadelphia : J.B. Lippincott Company. 1991; 400.

27. Polit, Denise F., Hungler, B.P. Nursing Research, Principles and methods.

Philadelphia : J.B. Lippincott Company. 1991; 400.

28. Basavanthappa, B.T. Nursing Research.1st Edition. J. P. Brothers, 1998.

29. Kerlinger, Fred, N. Foundations of Behavioural Research. Holt Rinchast &

Winston. Newyork : 1976.

30. Dutta, D. C. Text book of obstetrics. 5th Edition. Calcutta : New central Book

Agency, 2001; 1-16.

31. Dawn C.S. Text book of Gynaecology and contraception. Calcutta : Dawn

books.1985.

32. Pillitteri Adele. Maternal Child – Health Nursing. Philadelphia : J.B. Lippincot

company.1992; 45-46.

33. Dawn C.S. Text book of Gynaecology and contraception. Calcutta : Dawn

books.1985.

85
86
 ANNEXURES

A. Letter seeking permission to conduct the study

B. Letter granting permission to conduct study

C. Letter seeking expert opinion to establish the content validity of the tool

D. Evaluation Criteria Check List

E. Letter of consent by the student for the study

F. List of Content Validators of the prepared Tool

G. Tool used for the study.

H. Health education package on reproductive health.

I. Master Sheet

87
 ANNEXURES-A

LETTER SEEKING PERMISSION TO CONDUCT STUDY

From

SOPHIA
M.Sc. Nursing – II year
Sarvodaya College of Nursing
Vijayanagar
Bangalore

To

The Principal
B. E. S. College
Jayanagar, Bangalore

Sub : Permission to conduct a study in B. E. S. College, Jayanagar, Bangalore

I am IInd year student of M.Sc., Nursing ( Maternity Nursing ), Sarvodaya College

of Nursing, Vijayanagar, Bangalore. I have undertaken a thesis on the topic “ A STUDY

TO ASSESS THE KNOWLEDGE REGARDING SELECTED ASPECTS OF

REPRODUCTIVE HEALTH AMONG ADOLESCENT GIRLS, WITH A VIEW

TO DEVELOP A HEALTH EUDCATION PACKAGE IN B.E.S. COLLEGE,

JAYANAGAR, BANGALORE”.

88
The Objectives of the study are :

1) To assess the knowledge on selected aspects of reproductive health among

adolescents.

2) To determine the relationship between knowledge and selected socio –

demographic variables such as subject chosen, mother’s education, type of family,

place of residence, source of information, guardian’s occupation and family

income.

3) To compare the level of knowledge regarding selected aspect of reproductive

health between Science students and Arts students.

4) To prepare a health education package on selected aspects of reproductive –

health.

In this point of view, I request you to kindly grant me permission to conduct the study

in B. E. S. College, Jayanagar, Bangalore by collecting the necessary information related

to the study.

Thanking you,

Yours faithfully,

SOPHIA

Place : Bangalore

Date :

89
 ANNEXURES-B

LETTER GRANTING PERMISSION TO CONDUCT STUDY

The Principal
B. E. S. College
Jayanagar
Bangalore

Sub : Permission to conduct a study

With reference to the above letter it has been informed that Ms. SOPHIA, Final

year M.Sc. Nursing student, Sarvodaya College of Nursing, Vijayanagar granted

permission to conduct her study in B. E. S. College, Jayanagar, Bangalore. In this regard

the teachers have been directed to provide full help and co-operation in facilitating the

study.

Principal
B. E. S. College
Jayanagar, Bangalore

Place : Bangalore

Date :

90
 ANNEXURES-C

LETTER REQUESTING THE EXPERTS TO COMPUTE THE

CONTENT VALIDITY OF THE TOOL

From :

Mrs. SOPHIA
II year M.Sc., Nursing
Sarvodaya College of Nursing
Bangalore – 560 040

To :

Sir / Madam,

Sub : Request of the Validation of the tool

I Mrs. SOPHIA, M.Sc., Nursing IInd year student of Sarvodaya College of

Nursing, Bangalore have taken a project on “Study on assessment of knowledge

regarding reproductive health among adolescent with the view to develop health

education package” in B E S college, Jayanagar, Bangalore to be submitted to Rajiv

Gandhi University Of Health Sciences, Bangalore as partial fulfillment for Master of

Nursing Degree.

91
The Objectives of the study are :

¾ To assess the knowledge on selected aspects of reproductive health among

adolescents.

¾ To determine the relationship between knowledge and selected socio -

demographic variables such as subject chosen, mother’s education, type of family,

place of residence, source of information, guardian’s occupation and family

income.

¾ To compare the level of knowledge regarding selected aspects of reproductive

health between Science students and Arts students.

¾ To prepare a health education package on selected aspects of reproductive –

health.

I request you to give me your expert opinion and suggestion on the

appropriateness of the items, which need to be modified or deleted, by using the

evaluation criterion check list enclose.

Kindly sign the certificate of validation stating that you have validated the tool

Thanking you in anticipation

Yours faithfully,

Place : Bangalore SOPHIA

Date :

92
 ANNEXURES-D

EVALUATION CRITERIA CHECKLIST

Kindly go through the evaluation criteria checklist for a validation of the tool.

There are two columns given for your responses and a columns for remarks, kindly place

a check ( ) in the appropriate column and give your remarks in the remark column

whenever appropriate.

I request you to kindly give me your valuable suggestions to the content of the

tool. Please give your expert comments on the items you think should be modified or

deleted in respective tool.

