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Trina Sengupta, MBBS*, Bobby Paul, DCH, M.D.(PSM)**, Lina Bandyopadhyay, M.D. (PSM)***, Ranjan Das,
M.D.(PSM)****, Ankush Banerjee, MBBS, M.D.******
*Department of Preventive & Social Medicine, All India Institute of Hygiene & Public Health, Kolkata, India, **Department of Occupational Health,
All India Institute of Hygiene & Public Health, Kolkata, India, ***Department of Preventive & Social Medicine, All India Institute of Hygiene &
Public Health Kolkata, India, ****Department of Preventive and Social Medicine, All India Institute of Hygiene & Public Health Kolkata, India,
*****Department of Preventive & Social Medicine, All India Institute of Hygiene & Public Health Kolkata, India.
Determinants of Modern Contraceptive Usage
among Married Women: A Mixed-Methods Study
in a Rural Community of India
ABSTRACT
Objective: A woman’s multifaceted feelings, knowledge, and perceptions of their intimate relations greatly inuence
their contraceptive behavior. In addition, women empowerment has been increasingly recognized as a key factor
in family planning and reproductive health outcomes. is study aimed to assess modern contraceptive usage and
its determinants among currently married women of reproductive-age (WRA) in rural Bengal.
Materials and Methods: is mixed-method study was conducted in a rural area of Hooghly District, West Bengal
from April to September 2021. e quantitative strand of the study was conducted by interviewing 210 currently
married WRA. e qualitative strand was conducted via focussed group discussions among husbands/mothers-
in-law and in-depth interviews with healthcare workers. SPSS soware was utilized for quantitative data analysis
and factors associated with contraceptive usage were analyzed using logistic regression models. Qualitative data
were analyzed thematically.
Result: Currently 114 (54.8%) study participants were using modern contraceptive methods. Education (aOR=7.65,
95% CI=1.85-31.67), empowerment through freedom from family domination (aOR=5.56, 95% CI=1.30-23.66),
attitude on contraception (aOR=4.67, 95% CI=1.26-17.19), and family planning counselling (aOR=4.41, 95%
CI=1.12-17.33) were found to be signicantly associated with modern contraceptive usage. Lack of couple counselling,
family support, and knowledge gap was identied as the major barriers to contraceptive usage.
Conclusion: Since a woman’s decision-making ability signicantly aects their sexual and reproductive health
outcomes, eective measures should be undertaken to empower them by creating awareness regarding their rights
and freedom to make strategic life choices. Couple counselling should be prioritized to enhance male involvement
and eliminate perceived barriers.
Keywords: Contraceptive; empowerment; family support; India; mixed-methods (Siriraj Med J 2022; 74: 666-674)
Corresponding author: Ankush Banerjee
E-mail: ankush.banerjee20@gmail.com
Received 3 August 2022 Revised 24 August 2022 Accepted 7 September 2022
ORCID ID:http://orcid.org/0000-0003-2762-123X
http://dx.doi.org/10.33192/Smj.2022.78
All material is licensed under terms of
the Creative Commons Attribution 4.0
International (CC-BY-NC-ND 4.0)
license unless otherwise stated.
INTRODUCTION
Family Planning (FP) is a cost-eective investment,
the timely intervention of which can help in reducing
the impact of high population growth in any country.
India became the pioneer country in the world to launch
a National Family Planning Programme in 1952. e
current slogan of this program: “Jodi Zimmeder Jo Plan
Kare Parivar” (Responsible couples are those who plan
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their family) reflects the broader holistic aspects of
family planning rather than just mere achievement of
replacement level of fertility.
1
Modern contraceptive
services which are available under this program are
broadly of two types- spacing methods (condoms, oral
contraceptive pills, intrauterine devices), and permanent
methods (sterilization techniques). e present aim of
this program in India is to emphasize the need for a
reduction in the number of unintended pregnancies,
proper birth spacing, and attainment of the ideal age
of rst pregnancy.
is current initiative has helped the country to
traverse a long way in achieving its goal of slowing the
population growth as recent data as per the National
Family Health Survey (NFHS-5) statistics have shown that
India’s TFR (Total Fertility Rate) has come down to the
replacement level of 2. Despite this nationwide laudable
achievement, some states in India (Madhya Pradesh,
Rajasthan, Uttar Pradesh, Jharkhand) are still lagging
behind their desired fertility rates. Moreover, India still
houses approximately 9.4% of eligible couples with an
unmet need for FP, reecting a signicant gap between
their reproductive intentions and contraceptive behavior.