Sl. No. Criteria Yes No Remarks

1 DEMOGRAPHIC DATA

1.1 All the items necessary for the study are

present

1.2 Items are in measurable terms

1.3 Any other suggestions

2 STRUCTURED QUESTIONNAIRE

2.1 Relevant to the objectives of the study

2.2 Flow of thought about concept present

2.3 Language is clear to understand

93
Sl. No. Criteria Yes No Remarks

2.4 Content is
• Appropriate
• Organized well

2.5 Items would permit responses, which

would be in measurable terms

2.6 Any other suggestions

Any other suggestion (s) about the tool in general

________________________________________________________

______________________________________________________________

______________________________________________________________

Thanking you in anticipation

SIGNATURE OF THE VALIDATOR

94
 ANNEXURE – E

CONSENT BY THE SUBJECT

Dear Participants,

I Ms. SOPHIA, M.Sc. Nursing student of Sarvodaya College of Nursing,

Vijayanagar, Bangalore interested to know more about your knowledge regarding

selected aspects of reproductive health. The information which you are giving will be

kept confidential and will be used only for this study. Please participate in this program

by answering my questions honestly and state your willingness to participate in this

study.

Thanking you,

Yours truly,

SOPHIA

Participant’s Signature :

95
 ANNEXURE – F

LIST OF CONTENT VALIDATORS OF THE PREPARED TOOL

Mr. Chamanalakar
Principal
Sarvodaya College of Nursing
Bangalore

Mrs. Thamarai Selvi

Associated Professor
Sarvodaya College of Nursing
Bangalore

Mrs. Sangeetha
Associated Professor
Sarvodaya College of Nursing
Bangalore

Mrs. Thialakavathi
Professor
Oxford College of Nursing
Bangalore

Mrs. Jaya Kadambari

Principal
Nightingale College of Nursing
Bangalore

Mrs. Annamma Thomas

Lecturer
K. T. J. College of Nursing
Bangalore

96
Miss. Kanitha
T. John College of Nursing
Bangalore

Dr. Malini
Professor
Department of OBG
Bangalore

Dr. Kumaraswamy
Professor
Department of OBG
Bangalore

Ms. Chithra
Professor
Department of M.S.N.
Sarvodaya College of Nursing
Bangalore

97
 ANNEXURE - G

The tools used for the study “ Semi – Structured interview Schedule

On
Reproductive Health

Part – I : Demographic Data

Instructions : Here are some personal questions which will be kept confidential.

Please complete the following by placing tick ( ). Mark in the

appropriate column.

1. Name of the Student : __________________________________

2. Age : __________________________________

3. Religion : __________________________________

4. Qualification : __________________________________

5. Type of College : (1) Women’s College ( )

(2) Co – Education ( )

6. Mother’s Education : (1) Illiterate ( )

(2) Higher Secondary ( )
(3) Degree ( )
(4) Professional / Technical ( )

7. Father’s Occupation : (1) Business ( )

(2) Professional ( )
(3) Daily Wages ( )
(4) Unemployed ( )

98
8. Family Income – Monthly : (1) Below Rs.1000/- ( )
(2) Rs.1’000/- to Rs.3’000/- ( )
(3) Rs.3’000/- to Rs.5’000/- ( )
(4) Rs.5’000/- and Above ( )

9. Place of living : (1) Urban ( )

(2) Rural ( )
(3) Semi Urban ( )

10. College : (1) Urban ( )

(2) Rural ( )

11. Had you attended any

Sex Education class : (1) Yes ( )
(2) No ( )

12. Your Hobbies : (1) Browsing Internet ( )

(2) Watching Cinema ( )
(3) Sports / Games ( )
(4) Reading Books ( )
13. Sources of reproductive
health ( or ) Sex
Informative from : (1) Parents ( )
(2) Teachers ( )
(3) Friends ( )
(4) Mass Media ( )

99
 Part – II : Knowledge regarding reproductive health

Section – A : Anatomy & Physiology of Reproductive System

Instructions :

• Read the question carefully

• Answer all the questions to the best of your ability
• Please tick ( ) in the appropriate box provided
• You may tick more than response if applicable

1. Age of a girl considered as physically mature ?

(1) Above 15 years ( )

(2) After the age of 18 years ( )
(3) After the age of 21 years ( )
(4) Don’t now ( )

2. Most visible changes that occurs in a girl’s physic during Puberty ?

(1) Development of breast ( )

(2) Auxiliary and Public hair appearance ( )
(3) Widening of hip ( )
(4) All the above ( )

3. Reason for changes in Puberty ?

(1) Ovulation ( )
(2) Increased hormonal levels ( )
(3) Attraction towards opposite Sex ( )
(4) Don’t Know ( )

100
4. Female reproductive Organ consist of ?

(1) Ovaries and fallopian tubes ( )

(2) Uterus and Vagina ( )
(3) All the above ( )
(4) Don’t Know ( )

5. Female sex cell is named as ?

(1) Sperm ( )
(2) Zygote ( )
(3) Ovum ( )
(4) Don’t know ( )

6. Name of the organ which produces female sex cell ?

(1) Uterus ( )
( 2) Cervix ( )
(3) Ovary ( )
(4) Don’t know ( )

7. The release of Ovum from Ovary is called as ?

(1) Fertilization ( )
(2) Ovulation ( )
(3) Menstruation ( )
(4) Don’t Know ( )

101
8. Normally the eggs produce during each cycle ?