2
Family planning plays a central role in women’s health
by reducing the mortality rate of unsafe abortions and
undesired pregnancies.
3
Previous studies have shown
that approximately 15.6 million abortions have been
performed in India in the year 2015, which was associated
with a high rate of unintended pregnancy (70.1 per 1000
women aged 15-49 years).
4
NFHS-5 also showed that
the state of West Bengal deserves special mention as the
proportion of total unmet needs is particularly high in
rural areas (7.8%) as compared to urban areas(5.2%).
Lower rates of contraceptive usage in India; especially
in rural areas are largely driven by gender inequality
and lack of female autonomy over family planning
choices. A study by Shakya et al done in rural India
had shown that women empowerment was higher in
those couples who received increasing communication
regarding contraception.
5
Women empowerment which
has been dened as ‘the expansion of people’s ability to
make strategic life choices in a context where this ability
was previously denied to them’ has increasingly been
recognized as a key factor aecting FP and reproductive
health outcomes among women.
6,7
In developing nations
like India where gender discrimination is very prominent
(particularly in rural areas), a complete understanding
of how gender-based power inuences the ability to
access and use contraceptives is the need of the hour.
Moreover, the inuence of family-level stakeholders on a
woman’s choice of contraceptives as well as deciencies
at the health sector level needs further exploration, thus
mandating the necessity of mixed-method research. With
this backdrop, the present study aimed to assess the
contraceptive usage patterns and their major determinants
(through quantitative strand) among the currently married
women of the reproductive age group (WRA). Again the
perspective about using modern contraceptives among
family-level stakeholders (husbands and mothers-in-
law in the case of this particular study) and also the felt
barriers of healthcare workers with regards to providing
family planning services to the rural community were
explored through the qualitative strand of the study.
MATERIALS AND METHODS
is cross-sectional study with a mixed-methods
approach (convergent parallel design) was conducted
from April to September 2021in the rural service area of
the Rural Health Unit and Training Centre (RHUTC),
Singur, Hooghly District, West Bengal. Two primary
health centres and 12 sub-centers are situated in the
study area from where family planning services are
provided to the community comprising of 64 villages. e
quantitative strand of this study was conducted among the
currently married WRA (15 to 49 years of age), residing
in the study area for at least ve years. ose who did
not give written informed consent were critically ill or
had undergone hysterectomy or oophorectomy were
excluded. For the qualitative strand, family members
comprising of husbands and mothers-in-law of study
participants, as well as healthcare workers working in
the study area for at least 1 year, were selected.
Sampling:
According to the National Family Health Survey 5
(NFHS 5), the prevalence of modern contraceptive usage
among currently married women in West Bengal was
found to be 60.6%.
2
Considering P=0.606, an absolute
error of precision (L)=10%, design eect=2 (for cluster
sampling in the rst stage), and non-response rate=5%
(for simple random sampling done in the second stage)
the sample size estimated using standard Cochran’s
formula was 201.
8
Since a two-stage cluster sampling
technique was applied comprising 15 clusters, the nal
sample size came to be 210.
A list of all 64 villages (along with the population of
each village) situated in the rural service area of RHUTC,
Singur was taken. From that list, 15 villages were selected
through a probability proportional to size (PPS) method.
From each of those 15 villages, 16 currently married
WRA, residing at those villages were selected by Simple
Random Sampling. ese selected participants were
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approached at their residences with help of eld-level
healthcare workers. For the qualitative strand, participants
were selected purposively and data was collected till the
point of data saturation.
Data Collection, Study Tools, and Parameters used:
e quantitative part of the study was conducted
through face-to-face interviews among the currently
married WRA. A predesigned, pretested structured
questionnaire was prepared [translated into the local
language of Bengali] which was face and content validated
by a team of public health experts. It consisted of the
following domains-
a) Socio-demographic characteristics which included age,
religion, educational status, occupation, socio-
economic status, type of family, and number of
children.