(1) One ( )
(2) Two ( )
(3) Three and above ( )
(4) Don’t know ( )

9. Released Ovum is carried to uterus through ?

(1) Cervix ( )
(2) Fallopian tubes ( )
(3) Vagina ( )
(4) Don’t know ( )

10. The male sex cell is named as ?

(1) Ovum ( )
(2) Sperm ( )
(3) Zygote ( )
(4) Don’t know ( )

11. Sperms in male are produced by ?

(1) Testis ( )
(2) Abdomen ( )
(3) Penis ( )
(4) Kidney ( )

102
12. The fluid containing male sex cell ?

(1) Semen ( )
(2) Serum ( )
(3) Urine ( )
(4) Don’t know ( )

13. Fusion of Ovum and Sperm is called as ?

(1) Menstruation ( )
(2) Menopause ( )
(3) Conception ( )
(4) Don’t Know ( )

14. Hormones produced by Ovary ?

(1) Oestrogen and Progestrone ( )

(2) Oestrogen and Androgen ( )
(3) Any other ( )
(4) Don’t Know ( )

15. The male hormone responsible for secondary sexual characteristic ?

(1) Estrogen ( )
(2) Progestrone ( )
(3) Testosterone ( )
(4) Don’t know ( )

103
16. Hereditary traits are passed to children through ?

(1) Genes ( )
(2) Circulation ( )
(3) Hormones ( )
(4) Don’t know ( )

17. Sex of the child is determined by the chromosomes of ?

(1) Father ( )
(2) Mother ( )
(3) Both ( )
(4) Don’t know ( )

18. Consequences of Chromosomal abnormality is ?

(1) Congenital abnormality ( )

(2) Death of foetus ( )
(3) Both ( )
(4) Don’t know ( )

Section - B : Menstruation & Hygiene

19. Menstruation is ?

(1) White discharge from Vagina ( )

(2) Blood from Uterus ( )
(3) It is a destruction of endometrium through vagina every month( )
(4) Don’t know ( )

104
20. The first Menstruation is known as ?

(1) Menarche ( )
(2) Puberty ( )
(3) Menopause ( )
(4) Don’t know ( )

21. Reason for menstruation ?

(1) Hormonal changes ( )

(2) Bad blood is being purified ( )
(3) Body waste is remove ( )
(4) Women’s fate ( )

22. Common age for attaining menarche is ?

(1) Before 9 years ( )

(2) 10 – 13 years ( )
(3) 14 – 17 years ( )
(4) 18 – 24 years ( )

23. Amount of blood loss during each menstrual period ?

(1) 30 ml ( )
(2) 60 – 120 ml ( )
(3) More than 200ml ( )
(4) Don’t know ( )

105
24. Duration of normal menstrual cycle is ?

(1) 1 – 3 days ( )
(2) 3 – 5 days ( )
(3) 5 – 7 days ( )
(4) Don’t know ( )

25. Interval period between each menstruation cycle in ?

(1) 20 days ( )
(2) 22 days ( )
(3) 28 days ( )
(4) 35 days ( )

26. The Hygienic way during menstrual period hygienic is ?

(1) Use clean cloths ( )

(2) Use home made Sanitary napkins ( )
(3) Use of ready made Sanitary napkins ( )
(4) All the above ( )

27. If the cloth is used, it should be ?

(1) Washed in cold water first and then in hot water and dry in sunlight
( )
(2) Wash in hot water then soak in dettol for few minute and dry in dark room
( )
(3) Wash in soap & water ( )
(4) Don’t know ( )

106
28. Sanitary pad should be changed by ?

(1) Once a day ( )

(2) Twice a day ( )
(3) 4 – times a day ( )
(4) Whenever soaked ( )

29. The best method of disposing used pads ?

(1) Cover and discard in waste bin ( )

(2) Burying ( )
(3) Burning ( )
(4) Don’t know ( )

30. The correct technique to clean the hands after placing the pad ?

(1) Wash the hand with water ( )

(2) Wash with soap and water ( )
(3) Keep it as it is ( )
(4) Don’t know ( )

31. Menstrual hygiene is important because ?

(1) To avoid bad smell ( )

(2) To prevent infection ( )
(3) To give comfort ( )
(4) Don’t know ( )

107
32. The correct technique to clean the perineum ?

(1) Urithral orifice to down wards ( )

(2) Anal orifice to urithral wards ( )
(3) No specific method to clean ( )
(4) Don’t know ( )

Section – C : Pregnancy and Care

33. Recommended minimum age for marriage of boys in India is ?

(1) 18 – 20 years ( )
(2) 21 – 25 years ( )
(3) 25 – 30 years ( )
(4) Don’t know ( )

34. Recommended age for marriage for girls in India is ?

(1) 15 – 17 years ( )
(2) 18 – 20 years ( )
(3) 21 – 30 years ( )
(4) Don’t know ( )

35. Early marriage is unadvisable because ?

(1) Bad effect on mother’s health ( )

(2) Bad effect on Baby’s health ( )
(3) All of the above ( )
(4) Don’t know ( )

108
36. Decision to become pregnant is made by ?

(1) Husband ( )
(2) Wife ( )
(3) Parents ( )
(4) 1&2 ( )

37. Normally women become fertile during ?

(1) All days of menstruation ( )

(2) 5 – 7 days following menstruation ( )
(3) 10 – 14 days after the menstruation ( )
(4) Don’t know ( )

38. Early sign of pregnancy is ?

(1) Missing periods ( )

(2) Breast enlargement ( )
(3) Frequency in urination ( )
(4) Nausea / Vomiting ( )

39. A pregnant woman should have regular checkup to prevent ?

(1) Complications of mother ( )

(2) Complications of Baby ( )
(3) Both ( )
(4) Don’t know ( )

109
40. The pregnant woman’s diet should contain ?