b) Knowledge regarding contraceptives and attitude
towards their usage: e knowledge-based section
consisted of 12 items where the participants had to
respond as “True, False, or Don’t Know” (Cronbach’s
alpha=0.73). The correct response was given a
score of ‘1’ while the wrong response or “Don’t know”
fetched a score of ‘0’. Total scores ranged from 0 to
12 while the cut-o for having satisfactory knowledge
was taken to be the 75
th
percentile of the total attained
score (=8). Attitude toward using contraceptives
consisted of a 10-items questionnaire, distributed
across three domains: Attitude towards perceived
benets of contraception, perceived barriers from
family-level stakeholders, and perceived self-barriers
to contraceptive use (Cronbach’s alpha= 0.67). Each
item had three options (Disagree, Neutral, and
Agree) with scores ranging from -1 to 1. e total
(ranging from -10 to 10) was calculated by adding
scores of each domain. Cut-o for having a favorable
attitude was taken to be the 75
th
percentile of the
total attained score (=5).
c) Women’s Empowerment Scale adopted from
Compendium of Gender Scale by C-change (previously
applied in a similar demographic setting in Bangladesh):
It consisted of 18 items, distributed across three
sub-scales: i) women’s mobility (8 items) in which
each respondent was given a score of ‘1’ for each
place she had visited and an additional score of ‘1’
if she had ever gone there alone. us, the scores
ranged from 0 to 8 [Cut-o for being empowered
was taken as 75
th
percentile of the attained total score
(=5)] ii) Freedom from Family Domination (4 items);
the responses were scored as 1 for ‘Yes’ and 0 for
‘No’ response. A woman was classied as “empowered”
if she said that none of the mentioned items ever
happened to her or as “not empowered” if any of
these items had happened to her, iii) Economic
Security (4 items): A score of ‘1’ was assigned for
each of the following items: if a woman owned her
house or land; owned any productive asset; had her
cash savings or her savings were ever used for
business or money-lending. A woman with a score
of ≥2 was classied as being empowered. Levels
of women empowerment were measured separately
for each sub-scale.
9
d) e current usage of modern contraceptives by the
study participants was the outcome variable of this
study. Participants were asked whether they have
used any of the modern contraceptive methods
(oral contraceptive pills, IUDs, condoms, injectables,
tubectomy) in the past 6 months. Any participant
who had utilized at least one of the mentioned
methods was considered a modern contraceptive
user.
For the qualitative strand of the study, two focus
group discussions (FGDs) were conducted among family-
level stakeholders of the study participants. One FGD
was conducted among six husbands (median age= 30
years) and the other among six mothers-in-law (median
age=67 years) to explore their diverse view-point about
family planning. Each FGD took place for about 45
minutes and was conducted with the help of an FGD
guide. In addition, in-depth interviews of health workers
[one public health nurse (56 years), one multipurpose
worker female (42 years), and three accredited social
health activists (median age=35 years)] were carried
out to explore their perceived barriers to providing
contraceptive services to the community. ey were
interviewed with a pre-tested, semi-structured interviewer
guide. All FGDs and IDIs were audio-recorded with the
prior consent of the study participants.
Data analysis
Quantitative data were analyzed by Microso Excel
(2016) & SPSS soware (IBM Corp. Chicago. USA.
version 16). Appropriate descriptive statistics were
utilized for denoting the outcome variables as well as the
independent variables. Aer excluding multicollinearity
(variance ination factor > 5), factors associated with
the current usage of modern contraceptives among the
study participants were analyzed by a test of signicance
(p-value <.05) via univariate logistic regression analysis
separately. All the biologically plausible signicant variables
in the respective univariate analysis were included in the
nal multivariable models. e data obtained through
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FGDs and IDIs were simultaneously processed using a
manual thematic analysis approach. e records were
listened to and transcribed verbatim in Microso Word
Version 2016. e transcripts were read thoroughly, the
important sentences were underlined and the main ideas
derived from them were labeled as codes. Appropriate
codes were then placed under appropriate themes.
RESULTS
Background characteristics of the study participants
Among 210 study participants, the median age was
found to be 28 years (IQR=23-32 years). e majority
(82.4%) were in the age group of 20-34 years. 58 (27.6%)
participants had an education level of primary or below
while only 6.2% of participants were involved in some
other occupation and the rest were home-maker. 84 (40%)
belonged to socio-economic class III and 79 (37.6%)
belonged to class IV according to Modied B.G. Prasad’s
Scale 2020.
10
(Table 1)
Contraceptive usage patterns among the study participants
Currently, 114 (54.8%) study participants were using
any of the modern methods of contraceptives. Among all
participants, ligation was used by 21.4% while condom
was utilized by 19% of the participants. (Fig 1)
TABLE 1. Descriptive characteristics of the study participants (N=210).
Parameters Categories Number (Percentage)
Age (in completed years) 15-19 2 (1.0)
20-34 173 (82.4)
35-49 35 (16.6)
Religion Hindu 190 (90.4)
Muslim 20 (9.6)
Respondent’s education
¥
Illiterate 19 (9.0)
Primary or below 58 (27.6)
Middle 54 (25.7)
Secondary 43 (20.5)
Higher Secondary 21 (10.0)
Graduate or above 15 (7.2)
Husband’s education Illiterate 15 (7.2)
Primary or below 66 (31.4)
Middle 51 (24.3)
Secondary 29 (13.8)
Higher Secondary 27 (12.9)
Graduate or above 22 (10.4)
Occupational status of the respondents Home-maker 197 (93.8)
Other professionals 13 (6.2)
Type of family Joint 81 (38.6)
Nuclear 129 (61.4)
Socio-economic status
£
Class I (upper class) 3 (1.4)
Class II (upper middle class) 39 (18.6)
Class III (middle class) 84 (40.0)
Class IV (lower middle class) 79 (37.6)
Class V (lower class) 5 (2.4)
No of children ≤2 143 (68.1)
>2 67 (31.9)
¥ below primary= below 5
th
standard, primary=passed 5
th
standard, middle= passed 8
th
standard, secondary= passed 10
th
standard, higher
secondary= passed 12
th
standard
£ according to modied B.G Prasad’s scale 2020
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670
Fig 1. Pie-Diagram showing the current pattern of contraceptive usage among the study participants (n=210).
Knowledge regarding contraceptives and Attitudes
toward their usage among the study participants
51.9% (n=109) of the participants had satisfactory
knowledge about contraceptives (median score=7, IQR=
6-8) while only 29.5% (n=61) had a favorable attitude
towards their usage (median score=3, IQR=1-5).
Women’s Empowerment among the study participants
58.6% of women were found to be empowered
through the ‘Women’s Mobility’ scale whereas 56.2% were
empowered on the ‘Freedom from Family Domination’
scale. Only 20% of the participants were found to be
empowered through the ‘Economic Security’ sub-scale.
It was detected that women who were using any of the
modern contraceptive methods were more empowered
in all the three sub-scales compared to those not using
any. (Fig 2)
Factors associated with the current usage of modern
contraceptives by the study participants
Signicant factors of modern contraceptives use
among study participants were educational status of
middle school and above [aOR=7.65, 95% CI = 1.85-
31.67], favourable attitude towards modern contraceptive
usage [aOR=4.67, 95% CI = 1.26-17.19], empowerment
through freedom from family domination [aOR = 5.56,
95% CI = 1.30-23.66], recipients of family planning
counselling [aOR = 4.41, 95% CI = 1.12-17.33]. e
Fig 2. Radar diagram showing the association of usage and non-usage of modern contraceptive methods with woman empowerment.
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multivariable regression model deduced was of good
t (non-signicant Hosmer-Lemeshow test, P-value
>.05) while 42% to 63% of the variance of the outcome
variable could be explained by this model. (Table 2)
Qualitative exploratory ndings
Qualitative exploration from the two FGDs among
family-level stakeholders and 5 IDIs among healthcare
workers revealed two major themes: a) Perspective about
TABLE 2. Factors associated with modern contraceptive usage among the study participants: Logistic Regression
Analysis (N=210)
Total No. Usage of Modern Unadjusted OR
ƪ
Adjusted OR
Parameters Contraceptives (95% CI) (95% CI)
n (%)
Education
Below middle school 77 20 (25.9) 1 (Ref) 1 (Ref)
Middle school and above 133 94 (70.6) 6.89 (3.04-15.62) 7.65 (1.85-31.67)
Husband’s Education
Below middle school 81 22 (27.1) 1 (Ref) 1 (Ref)
Middle school and above 129 92 (71.3) 6.73 (3-15.07) 3.21 (0.87-11.7)
Type of Family
Joint Family 81 28 (34.5) 1 (Ref) 1 (Ref)
Nuclear Family 129 89 (66.7) 3.57 (1.67-7.62) 3.31 (0.96-11.44)
Socio-economic
ƚ
Status
Below middle class 84 25 (29.7) 1 (Ref) 1 (Ref)
Middle class and above 126 86 (70.6) 5.62 (2.56-12.29) 1.44 (0.37-5.61)
No. of Children
≤2 143 65 (45.4) 3.11 (1.37-7.02) 3.24 (0.86-12.24)
>2 67 49 (73.1) 1 (Ref) 1 (Ref)
Knowledge regarding modern contraceptives
Satisfactory 109 77 (70.6) 4.18 (1.97-8.84) 2.10 (0.58-7.55)
Unsatisfactory 101 37 (36.6) 1 (Ref) 1 (Ref)