(1) Egg, Milk, Meat, Fish, Pulses ( )

(2) Fresh fruits, Vegetables ( )
(3) All the above ( )
(4) Don’t know ( )

41. Vaccine to be given during pregnancy ?

(1) Injection Tetanus Toxide ( )

(2) Injection B12 ( )
(3) Injection BCG ( )
(4) Don’t know ( )

42. A pregnant women must avoid ?

(1) Alcohol / Self medication ( )

(2) Tobacco ( )
(3) All the above ( )
(4) Don’t know ( )

43. Pregnant woman should visit a Doctor if there is ?

(1) Bleeding from the genital passage ( )

(2) Swelling in any part of the body ( )
(3) Severe Headache ( )
(4) All of the above ( )

110
44. Expected month of delivery is ?

(1) 8 – 9 months of pregnancy ( )

(2) 9 – 10 months of pregnancy ( )
(3) 10 – 11 months of pregnancy ( )
(4) 11 – 12 months of pregnancy ( )

Section – D : Family Planning

45. Meaning of family planning is ?

(1) Avoid unwanted pregnancy ( )

(2) Regular interval between pregnancy ( )
(3) Determine number of children in family ( )
(4) All the above ( )

46. The ideal gap between two pregnancy ?

(1) 1 – 2 years ( )
(2) 2 – 3 years ( )
(3) 4 – 5 years ( )
(4) Don’t know ( )

47. The number of children per a couple recommended by Indian family planning ?

(1) Two Children ( )

(2) One Child ( )
(3) Three children ( )
(4) Any Number ( )

111
48. Family planning method are ?

(1) Natural method ( )

(2) Artificial method ( )
(3) Both ( )
(4) Don’t Know ( )

49. The temporary method of male contraception is ?

(1) Condom ( )
(2) Cutting the tube which carries sperm ( )
(3) Both ( )
(4) Don’t know ( )

50. The permanent method of male contraception is ?

(1) Condom ( )
(2) Cutting the tube which carries sperm ( )
(3) Both ( )
(4) Don’t know ( )

51. The permanent method of female contraception is ?

(1) Copper – T ( )
(2) Oral pills ( )
(3) Cutting the tube which carries Ovum ( )
(4) Don’t know ( )

112
 ANNEXURE – H

HEALTH EDUCATION PAMPHLET

INTRODUCTION

Adolescence is the period between the beginning of puberty ( 11 to 14 years ) and

the cessation of bodily growth, during this period there will be massive changes in

psychical growth and psychological development, with emotional maturity and transition

in sexual roles. This period can be divided into early ( 12 through 14 years ) middle ( 15

through 16 years ) and late adolescence ( 17 through 18 years ). Adolescent girls should

have basic knowledge regarding the aspect of reproductive health.

OBJECTIVE

The health education pamphlet helps the girls to learn about anatomy and

physiology of reproductive health, menstrual hygiene, pregnancy and care and family

planning methods.

113
 LESSON – 1

ANATOMY & PHYSIOLOGY OF REPRODUCTIVE SYSTEMS

The female reproductive system consists of the external, internal and accessory

reproductive organs.

External Female Genitalia

Vulva : The term used to designate all visible structure from

pubis to perineum.

Mons Pubis : It is the fatty cushion that lies over the anterior

symphysis pubis.

Clitoris : Is a small cylindrical body which corresponds with the

penis of the male. It is very sensitive to touch and

temperature and also the center of sexual arousal and

orgasm in the female.

114
Labia Majora : Labia majora forms the side of vulva

Labia Minora : Posterior to monsveneris, spread two folds of

connective tissue is labia minora.

Vestibule : Is an almond – shaped area, that extends from the

clitoris to the posterior fourchette. It contains urethra,

skene’s dects, vaginal orifice and bartholin’s gland.

Hymen : It is a thin elastic tissue covering the opening the

vagina, which is perforated centrally to drain menstrual

blood flow.

The Internal Genital Organ

115
Vagina

Vagina is a muscular tube opening, which leads to the uterus.

Functions :

ƒ Active part in sexual intercourse.

ƒ To receive the sperm.

ƒ It act as a excretory channel for uterine secretions and

menstrual blood flow.

ƒ It forms the birth canal during delivery.

Uterus

The Uterus is a small, hollow organ. It has got three layers – endometrium,

myometrium and perimetrium. Its weight is about 60 gms.

Functions :

ƒ Protect and nourishes the fetus for nine months

Ovaries

Two almond shaped organ, situated by the side of uterus. The ovary

releases an ovum called ovulation.

Functions :
ƒ Produces Ovum

ƒ Produces hormones, estrogen and progesterone responsible

for secondary sexual characteristics.

ACCESSORY REPRODUCTIVE ORGAN

Breast :
It concerned with lactation following child birth. A dark colored

pigmented area at the center of breast called areola and a muscular projection at

the center of areola is called nipple.

116
PHYSICAL AND PHYSIOLOGICAL CHANGES IN GIRLS

ƒ Enlargement of the breast and nipples

ƒ Widening of hips

ƒ Growth of hair in the armpits and genital area

ƒ Development of pimples on the face

ƒ Occurrence of menstruation at each month

ƒ Skeletal growth ends by 18 years of age.30

LESSION – II

MENSTRUATION AND HYGIENE

ƒ Meaning : It is the monthly discharge of blood, and endometrium, from the

uterus, beginning at the age of puberty and lasting until the menopause.

ƒ Interval between menstrual cycle : 28 – 30 days

ƒ Average duration of menstrual cycle : 3 – 5 days

ƒ Average amount of blood flow during menstruation : 60 – 120ml

Menstruation is not caused by disease but controlled

by the sex hormones oestrogen and progesterone

117
PHASE OF MENSTRUAL CYCLE

There are three phases of menstrual cycle. The phases occur as a result of the effect

of hormonal influence on the ovaries and uterus.

Menstrual Phase :

This is the phase of menstrual bleeding.

Proliferative-follicular phase :

During this phase, a single follicle has assumed dominance. Under the influence

of LH, the release of the dominant follicle in preparation for conception.

Secretary – luteal phase :

Begins after ovulation. During this phase the endometrial lining charges in

substance to provide a glycogen rich environment to foster implantation. If pregnancy

does not occur, shedding of endometrium occurs which results in menstruation.

Menstrual Hygiene

ƒ Give special attention to cleaning the vulva thoroughly from urethral orifice to anal

orifice with water every time your change your sanitary pad / cloth.

ƒ Change your sanitary pad / cloth every 3 to 4 hours or as often as necessary to prevent

odour and infection.

ƒ Dispose the pad by burning & sanitary cloth can be washed with tap water and soap

and dry under sun before the next use.

ƒ It is common to have some discharge coming from vagina, before menstruation.

ƒ If the discharge is smelling, a doctor may be consulted

118
ƒ There may also be some itching around the genital opening or in the groins especially

after menstruation.31

LESSION - III

PREGNANCY AND CARE

i) Meaning of Pregnancy : It is a period from conception to the

expulsion of the fetus. Normally it covers

280 days or nine calendar months.

ii ) Conception : It is the stage, when the seed ( zygote ) is

formed by the union of male sperm and

ovum, and the uterus provides space and

nourishment to the “seed”.

iii) Signs and symptoms of pregnancy :

ƒ The woman misses her periods

ƒ Nausea and vomiting during the first three months

ƒ Frequency in urination

ƒ Abdominal enlargement

ƒ Enlargement of the breast

ƒ Dark areas on the face, breasts, silvery white markings in abdomen

ƒ Baby starts moving in the womb from the fifth month.

119
iv ) Stages of Growth :

1ST Lunar Month

™ The fetus is 0.75cm to 1 cm in length

™ Foundations for nervous system.

Genitourinary system, skin, bones and

Lungs are formed.

™ Buds of arms and legs begin to form

™ Eyes, ears and nose appear.

2nd Lunar Month

™ The fetus is 2.5cm in length and weighs 4gm.

™ Fetus is markedly bent

™ Head is disproportionately large for brain

Development

3rd Lunar Month

™ The fetus is 7cm to 9cm in length and

Weight 28gm.

™ Fingers and toes are distinct.

™ Fetal circulation is complete.

4th Lunar Month

™ The fetus is 10cm to 17cm in length and

Weighs 55gm to 120gm.

™ Sex is differentiated.

120
 ™ Kidneys secrete urine

™ Heartbeat is present.

5th Lunar Month

™ The fetus is 25cm in length and weighs 223gm.

™ Hairs covers entire body.

™ Fetal movements are felt by mother

6th Lunar Month

™ The fetus is 28cm to 36cm in length

And weighs 680 gm.

™ Skin appears wrinkled

™ Eyebrows and fingernails develop.

7th Lunar Month

™ The fetus is 35cm to 38cm in length

And weighs 1200gm.

™ Skin is red.

™ The fetus has an excellent change of

Survival.

8th Lunar Month

™ Length 38cm to 43cm, weighs 2.7 kg.

™ Fetus is viable

121
9th Lunar Month

™ Length 42cm to 49cm, weighs

1900gm to 2700gm.

™ Fat deposit on the body.

10th Lunar Month

™ Length 42 – 42cm, weighs 3000gm.

™ Full term baby

V ) Do’s and Don’ts during Pregnancy :

Do’s in Pregnancy :

a) Diet :

The pregnancy diet ideally should be light, nutritious, easily digestible and rich in

protein, minerals and vitamins.

122
 THE FOOD GUIDE PYRAMID

A guide to daily food choices

Recommended daily prenatal vitamin and mineral supplement for pregnant women.

Iron 30 – 60 mg Vitamin C – 80 mg
Zinc 15mg Vitamin D – 10mg
Copper – 2 mg Calories – 2800 kcal
Calcium – 250mg Protein – 60g / day

a) A pregnant mother has to drink ten to twelve glasses of water per day.

Supplementary iron therapy is needed for all pregnant mother from 20 week

onwards.

b) Exercise : Regular mild exercise like walking is helpful for pregnant women.

c) Rest and sleep : A pregnant woman should sleep at least, 8 hours at night and 2

hours at noon.

123
 d) Antenatal Hygiene :

Bowel : Regular bowel movement can be encouraged by

regulation of diet, taking plenty of fluids, vegetables

and fruits.

Bathing : Bathe daily and wear light cotton loose clothes.

Avoid heel shoes.

Dental Care : Proper oral hygiene is to be maintained.

Care of the breasts : Maintain cleanliness. If the nipples are retracted,

correction is to be done in the later months by using

shields.

e) Immunization : Two does of injection tetanus toxoid at 6 weeks

interval is to be given.

f) Health checkup : Regular checkups are needed. Report to doctor

immediately if symptoms like intense headache,

disturbed sleep with restlessness, urinary troubles,

epigastric pain, vomiting and scanty urination

occurred.

g) Prepare for safe delivery: Keep article needed for both mother & baby.