Attitude towards usage of contraceptives
Favorable 81 77 (70.6) 5.95 (2.58-13.70) 4.67 (1.26-17.19)
Unfavorable 129 37 (36.6) 1 (Ref) 1 (Ref)
Women’s mobility
Empowered 123 82 (66.7) 3.54 (1.68-7.48) 1.10 (0.26-4.68)
Non-empowered 87 32 (36.8) 1 (Ref) 1 (Ref)
Freedom from family Domination
Empowered 118 89 (75.4) 8.31 (3.71-18.62) 5.56 (1.30-23.66)
Non-empowered 92 25 (27.1) 1 (Ref) 1 (Ref)
Economic Security
Empowered 94 67 (71.2) 3.66 (1.72-7.77) 2.86 (0.69-11.81)
Non-empowered 116 47 (40.5) 1 (Ref) 1 (Ref)
Received FP Counselling
Yes 136 101 (74.2) 3.66 (1.72-7.77) 4.41 (1.12-17.33)
No 74 13 (17.5) 1 (Ref) 1 (Ref)
ƪ OR- Odds Ratio, CI- Condence Interval
ƚ according to B.G Prasad Scale 2020
Hosmer-Lemeshow test statistic=0.61, Cox and Snell’s R
2
=0.42 & Nagelkerke’s R
2
=0.63
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modern methods of contraceptives and b) Barriers to
adopting modern family planning methods. Communication
gap, woman’s authority in choice of contraception, and
lack of couple counselling were the major codes under
the theme ‘Barriers to adopting modern family planning
methods’. Lack of knowledge and experience emerged as
the most important code under the theme of ‘Perspective
about modern methods of contraception. (Table 3).
TABLE 3. Juxtaposed Findings of both Qualitative and Quantitative Inquiry on Modern Contraceptive Usage in
among study participants.
Associated Quantitative Qualitative Components Qualitative
Survey Themes Components with Quotable quotes Codes
Barriers to
adopting modern
family planning
methods
Perspective about
Modern methods
of Family
Planning
Communication
Gap
Women’s Authority
in Contraceptive
Choices
Knowledge Gap
Lack of Couple
Counselling
Lack of knowledge
and experience
“One can feel
embarrassed in discussing
contraceptives with
spouse”-46.7%
responded “YES”
“Husband’s objection to
contraceptive methods can
prevent a woman
from using it”- 52.3%
responded ‘YES’
“Does your partner know
about newer contraceptive
methods like Antara”-87.4%
responded “NO”
“Have you received
a couple counseling”-
98% replied “NO”
“Change in Mother-in-
law’s attitude may improve
contraceptive use”- 46.2%
replied “YES”
Less interaction about sexual and
reproductive life with spouses.
Husband’s domination in decision-making.
Decient knowledge of husbands about
various contraceptive choices.
“In our time there was no one to teach us
about reproductive health. It is important to
teach sex education in schools”- a 35 years
old male quoted.
Men do not feel enough empowered for
choosing contraceptives due to a lack of
couple counseling.
“ASHA didi told my wife to use contraceptives,
but it would have been better if both of us were
counselled in private. We could share more
things then”- a 28-year-old husband remarked.
“When we visit house to house we only get the
women at home, their husbands are at work
then. And especially we target the women who
come for ANC or PNC clinics at health-centres,
for FP counseling”- a 38-year-old ASHA told.
Preformed notions about harmful side-effects
of modern-day methods of contraception
and lack of experience.
“These modern-day girls don’t discuss their
lives with us, the elderly. They won’t take our
advice too. So I don’t talk about this with my
daughter-in-law and I personally never used
any contraceptives in our times”- a 68-year-old
mother-in-law remarked.
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DISCUSSION
e present study tried to address holistically all
the aspects of FP and elicited some major determinants
of practicing modern FP methods among currently
married women of reproductive age group in a rural area
of Bengal. A study by Ahirwar RK et al, done in central
India showed that 88.5% of study participants had never
used any contraceptive methods while the current study
found a considerable proportion of reproductive-aged
married women using any of the modern contraceptive
methods (54.8%).
11
Another research work done in
rural Maharashtra, India by Dixit A et al found this
percentage to be only 38.3% (more than one-third of
the study sample).