( Money, clean cotton clothes for mother and baby

etc. )

Don’t in Pregnancy

ƒ Long journey to be avoided during first and last 3 months

ƒ Avoid smoking and alcoholism

124
 ƒ Avoid self – medications

ƒ Avoid vigorous exercises like cycling, motor vehicle riding

ƒ Avoid X – ray examination during the first 6 months.

vi) Care of mother after delivery

ƒ Daily bathing and keep the genital area clean and dry. Change the pads, 3 – 4

times a day and whenever necessary.

ƒ Take a light diet on the first day and normal diet may be resumed from the 2nd

day.

ƒ Drink at least 6 – 8 glasses of fluid in a day.

ƒ Early ambulation and light exercises are encouraged

ƒ Observe for any abnormal discharge and bleeding per vagina

ƒ Pass urine every 4 – 5 hours interval

ƒ A diet rich in fiber, and fluids helps to move the bowel

ƒ Mother has to come to the hospital for check – up after 6 weeks.

vii) Care of Body

ƒ Feed the baby with colostrums ( first breast milk ) at the earliest. It is rich in

antibodies and vitamin A and protects the baby against infection

ƒ Protect the baby from excessive heat or cold.

ƒ Bathe the baby daily with mild soap and keep the umbilical cord clean and dry.

ƒ Keep the baby close to the mother’s body.

ƒ Change diaper or clothes each time it has got wet

ƒ Protect the baby from mosquitoes and insects.

125
 ƒ Avoid people with infections coming in contact with the baby.

ƒ Provide a room away from smoke and dust.

ƒ Do not apply any ointments / powder on the umbilical stump.

ƒ Give immunization as per schedule.32

LESSION – IV

FAMILY PLANNING

Meaning :

Family planning is a way of thinking and living in order to build a healthy

family by small family norm.

Types of Family Planning

ƒ Temporary methods

ƒ Permanent methods

1. Temporary Methods

ƒ This method adopted to postpone or space births.

a) Birth control pills ( Oral contraceptives )

126
 It is a temporary method of family planning. Seek medical advice before taking

birth control pills.

b) Condom ( Prophylactic, “Sheath or rubber” )

It is narrow, rubber, or latex bag intended for men. It helps to prevent pregnancy

as well as sexually transmitted diseases.

c) Diaphragm

It is a shallow cup made of soft rubber and intended for women.

d) The Intra Uterine Devices

It is a plastic or sometimes a metal object that a medical person, places inside the

womb to prevent pregnancy. It is the simplest and most economical method.

Spermicide : It is a chemical method of contraception, to kill the sperm.

e) Withdrawal method ( Coitus interrupts )

This is another form of family planning methods used by the men.

f) Injections

There are special injections to prevent pregnancy. An injection is given every

three months.

127
g) Safe period ( Rhythm method ) ( Calendar method )

The couple can be advised to have intercourse one week before the day of

menstrual cycle and up to one week from the first day of the menstrual period. Ovulation

usually occurs 14th day prior to the next menstruation.

II. Permanent Methods

ƒ Tubectomy or female sterilization

It is the surgery done where the tube which carries ovum is cut so that the

ovum and sperm cannot meet each other and pregnancy does not occur.

ƒ Vasectomy or male sterilization

In this the tube which carries sperm is cut and clamped. This helps the

male to become sterile.33

SUMMARY

You have learned the aspects of reproductive health such as anatomy &

physiology of reproductive system, menstruation and hygiene, pregnancy care and family

planning methods.

128
 ANNEXURE – I

Demographic Data

Q. N
2 3 4 5 6 7 8 9 10 11 12 13
S. N
A
1. 17 H 2 3 1 4 3 1 2 2 3
2. 16 H A 2 2 1 4 1 1 2 2 4
3. 17 M Sc. 2 1 1 4 3 1 3 3 4
4. 18 H A 2 3 1 4 3 1 2 2 3
5. 17 M Sc. 2 2 1 4 1 1 2 2 4
6. 19 H A 2 1 1 4 3 1 3 3 4
7. 17 H A 2 3 1 4 3 1 2 2 3
8. 16 H Sc. 3 2 1 3 2 1 2 3 2
9. 17 H A 2 3 1 4 3 1 2 2 3
10. 16 H A 2 2 1 4 1 1 2 2 4
11. 17 H Sc. 2 1 1 4 3 1 3 3 4
12. 18 H A 2 3 1 4 3 1 2 2 3
13. 17 H Sc. 2 2 1 4 1 1 2 2 4
14. 19 H A 2 1 1 4 3 1 3 3 4

129
15. 17 H A 2 3 1 4 3 1 2 2 3
16. 16 H Sc. 3 2 1 3 2 1 2 3 2
17. 19 H A 2 1 1 4 3 1 3 3 4
18. 17 H A 2 3 1 4 3 1 2 2 3
19. 16 H Sc. 3 2 1 3 2 1 2 3 2
20. 17 H A 2 3 1 4 3 1 2 2 3
21. 16 H A 2 2 1 4 1 1 2 2 4
22. 17 H Sc. 2 1 1 4 3 1 3 3 4
23. 18 H A 2 3 1 4 3 1 2 2 3
24. 19 H A 2 1 1 4 3 1 3 3 4
25. 17 H A 2 3 1 4 3 1 2 2 3
26. 16 H Sc. 3 2 1 3 2 1 2 3 2
27. 18 C A 2 3 1 4 3 1 2 2 3
28. 17 H Sc. 2 2 1 4 1 1 2 2 4
29. 19 H A 2 1 1 4 3 1 3 3 4
30. 17 H A 2 3 1 4 3 1 2 2 3
31. 16 H Sc. 3 2 1 3 2 1 2 3 2
32. 19 H A 2 1 1 4 3 1 3 3 4
33. 17 C A 2 3 1 4 3 1 2 2 3
34. 16 H Sc. 3 2 1 3 2 1 2 3 2

130
35. 17 H A 2 3 1 4 3 1 2 2 3
36. 19 H A 2 1 1 4 3 1 3 3 4
37. 17 H A 2 3 1 4 3 1 2 2 3
38. 16 H Sc. 3 2 1 3 2 1 2 3 2
39. 19 H A 2 1 1 4 3 1 3 3 4
40. 17 C A 2 3 1 4 3 1 2 2 3
41. 16 H A 2 2 1 4 1 1 2 2 4
42. 17 H Sc. 2 1 1 4 3 1 3 3 4
43. 18 H A 2 3 1 4 3 1 2 2 3
44. 17 H Sc. 2 2 1 4 1 1 2 2 4
45. 18 C A 2 3 1 4 3 1 2 2 3
46. 17 C A 2 3 1 4 3 1 2 2 3
47. 16 H Sc. 3 2 1 3 2 1 2 3 2
48. 17 H A 2 3 1 4 3 1 2 2 3
49. 16 H A 2 2 1 4 1 1 2 2 4
50. 17 H Sc. 2 1 1 4 3 1 3 3 4
51. 18 H A 2 3 1 4 3 1 2 2 3
52. 17 H Sc. 2 2 1 4 1 1 2 2 4
53. 19 H A 2 1 1 4 3 1 3 3 4
54. 17 H A 2 3 1 4 3 1 2 2 3

131
55. 16 H Sc. 3 2 1 3 2 1 2 3 2
56. 16 H A 2 2 1 4 1 1 2 2 4
57. 17 H Sc. 2 1 1 4 3 1 3 3 4
58. 18 H A 2 3 1 4 3 1 2 2 3
59. 17 H Sc. 2 2 1 4 1 1 2 2 4
60. 19 H A 2 1 1 4 3 1 3 3 4

132
 PART – II

Section – A : Anatomy and Physiology of Reproductive System

Q. N
1 2 3 4 5 6 7 8 9 10 11 12 13 14
S. N
1. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
2. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
3. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
4. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
5. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
6. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
7. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
8. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
9. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
10. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
11. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
12. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
13. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
14. 2 1 1 2 4 2 4 3 3 4 2 2 2 2

133
15. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
16. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
17. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
18. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
19.
20. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
21. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
22. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
23. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
24. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
25. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
26. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
27. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
28. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
29. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
30. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
31. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
32. 2 1 1 2 4 2 3 3 3 4 1 2 1 3

134
33. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
34. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
35. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
36. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
37. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
38. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
39. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
40. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
41. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
42. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
43. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
44. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
45. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
46. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
47. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
48. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
49. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
50. 2 1 1 2 4 2 3 3 3 4 1 2 1 3

135
51. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
52. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
53. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
54. 2 1 1 2 3 2 3 3 3 3 1 2 3 1
55. 2 1 2 2 3 2 3 3 1 3 2 2 3 3
56. 2 1 1 2 4 2 3 3 3 4 1 2 1 3
57. 2 1 1 2 4 2 4 3 3 4 2 2 2 2
58. 2 1 4 3 3 3 3 3 2 3 3 2 1 2
59. 3 1 1 2 2 1 3 3 2 4 1 2 2 2
60. 2 1 1 2 3 2 3 3 3 3 1 2 3 1

136
 Section – B : Menstrual Hygiene

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
2 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
3 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
4 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
5 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
6 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
7 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
8 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
9 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
10 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
11 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
12 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
13 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
14 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
15 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
16 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
17 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
18 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
19 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
20 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
21 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
22 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1

137
23 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
24 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
25 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
26 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
27 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
28 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
29 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
30 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
31 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
32 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
33 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
34 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
35 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
36 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
37 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
38 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
39 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
40 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
41 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
42 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
43 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
44 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
45 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
46 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
47 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2

138
48 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
49 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
50 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
51 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
52 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
53 1 2 2 1 2 2 3 3 3 2 1 1 3 3 3 1 3 1
54 2 1 3 1 3 3 2 1 2 2 1 1 3 1 3 1 3 1
55 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
56 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3
57 1 1 4 1 3 2 3 1 2 2 3 1 3 2 3 1 3 1
58 2 4 1 1 3 3 1 1 3 2 3 1 3 2 3 1 3 2
59 4 3 1 1 3 2 1 2 2 1 1 2 3 2 3 1 3 1
60 2 1 2 1 3 3 2 1 3 2 1 1 3 1 3 1 3 3

139
 SECTION – C : Pregnancy and care

Q. N
1 2 3 4 5 6 7 8 9 10 11 12
S. N
1 3 2 1 4 2 4 3 1 1 3 1 1
2
2 2 1 4 2 1 3 1 2 3 1 1
3
2 2 2 4 4 4 3 1 2 3 1 2
4
3 2 3 4 3 4 3 1 1 3 1 1
5
3 2 3 4 3 1 3 3 1 3 2 1
6
3 2 1 4 2 1 3 3 1 3 2 1
7
3 2 1 4 2 4 3 1 1 3 1 1
8
2 2 1 4 2 1 3 1 2 3 1 1
9
2 2 2 4 4 4 3 1 2 3 1 2
10
3 2 3 4 3 4 3 1 1 3 1 1
11
3 2 3 4 3 1 3 3 1 3 2 1