12
e current study detected that
tubal ligation was the most commonly used method of
contraception which was found concordant with a study
conducted at the national level in India by Ewerling F et al,
where it was found that the majority of the reproductive-
aged married women were using modern methods of
contraceptives mostly in the form of sterilization. Condom
and oral contraceptives were the second and third most
commonly used contraceptive methods.
13
Another study
done by Talungchit et al in ailand showed that the most
commonly used method of contraception among teenage
multigravida and primigravida was oral contraceptive
pills, while only 5% among primis and 25% among
multigravidas were using contraceptives.
14
A retrospective
cohort study conducted at a medical college clinic in
ailand showed that approximately 15% of women
had never used any contraceptive methods.
3
A research
work conducted by Chopra S et al demonstrated that
acceptance of a permanent method of contraception
among a tribal population in northern India was only
5%.
15
Although the status of women in India has improved
over time, across dierent dimensions, gender discrimination
and patriarchal social norms still remain a burning
issue in this nation, especially in rural areas. Only 20%
of participants in the present study were found to be
empowered by means of economic security. Moreover,
this study found that women who are free from any kind
of family domination were more likely to use modern
contraceptives. Another study of rural Maharashtra,
India by Reed E et al elicited that there was a signicant
association between woman’s access to money and the
usage of condoms or other methods of contraceptives.
Other signicant determinants detected in that research
work were women’s control over reproductive health
decision-making and freedom of movement to seek
health care.
16
A study conducted in Egypt by Samari G
et al found that determinants of women empowerment
like household decision-making, non-acceptance towards
intimate partner violence, and joint decision-making power
are signicantly associated with modern contraceptive
usage.
17
is mixed-methods study is a strength in itself as the
qualitative exploration led to an in-depth understanding
of the perspectives of modern contraceptive usage and its
important barriers among the family-level stakeholders
and healthcare providers. Previous studies in India and
abroad had explored some of the major barriers to modern
contraceptive usage such as a woman’s fear of side eects or
other health concerns and the absent cafeteria approach.
18-20
A scoping review on determinants of unmet need of
family planning in low and middle income countries
by Wulan et al showed that the reasons behind the
non-usage of contraceptives among women were mostly
opposition from husbands, their fear of indelity and
fear of side eects.
21
From the health workers’ point of
view, the barriers that had been explored by prior studies
are low prioritization of contraceptive training, disputes
over funding, and an overburdened health system.
22,23
In addition to these above ndings, the current study
found some new emerging barriers like lack of couple
counselling, misinformation from peer groups, generalized
fear, and misconception about modern contraceptive
methods among the elder generation. Hence appropriate
and suitable interventions are necessary so that they can
gradually adjust to and overcome these pre-existing as
well as emerging barriers to modern family planning
use.
Limitations
As the study participants came from a unique
population, the generalizability of the present study had
been compromised. Since this study was of cross-sectional
nature, a causal relationship between the variables and
contraceptive usage could not be established. Moreover,
as some information obtained was recall-based, bias
might be possible.
CONCLUSION
Investing in family planning is the most intelligent
step that developing nations like India can undertake to
improve their socio-economic and maternal-child health
scenario. us, in order to improve the overall family
planning practice, certain measures like awareness generation,
education, extending help for self-empowerment, and
most importantly economic independence among women
need to be prioritized. Support from healthcare facilities
like couple counseling is needed to overcome barriers
like the lack of involvement of family-level stakeholders,
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especially the husbands in process of making a decision
on contraception. Ensuring the availability of all kinds
of modern contraceptives in remote and rural health
centres should also be done sustainably.
ACKNOWLEDGMENTS
e authors were grateful to the ocer-in-charge
and sta of RHUTC, Singur, for their constant support
and co-operation during this dicult pandemic phase
throughout our study. We extend our heartfelt gratitude
to all the participants who participated in this study.
Declaration of Conicting Interests: e authors declared
no potential conicts of interest concerning the research,
authorship, and/or publication of this article.
Funding: e authors received no nancial support for
the research, authorship, and/or publication of this article.
Ethical Issues: is study was conducted aer ethical
clearance from the Institutional Ethics Committee of All
India Institute of Hygiene and Public Health, Kolkata.
Appropriate written informed consent was taken from
the participants before conducting the study. ey were
assured of the condentiality of the data provided by
them. All other ethical principles as per the Declaration
of Helsinki were strictly adhered to.
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Sengupta et al.