140
12
3 2 1 4 2 1 3 3 1 3 2 1
13
3 2 1 4 2 4 3 1 1 3 1 1
14
2 2 1 4 2 1 3 1 2 3 1 1
15
2 2 2 4 4 4 3 1 2 3 1 2
16
3 2 3 4 3 4 3 1 1 3 1 1
17
3 2 3 4 3 1 3 3 1 3 2 1
18
3 2 1 4 2 1 3 3 1 3 2 1
19
3 2 1 4 2 4 3 1 1 3 1 1
20
2 2 1 4 2 1 3 1 2 3 1 1
21
2 2 2 4 4 4 3 1 2 3 1 2
22
3 2 3 4 3 4 3 1 1 3 1 1
23
3 2 3 4 3 1 3 3 1 3 2 1
24
3 2 1 4 2 1 3 3 1 3 2 1

141
25
2 2 2 4 4 4 3 1 2 3 1 2
26
3 2 3 4 3 4 3 1 1 3 1 1
27
3 2 3 4 3 1 3 3 1 3 2 1
28
3 2 1 4 2 1 3 3 1 3 2 1
29
2 2 1 4 2 1 3 1 2 3 1 1
30
2 2 2 4 4 4 3 1 2 3 1 2
31
3 2 3 4 3 4 3 1 1 3 1 1
32
3 2 3 4 3 1 3 3 1 3 2 1
33
3 2 1 4 2 1 3 3 1 3 2 1
34
2 2 1 4 2 1 3 1 2 3 1 1
35
2 2 2 4 4 4 3 1 2 3 1 2
36
3 2 3 4 3 4 3 1 1 3 1 1
37
3 2 3 4 3 1 3 3 1 3 2 1

142
38
3 2 1 4 2 1 3 3 1 3 2 1
39
2 2 1 4 2 1 3 1 2 3 1 1
40
2 2 2 4 4 4 3 1 2 3 1 2
41 3 2 3 4 3 4 3 1 1 3 1 1
42 3 2 3 4 3 1 3 3 1 3 2 1
43 3 2 1 4 2 1 3 3 1 3 2 1
44 2 2 1 4 2 1 3 1 2 3 1 1
45 2 2 2 4 4 4 3 1 2 3 1 2
46 3 2 3 4 3 4 3 1 1 3 1 1
47 3 2 3 4 3 1 3 3 1 3 2 1
48 3 2 1 4 2 1 3 3 1 3 2 1
49 2 2 1 4 2 1 3 1 2 3 1 1
50 2 2 2 4 4 4 3 1 2 3 1 2
51 3 2 3 4 3 4 3 1 1 3 1 1
52 3 2 3 4 3 1 3 3 1 3 2 1
53 3 2 1 4 2 1 3 3 1 3 2 1
54 2 2 1 4 2 1 3 1 2 3 1 1
55 2 2 2 4 4 4 3 1 2 3 1 2

143
56 3 2 3 4 3 4 3 1 1 3 1 1
57 3 2 1 4 2 1 3 3 1 3 2 1
58 2 2 1 4 2 1 3 1 2 3 1 2
59 2 2 2 4 4 4 3 1 2 3 1 1
60 3 2 3 4 3 4 3 1 1 3 1 1

144
 SECTION – D : Family planning

1 2 3 4 5 6 7
1 3 2 1 4 1 2 3
2 3 2 1 4 1 2 3
3 1 1 1 4 1 2 3
4 4 1 1 1 1 2 3
5 3 3 1 1 1 2 3
6 2 1 1 4 1 2 3
7 3 2 1 4 1 2 3
8 3 2 1 4 1 2 3
9 1 1 1 4 1 2 3
10 4 1 1 1 1 2 3
11 3 3 1 1 1 2 3
12 2 1 1 4 1 2 3
13 1 1 1 4 1 2 3
14 4 1 1 1 1 2 3
15 3 3 1 1 1 2 3
16 2 1 1 4 1 2 3
17 3 2 1 4 1 2 3

145
18 3 2 1 4 1 2 3
19 3 2 1 4 1 2 3
20 3 2 1 4 1 2 3
21 1 1 1 4 1 2 3
22 4 1 1 1 1 2 3
23 3 3 1 1 1 2 3
24 2 1 1 4 1 2 3
25 3 2 1 4 1 2 3
26 3 2 1 4 1 2 3
27 1 1 1 4 1 2 3
28 4 1 1 1 1 2 3
29 3 3 1 1 1 2 3
30 2 1 1 4 1 2 3
31 1 1 1 4 1 2 3
32 4 1 1 1 1 2 3
33 3 3 1 1 1 2 3
34 2 1 1 4 1 2 3
35 3 2 1 4 1 2 3
36 3 2 1 4 1 2 3

146
37 3 2 1 4 1 2 3
38 3 2 1 4 1 2 3
39 1 1 1 4 1 2 3
40 4 1 1 1 1 2 3
41 3 3 1 1 1 2 3
42 2 1 1 4 1 2 3
43 3 2 1 4 1 2 3
44 3 2 1 4 1 2 3
45 1 1 1 4 1 2 3
46 4 1 1 1 1 2 3
47 3 3 1 1 1 2 3
48 2 1 1 4 1 2 3
49 1 1 1 4 1 2 3
50 4 1 1 1 1 2 3
51 3 3 1 1 1 2 3
52 2 1 1 4 1 2 3
53 3 2 1 4 1 2 3
54 3 2 1 4 1 2 3
55 2 1 1 4 1 2 3

147
56 1 1 1 4 1 2 3
57 4 1 1 1 1 2 3
58 3 3 1 1 1 2 3
59 2 1 1 4 1 2 3
60 3 2 1 4 1 2 3

148